Custom Soft Contact Lenses for High Powers and High Astigmatism
Understanding High Powers and High Astigmatism
A high power prescription generally refers to a strong degree of nearsightedness or farsightedness that falls outside the typical range of standard contact lenses. For nearsightedness, prescriptions beyond -8.00 to -10.00 diopters are often considered high, while farsightedness prescriptions above +6.00 diopters may require custom solutions.
These stronger prescriptions mean your eye needs significantly more correction to focus light properly on your retina. The type of prescription affects lens thickness differently: plus lenses for farsightedness are thicker in the center, while minus lenses for nearsightedness are thicker at the edges. Even with high oxygen materials, this added thickness can reduce oxygen transmission to your cornea. Additionally, high spectacle prescriptions often require different contact lens powers than your glasses prescription due to the distance between the lens and your eye, called vertex distance.
Astigmatism occurs when your cornea or lens has an irregular shape, causing blurred or distorted vision at all distances. High astigmatism typically refers to a cylinder power of 2.75 diopters or greater, though some sources consider anything above 2.00 to be in the higher range. What qualifies as high can vary by lens availability, and irregular astigmatism from corneal conditions behaves differently than regular astigmatism.
- Mild astigmatism ranges from 0.25 to 1.00 diopters
- Moderate astigmatism ranges from 1.25 to 2.50 diopters
- High astigmatism is generally 2.75 diopters or more
- Very high astigmatism may exceed 4.00 diopters
Standard soft contact lenses are mass produced in steps of 0.25 or 0.50 diopters for common prescriptions. They also come in a limited selection of astigmatism corrections, typically maxing out around 2.25 to 2.75 diopters of cylinder power.
When your prescription exceeds these parameters, standard lenses simply cannot be manufactured with the precise power you need. Even if a lens comes close to your prescription, the slight mismatch can leave you with blurry vision, eyestrain, and headaches throughout the day.
Without proper correction for your high prescription, everyday tasks can become frustrating and tiring. You may notice that your vision seems good in some situations but poor in others, or that your contacts never quite feel right no matter which brand you try.
- Blurry or hazy vision, especially in low light conditions
- Double vision or ghosting around lights at night
- Difficulty reading small print or seeing fine details
- Eye fatigue and headaches after wearing contacts for a few hours
- Constant awareness that your vision is not as clear as it should be
Who Needs Custom Soft Contact Lenses
Many patients try multiple brands of standard contact lenses before realizing that their prescription simply cannot be met with off the shelf options. If you have cycled through several different lenses and still experience poor vision, custom lenses may be the answer.
You might also notice that your contacts rotate or shift on your eye, especially if you have high astigmatism. This movement can cause vision to fluctuate throughout the day, making it hard to see clearly when you need it most.
Several eye conditions can result in prescriptions that require custom correction. Some people are born with eyes that grow too long or too short, leading to significant nearsightedness or farsightedness from an early age.
- High myopia or nearsightedness, often developing during childhood and progressing into early adulthood
- High hyperopia or farsightedness, which may cause eyestrain and difficulty with near tasks
- Irregular astigmatism from conditions like keratoconus or corneal scarring, though many irregular corneas are better served by gas permeable, hybrid, or scleral lens designs; custom soft lenses may be considered in select cases such as milder irregularity or when rigid lens options are not tolerated
- Residual refractive error after laser eye surgery or cataract surgery
Custom soft contact lenses are one option among several for correcting high powers and high astigmatism. Depending on your eye shape, prescription, and comfort needs, we may also discuss other lens types or vision correction methods.
- Gas permeable or rigid gas permeable lenses, which often provide sharper optics for irregular astigmatism
- Scleral lenses, which vault over the cornea and can be very effective for irregular corneas and high prescriptions
- Hybrid lenses, which combine a rigid center with a soft outer skirt for better optics and comfort
- Optimized eyeglasses with high index materials and anti reflective coatings
- Evaluation for refractive surgery options, if you are a candidate
Beyond blurry vision, certain symptoms suggest that your eyes require a more personalized approach to contact lens correction. These signs often point to a mismatch between what standard lenses can provide and what your eyes actually need.
