Medically Necessary Contact Lens

For certain patients, glasses alone cannot provide adequate vision correction. While many contact lens users may feel their lenses are essential for vision or health, “medically necessary contact lenses” are specifically prescribed to achieve better visual outcomes than glasses or standard soft contact lenses. To illustrate, some individuals struggle to see any letters on an eye chart, even with the help of glasses or soft lenses. These patients often have two choices: undergo invasive procedures like corneal transplantation or opt for advanced, customized contact lenses to achieve optimal vision.

Medically necessary contact lenses are designed to deliver vision that surpasses what glasses or soft contact lenses can provide.

Who qualifies for medically necessary contact lenses?

High Prescriptions:

When glasses have a very high prescription, the quality of vision they provide can start to decline. If your glasses prescription is significantly high, you might benefit from specialized contact lenses. This condition is referred to as high ametropia.

Irregular Corneas:

The cornea, the eye's clear front surface, or "window," plays a critical role in focusing vision. For clear sight, this structure must remain smooth and regular. When the cornea becomes irregular, as seen in conditions like Keratoconus or Pellucid Marginal Degeneration, it distorts vision due to corneal warping.

Procedures such as corneal transplants can also leave the corneal surface irregular, and corneal scarring may further contribute to visual distortion. Patients with these conditions often have "hard-to-fit" eyes and may struggle with soft contact lenses, making medically necessary contact lenses a transformative solution for them.

Such patients frequently face restrictions, including ineligibility for unrestricted driving licenses due to their impaired vision. Medically necessary contact lenses can significantly reduce glare, correct visual distortions, and improve vision clarity. Studies, such as Severinsky (2010), demonstrate an improvement in visual acuity from an average of 20/70 to 20/32. This enhanced vision often allows these patients to qualify for standard driving privileges.

Ocular Surface Diseases:

Uses for medically necessary contact lenses include the treatment of severe dry eye disease and eye discomfort. Scleral contact lenses (see below for details) can provide a new “environment” for the very dry, uncomfortable eyes. People that would most benefit from scleral contact lenses are people with rheumatological diseases (such as Rheumatoid Arthritis or Sjogren’s syndrome) or ocular graft versus host disease. Someone with dry eye disease typically lacks a proper tear film (the eye’s source of lubrication), which leads to friction across the highly sensitive cornea every time they blink. Scleral contact lenses combat this by providing a constant source of fluid to the eye while protecting the eye from the blinking eyelids. PScleral lens wearers report that their life has significantly improved with the use of these lenses. Their feedback has been characterized by a marked relief of eye discomfort and overall improvement in daily life (Segal et al., 2003) (Romero-Rangel et al., 2000).

Types of Medically Necessary Contact Lenses

1. Soft Contact Lenses

Soft contact lenses are less commonly used for medically necessary cases as they generally do not provide optimal visual benefits. These lenses fit the eye like a thin, flexible layer, which can sometimes result in less precise vision. While off-the-shelf soft lenses are available, custom-designed options can be ordered to cater to specific prescriptions when needed.

2. Hybrid Contact Lenses

Hybrid contact lenses combine the best features of soft and rigid lenses. They consist of a rigid center, which offers the crisp vision associated with hard lenses, and a soft surrounding skirt, which enhances comfort during wear.

3. Gas Permeable Contact Lenses

Gas-permeable lenses are rigid and allow oxygen to pass through, making them effective for improving vision on a distorted cornea. These lenses are smaller in size compared to soft lenses and provide sharper optics. However, they can be less comfortable initially and may require a longer adjustment period compared to soft lenses.

4. Scleral Contact Lenses

Scleral lenses are a specialized type of gas-permeable lens designed for maximum comfort and exceptional visual clarity. Unlike traditional lenses that rest on the cornea, scleral lenses vault over the cornea and sit on the sclera (the white part of the eye). This unique design prevents contact with the cornea and creates a fluid-filled reservoir that provides both hydration and protection. Scleral lenses are particularly effective for managing severe refractive errors and ocular surface conditions, offering a prosthetic-level benefit for those with complex eye conditions.