This query was received at the Membership Department recently. Our member had concerns that a patient of the practice was developing dementia and was also a contact lens wearer of many years standing. Was it professional to continue supplying lenses in such circumstances?
It is a sad fact that an increasing percentage of the general population suffers from dementia and related conditions. As ‘baby-boomers’ become pensioners, the onset of dementia can become an issue for their contact lens practitioners. What should a contact lens optician do in such circumstances?
I think one way to approach this problem is to consider it in the same way as patients with learning difficulties – perhaps by asking yourself the question, “Is the patient competent to handle and care for contact lenses?”
There is a difference between a patient who presents wanting contact lenses for the first time for the usual cosmetic reasons (their spectacles may be heavy or ugly, and/or they believe that contact lenses will solve all their problems, making their specs redundant); and those who have worn contact lenses safely and responsibly for many years but with the onset of dementia become increasingly forgetful of the care and maintenance of their lenses.
Great care is needed when considering if a patient is suitable for contact lens fitting. The patient must be capable of looking after the lenses, keeping aftercare appointments and having a responsible attitude to their own ocular wellbeing. This decision can only be made when the practitioner is aware of all the facts concerning their patient’s general health, ocular health and general circumstances, hence the importance of accurate and complete history taking.
With the patient who has been a contact lens wearer over many years (it is especially useful if they have always been a patient of the practice) but becomes unwell, it is a different problem to the new fit patient. The onset of dementia is often a slow process, barely noticeable at first; the odd forgotten appointment and/or failure to collect a new supply of lenses can all point to this condition.
Such lapses, of course, happen all the time to everyone but it might be possible if these lapses are recorded on the records for a pattern to be discernible. In these circumstances, it is helpful to have another contact, a family member perhaps, to say to, “Mrs Brown hasn’t collected her contact lenses. Is there a problem at all?” For dementia patients, routine is all, and the familiar tasks of inserting and removing contact lenses may give structure to a day.
If the records show no underlying pathology and appointments are made at reasonable intervals to check that no adverse reactions are present, the patient will benefit from continuing with contact lens wear. If the eyes become adversely affected by neglect of care of contact lenses, the situation must be reviewed.