If you have been told you have hard-to-fit eyes, you still have options with us. Specialized contact lenses are designed for people whose eyes do not work well with standard lenses. Conditions like keratoconus, severe dry eye, high astigmatism, or irregular corneas can make regular contacts uncomfortable or ineffective. The right lens type depends on your specific eye shape and vision needs.
Rigid gas permeable lenses, also called RGP or GP lenses, are smaller and firmer than standard soft lenses. They hold their shape on the eye rather than molding to the cornea. This creates a smooth optical surface that can correct vision problems caused by irregular corneas.
RGP lenses work well for people with astigmatism and mild to moderate keratoconus. Because they maintain a stable shape, they often provide sharper vision than soft lenses. They also allow more oxygen to reach the cornea than older hard lens designs. Many people find that their vision stays clearer throughout the day with RGP lenses compared to soft lenses that can dry out or shift position.
Scleral lenses are larger than standard contacts. They rest on the sclera, which is the white part of the eye, instead of sitting directly on the cornea. A layer of saline solution fills the space between the lens and the cornea.
This design offers several benefits:
Scleral lenses are often the best choice for severe dry eye, keratoconus, and eyes that have had previous surgeries. At Insight Vision Center Optometry, we can create wavefront-guided scleral lenses using the Tomey WaveDyn Aberrometer. These custom lenses correct higher-order aberrations that standard lenses cannot address.
Hybrid lenses combine two materials in one lens. The center is made of rigid gas permeable material for clear vision. A soft outer ring surrounds the rigid center for comfort.
These lenses can be a good middle ground for people who need the visual clarity of RGP lenses but find them uncomfortable. They work well for high astigmatism and irregular corneas. Products like SynergEyes Duette use this hybrid design. The soft skirt helps the lens center properly on the eye and provides a comfortable edge that feels more like a regular soft lens.
Toric lenses are designed specifically for astigmatism. Regular contacts have the same curve all the way around. Toric lenses have different curves in different parts of the lens to match the shape of an astigmatic eye.
These lenses must stay in a specific position on the eye to work correctly. They include features that help them align properly and resist rotation when you blink. For mild astigmatism, soft toric lenses work well. Higher amounts of astigmatism may require RGP or scleral toric designs for the clearest vision.
When standard soft lenses do not fit properly, custom soft lenses can be made to match your exact eye measurements. These lenses are designed for people with larger pupils, unusual corneal sizes, or other features that make off-the-shelf lenses uncomfortable.
Options like KeraSoft IC and NovaKone are made specifically for irregular corneas while still offering the comfort of soft lens material. These lenses work well for people with mild keratoconus or corneal irregularities who prefer the feel of soft contacts over rigid options. You can learn more about custom soft contact lenses on our dedicated page.
Fitting specialty contact lenses takes more time and skill than fitting standard lenses. We will measure your cornea in detail using advanced imaging. This may include corneal topography or tomography to map the exact shape of your eye.
At Insight Vision Center Optometry, we use tools like the Pentacam and AS-OCT to capture detailed images of the cornea. These measurements help us determine which lens type and design will work best. The Pentacam creates a three-dimensional map of the cornea that shows thickness, curvature, and elevation at thousands of points.
Most specialty lens fittings require trial lenses. You may try several lenses before finding the best fit. The fitting process often takes multiple visits to fine-tune the lens parameters. Each visit allows us to assess how the lens sits on your eye and make adjustments to improve comfort and vision.
Dr. Nathan Schramm, OD, FSLS, FBCLA and Dr. Thanh Mai, OD, FSLS, FIAOMC both hold advanced fellowships in scleral lens fitting. Their training helps them fit complex cases that other practices may struggle with. Dr. Schramm co-founded the International Congress of Scleral Contacts and has been a principal investigator for wavefront-guided scleral lens studies.
Specialty lenses require different handling techniques than standard contacts. Scleral lenses need to be filled with saline before insertion. We will teach you how to insert and remove your lenses safely. Most people become comfortable with the process after a few practice sessions.
You will also learn how to recognize signs that something is wrong. Air bubbles under scleral lenses, debris on the lens surface, or lenses that feel different than usual should be addressed promptly. We are available to help troubleshoot any problems.
Once you have the right lenses, regular follow-up visits help ensure they continue to fit well. Your eye shape can change over time, especially with conditions like keratoconus. We will monitor your eyes and adjust your lenses as needed. Annual exams allow us to check both your lens fit and your overall eye health.
Keratoconus causes the cornea to thin and bulge into a cone shape. This creates irregular astigmatism that glasses and regular contacts cannot fully correct. Scleral lenses, RGP lenses, and hybrid lenses can all improve vision for people with keratoconus by creating a smooth surface over the irregular cornea.
The best lens choice depends on how advanced your keratoconus is. Mild cases may do well with custom soft lenses or small RGP lenses. Moderate to advanced keratoconus often requires scleral lenses for the best combination of vision and comfort.
Scleral lenses are often helpful for people with severe dry eye. The fluid reservoir between the lens and cornea keeps the eye moist all day. This can provide relief when drops and other treatments are not enough. If you are unsure about your symptoms, you can take our dry eye quiz to learn more.
Some people develop irregular corneas after refractive surgery like LASIK or RK. Others may have scarring from injury or infection. Specialty lenses can often restore clear vision when the cornea no longer has a smooth, regular shape. Even corneas with significant scarring can often achieve good vision with properly fitted scleral lenses.
Very high prescriptions or unusual combinations of nearsightedness, farsightedness, and astigmatism may not be available in standard contact lenses. Custom lenses can be made to match nearly any prescription. This includes multifocal designs for people who need help with both distance and reading vision.
Some people need contact lenses to improve the appearance of an eye affected by injury, disease, or birth defects. Dr. Nhi Nguyen, OD works with patients who need prosthetic lenses for conditions like iris atrophy or corneal scarring. These lenses can match the appearance of the other eye while also correcting vision when possible.
Adaptation time varies by lens type. Scleral lenses are often comfortable right away because they do not touch the sensitive cornea. RGP lenses may take a few weeks of gradual wear to feel comfortable. We will give you a wearing schedule to help your eyes adjust.
Specialty lenses typically cost more than standard contacts because they require custom manufacturing and more fitting time. However, they may be the only option that provides clear, comfortable vision for certain conditions. Some vision insurance plans cover medically necessary contact lenses.
Most specialty lenses are designed for daily wear only and should be removed before sleep. Sleeping in contact lenses increases the risk of eye infections and other complications. We will tell you the recommended wearing schedule for your specific lenses.
Scleral lenses require daily cleaning with approved solutions. You will also need preservative-free saline to fill the lens before insertion. We will teach you the proper insertion, removal, and cleaning techniques during your fitting appointments.
Many people who failed with standard contacts do well with specialty lenses. The lens types and fitting technology have improved significantly. If you were told you could not wear contacts years ago, it may be worth trying again with current options.
Yes, children can wear specialty lenses when needed. Some conditions like keratoconus can appear during the teenage years. Children with high prescriptions or irregular corneas may see better with contacts than glasses. Dr. Valerie Lam, OD, FAAO, FOVDR works with pediatric patients who need specialty contact lens fittings.
