Why wear contact lenses?

The patient may have no clear idea about contact lenses in general and so a good deal of information may need to be given in a clear and concise form before any actual examination takes place. In many cases a patient may have some confused or exaggerated belief about lenses which may need clarification. Very often the patient requires simple reassurance.
During the examination and fitting, a practitioner needs to assess the suitability of the patient and must consider indications and contra-indications for lens wear or for a particular choice of lens design or material. Furthermore, during the aftercare consultations, the practitioner should ascertain how the patient is coping with their lenses. Contact lenses require a degree of compliance on the part of the patient for successful wear. Compliance with, and understanding of, advice is a very important area of study in many clinical disciplines.
It is obviously true that a large proportion of ametropes are not corrected by contact lenses. It is unlikely that these patients are all familiar with the pros and cons of contact lens wear or are unsuitable for a particular clinical reason. A large number of these people might actually consider contact lens wear if offered the option with all the relevant and necessary information. The optometrist or contact lens practitioner is surely the best person to make such a recommendation.
Such behaviour on the part of the practitioner might be termed 'proactive'. Reactive behaviour might describe the action of discussing and fitting contact lenses only when asked to by the patient. This is dependent to a large extent on a filtering of awareness and knowledge of contact lenses through society as a whole and is, therefore, open to the influence of myth, hearsay and many various health beliefs.
Several studies have attempted to assess the effect of proactive behaviour in consultations. Jones et al1 reported a six-fold increase in the number of patients fitted successfully with contact lenses when a proactive behaviour was adopted.
Morgan et al2 compared the successful uptake of contact lenses in a selected sample of 300 patients who were divided into groups exposed to either reactive behaviour or proactive behaviour by the participating practitioners. It was found that a proactive approach almost doubled the contact lens prescribing rate.
A proactive approach might include mention of various advantages of contact lens wear as indicated in the table. It is hoped that a full eye examination would allow the practitioner to develop a good knowledge of the patient's overall requirements and thus allow for a proactive approach based on the considerations listed.

References
1 Jones et al. Reactive or proactive contact lens fitting-does it make a difference? Journal of the BCLA, 1996; 19, 2:41-43.
2 Morgan et al. The benefits of a proactive approach to contact lens fitting. Journal of the BCLA, 1996; 19,3:97-101.
3 Terry R L. Eyeglasses and gender stereotypes. Optometry and Vision Science, 1989; 66, 694-697.
4 Foot H. The liberated ladies? What the psychologist thought. Optical Management, 1986; p18-19.
5 Terry R L, Brady C S. Effects of framed spectacles and contact lenses on self-ratings of facial attractiveness. Perception and Motor Skills, 1976; 42, 789-790.
6 Hadjistavropoulos T, Genest M. Reconsideration of the effects of contact lenses. American Journal of Optometry and Physiological Science, 1988; 65, 814-818.

The CET series on compliance will be sponsored by Johnson & Johnson

BOXTEXT: Considerations for contact lens wear
Optical 
Near normal retinal image size minimises effects of magnification, minification or aniseikonia. Differences of more than 4-5.00D may be difficult to tolerate with spectacles, while contact lens wear may allow toleration of up to 12.00D difference
Wider field of view and the absence of a 'frame scotoma' with hypermetropes
No prismatic effects on eye movements and, therefore, no need for hypermetropes to have to overcome base-out prism on convergence
Aberrations may be minimised

Psychological 
Very often patients will say that the reason they want lenses is to avoid wearing glasses for cosmetic reasons, but there is only scant evidence for this.3 Advertising towards women stressing the cosmetic advantages of contact lenses has been identified.4 Some studies of self-perception of attractiveness, often aimed at women, have shown reduced self-rating scores in spectacle wearers.5 Another study failed to show any psychological differences between groups of spectacle wearers and contact lens wearers,6 but patient selection did not direct attention to those wearing contact lenses for strong reasons (such as those with high prescriptions). Anecdotal and observational studies would strongly suggest a clear psychological advantage in such patients
In the more unusual situation where a cosmetic contact lens masks an underlying lesion, such as a heavily scarred cornea, the psychological benefits are clear

Clinical 
There are many therapeutic uses of lenses, such as for bandage purposes (eg Sjgren's, bullous keratopathy) or for barrier protection (eg symblepharon, pemphigoid)
Vision may be stabilised in certain corneal conditions (eg keratoconus)

Practical or lifestyle 
Outdoor pursuits are less at the mercy of weather problems with contact lenses
Contact sports are less easy in glasses
Some occupations may fit well with contact lens wear