- Vision that seems okay at your exam but disappointing in real world use
- Lenses that feel unstable or rotate out of position when you blink
- Persistent discomfort or a feeling that something is always slightly off
- Difficulty driving at night due to glare and halos around lights
- Relying on glasses over your contacts because they provide sharper vision
We may recommend custom soft contact lenses after exhausting standard lens options or when your initial measurements show that your prescription falls outside typical ranges. Our goal is always to provide you with the clearest, most comfortable vision possible.
If you have tried multiple standard lenses without success, or if your refraction reveals high powers or high astigmatism, we will discuss whether custom lenses are the right next step. This decision is based on your specific measurements, lifestyle needs, and vision goals.
How We Diagnose and Measure for Custom Lenses
Your journey to custom soft contact lenses begins with a thorough eye examination. We start by testing your vision with different lens powers to determine your exact prescription, a process called refraction.
During refraction, we use a phoropter, the instrument that lets you compare different lens choices, or trial lenses to find the precise combination of sphere, cylinder, and axis that gives you the sharpest possible vision. For high prescriptions, even small changes in power can make a significant difference, so we take extra time to fine tune these measurements.
To design a custom lens that fits your eye perfectly, we need detailed information about the shape and curvature of your cornea. We use corneal topography or tomography, three dimensional mapping technology, to create a detailed map of your corneal surface.
- Corneal topography measures thousands of points across your cornea to detect irregularities
- These measurements reveal the exact curvature, diameter, and shape your lens needs to match
- Advanced devices also measure your pupil size in different lighting conditions
- We assess any asymmetry or irregularity that might affect lens performance
Healthy eyes and a stable tear film are essential for successful contact lens wear, especially with custom lenses designed for daily wear. We examine the front surface of your eye to check for any conditions that might interfere with lens comfort or safety.
We also evaluate your tear production and quality, since dry eyes can affect how well lenses perform and feel. If we identify any concerns, we may treat those issues before proceeding with your custom lens fitting to ensure the best possible outcome.
Once we have gathered all your measurements, we work with the contact lens laboratory to create a lens design tailored specifically to your eyes. This involves selecting the right base curve, diameter, power, and design features to maximize both vision and comfort.
- We specify your exact sphere power, often in increments finer than standard lenses
- We provide your precise cylinder and axis for astigmatism correction
- We choose the optimal base curve and diameter based on your corneal shape
- We may request special stabilization features for high astigmatism
- We select the most appropriate material for your prescription and wearing needs
Custom Soft Contact Lens Options and Features
Unlike mass produced lenses that come in predetermined parameters, custom soft contact lenses are manufactured individually to match your unique prescription and eye shape. This means the laboratory creates each lens based on the specific measurements we provide for your eyes.
Standard lenses are made in large batches with limited options for power, astigmatism correction, and base curve. Custom lenses, on the other hand, can be produced in a wider range of parameters than standard lenses, within material and design limits. They can include design modifications that address challenges like lens rotation or edge thickness.
Custom soft lenses are often available in advanced silicone hydrogel or other specialty materials that allow oxygen to reach your cornea while maintaining the structural integrity needed for high powers. However, even with high oxygen permeability materials, increased lens thickness can reduce the effective oxygen transmission, measured as Dk over thickness. We monitor your eyes at follow up visits to watch for any signs of oxygen related problems such as corneal swelling or blood vessel growth.
- High oxygen permeability reduces the risk of corneal complications when lenses are properly fitted and monitored
- Modern materials resist protein and lipid deposits better than older lens types
- Moisture retention technology helps lenses stay comfortable throughout the day
- UV blocking properties may be built into some lens materials for added protection, though UV blocking contact lenses are not a substitute for sunglasses and do not protect the entire eye area
High astigmatism requires not only the correct power but also a lens that stays in the proper orientation on your eye. Custom lenses incorporate advanced stabilization designs that prevent rotation and keep the astigmatism correction aligned with your visual axis.
