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
Scleral Lenses for Dry Eye Relief and Corneal Irregularities
For patients with Dry Eye Syndrome or corneal irregularities, Scleral lenses are an excellent solution. Scleral lenses are large-diameter, gas-permeable lenses that rest on the sclera (the white part of your eye) rather than the cornea. This design creates a fluid-filled reservoir, which continuously hydrates the eye and provides relief from dryness, irritation, and discomfort. Scleral lenses are also a great option for those with Keratoconus, post-surgical complications such as after LASIK, or severe allergies.
Advantages of Scleral Lenses:
- The lens vaults over the cornea, reducing irritation and dryness.
- The larger size ensures the lens stays securely in place.
- The fluid reservoir helps maintain eye moisture and protects the cornea.
- Each lens is custom-made to fit the unique shape of your eye.
Dry Eyes and Contact Lenses
Dry Eye Syndrome can cause dryness, itching, and blurred vision, which may be exacerbated by traditional contact lenses. Many soft lens brands now offer options designed for those with dry eyes, including solutions with moisturizing agents. Additionally, gas permeable (GP) or rigid gas permeable (RGP) lenses are another excellent option for dry eyes, as they do not dry out like soft lenses and hold moisture beneath the lens. Scleral lenses, with their fluid reservoir, are often recommended for patients with more severe dry eyes.
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.