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Contact Lenses for the “Hard-to-Fit” Patient

It is not uncommon for patients to have difficulty wearing contact lenses for a number of reasons. Due to the individual eye shape, certain conditions or impairments or the aftermath of surgery, some patients are considered to be “hard to fit” as contact lens wearers.

For hard to fit patients that prefer to wear contact lenses however, there are options available that can provide comfortable and effective contact lens wear. This will require a specialized fitting with an eye doctor that is an expert that knows your condition and the various products available to find the right match for your specific condition. You may be considered a hard to fit contact lens candidate if you have one of the following conditions:

  • Dry Eyes
  • Astigmatism
  • Giant Papillary Conjunctivitis (GPC)
  • Keratoconus
  • Pellucid Marginal Degeneration
  • Post-LASIK or other refractive surgery
  • Presbyopia (reduced near vision common in individuals aged 40 and over).
  • Corneal Scarring

Dry Eyes and Contact Lenses

Dry Eye Syndrome causes your eyes to feel dry, gritty, burning, red, and irritated. Dry Eye Syndrome can also cause blurred vision. Often these symptoms can sometimes worsen by the use of contacts. In fact, many people who do not normally suffer from chronic dry eyes, will experience some of these symptoms as a result of contact lens wear.

First of all, if you have chronic dry eyes, you should see your eye doctor for treatment and relief before you think about contact lenses. Once your dry eyes are treated, it is safe to try contacts and there are a number of options that can be considered.

Many brands of soft contacts and products such as disinfectant and cleansing solutions are made with ingredients that are designed to be more comfortable for individuals with dry eyes. Your eye doctor will be able to recommend some of these brands and products to you. Alternatively, gas permeable (GP) or rigid gas permeable (RGP) lenses are made with a hard material that in some cases does not dry out like soft lenses and they are able to hold a certain amount of moisture beneath the lens to keep the eye from drying out. Gas permeable lenses are a very good option and can be quite comfortable for individuals with dry eyes.

Additionally, your doctor might recommend a specific wearing schedule such as limiting the time you wear your contacts throughout the day or replacing your contacts on a more frequent basis.

Toric Lenses for Astigmatism

Astigmatism is a condition that causes blurred vision (in some cases double vision) because rather than being round, the front of the eye (the cornea) has two curves instead of one, therefore, having two focal points instead of one. This makes it hard for traditional contact lenses to fit and therefore requires specialized contact lenses such as toric lenses or rigid gas permeable lenses (RGPs).

Toric contact lenses are designed to correct astigmatism and custom made to fit the eye of the patient. Most are made of soft material designed to stay in place on the eye, however in some cases, when the rotation of the lens (due to blinking and eye movement) can’t be stopped, gas permeable lenses might be tried. Due to the customization and more complicated fitting process required for these lenses, they are more expensive and take more time for the contact lens laboratory to make than traditional lenses.

Giant Papillary Conjunctivitis (GPC) and Contact Lenses

GPC is a type of conjunctivitis in which the inner surface of the eyelid becomes swollen. The condition can be caused or worsened by a buildup of protein deposits on contact lenses. Your eye doctor may either recommend daily disposable lenses or RGP lenses (which are not water based) and therefore have less of a tendency for protein buildup. Your doctor may also prescribe medicated eye drops and require you to stop the use of contact lenses until the symptoms improve.

Rigid Gas Permeable (RGP) or Gas Permeable (GP) Lenses

Rigid Gas Permeable (RGP) also known as Gas Permeable (GP) lenses are effective for many hard to fit patients. The hard, oxygen permeable material lets the eye breathe and significantly reduces the chance of infection due to protein deposits which tend to harbor bacteria on soft lenses. RGPs also hold moisture under the lens to keep eyes from drying out.

Rigid Gas Permeable (RGP) Lenses for Keratoconus

Keratoconus is a condition in which the cornea thins and bulges forward into a cone shape. Traditional contact lenses may cause some discomfort in these patients and the vision may still be blurry therefore RGPs are often used for treatment for mild, moderate, and some severe cases. Rigid gas permeable lenses may help to slow down the cone shape from worsening in some cases. Further, RGPs are able to assist in vision correction for keratoconus which is often not possible with soft contacts or even eyeglasses.

