At our specialty practice, we provide medically necessary contact lenses tailored to patients with complex eye conditions like keratoconus and severe dry eye. Dr. Smith specializes in custom fittings to restore clarity and comfort to your vision.
Medically necessary contact lenses are an essential component of treatment when standard glasses are not enough to correct significant visual challenges. They are prescribed by our cornea specialist for conditions where the cornea’s irregularities or severe refractive errors demand a more customized approach. In many cases, these lenses not only correct vision but also protect the eye from further complications.
Medically necessary contact lenses differ from everyday lenses by being prescribed for patients whose eye conditions require more than a simple prescription change. These lenses are considered a standard of care for various eye conditions where glasses fall short. Whether the concern is a high refractive error or an underlying medical condition in the eye, these contact lenses provide both visual rehabilitation and protection.
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:
The specific type of lens prescribed depends on the individual patient’s condition and the unique characteristics of their eyes. The goal is to provide the most effective correction and protection while offering comfort and stability for daily use. Our cornea specialist carefully consider the patient’s ocular health to determine the best option available.
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.
The decision to prescribe medically necessary contact lenses is based on specific ocular conditions where conventional correction methods fail to provide adequate support. These lenses are your eyes’ best friend when it comes to matching a unique anatomy or dealing with complex refractive errors.
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.
Medically necessary contact lenses offer benefits that extend beyond simple vision correction. They improve the overall quality of life by addressing conditions that can otherwise lead to discomfort or even further deterioration of eye health when left untreated.
For patients with high refractive errors or significant corneal irregularities, standard corrections may not yield the desired visual clarity. Medically necessary lenses, whether they are RGP, scleral, or hybrid, provide significant improvements in visual acuity. They create a smooth optical surface, ensuring light is directed accurately onto the retina, which is essential for clear, stable vision.
When the eye’s surface is irregular or compromised, wearing traditional lenses can lead to increased discomfort. Custom-designed lenses can protect the cornea, reduce irritation, and maintain moisture on the eye’s surface—particularly important for those with conditions like Sjögren’s syndrome or severe dry eye. By creating a protective barrier, these lenses help to minimize the risks associated with ongoing corneal damage.
No two eyes are the same, and medically necessary contact lenses are crafted to meet the individual needs of every patient. When standard lenses or glasses fall short, specially fitted lenses provide a higher level of correction that takes into account unique anatomical differences. This customization is key to ensuring that patients achieve the fullest visual potential possible while also addressing the underlying condition.
For many patients, managing a significant refractive error or corneal irregularity with glasses is simply impractical. Medically necessary contact lenses offer an alternative that not only corrects vision more effectively but also frees patients from the limitations imposed by heavy or uncomfortable spectacles. This enhanced freedom can contribute to improved day-to-day performance, both at work and in personal activities.
The process of fitting medically necessary contact lenses is meticulous and tailored directly to the patient’s needs. Unlike regular lenses, these fittings require an extra level of precision. The goal is to ensure both excellent vision correction and long-term comfort while safeguarding the health of the ocular surface.
Contact our office today to find out if you qualify for medically necessary contact lenses. Our cornea specialist, Dr. Smith, is ready to help you achieve optimal vision and comfort tailored to your unique eye condition.
During the initial consultation, our cornea specialist measure key parameters like corneal curvature and refractive errors. Advanced imaging techniques help map out the surface of the cornea to identify irregularities that demand a specialized lens design. This step is essential in selecting the most effective lens type and ensuring it matches the unique contours of your eye.
A comprehensive assessment of the ocular surface is crucial. Our cornea specialist evaluate the cornea, conjunctiva, and eyelids to determine how the chosen lens will interact with the eye. For patients with conditions such as severe dry eye or previous corneal surgeries, this careful evaluation minimizes the risk of irritation or additional complications.
Once the initial measurements are complete, a trial lens fitting is conducted. The lens is checked for proper centering, stability during blinking, and overall patient comfort. Adjustments are made as necessary so that the final prescription is optimized for the best level of visual acuity. This step is also useful for confirming that the chosen lens type – whether it is a rigid, hybrid, or scleral design – meets the specific needs of the condition.
Before a contact lens is classified as medically necessary, our cornea specialist must perform a comprehensive evaluation along with detailed documentation. This rigorous process not only ensures that the patient receives the most appropriate lens but also helps navigate the intricacies of insurance coverage provided by third-party payors such as Vision Service Plan (VSP) or EyeMed Vision Care.
Getting the right medically necessary contact lens is a multi-step process that starts with a thorough eye exam. Here’s how the process generally unfolds:
An in-depth examination of the eye is conducted, including the measurement of corneal curvature, checking for irregular astigmatism, and assessing overall ocular health. Our cornea specialist look for signs of keratoconus, corneal scarring, or other conditions where glasses would not suffice.
Advanced imaging techniques, such as corneal topography, provide detailed maps of the eye’s surface. These tests confirm irregularities and help determine the best lens type for correction.
Custom fittings are crucial for these specialized lenses. The initial lenses might be used as a trial to assess comfort, movement, rotation, and visual outcome before the final design is ordered.
Extensive clinical notes are compiled, detailing the patient’s medical or visual condition along with the rationale for the selected lens type. This documentation helps in submitting claims to insurance providers.
Each vision plan sets its own criteria. Our office must demonstrate that the condition meets these criteria, often by showing the failure of glasses to adequately correct the vision.
Navigating insurance for medically necessary contact lenses can be complex. Vision services plans like VSP and EyeMed Vision Care have distinct criteria for covering these lenses. Obtaining the necessary reimbursement involves detailed documentation and clinical justification.
Each vision plan has its specific guidelines, often based on metrics such as the degree of refractive error or the severity of a corneal condition. Our cornea specialist ensure that the submitted clinical records include:
To support reimbursement, every case includes a full medical record that demonstrates how the lens will correct the condition. This record must be legible, properly authenticated by our cornea specialist, and include all diagnostic imaging and test results. The documentation is not only key to ensure that the patient receives the correct lens but also plays a vital role in the administrative process with the insurance providers.
Contact our office today to find out if you qualify for medically necessary contact lenses. Our cornea specialist, Dr. Smith, is ready to help you achieve optimal vision and comfort tailored to your unique eye condition.
Find expert care for medically necessary contact lenses at our specialty practice. Get the support you need for complex eye conditions.
