At our practice, we understand that medically necessary contact lenses are not chosen for convenience or aesthetics but based on a clear clinical need. They are indicated when glasses cannot provide the desired visual clarity due to an underlying medical issue or when the patient’s prescription is so severe that conventional lenses fail to correct the vision properly. These lenses play a key role in treating conditions where the structure or function of the eye is affected.

There are two primary classifications for necessary contact lenses: visual necessity and medical necessity. It is important to separate the two:

• Visual Necessity: This category applies when glasses cannot offer a satisfactory outcome due to high refractive errors, such as high myopia or a significant prescription difference between the eyes (anisometropia). The problem arises from the extreme nature of the prescription, causing issues like distorted images or double vision.
  
• Medical Necessity: This occurs when an underlying disease or condition makes standard eyeglasses inadequate. Conditions such as keratoconus, corneal scarring, post-corneal transplant irregularities, or chronic dry eye conditions fall under this classification. Here, the lenses help manage symptoms as well as protect the eye’s health.

Soft contact lenses can be custom-designed for specific conditions, such as mild asymmetry or minor corneal irregularities. They are available as disposable or extended wear options. In some cases, custom soft lenses are used when the refractive error is significant but does not require a more rigid support system.

RGP lenses are durable and maintain their shape on the eye, offering clear vision even in cases of severe refractive errors or irregular corneal surfaces. Patients with keratoconus or high astigmatism often benefit from these lenses because they create a new refractive surface. Even though they may feel less forgiving initially compared to soft lenses, the visual improvement is unparalleled for certain conditions.

Hybrid lenses combine the clarity of RGP lenses with the comfort of soft lenses. These lenses offer a rigid center for optimal vision along with a soft peripheral skirt that reduces discomfort on sensitive eyes. They are especially useful for patients who need the precise optical correction of a rigid lens but desire the extended comfort of a soft lens.

Scleral lenses are larger in diameter and rest on the sclera (the white part of the eye) rather than the cornea. This design is particularly beneficial for patients with severe corneal irregularities, such as those seen in advanced keratoconus or corneal scarring. With a fluid reservoir between the lens and the cornea, scleral lenses also provide long-lasting moisture, which is a game-changer for those suffering from severe dry eye syndromes.

Prosthetic lenses are used both for therapeutic and cosmetic purposes when the eye’s appearance or function is significantly compromised by injury or disease. These lenses are custom crafted to improve vision and also to address issues like light sensitivity by blocking aberrant light from entering the eye. They are essential for patients with congenital abnormalities or post-traumatic situations that require both functional and cosmetic reconstruction.

Keratoconus is characterized by a thinning and bulging of the cornea, which causes irregular astigmatism and significant vision distortion. When glasses cannot provide a smooth refractive surface due to the cone-shaped cornea, lenses such as RGP or scleral variants are usually the preferred solution. Similarly, corneal ectasia, which can sometimes occur after procedures like LASIK, also benefits from specialist lens fittings that create a new, functional optical surface.

Scarring from trauma, infections, or previous surgeries leads to irregularities on the surface of the cornea. These scars distort vision by causing light to scatter unpredictably. Medically necessary contact lenses can mask these irregularities by creating a smooth optical surface, thereby reducing glare and improving visual clarity.

After a corneal transplant, the new cornea might not have a perfectly regular shape, causing astigmatism or other distortions. Instead of traditional glasses, specialized lenses can help fine-tune vision and offer a better cosmetic and functional outcome. The lens fitting in these cases is especially critical, ensuring that the transplanted tissue is well-supported and protected.

Patients with Sjögren’s syndrome often experience severe dry eye symptoms that glasses and conventional contacts cannot alleviate. Scleral lenses, which create a protective fluid reservoir over the cornea, provide much-needed moisture throughout the day. This not only improves comfort but is essential for maintaining good vision and corneal health.

Aphakia is the absence of the eye’s natural lens, often following cataract surgery or due to a traumatic event. In these situations, contact lenses are crucial for refractive correction as glasses cannot fully substitute the missing lens for optimal vision.

When the cornea loses much of its sensation, as seen in neurotrophic keratitis, the risk of developing non-healing ulcers increases. Medically necessary contact lenses provide a protective barrier, retaining moisture and shielding the cornea from external irritants. This contributes significantly to both healing and visual improvement.

Some patients are born with conditions such as iris coloboma or experience significant differences in refractive power between their eyes (anisometropia). When conventional glasses lead to issues like aniseikonia or significant imbalance in vision, medically necessary lenses offer more precise correction and can reduce symptoms such as double vision or visual discomfort.