I.  Patient Selection:

 Prospective contact lens patients are any individuals who are motivated to use contact lenses to correct their visual needs and who are willing to accept the responsibility for their care.  Fortunately with new contact lens designs and materials, almost all optical prescriptions can be fitted with appropriate contact lenses. But, even with all the options available, not all patients desiring contact lenses can necessarily wear them. The optometrist uses his or her professional judgment to advise patients about the best option available for their specific visual needs.   There may be limitations on contact lens options for individual patients because of the availability of designs and parameters. Special circumstances, such as unique vision needs and dusty, dirty, or dry environments may impact the recommendation of specific contact lens designs for specific patients.  The optometrist’s and patient’s previous contact lens experience with different designs may influence decisions about the best contact lens option.

 As in any custom device correction, the ability to evaluate the specific needs of individual patients and recommend the most appropriate option requires highly educated professional judgment and experience. To assure the continued appropriateness of a specific recommendation, periodic professional evaluation of the visual system is necessary to make sure that eye health and vision are not compromised.

II. Examination

Prior to a contact lens diagnostic evaluation, patients should undergo a comprehensive eye examination to assess current visual status and eye health. A thorough case history, including previous contact lens experience, helps identify patients’ desires and expectations as well as past issues and concerns regarding contact lens options. A comprehensive eye examination includes tests to evaluate refractive error and eye health. In addition to the comprehensive examination, there are additional procedures necessary to fit contact lenses. Careful inspection of the eyes front surface (cornea) and eyelids may find conditions that dictate certain lens options. Examples of additional tests are corneal curvature readings and corneal topography (shape) that may indicate unique eye conditions that require and account for specific options and recommendations made by the practitioner.

 Diagnostic contact lens evaluations offer substantial benefits to both optometrists and patients. Examination of lenses on eyes enhances an optometrist’s professional judgment about the best option that may enhance the visual performance of a specific lens design. Patients get to experience the physical sensation of and vision with the contact lens.  Periodic re-evaluation reveals underlying problems, which may interfere with success, and indicates alternatives to improve the experience.

 Although many patients require contact lenses for vision correction, interest in non-

prescription (Plano) contact lenses have occurred due to the availability of tints and designs for patients who do not wear glasses.  As with prescription lenses, professional fitting of these lenses is still required to assure that the eye health is not compromised. The patient is unable to self-evaluate or self-diagnose the lens fit and effects on the eyes so periodic professional evaluations are necessary.In summary, because of the effect of a contact lens on eye health, a routine comprehensive eye examination alone is inadequate to supply the information needed to prescribe contact lenses.  Additional testing with proper lens fitting and adaptation is needed before contact lens prescriptions are determined.

III.  Instructions on the Application and Care of Contact Lenses

Patients should be carefully instructed in the requirements of contact lens wear in order to greatly reduce the potential for problems that arise with noncompliance with the optometrist’s recommendations. Instruction in the recommended methods of lens insertion and removal and the prescribed care system, wearing and lens replacement schedule assures success.  There are eye health issues specifically related to contact lens wear.  They require professional evaluation.  Because some of the subtle physiological changes may not cause any symptoms, periodic evaluation by an eye care professional may prevent future problems.  Early detection of problems and intervention assure maximum success and good eye health when contact lenses are worn.  One example of an objective sign, which may not be observed by patients, is the availability of sufficient oxygen to the cornea as a result of wearing lenses.  Because contact lenses rest on the cornea, they affect the primary source of oxygen to the eye. In most cases, patients do not know their own corneas’ oxygen demand and will not know when a contact lens causes a problem.

IV. Urgent Care

Simply removing contact lenses and contacting an optometrist is recommended when eyes become red or painful or when vision is blurry. The problems associated with contact lens complications rarely become sight threatening when early detection and intervention occur. Delaying care can increase the risk of damage and/or can affect future potential success with contact lenses.

V. Contact Lens Compliance

Success with any medically prescribed regimen is dependent on the compliance of the patient and contact lenses are no exception. Contact lens success is directly related to proper care of the eyes and lenses. Failure to comply with the recommended contact lens care products may cause irritation and contact lens intolerance. Contact lenses are made of plastics that can become coated with proteins and lipids from the tears. Without proper replacement schedules, the accumulation of the debris and tear by-products deteriorate the lens surface and affects contact lens success. Extending the lens life past the recommended wearing schedule may increase the risk of complications and decrease the success of lens wear.Annual eye examinations are generally recommended, but the optometrist will prescribe that appropriate return visit schedule for an individual patient. Frequent periodic evaluations allow patients to take full advantage of all the benefits of contact lenses and allow the experience to be as successful as possible. This report is furnished for general information purposes only.  It does not constitute the practice of optometry or medicine, nor should it be relied upon for dealing with a specific, individual medical or health condition.  Please consult a qualified eye care professional for advice about a specific condition.

 

American Academy of Optometry