Post-LASIK or Vision Correction (Refractive) Surgery

While LASIK surgery has a very high success rate, there are vision complications and symptoms that sometimes remain. Night vision after LASIK, in particular, can sometimes give you side effects such as glare or halos around lights. RGPs are often effective in helping with these side effects and restoring clear vision.

Bifocal and Multifocal Contact Lenses for Presbyopia

Presbyopia is a common condition in those people usually over 40 years old in which the eyes’ ability to focus on close objects is impaired. Many people keep a pair of bifocal or multifocal glasses on hand for times when they have to read menus, newspapers, books, and other objects that require near vision. For those that prefer contact lenses over eyeglasses, bifocal and multifocal contact lenses are an option.

For some patients that have presbyopia and need correction for distance vision as well, one option is monovision. Monovision is a contact lens fitting process in which you wear a contact lens in one eye for distance vision and the other contact lens of your other eye for near vision. Another option is multifocal contact lenses. In this contact lens fitting process, both eyes are usually fit for distance vision and both eyes are used for near at the same time. Both contact lens fitting options usually take about one week for the brain and the eyes to adjust.

If you have one of these conditions or find contact lens wear difficult for another reason, speak with your eye doctor. As technology improves there are more and more options for hard to fit contact lens patients to benefit from the comfort and convenience of contact lens use.

 

attractive blond putting in contact lens

Q&A for Hard To Fit Contacts

What is a hard to fit contact lens patient?

These patients are often told by other offices, “You can’t wear contacts.” What they should have been told is, “You can’t wear the generic contacts that I’m comfortable fitting.”

These patients often have prescriptions and visual demands that require a larger time investment, and breadth of knowledge on the part of the professional fitting them, which is why a specialist is necessary.

What are the types of contact lenses used for hard to fit patients? What are the benefits of each type?

Rigid Gas Permeable (RGP) lenses are often used for high prescriptions or unusual corneas and can be completely customized. The advantage is a much higher vision quality when compared with soft lenses. They can be more challenging for the patient to adapt to their comfort. Motivated patients do very well, and eventually adapt, however not every patient succeeds.

Hybrid lenses can be a great way to address some comfort hurdles, while at the same time treating irregular corneas, or post-surgical corneas.

I have issues with contact lenses due to dry eyes, can you help?

Every case history for every patient is unique. A consult would be needed to determine if contacts would be in your best interest if you have dry eyes. Depending on the underlying causes for your dry eye, and how well managed your symptoms are, contacts could absolutely still be on the table for you.

What are the costs for hard to fit contact lens patients? Are they covered by insurance?

Costs vary widely on what kind of contacts will best address your needs, and all of that can be addressed during your consult.

As for insurance… sometimes. Getting insurance involved with any kind of contact lenses is tricky. Most medical insurances don’t cover contacts of any kind. Some vision plans will help cover the cost if the patient meets certain criteria established by their plan. If the plan deems the contacts as “medically necessary” then, yes.

Your candidacy can be largely determined at your initial consult.

What is pellucid marginal degeneration? How is it treated?

Pellucid Marginal Degeneration, or PMD is actually much more rare than previously believed and is frequently lumped in as a type of keratoconus. Historically it has been diagnosed by corneal topography maps characterized by the “kissing doves” or “crab claw,” patterns, but recent studies have shown that these maps don’t tell the whole story, and a more thorough type of corneal imaging called Optical Coherence Tomography (OCT) is required to diagnose the trademark “band of thinning inferior to the visual axis.” Corneal topography images the front surface of the cornea only, whereas OCT images the front and the back. You might think of the topography as a very detailed, high resolution photo vs the OCT as more like an X-Ray.

Treatment for PMD and keratoconus are similar with careful monitoring and imaging for progression. Visual symptoms are best managed with a scleral lens.

Is irregular astigmatism the same as keratoconus?

This is a little bit tricky as all keratoconus is considered to be “irregular astigmatism” but not all “irregular astigmatism” is keratoconus. Keratoconus is one type of irregular astigmatism.

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