Contact Lenses for the 'Hard-to-Fit' Patient

Not everyone is well suited to the most common types of contact lenses. If you have one or more of the following conditions, contact lens wear may be more challenging:

• astigmatism
• dry eyes
• presbyopia
• giant papillary conjunctivitis (GPC)
• keratoconus
• post-refractive surgery (such as LASIK)

But "challenging" doesn't mean impossible. Often, people with these conditions can wear contacts quite successfully. Let's take a closer look at each situation - and possible contact lens solutions.

Contact Lenses for Astigmatism

Astigmatism is a very common condition where the curvature of the front of the eye isn't round, but is instead shaped more like a football or an egg. This means one curve is steeper or flatter than the curve 90 degrees away. Astigmatism won't keep you from wearing contact lenses - it just means you need a different kind of lens.

Lenses specially designed to correct astigmatism are called "toric" lenses. Most toric lenses are soft lenses. Toric soft lenses have different corrective powers in different lens meridians, and design elements to keep the lens from rotating on the eye (so the varying corrective powers are aligned properly in front of the different meridians of the cornea). 

In some cases, toric soft lenses may rotate too much on the eye, causing blur. If this happens, different brands that have different anti-rotation designs can be tried. If soft lens rotation continues to be a problem, gas permeable (GP) lenses can also correct astigmatism.

Contact Lenses for Dry Eyes

Dry eyes can make contact lens wear difficult and cause a number of symptoms, including:

a gritty, dry feeling

feeling as if something is in your eye

a burning sensation 

eye redness (especially later in the day) 

blurred vision

If you have dry eyes, the first step is to treat the condition. This can be done in several ways, including artificial tears, medicated eye drops, nutritional supplements, and a doctor-performed procedure called punctal occlusion to close ducts in your eyelids that drain tears away from your eyes.

Once the dry eye condition is treated and symptoms are reduced or eliminated, contact lenses can be tried. Certain soft contact lens materials work better than others for dry eyes. Also, GP lenses are sometimes better than soft lenses for dry eye sufferers, since these lenses don't dry out the way soft lenses can.

Replacing your contacts more frequently and reducing your wearing time each day (or removing them for specific tasks, such as computer work) can also reduce dry eye symptoms when wearing contacts.

Contact Lenses for Giant Papillary Conjunctivitis (GPC)

Giant papillary conjunctivitis (GPC) is an inflammatory reaction on the inner surface of the eyelids. One cause of GPC is protein deposits on soft contact lenses. (These deposits are from components of your tear film that stick to your lenses and become chemically altered.)

Usually, changing to a one-day disposable soft lens will solve this problem, since you just throw these lenses away at the end of the day before protein deposits can accumulate on them. Gas permeable lenses are also often a good solution, as protein deposits don't adhere as easily to GP lenses, and lens deposits on GP lenses are more easily removed with daily cleaning. 

In some cases of GPC, a medicated eye drop may be required to reduce the inflammation before you can resume wearing contact lenses.

Contact Lenses for Presbyopia

Presbyopia is the normal loss of focusing ability up close when you reach your 40s.

Today, there are many designs of bifocal and multifocal contact lenses to correct presbyopia. Another option for presbyopia is monovision. This is wearing a contact lens in one eye for distance vision and a lens in the other eye that has a power for near vision. 

During your contact lens fitting we can help you decide whether bifocal/multifocal contact lenses or monovision is best for you. 

Contact Lenses for Keratoconus

Keratoconus is a relatively uncommon eye condition where the cornea becomes thinner and bulges forward. The term "keratoconus" comes from the Greek terms for cornea ("kerato") and cone-shaped ("conus"). The exact cause of keratoconus remains unknown, but it appears that oxidative damage from free radicals plays a role.

Gas permeable contact lenses have historically been the treatment option of choice for mild and moderate keratoconus. Because they are rigid, GP lenses can help contain the shape of the cornea to prevent further bulging of the cornea. They also can correct vision problems caused by keratoconus that cannot be corrected with eyeglasses or soft contacts.

The last few years have produced quite a bit of innovation in contact lenses for keratoconus. There are now several soft lenses for keratoconus, as well as many scleral lenses. These are large lenses made of GP material that remain completely above the cornea, with the outer edge of the lens resting on the white of the eye (sclera).

Another option is called "piggybacking," where soft and GP lenses are worn together on the eye for greater comfort than a GP alone would provide. Hybrid contact lenses that have a GP center surrounded by a soft "skirt" can produce the same effect.

Contact Lenses After Corrective Eye Surgery

Hundreds of thousands of people each year have LASIK surgery to correct their eyesight. Sometimes, vision problems remain after surgery that can't be corrected with eyeglasses or a second surgical procedure. In these cases, gas permeable contact lenses - including large GP scleral lenses - can often restore visual acuity and eliminate problems like glare and halos at night.

GP lenses are also used to correct vision problems after corneal transplant surgery, including irregular astigmatism that cannot be corrected with eyeglasses.

Problem-Solving Contact Lens Fittings Cost More

Fitting contact lenses to correct or treat any of the above conditions will generally take much more time than a regular contact lens fitting. These "hard-to-fit" cases usually require a series of office visits and multiple pairs of trial lenses before the final contact lens prescription can be determined. Also, the lenses required for these conditions are usually more costly than regular soft contact lenses. Therefore, fees for these fittings are higher than fees for regular contact lens fittings. Call our office for details. 

Find Out if You Can Wear Contact Lenses

If you are interested in wearing contact lenses, call our office to schedule a consultation. Even if you've been told you're not a good candidate for contacts because you have one of the above conditions or for some other reason, we may be able to help you wear contact lenses safely and successfully. 

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