Contact lenses quite literally come in all shapes and sizes. People may 'know their brand' but do not even know if that contact is the best fit for them. Other people have been told that they cannot wear contact lenses – they have too much farsightedness, too much near sightedness, too much astigmatism, or are too old (that's just rude). Consider this; people who have advanced corneal disease, have received corneal transplants or have chronic dry eye wear contact lenses successfully. How? Because they are not wearing a traditional spherical contact lens that simply corrects nearsightedness or farsightedness. They are wearing specialty contact lenses – which are not prescribed by every eye doctor.
There are a variety of specialty contact lenses available to patients. There are rigid gas permeable (RGP) or 'hard' lenses, extended range soft contact lenses, scleral lenses, hybrid lenses (no they do not plug in to charge) and multifocal lenses. The exact lens that fits your visual needs depends on several factors – which the doctor will analyze during the fitting. Lets discuss some of the more popular specialty contact lenses
Extended Range Toric Contact Lenses
A 'toric' contact lens is one that corrects for astigmatism. For some, fitting any toric lens may be considered to be a specialty contact lenses. This is especially true with higher amounts of astigmatism. Many 'off the shelf' contact lenses do not offer high amounts of astigmatism correction. This means that with contacts on you will experience blurred vision or fluctuating vision. An extended range toric contact lens will correct higher amounts of astigmatism in a 'soft' contact lens. This option works well for many patients who want to continue wearing a soft contact lens but need greater clarity because of their prescription. Instead of settling for blurred vision, find a doctor who fits specialty contact lenses who can fully correct your prescription.
Rigid Gas Permeable (RGP) Lenses
RGP contact lenses are a great lens with a big public relations problem. When you are labeled as a 'hard' lens and compared to a 'soft' lens you really don't stand a chance. While an RGP lens is less flexible than a conventional soft contact lens, they do not have to be less comfortable. The big difference comes during the fitting. A poorly fitting RGP lens does not feel comfortable while a poorly fit soft contact lens is just mildly annoying. A well fit RGP lens is quite comfortable and has several advantages over a soft contact lens. Ultimately, an RGP will provide clearer vision than a soft contact lens. This is not the exception, this is the rule. If you ever try to take an RGP contact lens wearer and put them in a soft contact lens they will not like the clarity of their vision.
A well fit RGP lens is a great option for people with high prescriptions and high amounts of astigmatism. They are also the lens of choice for patients with certain corneal conditions, such as keratoconus. An RGP may be necessary to provide clear vision in cases of mild to moderate keratoconus as 20/20 vision is not possible with glasses or soft contact lenses. This is possible because RGP lenses are highly customizable, whereas traditional soft contact lenses are a 'one size fits all'.
So do not fear the RGP, fear the technician who is fitting your contact lens who didn't go to school to learn how to fit complicated corneas. Find an optometrist who fits specialty contact lenses and you will be happy with your RGP contact lenses.
Scleral Contact Lenses
Did you know that there is a contact lens that provides better clarity than a soft contact lens, even better comfort than an RGP, can be worn by people with corneal disease and can actually help manage dry eye? Scleral contact lenses are a type of specialty contact lens that can be considered a 'best kept secret'. Why have you not heard of a scleral contact lens? Because very few eye doctors fit them. They are highly customizable and take a high level of skill to fit. A scleral lens is able to have so many benefits because it does not even sit on the cornea like other contact lenses. It vaults the entire cornea and rests on the sclera (white part of your eye) – hence scleral lens. This essentially allows you to bypass an irregular cornea and re-establish a new refractive surface for the eye. This gives better clarity while bathing the cornea in fluid – comfortable and potentially therapeutic fluid. Scleral lenses are the lens of choice for patients with moderate to severe keratoconus or other forms of corneal ectasia. As a fun fact, they are also the lens of choice for costume designers. Ever wonder how they make mythical creatures of aliens with eyes that do not resemble the human eye?
Multifocal Contact Lenses
Multifocal contact lenses are the closest thing to the fountain of youth that you will find in contact lenses. If you have started to notice changes in your near vision and recently received too many 'over the hill' cards from your friends, a multifocal contact lens will interest you. A multifocal contact lens has both distance and near portions in the same lens. This means that you will be able to see clearly in the distance as well as at near with your contact lenses on.
Now if the thought 'I have heard of something like this before' pops into your head you are not wrong. Progressive lenses and bifocals exist in glasses – which is similar but different. Some people wear 'monovision' contacts where one eye sees distance and one eye sees near – which is different. So how is a multifocal contact lens different?
The right progressive lens is great in glasses. Check out our blog Progressive Lenses: Insider Tips to learn more. The similarity between progressive glasses lenses and multifocal contact lenses is that they both let you see things at all distances. The difference is everything else. In glasses, you must look down to read or see up close. In a multifocal contact lens you can look in any direction and see either distance or near (it all comes down to how the lenses are designed). This is why many people who work in tight spaces like multifocal contact lenses. If you are reading a part number off of something above your head it will be clear in your multifocal contact lenses. So no matter where you look, you will see clearly with multifocal contact lenses.
Monovision contact lenses correct one eye for the distance and one eye for near. Multifocal contact lenses correct both eyes for distance AND near. This creates a number of disadvantages of monovision contacts. You give up binocular vision (using both eyes together). This is a big deal because we are designed to use both eyes together. Choosing monovision sacrifices depth perception and balance and impairs clarity. The visual system uses a process of summation to gain greater clarity by using both eyes than using one at a time. Simply put, monovision contacts cannot be as clear as both eyes working together. You have two eyes, meaning you have to choose two distances with monovision contacts. What are you going to choose? Distance, computer, laptop, reading, your phone. Pick two, you may have to give up the rest. It is the same problem you run into with bifocals, you can only make certain things clear while others have to be blurry (it is a math equation that you cannot avoid).
Enter multifocal contact lenses. Both eyes see clearly in the distance, improving overall clarity and preserving depth perception. The design of multifocal contact lenses also allows you to achieve clarity at more distances (think progressives as opposed to lined bifocals). So if you are a multitasker, if you are active, if you enjoy seeing clearly, if you enjoy having depth perception then you need to find a doctor who fits multifocal contact lenses.
Knowing which contact lens is best for you is not something you have to decide before scheduling your eye exam or contact lens fitting. A doctor who fits specialty contact lenses will perform the testing necessary to discuss your options with you. This brings up a very important point. If you wear contact lenses you should go to a practice where an optometrist performs the contact lens fitting. Optometrists receive training specifically in fitting contact lenses (and some go on to learn how to fit specialty contact lenses). If a technician or support staff is tasked with fitting your contact lens you should ask about their schooling and certification in fitting contact lenses. Simply put, do you want someone with minimal or no training putting a medical device on your eye that can affect not only how well you see, but also the health of your eye? Next time you schedule your eye exam, ask if they have a doctor who fits specialty contact lenses, you may find out that there are more options than you realized.