Hard to Fit Contacts

Having a hard time wearing contacts?

Not all eyes are the same.

There are a number of eye conditions that can make wearing contacts difficult. Some of these conditions include, astigmatism, dry eyes, giant papillary conjunctivitis (GPC), keratoconus, post-refractive surgery (such as LASIK), and presbyopia. Many of these conditions are labeled as ‘hard-to-fit’ eyes and require special attention. If you have one or any of these eye conditions, you still might be able to wear contacts. You may need to be fitted with lenses that are specially made and designed for your condition.

The most common of these eye conditions is Astigmatism. Astigmatism is where the curvature of the front of the eye isn’t symmetrical in all meridians (like a ball). This means that the cornea is shaped more like a football or the back of a spoon, with one meridian being relatively flat and another meridian being significantly steeper. These meridians are 90 degrees away from each other to create that football effect. Because astigmatism creates this shape to the eye, you will need a different kind of contact lens. These contacts are soft contact lenses and are called ‘toric’ lenses. They are specially designed to correct astigmatism. These lenses have corrective design features to prevent the lens from rotating on the eye. Because they are designed with stabilizing features, it keeps the lens powers aligned in front of the proper meridians of the eye for clear vision. Sometimes toric soft lenses may rotate on the eye too much which will cause blurring. If this happens, there are other brands with different stabilizing features that can be tried. Another option is to try gas permeable lenses, if the rotation of the toric soft lens is a problem. Both of these lens options, toric soft lens and gas permeable lens, can correct astigmatism.

While astigmatism is the most common eye condition, dry eye is the most common cause of contact lens discomfort. Dry eyes can cause many symptoms, which include:

  • a gritty or dry feeling,
  • a burning sensation,
  • a feeling that something is ‘in’ your eye (also called foreign body sensation),
  • eye redness (at end of day),
  • blurred or fluctuating vision.

Dry eyes can cause much discomfort and to relieve that discomfort the first step is to treat the condition. Treatment methods include, frequent use of artificial tears or other eye drops, use of nutritional supplements, and a doctor-performed procedure called punctual occlusion to close the ducts in your eyelids that drain tears away from your eye. Once the condition is treated and symptoms are reduced or even eliminated, this is when contact lenses can be tried. Certain soft contact lens material usually works better for dry eyes. There is even some contact lenses that are specifically designed for dry eyes. In some cases, rigid gas permeable lenses can be better than soft lenses because they do not dry out the way soft lenses can. Another tip for dry eyes is to replace your contacts more frequently. Also by reducing your wear time each day and wearing your glasses instead, giving your eyes a break and helping with dry eyes.

Almost everyone experiences some symptoms of presbyopia by ages 45 to 50.

Giant papillary conjunctivitis (GPC) is an inflammatory reaction on the inner surface of the eyelid. This can cause protein deposits on soft contact lenses. These protein deposits can stick to your lenses and therefore they become chemically altered. One way to solve this problem is to change to one-day disposable contact lenses, since you will throw these lenses way at the end of the day the protein deposits wont accumulate on them. Another solution is to use gas permeable lenses, as protein deposits don’t adhere to these lenses as easily. Any lens deposits on gas permeable lenses are removed more easily with daily cleaning. Using medicated eye drops for a period of time may be required to reduce the inflammation in some cases of GPC.

A relatively uncommon eye condition where the cornea becomes thinner and bulges forward is called Keratoconus. There is no known cause for keratoconus but it is said that genetics and oxidative damage from free radicals play a role. The treatment of choice for mild to moderate keratoconus is gas permeable contact lenses. Gas permeable contact lenses can help contain the shape of the cornea because they are rigid. They can also correct vision problems from keratocous that otherwise could not be corrected with eyeglasses or soft contacts. There is another technique that can be used to correct keratoconus which is called ‘piggybacking’. This is when a soft contact lens is worn under the gas permeable lens for greater comfort. One other option is to wear a hybrid contact lens, which has a gas permeable center and is surrounded by a ‘skirt’ of comfortable soft lens material.

LASIK is a popular surgery to correct your eyesight. Sometimes there are vision problems that remain after surgery. These problems can’t be corrected with eyeglasses or further surgery. Therefore, gas permeable lenses are often used to restore visual acuity and to eliminate problems like glare and halos at night. Cornea transplant surgery also use gas permeable lenses to correct vision problems after. These issues include irregular astigmatism that cannot be corrected by wearing eyeglasses. These gas permeable lenses that are prescribed after LASIK and cornea transplants sometimes have a special design called ‘reverse geometry’. This means that the back surface of these lenses is flatter in the center and steeper in the periphery to allow for better comfort to the altered shape of the cornea after surgery.

Even if you have been told you are not a good candidate for contacts, we may be able to help you wear contact lenses safely and successfully.

Almost everyone experiences some symptoms of presbyopia by ages 45 to 50. Presbyopia is the loss of ability to focus on objects that are near. There are a multitude of lenses, both bifocal and multi-focal, that can correct presbyopia. Monovision is another option for patients with presbyopia. This means wearing a contact lens in one eye for distance vision and a lens in the other eye that has a modified power for near vision. Your eye doctor can help you decide whether monovision, bifocal or multifocal contact lenses are best for you.

Treatment for any of the above conditions generally takes more time than regular contact lens fitting. They generally require a series of office visits and multiple pairs of trail lenses before the final contact lens prescription can be determined, hence why these conditions are labeled as ‘hard-to-fit’ eyes. Therefore, fitting fees can be higher than the fees for fittings on regular contacts. Typically these special-designed contact lenses that are required for these conditions are more costly than regular soft contact lenses.

If you have any of these eye issues and you are interested in wearing contact lenses, you can call your optometrist office to schedule a consultation. Even if you have been told you are not a good candidate for contacts, they may be able to help you wear contact lenses safely and successfully.

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