For some people, contact lenses go beyond aesthetics and convenience—they’re a medical need. While eyeglasses are considered the industry standard for treating vision issues, there are also some eye conditions for which eyeglasses are ineffective, making contact lenses a medically necessary alternative.
What Are Medically Necessary Contact Lenses?
Medically necessary contact lenses are prescribed by an eye care professional to manage and correct specific eye conditions for which glasses are either insufficient or inappropriate. These lenses aren’t prescribed for vanity or comfort; they solve medical conditions that impair vision or eye health.
Insurance companies often categorize “medically necessary” contacts separately because they address unique health needs, such as helping patients maintain functional vision or relieving discomfort linked to eye conditions.
What Are The Medical Indications For Contact Lenses?
Medically necessary contact lenses are often prescribed for people with eye conditions that cannot be corrected adequately with glasses. Here are some common medical indications where these lenses play a critical role:
- Anisometropia: A condition with a significant difference in prescription strength between both eyes. This difference in prescription strength can make glasses impractical. For patients with anisometropia, contact lenses balance vision more effectively.
- Corneal Scars or Irregularities: Scarring caused by trauma or infections can distort the corneal surface. Custom-fitted contacts, such as scleral lenses, can bypass these irregularities to offer more precise and comfortable vision.
- High Astigmatism: Standard glasses or soft contact lenses may not be enough to correct high levels of astigmatism. Rigid Gas Permeable (RGP) lenses, explicitly customized for the patient’s corneal irregularities, can often do the trick.
- Keratoconus: Patients with keratoconus experience thinning and irregular corneal shaping, which causes significant distortion of vision. Contact lenses fitted specifically for keratoconus provide a smooth surface that corrects these irregularities, enabling clearer sight.
- Post-Surgical Vision Issues: After eye surgeries like corneal transplants or refractive surgery, patients may require contact lenses to help restore optimal vision.
- Severe Dry Eye Syndrome (DES): Patients with severe DES may be fitted with scleral lenses, which create a fluid reservoir and improve eye hydration. These lenses protect the cornea and offer relief when other treatments fall short.
Types of Medically Necessary Contact Lenses
Depending on your eye condition, different types of medically necessary contact lenses may be prescribed.
- Rigid Gas Permeable (RGP) Lenses: These are durable, hard lenses that maintain their shape on the eye. They’re commonly used for keratoconus and other conditions involving irregular corneas.
- Scleral Lenses: Larger than standard contacts, scleral lenses rest on the sclera (the white part of your eye) rather than the cornea. They create a fluid-filled reservoir between the lens and cornea, offering comfort and optical correction for patients with severe corneal irregularities or dry eye syndrome.
- Hybrid Lenses: These lenses combine a rigid center with a soft outer ring, offering the optical advantages of RGP lenses with the comfort of soft lenses. Hybrid lenses are great for keratoconus and high astigmatism.
- Soft Custom Contact Lenses: These lenses are tailored specifically for patients with unique prescriptions or conditions requiring more advanced correction than standard soft lenses can provide.
- Prosthetic Contact Lenses: For therapeutic or cosmetic purposes, prosthetic lenses help patients with eye trauma or significant abnormalities that cause discomfort or reduce vision.
How Do Medically Necessary Contact Lenses Work Toward Vision Correction?
Medically necessary lenses address eye structure irregularities that glasses can’t fix. While glasses sit approximately half an inch away from the surface of your eyes, contact lenses offer closer interaction with your eye’s anatomy, providing better correction for conditions like irregular corneas or severe dryness.
For conditions like keratoconus, rigid or scleral contact lenses act as an artificial surface, allowing light to refract correctly into the eye. For dry eyes, scleral lenses maintain a layer of moisture that protects and hydrates the eye throughout the day.
What Are Elective Contact Lenses?
Elective contact lenses are typically chosen for convenience, appearance, or personal comfort, not because of a medical necessity. Most contact lens wearers use them for everyday vision correction.
Some common examples of elective lenses include daily disposable lenses, colored contacts, and lenses prescribed for mild refractive errors like nearsightedness, farsightedness, or mild astigmatism.
What’s the Difference Between Elective & Medically Necessary Contact Lenses?
The fundamental difference lies in why contact lenses are prescribed and how insurance handles them. Medically necessary contacts are prescribed for specific medical conditions in cases where glasses won’t suffice. Due to their medical necessity, these lenses are often partially or fully covered by insurance.
Elective contacts, on the other hand, are used for general vision improvement or aesthetic appeal. Because glasses are considered to be the standard of care, it’s not “medically necessary” to wear contact lenses in cases where glasses could do the job.
As a result, elective contacts are an out-of-pocket expense because they are typically not covered by insurance.
The Process of Getting Medically Necessary Contacts
The Eye Exam
Your optometrist will thoroughly examine your condition and determine the best lens type for your situation. This includes measuring your corneal curvature and assessing any irregularities or health issues affecting your eyes.
The Fitting
Medically necessary lenses often require custom fittings. Precise measurements will ensure the lenses fit comfortably and provide the proper level of correction. Your first set of lenses might act as a trial to fine-tune the final prescription.
The Trial Period
You’ll start by wearing your lenses for a trial period. After this period ends, you’ll meet with your eye care professional for follow-ups to ensure that your new lenses fit as expected.
Finding the perfect pair of contact lenses sometimes takes some trial and error. It’s normal to have one or two adjustments to your prescription.
Transforming Vision, Restoring Confidence
Medically necessary contact lenses are more than a medical device—they’re a life-changing solution for those with complex eye conditions.Total Vision Diamond Bar tailors our treatments specifically for you and your family to ensure you receive quality eye care each time you visit. Contact us today to discuss whether medically necessary contact lenses are right for you.
