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. Dr. Bearden has special expertise in contact lens fitting and will welcome the opportunity to fit your unusual eye.

Are Your Eyes Hard to Fit?

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

If you have (or suspect you have) any of these conditions and you want to wear contacts, visit an eyecare 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, Dr. Bearden may 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.

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.

Still another contact lens option for keratoconus is scleral GP lenses. These large gas permeable lenses vault over the irregular surface of the cornea and rest on the white sclera of the eye. The large diameter of scleral lenses provides a more stable fit than regular gas permeable lenses on highly irregular corneas with keratoconus.

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. 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.

Dr. Bearden 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, dietary supplements for eye nutrition, and lid scrubs to maintain optimal lid hygiene.

Your eye doctor may consider punctal plug 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.

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.

Contact Lenses after PK (Penetrating Keratoplasty or corneal transplant)

A corneal transplant, also known as a corneal graft, or as a penetrating keratoplasty, involves the removal of the central portion (called a button) of the diseased cornea and replacing it with a matched donor button of cornea. Corneal grafts are performed on patients with damaged or scarred corneas that prevent acceptable vision.

Contact Lenses After Surgery

Most transplants have significant astigmatism and often some distortion requiring correction with contact lenses made of rigid materials. Many factors make fitting contacts after transplant a challenge. It is common for the edge of the transplant to be slightly raised with respect to the surrounding cornea. The graft is usually steeper than the normal cornea, and may be tilted with respect to the surrounding tissue. To combat high amounts of astigmatism some of the sutures may be removed early. Following healing a relaxing incision or a wedge resection may be done to decrease the astigmatism. In any case there is usually some distortion of the transplant and most patients will obtain better vision with a rigid contact lens. Rigid corneal lenses, scleral (haptic) lenses, and the SoftPerm lens are all viable options.

If a contact lens is required following keratoplasty it is customary to wait at least 3 months after the surgery and preferably until after the sutures are removed, which may be up to a year, before fitting contact lenses.

Due to the irregularity of the cornea after transplant, soft contact lenses seldom give satisfactory vision. In addition, hydrogel lenses, scleral lenses and the SoftPerm lens may encourage vessel invasion into the graft. Therefore, rigid gas permeable corneal lenses are usually the lens of choice. Keratometer readings are seldom of any significant value in determining the base curve of the lens to use, but may be useful for baseline values to determine if any changes are occurring. Corneal topography with a computerized topographer can be of some value in determining the shape of the transplant and surrounding cornea. However, diagnostic lenses must be used to fit these eyes.

Due to the size and shape of the button and the transition area between the button and the host cornea, it is often best to use a larger diameter lens to maintain lens centration. In the rare instance that a corneal transplant is placed off-center, rigid corneal lenses are nearly impossible to properly fit. In these few cases scleral or SoftPerm lenses may be the only viable option.

Parameters of the lenses are assessed using the fluorescein pattern. The power of the final rigid lens is determined by an accurate refraction over the diagnostic lens. A lens material with good oxygen permeability should be used to minimize corneal swelling.

The corneal transplant patient should be followed closely, especially during the first year or two following surgery to be sure corneal integrity is not compromised and that graft rejection is not occurring.

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.

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2222 James Street; Suite A
Bellingham, Washington 98225
Optometric Phys. NW Whatcom Optical
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