Did You Know That There Are Contact Lenses Used for Medical Purposes?

Contact lenses are used to help people see better or for cosmetic purposes and they're also used for a variety of medical reasons which will be discussed below.

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Non-Elective Contacts

Contacts are considered medical devices because they require an optometrist's prescription. However, since in most cases they are used for cosmetic reasons or personal preferences, they are considered “elective” and health insurance companies won't cover the cost.

Yet in certain instances, contacts are listed as medically necessary for vision correction, and health insurance plans may pay for them. The following article explores several examples of medical lenses and the reasons they may be prescribed.

What Kinds of Conditions Require Medical Contacts?

There are several types of ocular diseases and conditions in which standard glasses cannot provide adequate corrective measures. In these instances, contacts become a necessity rather than a cosmetic option. The following conditions sometimes require such lenses:

Ametropia: These include cases where someone has such a high prescription that is no longer effective. Myopia (nearsightedness) is a type of ametropia, and myopia management often involves the use of contact lenses to slow down the progression of the condition.In these examples, contacts provide superior benefits.
Anisometropia: An ocular condition where the eyes have unequal focus or power.
Aphakia: A condition involving the absence or removal of an ocular lens, either from trauma, surgery, or an underlying condition.
Dry Eye Syndrome: People with severely dry eyes are sometimes prescribed lenses that provide a more moisturized environment. Scleral lenses are sometimes prescribed for this condition.
Corneal Irregularities: Corneas that are shaped differently. Keratoconus is an ocular disease that causes structural damage and alters the shape from spherical to cone-shaped. Other corneal complications that are treated with contacts include Fuchs’ dystrophy which causes a thickening of the cornea, blurriness, and sensitivity to light/glare; and Lattice dystrophy, which can cause pain (a sensation that something is in the eye), tearing, blurriness, and sensitivity to light and glare.
Corneal surgery: Sometimes complications involving scarring occur after corneal surgeries such as Lasik, Prk, and LASEK. In such instances, standard glasses are inadequate and speciality contacts may be necessary. These include the use of scleral lenses which rest on the sclera portion of the eye, rather than the cornea.

Types of Contacts for Medical Purposes

The above-mentioned conditions require lenses to correct eyesight since standard glasses cannot provide adequate visual acuity. They come in the following types:

Hybrid: a combination of soft and hard providing crisp vision with the comfort of a soft lens.
Gas permeable: Permits the optimal flow of oxygen to the ocular region.
Scleral: These differ from other lenses in that they sit on the sclera rather than the cornea.
Soft: While they are more comfortable than hard options, they usually don't provide the best vision for health reasons.

Additional Information

Many health insurance plans will cover the cost of contacts when they are essential. Speak with your provider.

Common Questions

Will my insurance plan cover the cost of elective contacts?

In most instances, they are not covered, although hi-tier plans may differ.

Aren't they considered medical devices? Why won't my insurance cover the cost?

They are only considered medical because they require a prescription. Health insurance plans generally agree that standard glasses are sufficient and most are only willing to cover instances where they are necessary. In those instances where glasses are not an option, they may be considered a necessity. Unless they are essential, most health plans consider them elective

Did You Know That There Are Contact Lenses Used for Medical Purposes?

Contacts For Health Reasons

Contacts are sometimes prescribed for ocular conditions where standard glasses cannot provide sufficient improvement of eyesight. Under such circumstances, they are considered a necessity for vision correction, and a patient may be covered under health insurance. Types of lenses include those that sit on the sclera, gas permeable types, hybrid, and soft options. For specifics on your health insurance’s policies, speak with a provider to find out more. You can schedule an eye exam with our eye doctor by calling (212) 752-6930. Patients who need medically necessary contact lenses, myopia management, or have difficulties wearing contact lenses visit our clinic from all over New York, and we are proud to be a leading provider of contact lens services for patients from New York, Queens, Brooklyn, and Long Island.

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