Overview

On occasion, soft contact lenses may not be the most appropriate option or may not be the solution to allow for the best vision correction or your eye health. Hard-to-fit contact lenses or specialty contact lenses come in many different materials, sizes, shapes, colors, and more for a variety of conditions. Some conditions treated with hard-to-fit contact lenses may be as follows:

  • Keratoconus
  • Pellucid Marginal Degeneration
  • Keratoglobus
  • Post-LASIK or other refractive surgery complications
  • Corneal Scarring (conditions such as: Stevens-Johnson Syndrome, cicatricial pemphigoid, keratitis, burn victims, and many others)
  • Severe Dry Eyes
  • High Corneal Astigmatism or Abnormal/Irregular Astigmatism
  • Giant Papillary Conjunctivitis

Your eye care provider will work with you to determine the best option(s) available to ensure the best eye health and visual outcome.

Eye Conditions

Keratoconus & Specialty Contact Lenses

Keratoconus is a eye disease where the cornea (front surface of the eye) thins and bulges forward into a cone shape. Soft contact lenses often cause discomfort and distortion because the lenses do not properly correct the patient’s vision. Rigid gas permeable lenses or other specialty contact lens options are instead recommended, as these lenses act as the cornea or the front surface of the eye due to the hard surface. It is also thought that some specialty lenses may slow the progression of the disease.

Pellucid Marginal Degeneration & Specialty Contact Lenses

Pellucid Marginal Degeneration (PMD) is a non-inflammatory, non-hereditary disease of the front surface of the where the cornea (front surface of the eye) becomes thinner in the peripheral aspect next to the limbus (white part of the eye). Rigid gas permeable or other specialty contact lenses are the best option due to often irregular astigmatism (multiple curvatures of the eye with fluctuating/changing power) making it challenging for the patient to see without distortion, double vision, ghosting, or haloes in the patient’s vision.

Keratoglobus & Specialty Contact Lenses

Keratoglobus is a non-inflammatory corneal (front surface of the eye) condition where the cornea becomes thinner and protrudes. Specialty contact lenses are often recommended to improve the visual outcomes for patients due to distortion, ghosting, and other visual symptoms.

Post-LASIK/Refractive Surgery & Specialty Contact Lenses

Refractive surgery often leads to improvement of the patient’s vision; however, there are rare cases where patients experience complications. Patients may experience glare at night or corneal ectasias (thinning of the front surface of the eye) causing visual distortions or even double vision. Specialty contact lenses are often recommended in these cases, as soft contact lenses may or may not improve those visual symptoms.

Corneal Scarring & Specialty Contact Lenses

Corneal scarring can occur from a host of insults that may include: burns, viral sources (shingles, simplex virus), bacterial infection, autoimmune response, or other sources. Specialty contact lenses often protect the front surface of the eye while also improving visual comfort and clarity.

Moderate/Severe Dry Eye & Specialty Contact Lenses

Moderate/Severe dry eye can cause symptoms such as: burning, redness, irritation, and a foreign body (gritty) feeling. Dry eye syndrome can also cause decreased vision or blurry vision at all distances. Many patients often report that contact lenses worsen their symptoms; therefore, it is important to determine the underlying cause of your dry eye. There are many options to improve your dry eye syndrome. After dry eye syndrome is addressed, specialty contact lenses may be a solution or part of the solution to address your concerns. Talk with your eye doctor to determine if this is right for you.

High Corneal Astigmatism & Specialty Contact Lenses

Corneal astigmatism is where the front surface of the eye has a significant curvature or steepness. Given this curvature difference, contact lenses often rotate causing vision distortion or blurry vision. Your eye care provider can offer multiple options to improve your vision that may not be readily available in traditional or common brands offered.

Giant Papillary Conjunctivitis & Specialty Contact Lenses

Giant papillary conjunctivitis (GPC) is a condition where the inner part of the eyelid surface (palpebral conjunctiva) becomes swollen with little bumps called papillae. This condition worsens or is caused due to the accumulation of protein or deposits on contact lenses (cloudy white deposits). To solve this, your eye doctor may recommend a new solution, daily contact lens options, or specialty contact lenses. In moderate/severe cases, your eye doctor may recommend not to wear contact lenses for a certain period while your eye doctor prescribes eye drops to improve your signs/symptoms.

What are some types of specialty contact lenses?

Rigid Gas Permeable Contacts

Rigid gas permeable contact lenses are made from a durable material that acts as the cornea (or front surface of the eye). These lenses offer superior optics, less flexure in the lens itself, and reduces protein buildup on the lens. The lenses are much smaller than most soft contact lenses with a longer lifespan of annual replacement.

Scleral Contact Lenses

Scleral contact lenses vault the entire front surface of the cornea without touching it at all. The edge of the contact lens sits on the conjunctiva/sclera (white part of the eye entirely). These lenses are often offered for patients with dry eye syndrome, advanced keratoconus or corneal ectasias (thinning of front surface of the eye). These contact lenses are filled with an approved preservative-free saline solution, which helps hydrate and lubricate the eye with contact lens wear. Discuss this with your eye doctor to determine if this option is right for you!

