Some people struggle to wear regular contact lenses. If you have been told you are a 'hard to fit' patient, it means certain eye conditions make standard lenses uncomfortable or ineffective. The good news is that specialty contact lenses can often provide clear, comfortable vision even when regular lenses fail.
At Insight Vision Center Optometry, our optometrists have advanced training in fitting complex contact lens cases. With the right lens design and proper fitting, most hard to fit patients can enjoy successful contact lens wear.
The cornea is the clear dome at the front of your eye. It bends light to help you see clearly. When the cornea has an irregular shape, standard contact lenses cannot sit properly on the eye. This leads to blurry vision, discomfort, and lenses that move around too much or pop out.
Keratoconus is one of the most common conditions that causes an irregular cornea. In keratoconus, the cornea thins and bulges outward into a cone shape over time. Regular soft lenses simply drape over this irregular surface instead of correcting it. Other causes of irregular corneas include corneal scarring from injury or infection, pellucid marginal degeneration, and corneal ectasia after refractive surgery.
Astigmatism occurs when the cornea or the lens inside your eye is curved more like a football than a round basketball. This uneven curvature causes light to focus at multiple points instead of one, resulting in blurry or distorted vision at all distances.
Mild to moderate astigmatism can often be corrected with toric soft lenses, which have different powers in different parts of the lens. However, higher amounts of astigmatism or irregular astigmatism may require gas permeable or scleral lenses to achieve clear vision.
Dry eye is a chronic condition where your eyes do not produce enough tears or the tears evaporate too quickly. Without adequate tear film, contact lenses can feel scratchy, cause redness, and lead to fluctuating blurry vision throughout the day.
Many factors contribute to dry eye, including aging, hormonal changes, certain medications, autoimmune conditions, and extended screen time. Ironically, contact lens wear itself can worsen dry eye symptoms. Patients with moderate to severe dry eye often struggle with soft lenses because the lenses absorb moisture from the eye surface.
Refractive surgeries like LASIK, PRK, and radial keratotomy (RK) reshape the cornea to reduce dependence on glasses. While these procedures help many people see clearly without correction, they change the corneal shape in ways that can make contact lens fitting challenging later.
Post-surgical corneas often have flatter central zones, irregular transitions between treated and untreated areas, or higher-order aberrations that cause glare and halos. Standard soft lenses cannot address these optical irregularities. Many post-surgical patients need specialty lenses to achieve their best possible vision.
Giant papillary conjunctivitis (GPC) is an allergic and inflammatory reaction that causes bumps to form on the underside of the eyelids. It commonly affects long-term contact lens wearers, especially those who do not replace their lenses frequently enough or who sleep in their lenses.
GPC causes itching, mucus discharge, lens awareness, and excessive lens movement. The bumps under the eyelids grab at the lens edge with each blink. Patients with GPC often need to take a break from lens wear, use daily disposable lenses, or switch to scleral lenses that tuck under the eyelids and avoid the affected tissue.
Presbyopia is the normal age-related loss of near focusing ability that typically begins in the early to mid-forties. As the lens inside your eye becomes less flexible, it becomes harder to shift focus from distance to near objects. Reading glasses or bifocals become necessary.
Contact lens options for presbyopia include multifocal lenses, monovision (one eye for distance and one for near), and blended approaches. Finding the right solution requires careful evaluation and often some trial and error. Patients with presbyopia combined with other hard to fit conditions face additional fitting challenges.
Scleral lenses are large diameter gas permeable lenses that vault completely over the cornea and rest on the sclera, the white part of the eye. Because they do not touch the cornea at all, they provide exceptional comfort for patients with irregular corneas and severe dry eye.
The space between the scleral lens and the cornea fills with preservative-free saline solution. This fluid reservoir keeps the cornea hydrated throughout the day and creates a smooth optical surface that corrects vision. Many patients describe the comfort of scleral lenses as better than soft lenses.
At Insight Vision Center Optometry, Dr. Nathan Schramm, OD, FSLS, FBCLA holds fellowships from both the Scleral Lens Society and the British Contact Lens Association. He co-founded the International Congress of Scleral Contacts and serves as a principal investigator for the WaveDyn wavefront-guided scleral lens study. Dr. Thanh Mai, OD, FSLS, FIAOMC also holds the FSLS fellowship and brings additional fitting experience.
Gas permeable (GP) lenses are made from rigid, oxygen-permeable plastic materials. Unlike soft lenses that conform to the shape of your cornea, GP lenses maintain their shape and create a smooth optical surface. Tears fill the space between the lens and any corneal irregularities, neutralizing distortions.
GP lenses provide sharper vision than soft lenses for most patients, especially those with astigmatism or mild corneal irregularities. They also allow more oxygen to reach the cornea than many soft lenses. The main drawback is an adaptation period of one to two weeks while your eyelids get used to the lens edges.
Hybrid lenses combine a rigid gas permeable center with a soft lens skirt around the outside edge. This design offers the crisp optics of a GP lens with comfort approaching that of a soft lens. The soft skirt helps center the lens and makes it less likely to dislodge during activities.
Hybrid lenses work well for patients who need the optical quality of GP lenses but cannot tolerate the adaptation period or lens awareness. Products like SynergEyes Duette are available at Insight Vision Center Optometry for appropriate candidates.
Custom soft lenses are manufactured to match your exact eye measurements and prescription needs. Unlike mass-produced lenses that come in limited parameters, custom lenses can correct higher amounts of astigmatism, unusual base curves, and other specifications that standard lenses cannot address.
