Old studies from the 80s showed that in the United States the percentage of soft contact wearers to firm contact lenses wearers was 80% to 20% – Europe showing almost the opposite percentages. A recent study from Optometric Management suggests it is now more like 94% to 6%, and apparently Europe is similar.
Since I practice in a relatively small university community with a significant proportion of internationals it is a reflective microcosm of Americana. It could be said that I tend to favor firm lens science over soft, but I obviously never push that bias onto my patients because my percentage of RGP fittings are a minority very similar to the national average.
Firm lenses require significant science, math and engineering to fit. Like handmade furniture the skill is being lost to simpler mass produced soft contact lenses. For some with high astigmatism or those with eye surface anomalies, firm lenses remain their only alternative.
I would like to leave you with one last thought. Those who have adapted well to firm lenses tend, in my opinion, to have few contact lens problems. RGP lenses can last up to four years and solutions costs are a mere pittance. These wearers are less prone to deposits, infections and inflammatory reactions, and in general, in my experience, their vision is clearer. One thing is for sure, good firm lens wearers do not want to be put in soft contact lenses.
Because of the advent of highly accurate computer numeric design and fabrication, there’s a revitalization of an old lens design – scleral contact lenses. These are rigid contact lenses that are as large as, and frequently larger than soft contact lenses. Because lens comfort is a product of size not softness, these lenses are as comfortable as soft lenses – frequently even more comfortable. They also can handle very complex, high and even aberrant prescriptions, so now most everyone can wear contact lenses if they wish. They work excellently on people who have had accidents causing damage to their cornea, keratoconus patients, and corneal transplant patients. Scleral contact lenses have their own moisture chamber, so they are also good for dry eyes.
Photo credit: By SucreRouge (Own work) [CC BY-SA 4.0 (http://creativecommons.org/licenses/by-sa/4.0)], via Wikimedia Commons