Contacts for Hard-to-Fit Eyes

By Nancy Del Pizzo, with updates and review by Gary Heiting, OD

If you have had trouble wearing contact lenses or have been told you're not a good candidate for contacts, you simply may have eyes that are "hard to fit."

But don't worry — this doesn't mean you can't wear contact lenses. You just need to know your options and how to find an eye care practitioner (ECP) who has special expertise in contact lens fitting.

Are Your Eyes Hard to Fit?

Any of the following conditions can make contact lens fitting and comfortable contact lens wear more challenging:

• Keratoconus
• Astigmatism
• Dry eyes
• Giant papillary conjunctivitis (GPC)
• Post-refractive surgery (such as LASIK)
• Presbyopia

If you have (or suspect you have) any of these conditions and you want to wear contacts, visit an eye care professional who specializes in contact lenses and welcomes hard-to-fit patients. Contact lens specialists usually are more aware of the latest contact lens technology and options than a general eye doctor. Many also use advanced equipment that can measure your cornea more precisely to achieve the best contact lens fit possible.

Contact Lenses for Keratoconus

If you have keratoconus, most contact lens specialists will recommend gas permeable contact lenses (also called GP, rigid gas permeable or RGP lenses). Since GP lenses are made of a non-pliable material, they retain their shape on the eye. Because of this feature, gas permeable contacts replace the irregular surface of a keratoconic cornea with a smooth, uniform surface to focus light and sharpen vision.

Sometimes an eye with keratoconus is too sensitive and unable to adapt to gas permeable lenses. In these cases, a fitting technique called "piggybacking" may be used. First the cornea is fitted with a soft contact lens, and then a GP lens is fitted over the soft lens. Because the soft lens acts like a cushion, piggybacking can make gas permeable contact lenses more comfortable for people with keratoconus.

Large-diameter scleral and semi-scleral GP lenses rest on the sclera and vault over the misshapen cornea in keratoconus.

Another option for keratoconus is hybrid contact lenses. These advanced lenses have a gas permeable optical center with a soft ring around it. For many wearers, hybrid contacts offer the clarity of GP lenses and wearing comfort that rivals soft lenses. Special hybrid lens designs are available specifically for eyes with keratoconus.

Other contact lens options for keratoconus include scleral and semi-scleral gas permeable lenses. These large-diameter GP lenses rest on the white sclera of the eye and vault over the irregularly shaped cornea.

Scleral GP lenses cover a large portion of the sclera, and semi-scleral lenses cover a smaller portion. Both types provide a more stable fit than smaller, conventional gas permeable lenses, which cover only a portion of the cornea and move freely with each blink.

Scleral and semi-scleral lenses can be more comfortable than conventional GP lenses for someone with keratoconus because they don't exert any pressure on the sensitive corneal tissue. Also, the large diameter and more stable fit of these specialty gas permeable contacts decrease the risk of the lenses dislodging or falling off a cone-shaped cornea.

Contact Lenses for People With Astigmatism

Toric contact lenses are specially designed to correct astigmatism. Fitting toric lenses is more difficult than fitting regular soft lenses for nearsightedness or farsightedness because these lenses must move adequately during blinks while remaining aligned in a specific way without rotating.

Astigmatism Contacts

How contacts can correct your astigmatism, with a comparison of lens designs. (Video by Acuvue)

Contact Lens Comfort with Hydraclear

How Hydraclear makes contact lenses smooth, moist and oxygen transmissible. (Video by Acuvue)

Contact Lenses for Dry Eyes

How Lacreon keeps daily disposable contact lenses moist. (Video by Acuvue)

Contact Lens Materials

From glass to soft, breathable plastics, the pros and cons of various contact lens materials. (Video by Acuvue)

Multifocal Contacts

Why use reading glasses? Multifocal contacts can provide near, far and intermediate vision. (Video by Acuvue)

Sometimes, several toric lenses must be tried to obtain the best possible fit, vision and comfort.

Toric contact lenses for astigmatism are available in both soft and gas permeable lens materials. Custom designs are available for people with unusual types or high amounts of astigmatism. Because they are custom-made, these lenses can cost significantly more than standard toric lenses and may require a longer delivery time.

Hybrid contact lenses also are a good solution for astigmatism, especially for people who want the clarity of GP lenses but desire a lens that feels more like a soft lens.

Contact Lenses for People With Dry Eyes

Studies suggest that up to 20 percent of Americans have chronic dry eyes. This common condition is why many people are told they can't wear contact lenses. Dry eye discomfort also forces many contact lens wearers to discontinue wearing their lenses.

