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Many individuals experience difficulty wearing contact lenses due to unique eye shapes, underlying ocular conditions, or changes following eye surgery. Such patients are often classified as “hard to fit” contact lens wearers. However, advances in contact lens technology and fitting techniques now allow most patients—even those with complex needs—to achieve comfortable and effective vision correction with contact lenses. Successful outcomes require a thorough assessment and specialized fitting by an experienced eye care professional who understands both your specific condition and the full range of available lens designs
Conditions That May Require Specialized Contact Lenses
You may be considered a hard-to-fit contact lens candidate if you have one or more of the following conditions:
Scleral lenses are large-diameter, gas-permeable lenses that rest on the sclera (the white part of the eye) and vault over the cornea. This design creates a fluid reservoir that continuously hydrates the eye, providing significant relief for patients with moderate to severe dry eye syndrome, corneal irregularities, or keratoconus. Scleral lenses are also beneficial for those with post-surgical complications or severe ocular allergies.
Dry eye disease can make contact lens wear challenging, leading to symptoms such as dryness, irritation, and fluctuating vision. Recent studies support the use of newer soft lenses with enhanced moisture retention or lubricating agents for mild to moderate dry eye. Rigid gas permeable (RGP) and scleral lenses are often preferred for more severe cases, as they do not absorb water and can retain a fluid reservoir against the ocular surface.
Astigmatism is caused by an irregular curvature of the cornea, resulting in blurred or distorted vision. Toric contact lenses, available in both soft and RGP materials, are specially designed to correct astigmatism by aligning with the eye’s unique shape. These lenses are custom-made and require precise fitting to ensure stability and optimal vision.
GPC is an inflammatory condition often associated with protein deposits on contact lenses. Evidence suggests that daily disposable lenses or RGP lenses—which are less prone to protein buildup—can reduce symptoms. Temporary discontinuation of lens wear and use of anti-inflammatory eye drops may also be recommended.
RGP lenses are highly effective for patients with keratoconus, pellucid marginal degeneration, and other corneal irregularities. Their rigid structure provides a smooth refractive surface, often resulting in superior vision compared to soft lenses or glasses. In keratoconus, RGPs or Scleral lenses can slow the progression of corneal distortion and offer clearer vision.
While LASIK and other refractive surgeries are generally successful, some patients may experience residual vision issues such as glare, halos, or irregular astigmatism. Custom RGP or scleral lenses can be fitted to restore clear vision and address these complications.
Presbyopia, the gradual loss of near focusing ability with age, can be managed with bifocal or multifocal contact lenses. These lenses allow for clear vision at multiple distances and are available in both soft and RGP materials. For some patients, monovision—fitting one eye for distance and the other for near vision—may be recommended. Both approaches require an adaptation period as the brain adjusts to new visual input.