I am commonly asked this question by my patients: “Am I able to wear contact lenses?” My typical response is: “It depends.”
I say this because not all patients are candidates for contact lens wear. To determine if a patient is a candidate for contact lens wear an ocular health assessment (eye exam) is required and must be performed by an ophthalmologist (MD) or optometrist (OD).
The clinician carefully examines the eye looking for ocular surface diseases such as chronic allergic conjunctivitis and dry eye disease, which when undiagnosed in new contact lens wearers can lead to decreased vision, ocular discomfort, inflammation and infection. Once the clinician has assessed the patient’s ocular health and has deemed the eyes healthy enough for contact lens wear the patient may be fit with contact lenses.
A contact lens fitting begins with the clinician discussing the patient’s visual expectations from contact lens wear. Patients are typically fit with either a soft contact lens or rigid gas permeable (hard) lens. Patients fit with soft contact lens may elect to wear daily disposable contact lenses, two-week or monthly lenses, or extended wear lenses. Most brands of soft contact lenses are designed for daily wear during waking hours and should be removed and cleaned each night before bed.
If a patient has a prescription that precludes them from wearing a soft contact lens, the patient is fit with a rigid gas permeable lens. Rigid gas permeable lenses are prescribed for those patients suffering from a high degree refractive error or irregular astigmatism that cannot be corrected with soft contact lenses. Both soft and rigid contact lenses have pros and cons. Soft lenses are easier to insert and remove and require less adaptation time, but the optics of a soft lens may not be sufficient to suit the patient’s visual needs. Rigid gas permeable contact lenses have superior optics, but require a greater period of adaptation, which may not be acceptable to the patient.
After the clinician and patient have discussed contact lens options the patient is fit with a contact lens. During the fitting the patients is instructed on how to insert and remove the contact lens, as well as proper lens wear and care. Once the patient has successfully inserted the contact lens the clinician examines the position of the contact lens on cornea. The clinician will examine the relationship between the contact lens and the ocular surface to make sure that the contact lens is centered on the cornea, is not too tight or too loose, and provides adequate coverage over the cornea. The clinician will then refine the power of the contact lens during the initial fitting to maximize visual acuity. After the clinician has made his initial assessment of the fitted contact lens the patient undergoes a trial period and must return for a follow up appointment within one to two weeks of the initial fitting. At the follow up appointment the clinician rechecks visual acuity and assesses the ocular surface to look for any contact lens-related damage to the eye. If the eye is healthy, visual acuity is at potential, and the patient is happy with the fit, the clinician will finalize the contact lens prescription, but only for that particular brand of contact lens. There are no generic contact lens prescriptions and the patient cannot change brands without a new fitting. The contact lens prescription expires in one year and must be renewed to purchase contacts after the expiration date.
A contact lens-related myth is that a person must be in the prime of their life to wear contact lenses. This is not true! Patients wearing bifocal spectacles may benefit from a multifocal soft contact lens or monovision fitting (one eye for distance vision and the other for near vision) if they wish to go completely forgo wearing glasses. Children who are responsible and can comply with proper lens wear and care may benefit tremendously from contact lens wear.