Issuing a contact lens specification is a subject that comes up quite often at the Membership Services Department. Indeed, it has been covered before in this column.
As a brief reminder, the law requires you to issue a specification ‘at the completion of the fitting’, which of course then brings the question right back to what exactly is the completion of the fitting? And what exactly is the ‘fitting’?
For a new patient, the question is quite straightforward: the patient, with their in-date prescription, is checked and assessed for their suitability to wear contact lenses in the manner they wish to. With that information, the fitting may proceed.
The appropriate diagnostic lenses may be inserted; their fit and the vision achieved can be noted. If all appears well, a small supply of one-day lenses or a single pair of monthly disposable lenses may be given to the patient with care instructions and lessons in handling lenses.
Strict instructions for the next aftercare appointment should be issued. These should include when it should be (or before if there is a problem), to attend wearing the lenses and to bring spectacles as well so the patient may leave the practice with vision correction.
At the next appointment, it might well be that a change to the lenses needs to be made – perhaps to the design or the modality of wear. The whole process must then start again. Further instruction needs to be given; and possibly a new wearing regime. Again, strict instructions as to the next appointment must be provided.
By the next appointment, the patient should be quite proficient with their lenses; though occasionally, further modifications may be needed. The practitioner would have satisfied themselves that there were no immediate problems following lens wear, but with an explanation to the patient that longer periods of wear may give rise to other problems that will need to be checked regularly. The patient may then take their own supply of lenses and sign up to any scheme that the practice offers to pay for lenses and care.
It might be argued that this is the completion of the fit but others will feel that further check-ups are needed before the practitioner is satisfied that any potential long-term problems have been resolved. This would particularly be the case if the lenses were to be worn overnight.
There is a slightly different situation when a regular wearer comes in for their check-up. All the usual stages would have been gone through but perhaps the latest eye examination showed a change in prescription. Would a specification be issued then, showing the change in prescription? Or would the practitioner wish to issue diagnostic lenses to confirm the new prescription and that the other details on the specification remain the same?
I am sure we would all agree that it depends on the individual circumstances – but has the ‘fitting’ been completed or is it continuing with a new prescription?
The professional judgement of the practitioner must decide when it would be safe for a patient to obtain their supply of contact lenses from another source before issuing a specification. To delay giving the specifications for any other reason would be illegal and unprofessional. Clinical records must show the reasons behind such decisions.