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).
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 do not have 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 iin 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 to 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.
Q&A For Hard To Fit Contacts
A patient who’s cornea requires a custom lens design. The “Hard to Fit” refers to the type and design of contact lens, not a “Hard to Fit Patient”. In general, we need these lenses for patients with corneal irregularities.
Each lens type has some sort of rigid-lens component. There are three main types:
- Small Rigid Gas Permeable Lens – This is the most common and the least expensive option. The lens is small, and will move upon blinking. Because it moves when blinks occur, lens sensation is possible, so this lens has the longest adaptation period.
- Hybrid Lens – This lens combines a central small rigid lens portion and a larger soft “skirt” around it. This gives us the vision of the small rigid, but less movement and more comfort than the rigid gas permeable. The soft skirt may dry faster than the rigid component, so end of day tightening is not uncommon.
- Larger Scleral Rigid Lenses – This is my lens of choice for these patients. In general, the larger the lens, the more comfortable it is. So these lenses can be extremely comfortable. This lens is designed to “vault” over the entire cornea, so any irregularities are ignored and masked. The other lens options do have some level of corneal touch and involvement.
These are specialty lenses, so the evaluation fee and cost of the lenses reflect that. A mainstream lens may be successfully fit in a single day, a specialty fit may take 6-10 weeks to accomplish, and each lens in the process is custom designed for the patient.
-Costs will range from $450 (small rigid lenses) to $2000 or more depending.
- Many VISION plans will have a “visually necessary contact lens benefit” in them, in which a small copay covers the entire evaluation process and the supply of contact lenses. MEDICAL plans are different. Medical plans will require a copay (or deductible amount) for each visit during the fitting process, the medical insurance will then pay a set dollar amount towards the supply of lenses, which may or may not cover the cost.
Pellucid marginal degeneration is similar to keratoconus in that it is a progressive thinning and distortion of the cornea. This change tends to happen more inferior on the cornea, which results in less impact on daily vision. It is treated the same way as keratoconus, with a specialty contact lens.
All keratoconus is irregular astigmatism, but not all irregular astigmatism is keratoconus. Various things can cause irregular astigmatism: scarring, surgeries, long term dryness etc…
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An irregular cornea generally causes problems or limitations with vision, and can be more complicated to correct with standard eyeglasses or contact lenses. I
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