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Hard-to-Fit Contacts

Contact Lenses for the Hard to Fit Patient

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 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 contact lens wear. The optometrist will discuss your eye condition and work to find a contact that would work well for you.  Some of the following condition may require extra time to find a good fit:

  • Dry Eyes
  • Astigmatism
  • Giant Papillary Conjunctivitis (GPC)
  • Keratoconus
  • Post-LASIK or other refractive surgery
  • Presbyopia (reduced near vision common in individuals aged 40 and over).
  • Corneal Scarring

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. Contact lenses often make these symptoms worse. In fact, many people who do not normally suffer from dry eyes will experience these symptoms only when wearing their contact lenses.

First of all, if you have chronic dry eyes, your eye doctor may want to treat that first in order get the best fit possibles. Once your dry eyes are treated, it is safe to try contacts and there are a number of options that can be considered.

Some brands of contacts and some disinfecting solutions are designed specifically to help the dryness associated with contact lens wear.  Dr. Vlasak will be able to recommend some of these brands and products to you. Surprisingly, rigid gas permeable (RGP) or hard  lenses may work better for some patients with dry eyes.  They are made with a hard material that 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. Once the eye is adapted, gas permeable lenses are quite comfortable for individuals with dry eyes and may even be more healthy for the eye.

Listen to your eyes.  If they are red, irritated, or blurry, take the contacts off and give your eyes a break by wearing your glasses.

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 often requires specialized contact lenses called a 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 toric contact lens (due to blinking and eye movement) is affecting the patient's vision, gas permeable lenses might be tried.

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 by a buildup of protein deposits on contact lenses.  At this point, your eye doctor will either recommend daily disposable lenses or RGP lenses (which are not water based) and therefore have less of a tendency for protein buildup.  Your doctor may also prescribe medicated eye drops and/or 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) or hard contacts are effective option for many hard to fit patients.  The hard material is very oxygen permeable material which lets the eye breathe.  It also significantly reduces the chance of irritation due to protein deposits.  RGPs also hold moisture under the contact lens itself 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 in 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 with 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.

Read about Ortho-K to see if you may be a good candidate for these gentle overnight cornea re-shaping contact lenses.

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