Hybrid contact lenses became a more viable modality for contact lens fitters approximately 13 years ago, with the introduction of design modifications that addressed previous shortcomings. Today, the hybrid contact lens category represents a small proportion of all reported contact lens fits—less than 5% of fits of any type of lens material and less than 10% of fits using any type of GP material (Nichols, 2018).

Globally, there are two hybrid lens manufacturers that exist in the market, with only one having U.S. Food and Drug Administration (FDA) clearance for use in the United States. So, the guesswork is taken out of which particular hybrid lens designs fitters can offer to their patients.

Who Can Benefit?

The indications for use of hybrid lenses remain the same. With the optical quality of a GP center and the peripheral comfort of a soft skirt, the largest fitting opportunities are likely in normal-eyed patients, because scleral lenses have become a popular go-to first choice for management of the irregular cornea, especially in more advanced cases.

Despite the wide range of available parameters for soft toric lenses, patients who wear them still experience visual fluctuations (Chamberlain et al, 2011). The stability of the hybrid lens optics can better correct our corneal astigmatic patients.

Multifocal Considerations

Currently available are both center-near and center-distance progressive optics, which better suit the needs of patients who have presbyopia, for example, who value their distance visual acuity. While this parameter availability can allow for more flexibility in modified powers that are prescribed to patients, fitters must ensure that lenses are centered adequately, both at initial fit and after hours of wear at a follow-up visit, to reap the benefits of these design options (Figure 1).

While its use would be strictly off-label, this new design option could open the doors for hybrid lens use in the management of juvenile myopia based on historical use of multifocal optics in this patient population. The same lens centration concerns would apply.

Addressing Comfort

Although wearing a hybrid lens is typically more comfortable than wearing a corneal GP lens alone, the level of comfort with these lenses is often inferior to that of soft lenses alone. For patients who complain of discomfort and dryness with lens wear and/or signs of poor surface wetting are evident (Figure 2), coatings applied to the lens surface can be used in an attempt to enhance the lens-wearing experience.

Summary

The use of hybrid lenses has slowly increased over the last decade, but still remains largely an afterthought for most fitters. Gone are the days when this modality was reserved only for difficult-to-fit contact lens patients who exhausted all other options. It is an exciting time to incorporate hybrid lenses into your fitting repertoire. CLS

For references, please visit www.clspectrum.com/references and click on document #267.