When a second opinion makes sense
Needing more than one lens is normal. In an international survey describing 259 scleral lens patients, fits used an average of 2.4 lenses over 3.8 visits, with some taking far more.[3] So a remake on its own isn’t a reason to leave. These are:
- Many remakes without clear progress. Each new lens should change something specific, with a reason. If the changes keep going back and forth and nothing improves, another view can help. See how many remakes is normal?
- Discomfort or redness that doesn’t settle, especially if you’ve been told the fit is fine. See my fitter says it fits, why does it still hurt?
- Vision that isn’t improving, or is worse than with your old lenses.
- Being told you’re not a candidate, or that nothing more can be done, particularly by a practice that doesn’t fit sclerals often.
- Your remake window is running out with no workable lens.
- Communication has broken down: your concerns aren’t being heard or follow-up is hard to get.
Experience makes a difference. One study following a new fitter’s first 156 fittings found fewer trial lenses and reorders were needed as experience grew.[4] If your eyes are complex, a fitter who sees eyes like yours every week may see options another didn’t.
Step 1: Gather your records
You have a legal right to see and get a copy of your health records. Under HIPAA, a practice must act on your request within 30 days, and can extend that once by up to 30 more days if it tells you why in writing.[1] It can charge only a reasonable, cost-based fee for copies.[1] You can also ask the practice to send the copy directly to the new doctor; that request must be in writing and signed.[1]
Ask for:
- Your lens parameters for each eye: the lens design and lab, diameter, base curve or sagittal depth, landing zone details, power, material, and any coating
- Each version you’ve tried, and what was changed each time
- Fitting notes: clearance measurements, edge observations, and over-refraction
- Imaging: corneal maps, OCT images, or scans
- Your diagnosis, surgical reports, and recent exam findings
If your fitting has been completed, you’re also entitled to a copy of your contact lens prescription without asking.[2] Mid-fitting, ask for the records and parameters above instead.
Wearers who had trouble getting records from a large institution found it helped to have the new practice send a signed release, and to contact the institution’s patient advocate if it stalled.
Step 2: Choose the second fitter
Look for someone who fits your condition often and offers approaches your current fitter doesn’t, for example lenses designed from a scan or mold, or a referral to a specialty program. Use the checklist for choosing a specialist. When you call, say clearly that you want a second opinion and send your records ahead.
Step 3: Prepare for the visit
- Bring your current lenses in their case, and wear them for some hours before the visit if the office agrees, so the fitter can see them settled.
- Bring a short written history: how many lenses, what each felt like, what’s still wrong.
- Bring photos of any redness or marks after removal, with the date and which eye.
- Bring your glasses.
What a second fitter can do
- Review the current fit and tell you whether it’s close or off in ways a small change won’t fix
- Try a different design, size, landing zone, or approach, such as an impression-based or scan-based lens (see impression-based, scan-based or PROSE)
- Look for another cause, such as dry eye, lid disease, solution sensitivity, or a cataract, that no lens change would fix
- Confirm the plan: sometimes the second opinion is that your current fitter is on the right track
What they usually can’t do is take over your existing remake window or warranty, which stay with the practice and lab that ordered the lens. Ask both practices.
What wearers say
A common story is many lenses with one fitter, then a comfortable fit after a fresh look elsewhere, often with a different design or technology. Others found the second fitter confirmed the first was right and the problem lay elsewhere, which was reassuring in its own way. Many wish they’d asked sooner, and say they waited too long out of loyalty or worry about offending their fitter.
Finding a practice
For where to look, see how do I find a good scleral lens specialist? If you decide to move your care for good, see switching scleral lens practices.
Common questions
Will my current fitter be offended?
Good fitters expect it, especially for complex eyes. You don't have to explain why you want your records. If you'd like to stay with them, you can say you want another view on a difficult fit.
How many remakes is too many before I get a second opinion?
There's no fixed number. What matters more is whether each lens is clearly better than the last and your fitter can explain what they're changing. If remakes keep coming without progress, it's reasonable to ask for another view.
Do I have to pay for my records?
Under HIPAA, a practice may charge a reasonable, cost-based fee for copies, limited to things like labor and supplies. Ask about any fee when you make the request.
Can the second fitter just reorder my lens with small changes?
Sometimes, if they work with the same lens design and lab. Often they'll want to measure your eye themselves and may start fresh with a different design. Bring your current lenses either way.
What if I'm in the middle of my remake window?
Ask the first practice what happens to the remaining window and any lens credits if you stop. Policies vary, and warranties usually stay with the practice and lab that ordered the lens.
Should I see a cornea specialist instead?
If you have new symptoms, changing vision, or a condition such as keratoconus or a transplant that may be changing, a cornea specialist's view can be useful alongside a fitter's. They answer different questions.