A 55-year-old African American male presented for a contact lens refit. The patient had been previously diagnosed with keratoconus and had been wearing hybrid contact lenses for 8 years. The current right contact lens was 4.5 years old and the left lens was 2.5 years old. He reported slightly blurry vision since receiving the lenses and uses an oxidative cleaning system daily.

Exam Findings

Evaluation of the contact lenses showed no movement of the lens on the right eye and minimal lens movement onthe left eye. Both contact lenses were inferiorly decentered and showed a tight-fitting relationship. A white ring was noted on both contact lenses at the junction of the hard and soft contact lens materials (Figures 1 and 2). New hybrid contact lenses were ordered with a flatter skirt in both lenses to encourage more movement.

Discussion

Hybrid contact lenses are a great option for high myopia or irregular corneas. They combine the vision correction of a GP lens with the comfort of a soft contact lens. The replacement period of most hybrid contact lenses is 6 months. This patient reported that he exceeded his replacement interval significantly due to being unable to find a provider that fit the lenses.

At this visit, the lens fit was inadequate due to a negative push up test (Figure 3). The white ring visible on the lenses results from using an oxidative lens cleaning system and may appear after 4 to 6 months of wear. The ring is a calcium salt that, although harmless, is permanent and results from the patient’s tear chemistry and an oxidative cleaning system.¹ Figure 4 shows a different patients’ contact lens that had ripped, but also exhibits the same white ring.

Conclusion

Hybrid contact lenses are a great option for those who have regular and irregular corneas. For patients who have intolerance or treatment failure with soft or GP lenses, hybrid contact lenses may yield better results. In a study from 2023, keratoconus patients who failed with other contact lens modalities were fit into hybrid contact lenses. The study reported a successful fit in 92.9% of eyes with improved vision.² As with all contact lenses, it is important to evaluate the fit on a regular schedule so adjustments can be made as needed to maximize vision and ocular health.

References

1. Henry VA, Pack L. Soft lens care and patient education. In: Bennett ES, Henry VA, eds. Clinical Manual of Contact Lenses5th ed. Wolters Kluwer PE; 2020:330-354.

2. Ozcan SC, Ozcan DO. Effects of a new-generation hybrid contact lens on visual performance and vision-related quality of life in patients with keratoconus. Arq Bras Oftalmol. 2023 Jan-Feb;86(1):7-12. doi: 10.5935/0004-2749.20230001