Contact Lens Exams

A contact lens exam includes everything in a comprehensive eye exam plus specific tests to ensure lenses will fit and function on the ocular surface. In addition to measuring refractive error, the clinician evaluates corneal shape, tear film quality, and the overall health of the ocular surface. These added steps allow the doctor to select appropriate lens materials and designs that match your eyes and lifestyle.

Because contact lenses sit directly on the eye, measurements such as corneal curvature and pupil size are taken to refine lens choice and fit. Trial lenses are often used to confirm comfort, vision at different distances, and how the lens interacts with your tear film through the day. Instruction on insertion, removal, and lens care is also provided to promote safe, successful wear.

A fitting typically includes keratometry or corneal topography to measure corneal curvature, pupil and limbal measurements, and a detailed assessment of the tear film and eyelid function. These objective parameters guide the selection of base curve, diameter, and lens design so the lens aligns properly with the cornea. The clinician will also check for any surface irregularities, scarring, or signs of ocular surface disease that could affect fit and comfort.

After initial measurements, diagnostic or trial lenses are used to observe lens movement, centration, and stability on the eye while assessing visual quality at near and distance. Measurements may be refined during follow-up visits to optimize parameters and wearing schedule. This iterative approach helps reduce irritation and improves long-term success with contact lenses.

Choosing a lens balances prescription needs, eye anatomy, daily routine, and personal preferences for care and replacement schedules. Factors such as hours of daily wear, screen time, sports or outdoor activity, and the need for multifocal correction influence whether soft daily disposables, reusable lenses, RGPs, or specialty designs are recommended. The clinician will discuss trade-offs like convenience versus long-term ocular surface compatibility to align the choice with your priorities.

Medical and environmental conditions—dry eye, allergies, or past corneal surgery—also affect material and replacement recommendations, as some materials better retain moisture or resist deposits. A trial period with follow-up ensures the selected lens meets comfort and vision expectations before committing to a long-term plan. If you have specific concerns or questions about lens options, the practice can tailor recommendations to your routine and ocular health.

Common options include soft hydrogel and silicone hydrogel lenses, daily disposables, reusable monthly or biweekly lenses, rigid gas-permeable (RGP) lenses, toric lenses for astigmatism, and multifocal designs for presbyopia. Soft lenses conform to the cornea and are known for initial comfort, while RGPs provide sharper optics for irregular corneas and are more durable. Toric and multifocal lenses address specific refractive needs like astigmatism and age-related near-vision loss, respectively.

Daily disposables offer hygiene and convenience by eliminating cleaning routines, whereas reusable lenses require a care regimen and regular replacement to avoid deposits. Extended-wear lenses exist but require careful medical assessment and monitoring due to increased infection risk during overnight wear. Your clinician will explain the benefits and limitations of each type to help you choose the best fit for vision and lifestyle.

Before prescribing lenses, the clinician performs a thorough anterior segment exam to look for signs of dry eye, inflammation, corneal staining, scarring, or infection risk factors. Tear film quality is assessed using tests that may include tear breakup time, staining with fluorescein, and evaluation of the lid margins and meibomian glands. These findings determine whether additional treatment is needed before initiating or continuing contact lens wear.

If ocular surface disease is present, the exam may result in treatment recommendations such as lid hygiene, lubricants, or medical therapies to improve comfort and lens tolerance. Regular follow-up visits are scheduled to monitor the eye’s response to lenses and to catch early changes that could compromise health. Maintaining ocular surface health is a core part of ensuring safe, long-term contact lens use.

Yes, many modern contact lens designs address astigmatism and presbyopia, and specialized options exist for eyes that have undergone refractive surgery. Toric lenses stabilize the optical axis for astigmatism, while multifocal or bifocal lenses and monovision strategies help manage presbyopia depending on patient preference and visual demands. Eyes that have had LASIK or similar procedures may need custom or specialty lenses to account for altered corneal shape.

Patients with irregular corneas or significant post-surgical changes may be fitted with custom rigid or hybrid lenses that provide clearer vision and better fit. The fitting process for these conditions is more involved and may require multiple visits and lens refinements to achieve optimal comfort and acuity. Your clinician will outline realistic expectations and the fitting steps needed for your specific situation.

Contact lens wear carries potential risks such as irritation, infection, corneal inflammation, and hypoxia if lenses are not properly fitted or cared for. Many risks are reduced through proper hygiene, adherence to recommended replacement schedules, avoidance of overnight wear unless approved, and by removing lenses at the first sign of pain or significant vision change. Regular follow-up exams help detect early signs of complications so they can be addressed before long-term damage occurs.

Patients should follow handling and disinfection instructions closely and avoid behaviors that increase risk, such as swimming while wearing lenses or sleeping in lenses not approved for overnight use. Prompt communication with your eye care provider about redness, discharge, or blurred vision ensures timely evaluation and treatment. The aim of the contact lens exam process is to minimize risk while enabling safe, comfortable wear.

Care recommendations depend on lens type but generally include proper handwashing before handling lenses, following manufacturer and clinician instructions for cleaning and disinfection with reusable lenses, and adhering to the prescribed replacement schedule. Daily disposables require minimal care beyond disposal after use, while reusable lenses need regular cleaning, case hygiene, and replacement of the storage case. Avoiding makeup contamination and replacing lens cases regularly are simple steps that reduce infection risk.

Follow-up visits after a new fitting ensure lenses continue to fit well and that the ocular surface remains healthy under wear conditions. Annual contact lens evaluations are recommended at minimum, with more frequent checks for patients using specialty lenses or those with ocular surface disease. Reporting any discomfort or vision changes between scheduled visits allows the clinician to intervene quickly and refine the plan as needed.

Difficult fits often benefit from specialty lens designs including custom rigid gas-permeable lenses, scleral lenses, hybrid lenses, or custom soft lens options that vault or conform to irregular corneas. Scleral lenses, for example, rest on the less sensitive sclera and create a fluid reservoir that can improve comfort and vision for keratoconus or severe ocular surface disease. These lenses typically require advanced diagnostic fitting and close follow-up to achieve optimal results.

Fitting for complex corneal conditions may require multiple visits, custom parameters, and sometimes lens modifications to balance vision, comfort, and ocular health. Collaborating with an experienced clinician and committing to the fitting process increases the likelihood of a successful, wearable solution. The practice has experience coordinating specialty fittings and can recommend a tailored approach based on your corneal shape and vision goals.

Begin by scheduling an appointment for a contact lens evaluation at one of the practice locations so the clinician can perform a comprehensive assessment and discuss your goals for lens wear. The exam will include diagnostic measurements, trial lens fitting as appropriate, and hands-on instruction for insertion, removal, and care to ensure you leave with the skills needed for safe wear. A follow-up visit is typically arranged to confirm fit, comfort, and visual performance after a trial period.

If you have had difficulty finding comfortable lenses in the past or have special needs such as high astigmatism or post-surgical corneas, mention this when booking so the office can allocate appropriate time and resources. Clear communication about your daily routine and visual priorities helps the clinician select suitable options and design an effective fitting schedule. Contact Harvard Square Eye Care to arrange an evaluation and start the fitting process.