These stabilization features may include prism ballast, a design that adds weight to the bottom of the lens to help keep it from rotating, or thin zones at specific positions that interact with your eyelids. The design we choose depends on your individual eye anatomy and how your eyelids interact with the lens surface.
Most custom soft contact lenses are designed for daily wear, meaning you insert them in the morning and remove them before bed each night. Overnight wear should only occur if we specifically prescribe extended wear lenses and monitor you closely for safety. The replacement schedule depends on the specific lens material and design, but many custom lenses are replaced monthly or quarterly.
- Daily wear lenses are removed every night and cleaned before storage
- Monthly replacement lenses are replaced based on the schedule prescribed, often counted from the date of opening or dispensing, not by appearance or comfort alone
- Quarterly replacement lenses may be prescribed for up to three months according to your specific schedule; overwearing lenses beyond the recommended period increases complication risk
- We will provide clear instructions on your specific replacement schedule
- Following the recommended schedule helps maintain eye health and optimal vision
Getting Fitted and Adjusting to Your Custom Lenses
Your custom lens fitting appointment is when we place the lenses on your eyes for the first time and evaluate how they perform. We check the fit, comfort, and vision quality, making note of any adjustments that might be needed.
We will assess how the lenses move with each blink, whether they center properly on your cornea, and if the stabilization features are working as intended. You will read eye charts and perform vision tasks to confirm that the lenses provide the clarity you need at all distances.
Even though custom lenses are designed for your eyes, you may need a short adjustment period as you get used to wearing them. Your brain needs time to adapt to the new visual input, and your eyes need to become accustomed to the sensation of the lenses.
- The first few days may involve mild awareness of the lenses on your eyes
- Your vision may fluctuate slightly as your tear film stabilizes around the lens
- Gradually increase your wearing time if we recommend a break in period
- Most patients adapt fully within one to two weeks
We will schedule follow up appointments to monitor how your eyes are responding to the custom lenses and to make sure your vision remains stable and clear. An initial follow up visit is often scheduled within one to two weeks, with periodic checks as directed to ensure continued safety and performance. These visits allow us to catch any issues early and make refinements if needed.
If your vision is not as sharp as expected or if the lenses are uncomfortable, we may adjust the prescription or design parameters and order a new set. Fine tuning is a normal part of the custom lens process, and our goal is to achieve the best possible result for you.
While custom soft contact lenses are safe for most patients, certain symptoms should prompt you to remove your lenses right away and contact our office. These warning signs may indicate an infection, allergic reaction, or other serious issue that needs prompt evaluation. If you experience severe eye pain, sudden vision loss, or marked light sensitivity, seek same day urgent evaluation from our office or visit an urgent care or emergency department if we are not available.
- Sudden eye pain or a feeling that something is stuck in your eye
- Significant redness, especially if accompanied by pain or blurred vision
- Increased light sensitivity or seeing halos and rainbows around lights
- Discharge or excessive tearing that is unusual for you
- Sudden decrease in vision that does not clear with blinking
- Do not resume lens wear until you have been evaluated and cleared by our office
- Keep the lens and case for evaluation if you suspect contamination or infection
- Do not self treat with leftover eye drops or medications unless we have instructed you to do so
Caring for Your Custom Soft Contact Lenses
Proper care of your custom lenses is essential to maintain eye health and extend the life of your lenses. Each time you remove your lenses, you should clean and disinfect them using the solution we recommend. The exact steps depend on whether you are using a multipurpose solution or a hydrogen peroxide based disinfection system, and on your specific lens material, so always follow the regimen we prescribe for you.
For multipurpose solution, place the lens in your palm, apply a few drops of solution, and gently rub the lens with your fingertip for about 20 seconds. Rinse the lens thoroughly with fresh solution before placing it in a clean case filled with new solution for overnight disinfection. Never use saliva, tap water, or any other liquid to wet or rinse your lenses.