Products like KeraSoft IC and NovaKone are custom soft lens designs specifically made for irregular corneas like keratoconus. These lenses use special optical zones to improve vision while maintaining the comfort advantages of soft lens materials.
Orthokeratology, or ortho-k, uses specially designed gas permeable lenses worn overnight to temporarily reshape the cornea. You remove the lenses in the morning and see clearly throughout the day without any correction. The reshaping effect is reversible and requires consistent nightly wear to maintain.
Ortho-k is commonly used for myopia control in children but also benefits adults who want freedom from daytime correction. Dr. Ariel Chen, OD and Dr. Nhi Nguyen, OD both fit ortho-k lenses including the Euclid Phoenix design.
Corneal topography creates a detailed color-coded map of your cornea's front surface curvature. This helps identify irregular areas, measure astigmatism, and guide contact lens design. Tomography goes further by imaging both the front and back corneal surfaces along with the full thickness.
The Pentacam at Insight Vision Center Optometry provides comprehensive corneal tomography. It measures elevation maps, pachymetry (thickness), and can detect early keratoconus or other corneal conditions. This information is essential for designing scleral and other specialty lenses.
Wavefront aberrometry measures how light travels through your entire optical system, not just basic nearsightedness, farsightedness, and astigmatism. It detects higher-order aberrations like coma, spherical aberration, and trefoil that cause glare, halos, and reduced contrast sensitivity.
The Tomey WaveDyn Aberrometer allows our doctors to design wavefront-guided scleral lenses that correct these complex optical errors. This technology can provide vision quality beyond what is possible with glasses or standard contact lenses.
Anterior segment optical coherence tomography (AS-OCT) takes high-resolution cross-section images of the front of your eye. This allows precise measurement of scleral lens clearance over the cornea, evaluation of the tear reservoir, and assessment of how the lens interacts with the ocular surface.
AS-OCT imaging removes much of the guesswork from scleral lens fitting. It helps confirm that the lens vaults adequately over the cornea without excessive clearance that could cause problems. Follow-up imaging ensures the fit remains optimal over time.
Every specialty contact lens fitting begins with a comprehensive eye examination. Your doctor will evaluate your overall eye health, measure your refractive error, assess your tear film quality, and carefully examine your corneal shape and condition. This thorough evaluation determines which lens type offers the best chance of success.
Be prepared to discuss your visual needs, lifestyle, occupation, hobbies, and any previous contact lens experiences. This information helps your doctor recommend the most appropriate lens design for your situation.
Your doctor will place diagnostic or trial lenses on your eyes to assess fit, comfort, and vision. For scleral lenses, this appointment typically takes one to two hours to allow the lenses to fully settle. Your doctor will evaluate lens centration, movement, edge alignment, and clearance over the cornea.
Multiple diagnostic lenses may be tried to optimize the fit. Your feedback about comfort and vision quality guides the process. Photography and OCT imaging document the fit for comparison at future visits.
Once the best lens parameters are determined, your custom lenses are ordered from the laboratory. Manufacturing time varies from a few days to several weeks depending on the lens type and complexity. When your lenses arrive, you will return for a dispensing appointment.
At the dispensing visit, your doctor confirms the fit of your new lenses and checks your vision. You will receive thorough training on lens insertion, removal, and daily care. Most patients need practice to become confident with handling, especially for scleral lenses. Take your time and know that the learning curve is normal.
Follow-up appointments are essential to ensure your lenses continue to fit well and your eyes remain healthy. Your first follow-up is typically scheduled within one to two weeks of dispensing. Additional visits may be needed to fine-tune the fit or address any concerns.
Even after the initial fitting period, regular check-ups are important. Your corneal shape, tear film, and visual needs can change over time. Annual comprehensive examinations allow your doctor to catch any issues early and update your lenses as needed.
You may be hard to fit if standard soft lenses cause persistent discomfort, fail to provide clear vision, or move excessively on your eyes. Patients with conditions like keratoconus, high or irregular astigmatism, severe dry eye, or history of eye surgery often fall into this category. A comprehensive contact lens evaluation can determine whether specialty lenses would help you.
Most patients find scleral lenses surprisingly comfortable, often more so than soft lenses. Because the lens vaults completely over the cornea and rests on the less sensitive sclera, there is minimal lens awareness. The saline reservoir also keeps the eye surface moist and comfortable throughout the day.
A complete specialty fitting typically requires multiple appointments over several weeks to months. The initial evaluation may last one to two hours. Additional visits are needed to refine the fit, dispense the final lenses, and teach proper handling. Complex cases involving significant corneal irregularity may require more appointments to achieve the best possible outcome.
Yes, many patients with severe dry eye successfully wear contact lenses. Scleral lenses are often the best choice because the fluid reservoir continuously bathes the cornea in moisture. Your doctor may also recommend treating the underlying dry eye condition with therapies like IPL, TearCare, or prescription eye drops alongside lens wear.
Coverage varies significantly by insurance plan. Some medical insurance plans cover medically necessary contact lenses for diagnosed conditions like keratoconus. Vision insurance plans may provide partial benefits toward the fitting fee or lens cost. Our staff can help verify your specific coverage before you begin the fitting process.
Gas permeable and scleral lenses typically last one to two years with proper care, though some patients get longer wear from their lenses. The replacement timeline depends on how well you care for the lenses, how your eyes respond, and whether any prescription changes occur. Custom soft lenses follow replacement schedules similar to standard soft lenses. Your doctor will recommend the appropriate replacement frequency for your situation.
