Though the list of reasons to fit corneal GP lenses is long, there are a few instances in which GP lens wear should generally not be considered or will need to be modified to provide a patient with stable vision and to maximize ocular safety. If GP lenses are medically necessary, supportive spectacles may be required. Patients and practitioners should be aware of potential downsides to corneal GP lens wear when applicable.

What to Consider

If corneal GPs are desired for simple refractive correction in a patient who has two otherwise healthy eyes, the only potential contraindications to GP lens wear are related to the patient’s desired wear schedule and activities. Patients who are interested in part-time contact lens wear may not be able to fully adapt physically to the sensation of corneal GP lenses on their eyes, which could limit consistently comfortable wear. They may also not be able to neurologically adapt to a more complex design such as a multifocal lens and thus may not obtain the desired visual outcome. Part-time lens wear is usually more successfully achieved with soft or hybrid lenses.

A highly active patient such as a competitive athlete may not want to risk the possibility of lens dislodgement and loss with a corneal GP lens. Scleral GPs, orthokeratology, hybrids, or soft contact lenses may be better options in these situations. Additionally, patients who live or work in environments that have excessive dirt or debris in the surrounding air may find that frequently getting small particles under their corneal GPs is uncomfortable or annoying, and those who work in potentially hazardous environments may risk injury while wearing corneal GP lenses. With these scenarios, safety eyewear must be recommended and encouraged in the form of sports goggles or ANSI Z87.1-approved safety spectacles worn either in place of or overtop of contact lenses.

If a patient has total or functionally monocular status, such as in the case of monocular disease or amblyopia (particularly if the vision in the affected eye is worse than 20/40), polycarbonate lenses in spectacles must be considered for eye protection. If corneal GP lenses are medically necessary and can improve poor vision that results from irregular astigmatism but patients still depend on predominantly one eye for most of their vision, they should consider wearing polycarbonate spectacles over their contact lenses, even if the spectacles are plano.

Lastly, corneal GP contact lens wear can occasionally cause corneal molding, whether inadvertently due to a poorly fitting lens or intentionally with orthokeratology. If a patient is considering an ocular surgery such as cataract or refractive surgery that may be dependent on accurate corneal measurements, corneal GP lens wear may interfere with refractive calculations. These patients are often required to discontinue GP lens wear for 15 to 30 days or longer, which can be inconvenient because of fluctuating vision and/or a lack of accurate backup spectacles.

Stable, Safe Vision Is the Goal

When screening candidates for corneal GP lens wear, it is important to consider the wearing habits and environments of potential patients. After any successful corneal GP lens fit, practitioners should remember the need for protective spectacles when indicated. While corneal GP lenses are often a great option (and in many cases medically necessary), some patients may require additional considerations to ensure safe and stable vision. CLS