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Contact Lenses for Hard-To-Fit Patients

Contact Lenses for Hard to Fit Patients Certain conditions and situations can make wearing contact lenses more difficult, but not necessarily impossible. If you suffer from any of the following, you may need a specialist's help to wear contact lenses successfully:

  • Astigmatism
  • Dry eyes
  • Giant Papillary Conjunctivitis (GPC)
  • Keratoconus
  • Presbyopia

In addition, wearing contacts after refractive surgery, such as LASIK, can sometimes be an issue and may require special lenses.

This common condition is when the curvature of the front eye is not uniform but instead has a bulge or oval shape. This makes part of the eye curve steeper than the rest, causing blurred vision. Contact lenses which are used to correct astigmatism are called ‘toric’ lenses; they are designed to fit on the eye without rotating, as the corrective power needs to be aligned with the bulge it is correcting. Soft lenses are usually recommended to give a good fit, but if the soft lenses continue to rotate then gas permeable lenses with or without the toric design may be used to correct the astigmatism. Toric lenses are generally custom-made for each patient's specific needs and therefore take longer to make and will cost more than standard lenses.

Dry Eye
Dry eye is a common problem and often simple to treat. Symptoms may include a gritty feeling in the eye, the sense of a foreign body in the eye, a burning sensation, redness or blurred vision. Artificial tears, ointments, medicated eye drops or even nutritional supplements can be used to improve the condition. If this sort of treatment is insufficient, a punctual occlusion can be performed by your doctor to plug the ducts which drain tears from the eye. Once the dry eye has been eliminated, contact lenses can be tried, although certain materials are more suitable than others. It may also help to replace your contact lenses more often, remove them during certain tasks, or reduce the amount time they are worn.

Giant Papillary Conjunctivitis (GPC)
This nasty-sounding condition is actually just an inflammatory reaction on the inner surface of the eyelids. This can sometimes be caused by caused by a protein buildup on your contact lenses and can be remedied by switching to one-day disposable contact lenses as these are thrown away before protein deposits can accumulate. Gas permeable lenses are also a good option as the protein in tears does does not adhere as easily to these lenses, so they can be kept cleaner. Medicated eye drops may also be prescribed to reduce the inflammation before contact lenses are worn gain.

This fairly uncommon condition is when the cornea becomes thinner, allowing the eye to bulge forward into a cone shape. The most common treatment for mild to moderate keratoconus is the use of gas permeable contact lenses. Their rigidity can help contain further bulging whilst correcting vision problems caused by the condition. Sometimes a soft lens is worn under a GP lens for greater comfort and cushioning; this is known as ‘piggybacking.’ Hybrid contact lenses are another option for keratoconus sufferers. These lenses combine the rigidity and clarity of a gas permeable center with a soft ring around it for extra comfort. Scleral and semi-scleral lenses are designed to rest on the white sclera of the eye and vault over the irregularly shaped cornea, providing a more stable fit whilst not applying any pressure on the sensitive corneal tissue.

As you become older, especially after you hit 40, you may find that you can't focus on close objects as well as you used to. This condition is called presbyopia and is a result of the natural aging process. Many bifocal and multifocal lenses are available specifically for this problem. Monovision lenses, where one eye is fitted for distance vision and the other for near vision, is another option for some patients.

After refractive surgery
Occasionally, after refractive surgery (such as LASIK), vision problems remain which cannot be corrected with further surgery. In such cases, gas permeable contact lenses can often restore vision while eliminating problems such as halos and glare at night. These lenses can also be prescribed to correct vision problems present after corneal transplant surgery, including irregular astigmatism.

After eye surgery, you may require special lenses called ‘reverse geometry’ lenses. These are designed to be flatter in the center to conform to the shape of the post-surgical cornea. Reverse geometry lenses are available as both rigid gas permeable (RGP) and soft lenses.

The cost implications of being hard-to-fit
Inevitably, special cases, such as those listed above, require more time to diagnose, correct and treat. They also may require additional visits to the eye doctor and several trial pairs of lenses before a satisfactory conclusion is reached. In particularly lengthy cases, a fitting fee of several hundred dollars may be charged in addition to the cost of the lenses. The lenses themselves will likely also cost more to produce than standard lenses, so fees will be correspondingly higher for hard-to-fit cases.

Since each case is unique, the best way to find out all your options (and the specific costs associated with them) is to schedule a consultation with an eye doctor or contact lens specialist.

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