When to Refit
Refitting becomes necessary when a patient's current contact lens prescription causes or contributes to ocular complications. The decision to refit is based on clinical findings at follow-up, patient symptoms, or both. Common triggers include persistent corneal staining, neovascularization, GPC, solution sensitivity, chronic dryness, or recurrent infections.
The refitting process follows a systematic approach: identify the problem, determine the likely cause, select the most appropriate modification, and monitor the outcome.
Material Change
Switching the lens material is often the first and least disruptive modification:
Upgrading Dk/t
- Problem: Corneal edema, neovascularization, hypoxia signs
- Solution: Switch from conventional hydrogel to silicone hydrogel for significantly higher oxygen transmissibility
- Many patients wearing older hydrogel materials experience immediate improvement when upgraded to modern silicone hydrogels
Changing Water Content
- Problem: End-of-day dryness, lens dehydration
- Solution: Switch to a lower water content material that resists dehydration, or to a silicone hydrogel with better moisture retention
Changing Ionic Properties
- Problem: Heavy protein deposits, GPC
- Solution: Switch from ionic (FDA Group IV) to non-ionic (FDA Group I or II) material to reduce protein attraction
Modality Change
If material change alone does not resolve the problem, altering the wear modality provides a more significant intervention:
Change Replacement Schedule
- Switch from monthly to two-week, or from two-week to daily disposable
- Shorter replacement cycles reduce deposit accumulation and associated complications
- Daily disposables eliminate solution exposure for preservative-sensitive patients
Change Wearing Schedule
- Extended wear to daily wear: For patients with hypoxia signs, CLARE, or increased infection risk
- Reduce maximum daily wearing hours for patients showing end-of-day edema or staining
Switch to GP Lenses
- GP lenses offer superior oxygen delivery (the tear pump mechanism refreshes the post-lens tear film with each blink)
- GP materials resist deposits better than soft materials
- Consider for patients with recurrent deposit-related complications, corneal warpage, or when optimal optics are needed
- Requires patient willingness to undergo the GP adaptation period
The refitting process should be systematic and escalating. Start with the least disruptive change (material), progress to more significant modifications (modality, lens type), and reserve discontinuation as the final option. Each change should be given adequate time to demonstrate its effectiveness before moving to the next level.
Refit Timeline
Allow adequate assessment time for each change:
- Soft lens material change: Evaluate at 1-2 weeks
- Replacement schedule change: Evaluate at 2-4 weeks
- GP lens conversion: Allow 2-4 weeks for adaptation, then evaluate
- Between refit attempts: Give each modification a fair trial (minimum 2 weeks) before concluding it has failed
Discontinuation Criteria
Permanent discontinuation of contact lens wear is the last resort, indicated when:
- Recurrent microbial keratitis: Multiple episodes despite appropriate material and care changes
- Progressive neovascularization: Continued vessel growth despite maximum Dk/t and reduced wearing time
- Severe, unresponsive GPC: Papillary changes that do not resolve despite daily disposables and pharmacological treatment
- Chronic corneal compromise: Persistent epithelial defects, stromal thinning, or other signs of ongoing corneal damage
Giving up on contact lens wear after a single complication without attempting systematic refitting. Many complications can be resolved with appropriate material or modality changes. Only recommend discontinuation after exhausting reasonable alternatives.
Document each refit attempt in the chart: what was changed, why, and the outcome. This creates a clear record that guides future decisions and prevents repeating failed approaches if the patient is seen by another practitioner.
Key Takeaways
- Refitting follows a systematic escalation: material change, modality change, lens type change, then discontinuation
- Material upgrades (higher Dk, lower water content, non-ionic) address hypoxia, dryness, and deposit issues
- Daily disposable lenses resolve many complications by eliminating deposits and solution exposure
- GP lenses offer superior oxygen and deposit resistance as an alternative to soft lenses
- Each refit attempt should be evaluated over 1-4 weeks before concluding it has failed
- Discontinuation is reserved for recurrent serious complications unresponsive to all modifications