Your lens case can harbor bacteria and other microorganisms if not properly maintained. Never reuse old solution or top off the solution in your case, as this can lead to contamination and increase your risk of eye infections.
- Empty your lens case every morning and rinse it with fresh solution
- Allow the case to air dry upside down on a clean tissue
- Replace your lens case every one to three months
- Never use tap water to rinse your lenses or case
- Do not wear lenses while swimming, showering, or using hot tubs; if water exposure occurs, remove your lenses, clean and disinfect them thoroughly, and monitor for any symptoms of irritation or infection
- Use fresh disinfecting solution each time and never mix different solution systems
Custom lenses designed for high powers may be slightly thicker than standard lenses, especially at the center or edges depending on your prescription. This added thickness requires a gentle touch when inserting and removing the lenses.
Make sure your hands are clean and dry before handling your lenses. Use the pads of your fingers rather than your nails, and avoid pinching the lens too hard, which can cause creases or tears in the material.
Following the replacement schedule we provide is crucial for maintaining clear vision and healthy eyes. Over time, protein deposits and other debris accumulate on the lens surface even with diligent cleaning, reducing both comfort and optical quality.
- Mark your calendar with the date you start wearing a new pair of lenses
- Discard and replace lenses according to the schedule we give you
- Replace your lens case every time you open a fresh bottle of solution
- Never extend the life of your lenses beyond the recommended timeframe
Even with excellent care, lenses can develop problems that affect your vision or comfort. If you notice any changes in how your lenses look or feel, schedule an appointment so we can examine them and determine if replacement or adjustment is needed.
- The lens appears cloudy, torn, or has visible deposits that do not clean off
- You experience increasing discomfort or dryness when wearing the lenses
- Your vision has become less clear than it was initially
- The lens seems to move excessively or no longer stays centered
- Your eyes feel irritated or look red after wearing your lenses
Frequently Asked Questions
Custom lenses typically cost more than mass produced options because they are individually manufactured to your exact specifications. The investment reflects the advanced technology, precise measurements, and specialized manufacturing required, but many patients find the improved vision and comfort well worth the additional expense.
The production time for custom soft contact lenses is generally longer than for standard lenses, often ranging from one to three weeks depending on the laboratory and complexity of your prescription. We will give you an estimated timeline at your fitting appointment so you know when to expect your lenses to arrive.
Many patients with dry eyes successfully wear custom soft contact lenses, especially those made from high oxygen silicone hydrogel materials. We may recommend artificial tears or other dry eye treatments to use alongside your lenses, and we will monitor your eye surface health closely during follow up visits.
Many patients achieve excellent vision with custom soft contact lenses. However, some individuals may still see more sharply in eyeglasses or in gas permeable or scleral lenses, depending on the regularity of their astigmatism, tear film stability, and how well the lenses stay positioned on the eye. Because the lens sits directly on your eye, it moves with you and eliminates issues like peripheral distortion or reflections that can occur with eyeglass lenses, especially in high prescriptions.
Unless we specifically prescribe extended wear lenses and give you approval, you should remove your custom soft contact lenses every night before sleeping. Sleeping in lenses not approved for overnight wear significantly increases your risk of serious eye infections and corneal complications.
If your prescription changes, we will need to order new custom lenses with updated parameters to maintain clear vision. We recommend annual comprehensive eye exams to monitor for prescription changes and ensure your lenses continue to meet your needs.
Getting Help for Custom Soft Contact Lenses for High Powers and High Astigmatism
If you have struggled to find contact lenses that give you clear, comfortable vision due to a high prescription or significant astigmatism, custom soft contact lenses may be the solution you have been seeking. Our eye doctor can perform the detailed measurements and evaluations needed to determine if custom lenses are right for you, and we will guide you through every step of the fitting and care process to help you achieve your best possible vision.