So Your Doctor Says You Can’t Wear Contact Lenses…
Written by Adeline Bauer, OD, FAAO, FSLS
Earlier this month, when seeing patients, I had three back to back with almost the exact same story…
They were new patients and had come in for their annual eye exams. Mid 50s, active, healthy, and previous contact lens wearers that had dropped out of lenses a few years prior.
Anytime a patient drops out of lens wear, I always ask them the reason behind their decision. These patients all gave almost the exact same answer, “My doctor told me I can’t wear lenses anymore.”
Unfortunately, I hear this all too commonly. I’ve heard it from patients who have regular astigmatism, need a multifocal, or those who struggle with dry eye disease.
Sometimes their vision isn’t being optimally corrected by their current lenses, or sometimes the lenses just aren’t comfortable for all day wear anymore. Whatever the reason, these patients are not usually presented with alternative options past the traditional “off the shelf” soft lenses stocked in most eye care offices.
While patients with less common prescriptions may have fewer options and require more time than simple myopic patients, there are still plenty of options available to meet their visual needs.
Open minded and motivated patients are often successful in lenses made from gas permeable (GP) materials, such as traditional corneal lenses, or scleral lenses.
Typically, when patients think of contact lenses, they picture a soft, silicon hydrogel lens in either a monthly or daily modality. Yet these aren’t the only modalities on the market. Open minded and motivated patients are often successful in lenses made from gas permeable (GP) materials, such as traditional corneal lenses, or scleral lenses. These annual replacement lenses have many benefits for patients with regular astigmatism. Having a lens made from gas permeable materials means that the tear lens corrects the corneal astigmatism, so patients no longer struggle with lens rotation causing blurry vision.
Patients who go into these lenses often feel that their vision is now “high def” because the optical properties mean their astigmatism is corrected perfectly, with the exact axis and power, and not just “close enough” like soft lenses.
For presbyopic contact lens patients, multifocal contact lenses, whether soft or gas permeable should always be discussed when presenting options for correction.
Technology with these lenses had advanced significantly over the years with new, more wettable materials for patients who struggle with dryness. While most soft lens designs offer near-center aspheric multifocal optics, distance-center designs are available in both sphere and toric powers, though they are less common.
In scleral and corneal gas permeable lenses, we have greater customization over optical designs and can even change the zone size of the central optics to get patients with small pupils into their add faster. For patients needing the clearest vision possible, don’t forget about the existence of translating gas permeable multifocals. They function just like progressive spectacle lenses, with the patient only looking through one power at a time, unlike traditional aspheric multifocals where patients look through multiple powers at the same time, causing increased blur. Presbyopic patients with astigmatism will benefit from lenses made from gas permeable materials just like single vision patients do. When it comes to multifocals, even a half diopter of uncorrected astigmatism may be the difference between meeting a visual goal and being unable to read small print.
One of the largest reasons for contact lens dropout is dryness and reduced wear time.
Patients that have been successful in lenses for years find themselves without their preferred correction due to discomfort, intermittently blurry vision, and lack of an appropriate referral. Scleral lenses have been used for years as treatment for advanced ocular surface disease, and have proven effective in reducing signs of corneal dryness. Patients with mild dry eye disease may find that switching from soft lenses to scleral lenses improves their comfort, decreases the signs of ocular dryness, and gets them back to full time lens wear. While these lenses are more involved than fitting traditional soft lenses, they may be the only option for continuing lens wear. Even if the patient’s eye care provider doesn’t fit the lenses themselves, they should be making a referral to a doctor in their area that can evaluate the patients’ ocular surface and determine if the lenses may be right for them.
In the end, all three of the patients that came into the office seeking a second opinion after being told they “couldn’t wear contact lenses,” were successfully fit in lenses.
None of them had any corneal pathology. They all had small to moderate amounts of astigmatism, needed presbyopic correction and one had mild dry eye symptoms. One ended up in a multifocal lens, one in single vision scleral lenses and one in multifocal scleral lenses.
All were happy with their vision and thankful that they were able to continue with contact lens wear. While many of the lenses discussed here are considered more advanced fitting difficulty, that doesn’t mean they should be discounted as poor options for patients. Presenting all the treatment options available to patients means they are able to choose the type of correction that is best suited to their lifestyle and visual needs and gives them the option of staying in contact lenses.
August 26th, 2024
Written by:
Adeline Bauer, OD, FAAO, FSLS
Valley Contax Professional Relations Director