Medically necessary contact lenses provide a tailored solution for vision correction when standard options fall short. Improve your eye health and comfort today.
Medically necessary contact lenses are specialized lenses prescribed to improve vision when glasses or standard soft contacts cannot deliver optimal clarity or comfort. They are designed to correct complex refractive errors or address ocular conditions that alter the smoothness of the corneal surface. Our eye doctors highly value these lenses because they not only greatly improve visual performance and eye comfort, but also contribute to overall eye health.
For many individuals, conventional vision correction options simply do not work due to high refractive errors, corneal irregularities, or chronic dry eye conditions. In these cases, medically necessary contact lenses provide a tailored solution that offers better visual quality and improved comfort. These lenses have the potential to transform daily life by minimizing visual disturbances such as halos, glare, and blurred or shadowy images.
There are several reasons why our eye doctors might recommend medically necessary contact lenses, and each case is carefully evaluated based on a patient’s unique vision needs. The primary indications include:
Not all contact lenses are created equal. When vision issues are complex or the ocular surface is compromised, our eye doctors choose from a range of specialty lenses to meet the patient’s needs:
Standard soft contact lenses have limitations when a patient’s prescription is exceptionally high. As the lens power increases, so does thickness, which can affect oxygen transmission to the cornea and lead to discomfort or even poor vision outcomes. When patients complain of blurred images, shadowy vision, halos, or double vision with conventional lenses, our eye doctors may consider medically necessary designs to address these issues.
For example, a patient with high sphere and cylinder powers might find standard lenses intolerable. A specialized lens design—such as mini scleral lenses—can be selected so that increased wear time is met with improved oxygen flow due to the saline reservoir beneath the lens. The result is often a dramatic improvement in both comfort and vision, allowing the patient to experience crisp, clear images day in and day out.
Corneal diseases like keratoconus and corneal ectasia cause the normally smooth corneal surface to become irregular and cone-shaped. This change in shape hampers the ability of glasses or conventional contacts to provide clear vision. Medically necessary contact lenses come into play by offering a customized solution that essentially “resets” the anterior refractive surface.
For mild to moderate cases, even standard soft lenses or RGP lenses might be sufficient. However, in more advanced stages of corneal irregularity, scleral and hybrid lenses can be instrumental. These lenses are meticulously fitted using precise diagnostic tools such as corneal topography, which measures the shape and curvature of the cornea. This high level of customization ensures that the lens vaults the irregular area correctly and provides a centered optic zone for optimal vision.
Dry eye disease can be debilitating, making it nearly impossible for patients to tolerate standard contact lenses. When the tear film is insufficient, the ocular surface suffers from constant friction, leading to discomfort and even damage over time. Scleral lenses are uniquely designed to overcome these challenges by vaulting over the cornea and trapping a reservoir of saline solution underneath the lens.
This built-in moisture reservoir not only protects the fragile surface of the eye but also acts as a constant lubricant during wear. In many cases, patients with severe dry eye conditions experience remarkable relief from discomfort and an overall improvement in visual clarity. Our eye doctors carefully choose these lenses for patients with underlying conditions such as rheumatoid arthritis, Sjögren’s syndrome, or ocular graft versus host disease, where preserving a healthy ocular surface is paramount.
Corneal infections, whether from Herpes simplex or other pathogens, can leave behind areas of scarring and irregularity. These changes may lead to decreased vision and increased sensitivity to light. Because standard soft lenses might not conform adequately to a scarred cornea, our eye doctors often recommend more specialized options like RGP lenses or scleral lenses.
The hard materials in these lenses can mask the surface irregularities caused by scarring, thereby providing a smoother optical surface. For patients with central or large areas of corneal scarring, scleral lenses are especially beneficial as they provide a generous vault over the scarring while maintaining excellent comfort. In some cases, a modified oblate design is chosen to better accommodate the altered curvature of the infected or scarred cornea.
Some individuals are born with congenital conditions, such as iris coloboma, where an opening in the iris allows excessive light to enter the eye. This can lead to significant glare and decreased vision quality. Medically necessary contact lenses for these patients often include custom prosthetic designs.
These lenses are made with an opaque backing and an open pupil design, which helps reduce the amount of unwanted light entering the eye while still providing the required corrective power. By effectively controlling light exposure, prosthetic lenses help minimize glare and halos, resulting in marked improvements in vision and overall comfort. Even though the color of the prosthetic backing may not exactly match the natural iris, the primary focus remains on the significant enhancement of visual performance.
Don't let vision challenges hold you back. Find a top optometrist near you to explore medically necessary contact lens options!
The process of fitting medically necessary contact lenses is multifaceted and requires substantial chair time and expertise. Our eye doctors perform a comprehensive eye examination that includes corneal topography and visual acuity testing to gain a complete understanding of the patient’s eye shape and visual needs.
Based on these detailed measurements, the correct lens parameters—including diameter, base curve, and design attributes—are selected. The fitting process isn’t a one-size-fits-all approach; instead, it is highly customized to account for factors such as the location and severity of corneal irregularities or the specific needs related to dry eye symptoms. Follow-up appointments are crucial following the initial fitting to assess the lens performance and comfort, and to make any necessary adjustments. This iterative process ensures that the lens not only provides the best possible vision correction but also maintains ocular health over time.
Unlike contact lenses worn solely for cosmetic purposes, medically necessary lenses are often covered by medical insurance because they form an essential part of a patient’s vision care. This coverage is particularly common when the visual benefits of the lenses significantly surpass those of glasses or conventional contacts.
Insurance companies may require specific criteria to be met, such as a high refractive error (often beyond 10 diopters) or a substantial difference in power between the two eyes (anisometropia). Because these lenses are custom tailored to address complex eye conditions, there are typically higher associated fitting and material costs compared to elective contacts. It is recommended that patients contact our office or their insurance provider for precise coverage details and discuss these options with our eye doctors to ensure that treatment is aligned with both medical necessity and financial considerations.
Medically necessary contact lenses are more than a vision correction tool—they are an investment in a patient’s daily comfort and long-term eye health. By offering uniquely tailored lens designs that better conform to the patient’s specific anatomy and vision needs, these lenses can transform how patients see and experience the world.
If you experience issues with your current vision correction methods or have been diagnosed with conditions affecting the cornea’s regularity, please schedule a consultation with our eye doctors. A comprehensive exam and advanced imaging such as corneal mapping will help determine the best medically necessary contact lens option for clear, comfortable vision.
Don't let vision challenges hold you back. Find a top optometrist near you to explore medically necessary contact lens options!
Discover the benefits of medically necessary contact lenses for vision correction and eye health. Schedule a consultation today!
