For many people, contact lenses are a convenient alternative to glasses. But standard soft lenses do not work well for everyone. Some people have unusual corneal shapes, significant astigmatism, dry eyes, or certain eye conditions that make ordinary lenses uncomfortable, unstable, or unable to provide clear vision.

That is where specialty contact lenses can help. Often called hard-to-fit contacts, these lenses are designed for eyes that need more than a standard lens prescription. They can include rigid gas permeable lenses, scleral lenses, hybrid lenses, and other specialty designs.

Being considered a hard-to-fit patient does not necessarily mean that contact lenses are off the table. In many cases, an experienced eye care professional can evaluate the shape and condition of the eye and determine whether a specialty lens may provide better vision and comfort. Understanding who may benefit can help patients know what to discuss during an eye examination.

What Are Hard-to-Fit Contacts?

Hard-to-fit contacts are specialty lenses used when conventional contact lenses do not provide an adequate fit, stable vision, or acceptable comfort. The term does not refer to one specific lens type. Instead, it describes patients whose eyes or vision needs require a more specialized fitting process.

A fitting may involve detailed measurements of the cornea, evaluation of the tear film, and examination of the eyelids and surrounding eye structures. Depending on the patient’s needs, the eye doctor may recommend a rigid gas permeable lens, scleral lens, hybrid lens, or another specialty design.

The goal is to find a lens that provides appropriate vision while fitting the eye safely and comfortably.

Who May Be a Good Candidate for Specialty Contact Lenses?

Several groups of patients may benefit from a specialty lens evaluation. The right option depends on the condition of the eye, the patient’s prescription, lifestyle, and overall eye health.

People With Significant Astigmatism

Astigmatism occurs when the cornea or lens has an irregular shape, which can cause blurred or distorted vision. Some people with mild or moderate astigmatism can wear standard toric soft contact lenses successfully.

More significant or irregular astigmatism can be harder to correct with ordinary lenses. Specialty rigid or scleral designs may provide a more stable optical surface in appropriate patients.

People With Keratoconus

Keratoconus causes the cornea to become thinner and bulge outward into an irregular shape. This can make vision increasingly distorted and may make ordinary soft lenses difficult to fit.

Specialty lenses, including certain rigid gas permeable and scleral lenses, may be considered for patients with keratoconus. These lenses can help create a smoother optical surface over an irregular cornea.

A patient with keratoconus should receive regular eye care because contact lenses do not treat the underlying condition itself.

People With Irregular Corneas

Corneal irregularities can develop for several reasons, including previous eye surgery, injury, disease, or other changes to the cornea. When the surface is significantly uneven, a standard soft lens may not provide sufficiently clear or stable vision.

A specialty lens can sometimes compensate for irregularities by creating a more regular refractive surface in front of the cornea. The exact approach depends on the cause and severity of the irregularity.

People With Dry Eye Symptoms

Dry eyes can make contact lens wear uncomfortable. Patients may experience burning, irritation, fluctuating vision, redness, or a feeling that something is stuck in the eye.

Some patients with significant ocular surface problems may be evaluated for scleral lenses. These lenses hold a fluid reservoir between the lens and the cornea, which may provide a different wearing experience for appropriate patients.

However, dry eye has many possible causes. A doctor should determine the underlying problem before deciding whether a specialty lens is appropriate.

People Who Have Had Certain Eye Surgeries

Some patients experience changes in corneal shape following eye surgery. Procedures that alter the cornea can sometimes make standard contact lens fitting more difficult.

Patients who have undergone corneal surgery or other procedures should discuss their history with an eye care professional. A specialty lens may be considered if conventional lenses do not provide satisfactory vision or comfort.

Which Types of Specialty Contacts May Be Used?

There is no single specialty lens that works for every patient. Eye care professionals select the design based on the patient’s eye shape, prescription, tear film, and other factors.

Rigid Gas Permeable Lenses

Rigid gas permeable, or RGP, lenses are made from durable materials that allow oxygen to reach the cornea. They maintain their shape on the eye and can provide clear vision for certain types of irregular corneas and astigmatism.

Some patients need time to adjust to the sensation of wearing a rigid lens. Proper fitting and gradual adaptation can be important.

Scleral Lenses

Scleral lenses are larger rigid lenses that rest primarily on the white part of the eye rather than directly on the cornea. They vault over the corneal surface and are filled with sterile saline before being placed on the eye.

