Contact lenses are an important aspect of many eyecare practices. Having competence with a wide variety of contact lens options is an important strategy in maximizing growth opportunities. Due to many factors, including a growing population of patients who have ocular surface disease, a rapidly increasing myopic patient population, irregular corneas, and corneal disease, the growth of specialty lens designs has exploded. If you have not been bitten by the specialty lens bug, consider the advantages of these treatments.

A Few Case Examples

Case 1 A 56-year-old female patient presented frustrated with her contact lens wear. Her vision was fluctuating throughout the day and was not very sharp at distance or near out of her current hybrid multifocal lenses. She has worn soft toric multifocal lenses and bitoric GPs in the past, but she prefers the comfort and vision with the hybrid design. Her spectacle prescription is +2.00 –3.25 x 175 OD and +0.25 –2.00 x 014 OS, with a +2.25D near add. Her corneal curvatures are 44.50/48.25 @ 085 OD and 45.25/47.25 @ 099 OS. This indicates that her cylinder is corneal cylinder, which means that a hybrid lens will most likely work.

After talking with the consultation department, we determined that flexure was most likely the cause of her intermittent blurriness and loss of sharpness. We decided to steepen the base curve and order the lens with an enhanced profile design, which increases the lens thickness slightly to reduce flexure when there are higher amounts of corneal cylinder. This change resolved her visual concerns. She returned with not only improved comfort, but with sharper vision at both distance and near and no fluctuations throughout the day.

Case 2 A 9-year-old female’s spectacle prescription jumped from –1.50DS OD and OS to –2.25DS OD and OS in the past nine months. I had already discussed orthokeratology (ortho-k) for myopia control with the patient and her parents. They agreed to the treatment to try to slow down the progression of her myopia. Both parents were myopic and understood the risks of high myopia.

After a few weeks of lens wear, topography revealed an inferior smile map (Figure 1). This lens was correcting her myopia fairly well, but the patient was experiencing some halo effects, especially later in the day, due to the slightly decentered lenses. This can be corrected by steepening the reverse curve and/or the alignment curve. Many of the custom lens labs’ consultation departments can assist with troubleshooting fitting or vision concerns with their ortho-k designs. Post-fit corneal mapping is critical to success with this type of patient.

Figure 1. Inferior smile patterns resulting from decentered ortho-k lenses can be corrected by steepening the reverse curve and/or the alignment curve.

Been Bitten Yet?

Practitioners should aim to market contact lenses to all of their patients, but the most rewarding can be the specialty cases. These take more time, creativity, and energy to solve and treat the patients’ condition, but they can provide the highest level of practitioner satisfaction.

You may need to take a deep dive into your specialty contact lens tool kit, but don’t be afraid to take the plunge. You may catch the specialty contact lens bug too. CLS