THROUGHOUT 2025, the contact lens-fitting community saw significant progress in digital lens design, wavefront-guided optical correction, myopia management, technology integration, and more. Learning to implement these newer advancements in practice benefits both practitioners and patients, with large and small improvements resulting in positive impact. Here are a few seemingly minor adjustments that created major wins in contact lens fitting last year.
#1: Listen First
Neither the practitioner nor the patient is pleased with the outcome if the patient’s primary goals are not addressed. Whether the main objective is simplifying the fitting process or maximizing vision at a particular range, the patient’s priorities should guide the design. Asking open-ended questions about how patients spend their days can help refine these details.
Clinical Example: A jeweler who valued crisp intermediate and near clarity was interested in contact lenses to correct vision at this range. She was willing to accept some distance blur and to use single-vision glasses over her contact lenses for distance tasks; all her visual needs were met in this way. Aligning the design with the patient’s visual demands turned an adequate fit into an exceptional one.
#2: Implement Technology to Add Value
Higher-order aberration (HOA) correction was a hot topic again this past year. It provides improved vision outcomes for many irregular cornea patients, but not every irregular cornea patient needs HOA correction (Gelles et al, 2024). Similarly, advancements in profilometry and digital lens design have streamlined the fitting process (Yoon et al, 2024). These lenses are highly customized for the patient, but they may not be necessary when there is a spherical scleral shape or mild scleral toricity. Therefore, it is useful to learn when to incorporate these advanced designs.
Clinical Example: An advanced keratoconus patient presented with scleral lens intolerance and was looking to be refitted in new lenses. After revisiting the patient’s corneoscleral profilometry, an irregular scleral shape was appreciated, and the patient was fit in freeform, scan-based scleral lenses. This immediately improved comfort, lens stability, and patient satisfaction.
#3: Remember the Basics
Troubleshooting a contact lens fit can require a modification as big as changing modality or as basic as switching up the material. Starting simple can help avoid going down long unwanted and unnecessary paths that ultimately cause frustration for both the patient and the practitioner. Details such as cleaning regimen, application and removal technique, lens material, and ocular surface health can be critical in troubleshooting.
Clinical Example: A long-time corneal GP lens wearer presented with discomfort and wetting issues. Her current lenses were made in a material with a higher Dk value and a much higher wetting angle than that in the lenses she previously wore. Despite the benefits of these properties, it is likely that the change worsened moisture retention and was contributing to her challenges. After being refitted with a material similar to that in her older pair, her symptoms improved immediately. In this case, a basic change had a huge impact.
Conclusion
In the past year, we saw significant advancements in contact lens design and the technologies available. Incorporating these new strategies, big or small, in a thoughtful way can often deliver the most effective results. Whether through patient discussions, subtle lens modifications, or new technologies, these intentional adjustments remain the foundation of successful contact lens practice.
References
1. Gelles JD, Su B, Kelly D, et al. Visual improvement with wavefront-guided scleral lenses for irregular corneal astigmatism. Eye Contact Lens. 2024;51(2):58-64. doi: 10.1097/ICL.0000000000001152
2. Yoon H, Harthan JS, Skoog W, et al. Process and outcomes of fitting corneoscleral profilometry and anterior scleral shape for scleral contact lens design. Eye Contact Lens. 2024;50(3):132-137. doi: 10.1097/ICL.0000000000001064.