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For most people, contact lenses are an excellent and versatile eyewear option. They allow you to enjoy day-to-day activities without worrying about the safety or cleanliness of eyeglasses.

Unfortunately, I’ve met a lot of patients who have already determined that contact lenses are not for them. They wear lenses once or twice, find them too uncomfortable or too difficult to keep in, and assume they just can’t wear contacts. In some cases, optometrists tell patients that their eyes are too hard to fit.

It’s certainly true that certain eye conditions or diseases make contact lens wear difficult or uncomfortable. However, that doesn’t necessarily mean that contact lenses aren’t an option. There are a wide variety of specialty contact lenses designed specifically for patients with hard to fit eyes.

Let’s talk about what it means to have hard-to-fit eyes, and what sort of specialty contact lenses exist to give you a better experience.

Why Are Some Eyes “Hard-to-Fit?”

When optometrists use the phrase “hard-to-fit,” they’re usually referring to the shape of the eye. Some conditions, like astigmatism, impact the shape of the cornea. When the cornea isn’t uniformly round, it makes it difficult for the contact lens to stick to the eye.

Other issues, like dry eye disease, make contact lens wear deeply uncomfortable and irritating for the eyes. This doesn’t necessarily impact your optometrist’s ability to fit you for contact lenses, but it will make traditional lenses more uncomfortable to wear. 

These are the four eye conditions that impact contact lens wear the most.

Presbyopia

Presbyopia is a condition that eventually impacts everyone in middle age. As you get older, your natural lens stiffens, which makes it harder to focus on near objects. That’s why people usually start relying on reading glasses in their mid to late 40s. 

This problem can be easily rectified with reading glasses if you don’t need any other correction. However, if you are also nearsighted or astigmatic, you’ll need multiple prescriptions for different distances. Owning multiple pairs of glasses is one thing, but having to switch contact lenses based on what activities you’re engaged in is rather unrealistic.

Dry Eye

Your eyes need tears to keep them hydrated, clean, and lubricated. When your body doesn’t produce enough tears or produces tears of poor quality, it irritates the eye. This irritation is made significantly worse when wearing contact lenses.

Contact lenses can dry out during the day. If your eyes are already dry, the additional dryness just compounds the problem, making your existing dry eye symptoms more prominent than before. Dry eye is one of the major causes of contact lens discomfort.

Astigmatism

Astigmatism describes an uneven corneal shape. As we’ve already established, the cornea needs to be uniformly round to work properly. Patients with astigmatism have irregularly-shaped corneas, which prevents light from refracting properly in their eye. As a result, their vision is blurry or unfocused to some degree at all distances. Astigmatism can also develop due to the shape of the natural lens inside the eye.

Contact lens wear can be difficult for patients suffering from astigmatism, not only because of their irregular corneal shape but also because different areas (or meridians) of the eye require different prescriptions (or corrective powers) to offer consistently clear vision.

Keratoconus

Keratoconus is a condition that causes the cornea to bulge outwards in a cone-like shape. There are a variety of elements that could cause keratoconus, such as excessive rubbing of the eye, or imbalanced enzymes in the cornea.

This structural change to the cornea alters the way light refracts in the eye, preventing clear vision. It also makes traditional contact lenses difficult to wear due to the cornea’s progressively-changing shape.

Specialty Contact Lenses for Hard-to-Fit Eyes

Contact lens technology is advancing all the time, providing us with new and innovative solutions for a variety of eye issues. Many of these specialty contact lenses are appropriate for multiple types of eye conditions. I’ve listed the conditions these lenses are typically used for, however, you’ll have to speak to your eye doctor to determine what works best for you.

Scleral Lenses

Diagram of scleral lens

Scleral lenses are hugely popular among patients who find traditional contact lenses uncomfortable. Scleral lenses cover more of your eye’s surface area, resting on the white part of the eye which is called the sclera. The sclera is not nearly as sensitive as the cornea, which makes the lens is more comfortable to wear. The additional surface area also stabilizes these lenses, making them less likely to shift as you blink.

Because the edges of the lens rest on the sclera, scleral lenses don’t actually touch your cornea at all; they vault directly over it, leaving space between the lens and your cornea. This space can act as a reservoir for tears, making scleral lenses a more comfortable choice for patients with dry eye.

Scleral lenses are typically used for:

  • Dry eye
  • Keratoconus
  • Irregular corneas

Hybrid Lenses

Diagram of hybrid contact lenses

Hybrid contact lenses are designed to offer the benefits of two different types of lenses. At the centre, hybrid contact lenses are rigid or gas permeable. This provides crisp and accurate vision. The outer ring or skirt of the lens is a soft contact lens which offers a higher degree of comfort. Hybrid lenses are relatively large in diameter, which makes them secure and helps them to stay centred on the eye. 

Hybrid lenses are typically used for:

  • Astigmatism
  • Presbyopia
  • Irregular corneas

Bifocal & Multifocal Lenses

Diagram of Multifocal contact types

Multifocal contact lenses are any type of contact that has more than one prescription or corrective power in a single lens. Bifocal contacts are a type of multifocal contacts that offer just two corrective powers. 

There are several different types of multifocal contact lenses, and each one lays out the different corrective powers in different patterns. Some use alternating rings, making a sort of target design, with each ring offering a different prescription level. Other multifocal lenses work in a sort of gradient, having one corrective power slowly fade Into the next. 

Bifocal & Multifocal lenses are typically used for:

  • Presbyopia

Toric Lenses

Toric lenses are a specific type of contact lens, offering different corrective powers in different areas of the lens. They are most often used to correct astigmatism. Astigmatism is unique in that it requires specific prescriptions for different meridians of the eye, which means that unlike traditional contact lenses, they have to be properly oriented to work. 

Thanks to stabilizing dual-thin zone, toric lenses automatically maintain the correct orientation with each blink; ensuring the appropriate prescription is applied to the right part of your eye. 

Toric lenses are typically used for:

  • Astigmatism

You Do Have Options

I certainly understand that a bad experience with contact lenses can be off-putting. But contact lens technology has come so far, and we now have so many different options to allow comfortable and effective contact lens wear for nearly every type of eye, even those who have found contacts too uncomfortable in the past. 

If you’ve been told that your eyes are too difficult to fit, I would encourage you to seek a second opinion from another optometrist, particularly one who specializes in contact lenses for hard to fit eyes. There is a good chance that there are some options available to you.

Written by Kevin Hesterman

DR. KEVIN HESTERMAN
Dr. Hesterman was born in Regina, Saskatchewan. He graduated from optometry at Waterloo in 2000. He and his wife, Rhonda, have three children. He enjoys swimming, biking, and running, having completed several triathlons. Hiking, skiing, and playing the piano and guitar are other interests. He has volunteered with Big Brothers and Big Sisters and was on the executive committee for Optometry Giving Sight, a charity raising money for third world optometry. Dr. Hesterman is currently on the executive council for the Alberta Association of Optometrists.

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