Hybrid Contact Lenses

Hybrid lenses offer a durable center allowing excellent clarity visually while offering a soft skirt (or peripheral design) allowing for maximal comfort for the wearer.

Prosthetic Soft Contact Lenses

Prosthetic soft contact lenses offer varying sizes, colors, pupil designs, and other features to cloak or cover up cosmetic variabilities for patients with eye diseases. For example, a patient with significant scarring may be self-conscious regarding a white spot on the front surface of the eye. A prosthetic soft contact lens may be used to match the non-affected eye to make the patient less self-conscious about the appearance of the affected eye.

New Rigid Gas Permeable Contact Lenses Wearers

Evaluation/Follow-ups from Start to Finish

  • Comprehensive Eye Examination + corneal topography mapping
    • Specialty contact lenses ordered (1-2 weeks)
    • All professional fees are non-refundable & paid in advance
    • Some contact lenses may be returned if non-adaptable to the product (inquire with the team)
  • 1st Follow-Up: Your eye doctor places the contact lens on the eye to ensure a proper fit and vision quality
    • Your eye doctor may change parameters of the lens and reorder
    • Your eye doctor may determine a near perfect fit with a contact lens class then scheduled
  • 2nd Follow-Up: Your optometry coordinator/assistant completes an insertion/removal class
    • Patient must insert/remove the contact lens a total of two times in office
    • Care instructions and maintenance discussed in office
  • Final Follow-Up: Your eye provider completes a last check of the front surface of the eye and to ensure good vision at distance and near

Questions about RGP’s

How to insert Rigid Gas Permeable Contact Lenses?

How to remove Rigid Gas Permeable Contact Lenses?

Recommended Wearing Schedule?

Days Wear Time
1 4
2 6
3 8
4 10
5 12
6 All day wear

Signs/Symptoms of a Contact Lens Related Infection?

  • Blurry vision
  • Unusual redness of the eye
  • Pain in the eye
  • Excessive tearing or discharge from the eye
  • Light sensitivity
  • Foreign body sensation (feels like something is in your eye like an eye lash)

Care Instructions for Rigid Gas Permeable Contact Lenses?

  • Multi-Purpose Solution (MPS) (Opti-Free®, BioTrue®, Acuvue Revitalens®, etc.):
    • STORING
    • Wash your hands with soap/water.
    • Place lenses in the palm of your hand and use 2-3 drops of MPS while rubbing the contact lens for about 10-15 seconds.
    • Ensure the contact lens case has new solution and place the contact lens in the solution.
  • Peroxide Based Solution (ClearCare® or CooperVision Refine One Step)
    • STORING
    • Wash your hands with soap/water
    • Place lenses in the palm of your hand and use 2-4 drops of peroxide-based solution (ClearCare®). Place lenses in the container/basket. Thoroughly rinse lenses for 5 seconds. Fill the lens case with ClearCare® solution. Tighten the cap (make sure the top hole is not covered) and store for at LEAST SIX (6) hours.
  • Boston Simplus Multi-Action Solution®
    • STORING
    • Wash your hands with soap/water.
    • Place lenses in empty lens case and fill with fresh Boston SIMPLUS Multi-Action Solution®. The lenses should soak for at least four (4) hours (or overnight) before wearing.
    • Always use fresh solution for soaking and storing lenses.
    • INSERTION
    • Wash hands.
    • Remove lenses and carefully apply four (4) drops of Boston SIMPLUS Multi-Action Solution® in the palm of your hand for twenty (20) seconds.
    • Rinse lenses for debris or surface deposits for five (5) seconds per Bausch & Lomb recommendation.
    • CASE MAINTENANCE
    • Use sterile disinfecting solution and not tap water to clean the case. Allow to air dry.
    • Cases should be thrown away every 90 days and a new bottle of solution should be replaced every 90 days (after opening bottle).

How long does my prescription last for?

Two years unless otherwise noted on your prescription.

How often should I replace my rigid gas permeable contact lenses?

The Food, Drug Administration recommends replacing annually but checking with your eye care provider for any other recommendations.

What are warranted versus non-warranted rigid gas permeable lenses?

Warranted lenses allow your eye doctor to make changes to your RGPs for an allotted period (usually 90-120 days). After that time, you will incur additional fees for any changes to the lens. Non-warranted lenses may be ordered after you have a finalized set of contact lenses for a reduced cost (approximately 30% less).

How long does your eye doctor have to make changes to my warranted contact lenses?

We have approximately 90-120 days (pending on the manufacturer) from the time of order to make any changes to the contact lenses at no cost. After this time, we can make changes only with additional fees. It is important to make all scheduled visits.

Are rigid gas permeable contact lenses more or less comfortable than soft contact lenses?

First, RGPs are often uncomfortable and cause tearing, a foreign body sensation, and redness during the first week of wear. After that time, those symptoms subside, and patients begin enjoying their clear, comfortable vision.

What happens if I decide that rigid gas permeable contact lenses are not for me?

You must return your rigid gas permeable contact lenses to the office. The office must return those to the manufacturer to receive credit.

Professional contact lens evaluation fees are non-refundable.

