Contact lenses

Both OOs and DOs have a requirement at entry level competency regarding contact lenses. DOs who train further and qualify as contact lens opticians are listed separately by the GOC on a specialist contact lens list. This specialist registration carries a further contact lens-dedicated CET requirement. However, it is interesting to remind readers of the necessary level of contact lens knowledge recommended for all registered practitioners

Optometrist Core Subject 7 - Contact Lenses
The ability to manage patients with contact lenses.

Dispensing Optician Core Subject 5 - Contact Lenses
An understanding of the choice, fitting and management of contact lenses.
Critical competence

Applied knowledge and skills

The emphasis here is knowledge. Many patients expect to be offered full advice about lens materials, choice, suitability, cost and much else well before entering the consulting room and this is recognised in the requirement for all dispensing opticians to keep abreast of contact lens practice development. The same competencies could sensibly be applied to all practice staff members.

Reasons for Wearing CLs

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. This will not only dictate the choice of lenses but also have an important impact upon the patient's compliance with the lenses.

Many texts exist which detail the various indications and contraindications for lens wear. As well as optical, practical and clinical reasons, some further consideration should be made relating to psychological factors.

Very often, patients will say that the reason they want contact lenses is to avoid wearing glasses for cosmetic reasons. A bias in the advertising towards women stressing the cosmetic advantages of contact lenses has been identified. Some studies of self-perception of attractiveness, often aimed at women, have demonstrated reduced self-rating scores in spectacle wearers.

Though another study failed to show any psychological differences between groups of spectacle wearers and contact lens wearers, 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 clearly measurable.

Many young patients attend for contact lenses, often accompanied by a parent or guardian. One situation that needs careful handling is when the practitioner suspects that the contact lenses are the wish of the parent rather than the patient themselves.

This needs clear discussion with the patient as to the nature of contact lens wear, and reinforcement to the parent that lens success will be dependent on full compliance of the patient themselves. If any doubt as to the motivation of the patient still exists, ceasing to continue with the fit needs to be considered.

Useful Reading

Gasson A and Morris J. The contact lens manual. Butterworth-Heinemann, 1998.
Terry RL. Eyeglasses and gender stereotypes. Optometry and Vision Science, 1989; 66, 694-697.
Foot H. The liberated ladies? What the psychologist thought. Optical Management, 1986; p18-19.
Terry RL and Brady CS. Effects of framed spectacles and contact lenses on self-ratings of facial attractiveness. Perception and Motor Skills, 1976; 42, 789-790.