Symptoms of dry eyes include:

• Feeling as if something is in your eye
• Tearing for no reason
• Frequent red or burning eyes
• Having very watery tears

If you have chronically dry eyes, soft contact lenses may dry out on your eyes and cause discomfort. To combat this problem, some new soft contacts are designed specifically for people with dry eyes. These lenses retain moisture better than other soft lenses, for longer periods of wearing comfort.

Many contact lens specialists prefer fitting gas permeable contact lenses on people with dry eyes. GP lenses are smaller and don't absorb moisture from your eyes like soft lenses do, and therefore may cause less dryness.

Your eye care practitioner may recommend treating your dry eye condition prior to contact lens fitting. Treatment may involve the use of artificial tears, medicated eye drops to help you produce more tears and dietary supplements for eye nutrition.

Your eye doctor may consider punctal plugs as part of your dry eye treatment. These tiny collagen or silicone devices are inserted into the tear drainage ducts near the inner margin of your eyelids to block tears from leaving the surface of your eyes. By keeping more tears on your eyes, punctal plugs often can improve contact lens comfort.

The procedure, called punctal occlusion or lacrimal occlusion, takes only a few minutes and is painless. Once the plugs are inserted, most people can't even feel them.

Read more about solving contact lens discomfort from dry eyes.

Contact Lenses for Giant Papillary Conjunctivitis (GPC)

Giant papillary conjunctivitis (GPC) is an inflammatory reaction caused by proteins secreted in your tears. This inflammatory reaction causes lid glands to secrete substances that create a filmy coating on contact lenses, making them uncomfortable and creating vision problems.

Practitioners have several options to fit a person who has GPC. Sometimes soft daily disposable contact lenses will do the trick. Because you discard these lenses after just a single day of wear, there's not much time for protein deposits to accumulate on disposable lenses.

Gas permeable lenses also are a good option. Proteins don't adhere to GP lenses as easily as they do to soft lenses, so gas permeable lenses stay cleaner and are less likely to cause an allergic reaction. Daily cleaning of gas permeable lenses generally will keep them free of residue, whereas soft lenses tend to retain protein deposits over time, even with proper care and cleaning.

A practitioner also may prescribe medicated eye drops to reduce the allergic reaction that causes GPC.

Contact Lenses After LASIK and Other Corrective Eye Surgery

It may seem odd even to consider contact lenses after corrective eye surgery. After all, aren't LASIK and other procedures supposed to eliminate the need for glasses or contacts?

Theoretically, yes. But LASIK doesn't always provide perfect vision. And sometimes, a second surgery to sharpen vision is not an option. In these cases, contact lenses may be in order.

For example, if you have very high astigmatism prior to LASIK, you may need toric lenses to correct a lesser degree of astigmatism that may remain after surgery. Soft lenses can work well for this, and specially designed gas permeable and hybrid contact lenses are also an option.

If you've had LASIK performed in a monovision fashion — with one eye corrected for distance and the other for near — occasionally you may want to wear a contact lens on the "near eye" so both eyes can see clearly in the distance for sports, driving at night and other activities that require the best possible vision.

Contact lenses also can help to address LASIK complications, such as indistinct vision from higher-order aberrations after surgery. Gas permeable or hybrid contact lenses are usually the preferred lenses for this problem. Excessive glare is another potential problem following LASIK. Here, too, GP contact lenses and hybrid contacts usually are your best choice. These lenses often provide sharper night vision than soft contact lenses after surgery.

Keep in mind that fitting contact lenses after LASIK or other corrective surgery may require more trial lenses and a longer period of time than fitting contact lenses on an eye that hasn't been surgically altered. Read more about contact lenses after refractive surgery.

Contact Lenses for Presbyopia

Bifocal contact lenses and monovision are contact lens options for people who are hard to fit because of presbyopia.

Like bifocal and progressive eyeglass lenses, bifocal and multifocal contacts have a more complex design than regular lenses, and precise fitting is essential for good results. Therefore, finding the best contact lenses to correct presbyopia typically is a more time-consuming and costly process than a regular contact lens fitting. The same is true for monovision contact lens fittings.

But the result usually is worth the extra time and expense. Improvements in multifocal contacts have increased satisfaction with these lenses in recent years, and most wearers are very pleased about how the lenses decrease their dependence on reading glasses.

Expect Higher Fees for Hard-To-Fit Contact Lens Services

Expect to pay more when you visit an eye care practitioner who specializes in contact lenses for the hard-to-fit person. You're paying for the time involved, the practitioner's special expertise and the advanced type of lenses you'll receive.

For some hard-to-fit cases, a fitting fee of several hundred dollars is not unusual, and fitting fees often do not include the cost of your lenses.

Additional Resources

To find an eye care practitioner in your area who specializes in contact lenses, visit our Find an Eye Doctor page.

[Page updated September 2009]