New Scleral Contact Lens Wearer

Evaluation/Follow-ups from Start to Finish

  • Comprehensive Eye Examination + corneal topography mapping
  • Diagnosis for Treatment

    • Specialty contact lenses ordered (1-2 weeks)
    • All professional fees are non-refundable & paid in advance
    • Prior authorization determined and submitted to relevant vision or medical insurance companies prior to proceeding with the evaluation/fit
    • Some contact lenses may be returned if non-adaptable to the product (inquire with the team)
  • 1st Initial Evaluation (1 hour)
    • Discuss scleral lenses, evaluate the front surface of the eye
    • Determine appropriate scleral lens design by placing lenses on the eye
    • Determine prescription parameters of the lenses
    • Empirically order scleral lenses from the laboratory (takes 1-2 weeks)
  • 2nd Lens Dispensing (1.5 hours)
    • Evaluate the first pair of scleral lenses
    • Educate patients about proper use, application, removal, and care of scleral lenses (pamphlet given)
    • Recommendations on solutions for cleaning, disinfection, storage, and filling lenses offered
  • 3rd ½ week Follow-Up (30-40 minutes)
    • Expectations of Patient
      • Must wear the scleral contact lenses for at least 2 hours before the visit
      • Record any symptoms or signs experienced (redness, discomfort, blurry vision)
    • During the Visit
      • Document best corrected vision
      • Evaluate the fit of the lenses
      • Review maintenance, care, storage, handling of lenses
      • Adjust parameters of the scleral lenses as needed
      • Reorder scleral lenses with new parameters (1-2 weeks)
  • 4th Visit: Modified Scleral Lens Dispensing (30 minutes)
    • Evaluate new scleral lens
    • Schedule follow-up for 1-2 weeks out to determine parameters
  • 5th Visit: Follow-up from Modifications (15-30 minutes)
    • Expectations of Patient
      • Must wear the scleral contact lenses for at least 2 hours before the visit
      • Record any symptoms or signs experienced (redness, discomfort, blurry vision)
    • During the Visit
      • Document best corrected vision
      • Evaluate the fit of the lenses
      • Adjust parameters or finalize scleral contact lenses
      • Schedule final follow-up in 1 month

Questions about Scleral Contact Lenses

How to insert Scleral Contact Lenses?

Doctor Eye Health Channel – Dr. Joseph Allen

Scleral Lens Society

How to remove Scleral Contact Lenses?

Doctor Eye Health Channel – Dr. Joseph Allen (start at 04:05)

Scleral Lens Society (start at 05:00)

What solution do I fill my scleral contact lenses prior to instillation?

Cleaning/ Disinfection, and Storage Solutions for Scleral Contact Lenses?

  • Multi-Purpose Solution (MPS) (Opti-Free®, BioTrue®, Acuvue Revitalens®, etc.):
    • STORING
    • Wash your hands with soap/water.
    • Place lenses in the palm of your hand and use 2-3 drops of MPS while rubbing the contact lens for about 10-15 seconds.
    • Ensure the contact lens case has new solution and place the contact lens in the solution.
  • Peroxide Based Solution (ClearCare® or CooperVision Refine One Step)
    • STORING
    • Wash your hands with soap/water
    • Place lenses in the palm of your hand and use 2-4 drops of peroxide-based solution (ClearCare®). Place lenses in the container/basket. Thoroughly rinse lenses for 5 seconds. Fill the lens case with ClearCare® solution. Tighten the cap (make sure the top hole is not covered) and store for at LEAST SIX (6) hours.

Recommended Scleral Contact Lens Wearing Schedule?

Days Wear Time
1 4
2 6
3 8
4 10
5 12
6 All day wear

Signs/Symptoms of a Contact Lens Related Infection?

  • Blurry vision
  • Unusual redness of the eye
  • Pain in the eye
  • Excessive tearing or discharge from the eye
  • Light sensitivity
  • Foreign body sensation (feels like something is in your eye like an eye lash)

How long does my prescription last for?

Two years unless otherwise noted on your prescription.

How often should I replace my rigid gas permeable contact lenses?

The Food, Drug Administration recommends replacing annually but checking with your eye care provider for any other recommendations.

What are warranted versus non-warranted scleral lenses?

Warranted lenses allow your eye doctor to make changes to your RGPs for an allotted period (usually 90-120 days). After that time, you will incur additional fees for any changes to the lens. Non-warranted lenses may be ordered after you have a finalized set of contact lenses for a reduced cost (approximately 30% less).

How long does your eye doctor have to make changes to my warranted contact lenses?

We have approximately 90-120 days (pending on the manufacturer) from the time of order to make any changes to the contact lenses at no cost. After this time, we can make changes only with additional fees. It is important to make all scheduled visits.

Are scleral contact lenses more or less comfortable rigid gas permeable lenses?

Scleral lenses are a very comfortable option given their unique design.

What happens if I decide that scleral contact lenses are not for me?

You must return your scleral contact lenses to the office. The office must return those to the manufacturer to receive credit. Another option will be presented to the wearer to proceed with the evaluation.

Professional contact lens evaluation fees are non-refundable.

Where can I order scleral contact lens plungers or a special insertion device?