They are commonly considered for certain patients with irregular corneas and ocular surface conditions. Their larger size can also provide a stable lens position for some patients who have difficulty with smaller lenses.

Hybrid Lenses

Hybrid lenses combine features of rigid and soft lens designs. They typically have a rigid central area surrounded by a softer outer portion.

For some patients, this design can offer the visual benefits of a rigid lens while providing a different level of comfort. Whether a hybrid lens is suitable depends on the individual eye.

What Happens During a Specialty Contact Lens Fitting?

A specialty fitting is generally more involved than receiving a standard contact lens prescription. The eye care professional may perform a detailed eye examination and take measurements of the cornea.

Corneal mapping, sometimes performed with a technology called corneal topography or tomography, can provide information about the shape and curvature of the eye. This information helps the practitioner determine which lens design may be appropriate.

Patients may need to try more than one lens before the final design is selected. Follow-up visits can also be necessary to evaluate vision, comfort, lens position, and the health of the eye.

What Should Patients Consider Before Getting Specialty Contacts?

Specialty lenses can require more time and care than standard contact lenses. Patients should be prepared to follow cleaning, disinfecting, insertion, and removal instructions carefully.

Cost is another consideration. Depending on the lens type, examination, fitting process, replacement schedule, and insurance coverage, specialty lenses may have different out-of-pocket costs than conventional contacts.

Ask the eye care provider what the fitting fee includes and whether follow-up visits or replacement lenses are covered. If you have vision insurance, check your benefits before beginning the fitting process.

Follow the Cleaning Instructions Carefully

Contact lens safety is important for every wearer, but specialty lenses may require specific cleaning and storage procedures. Use only the products recommended by your eye care professional.

Do not use tap water to clean or store contact lenses. Never share lenses with another person, and replace lenses and storage cases according to professional instructions.

If you develop significant pain, redness, light sensitivity, discharge, or sudden changes in vision, remove the lens and contact an eye care professional promptly.

Practical Tips for a Successful Fitting

Bring your current glasses and contact lens information to your appointment if available. Tell the eye doctor about previous contact lens problems, eye surgeries, allergies, medications, and how long you normally wear lenses each day.

Be honest about comfort and vision during the fitting. A lens that looks good during a brief examination may still cause problems during normal daily activities.

It can also help to explain your lifestyle. Someone who spends long hours at a computer may have different needs from someone who participates in sports or works in a dusty environment.

Conclusion

Not everyone who struggles with conventional contact lenses needs to give up on wearing contacts. People with significant astigmatism, irregular corneas, keratoconus, dry eye symptoms, or certain post-surgical changes may be candidates for specialty lenses.

The most important step is a comprehensive examination with an eye care professional who has experience fitting complex cases. If standard lenses have not worked for you, ask whether a specialty contact lens evaluation could be appropriate for your eyes.

With the right assessment, fitting, and ongoing care, specialty contacts may provide another option for patients who have difficulty achieving clear and comfortable vision with conventional lenses.

Frequently Asked Questions

Are hard-to-fit contacts only for people with eye diseases?

No. Some people simply have prescriptions, corneal shapes, or fitting challenges that make standard lenses unsuitable. A specialty lens evaluation can determine whether one is appropriate.

Are specialty contact lenses comfortable?

Comfort varies from person to person and depends on the lens design and eye condition. Some patients need an adjustment period before becoming comfortable with their lenses.

Can people with astigmatism wear specialty contacts?

Yes. Many people with astigmatism successfully wear conventional toric lenses, while others may benefit from specialty designs when their astigmatism is more complex or irregular.

Are scleral lenses the same as regular contacts?

No. Scleral lenses are larger and are designed to vault over the cornea while resting on the scleral surface. They also hold a fluid reservoir between the lens and cornea.

How long does a specialty contact lens fitting take?

The process varies depending on the patient’s eye condition and lens design. Some people may need several appointments to achieve an appropriate fit.

Does insurance cover specialty contact lenses?

Coverage varies by insurance plan and medical circumstances. Contact your insurer and eye care provider to understand which examination, fitting, and lens costs may be covered.

Can I get specialty contacts without an eye examination?

A proper examination and professional fitting are important for specialty lenses. An eye care professional needs to evaluate the health and shape of your eyes before recommending a lens.