Basic contact lens course - part 2

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A ll patients considering contact lenses require a full eye examination first and so all the relevant clinical information acquired during this history and symptoms interview will need to be available. In the instance of a patient attending with a recent prescription from another practice, it is worth asking some general questions surrounding history and symptoms before starting the contact lens consultation.

General and ocular health Knowledge of a patient’s general health has implications in all aspects of optometric care. A sensible policy would be to ask a general question regarding health, specify any conditions which are particularly relevant, such as diabetes or a strong history of allergic response, and then ask if there are any conditions for which the patient has received or is receiving any treatment.  ‘Is there anything else about your health you wish to tell me?’ is also a very useful cover-all safety net question. It is general practice now to ask whether a patient smokes. This is not to enter into a diatribe of anti-smoking propaganda, but it does allow for a discussion of health implications, allowing the patient to make a reasoned choice themselves, and has some links with compliance and microbial keratitis risk

Medications Many systemic medications influence ocular structures and tear flow. Register with BNF online as an eye care practitioner
Visual and optical correction The nature of the refractive error may influence lens choice and needs to be discussed in full early on with the patient.
Contact lens history Not all contact lens fitting is upon first time wearers and as the range of lens materials and wearing regimes expands, there is an significant number of patients returning to the fold. It is therefore very important to ascertain details of previous wear, not least as to the reason for the patient ceasing wear
Reasons for wearing contact lenses Whether a reactive or proactive approach has been adopted, once the practitioner has decided to go ahead with a consultation regarding contact lenses, it is important to understand the reason for a patient requiring them 
Discussion of contact lens choice The patient expects the practitioner to be an authority and so it is worth recommending the lens best suited to the patients health and visual needs
Patient perceptions of contact lens wear Before continuing with the fit, it is absolutely crucial that any other points relating to the wearing of contact lenses need to be clarified at this stage. ‘Is there anything else about contact lenses you wish to know?’ seems an innocuous enough question but may lead to a torrent of concerns and fears about lens wear, often based on irrational hearsay and myth. ‘What if they get stuck at the back of my eyes?’, ‘What if I can’t get them out?’, ‘Will wearing a correction all the time make my eyesight worse?’; just a few of the many possible fears most practitioners are familiar with. It is important to dispel any myths and to reassure a patient as to their concerns.