Contact Lenses and Vision-Related Quality of Life: Evidence and Clinical Insights.

Background: Contact lenses are a cornerstone of vision correction for ametropia and can be of particular value for management of irregular astigmatism and corneal ectasia. Beyond objective measures of visual acuity and corneal health, patient-reported outcomes and vision-related quality of life (VR-QoL) have emerged as critical endpoints. This review aimed to synthesize evidence on VR-QoL outcomes with contact lenses. Methods: We conducted a narrative review of studies published between 2000 and 2025 on the influence of various contact lens modalities including soft conventional lenses, rigid gas-permeable (RGP) lenses, scleral and mini-scleral lenses, orthokeratology, and specialty designs on VR-QoL across myopia, keratoconus, dry-eye disease, and other conditions. Descriptive tables were developed for all identified studies, and a synthesis of the impact of contact lenses on VR-QoL findings is presented. Evidence for VR-QoL measurement and instrumentation, special considerations for pediatric/adolescent populations, and barriers/limitations to sustained contact lens wear were also appraised. Results: VR-QoL evaluations using validated instruments demonstrate favorable findings with contact lenses. VR-QoL gains with contact lenses are more favorable compared with spectacle correction, particularly in appearance, activities, peer perception, and psychological domains. In keratoconus, RGP and scleral lenses dramatically improve NEI-VFQ-25 composite scores, even in cases of advanced disease. Barriers to sustained wear of contact lenses mostly relate to lens discomfort and dry eye due to ocular surface complications, although studies in patients with ocular surface disease/dry eye still derive VR-QoL benefits with contact lenses. There is a lack of head-to-head trials for certain modalities (eg, an absence of studies directly comparing multifocal contact lenses to spectacles for fall rates). Conclusion: Contact lenses provide significant and clinically meaningful gains in VR-QoL among adult and pediatric patients with refractive error, keratoconus, ocular surface disease or dry eye, and other indications. The VR-QoL benefits of contact lenses may exceed those achieved with spectacles.