A question asked of me recently was: “Does a dispensing optician have a duty of care to remove a ‘stuck’ contact lens from a patient’s eye?”
Firstly, let’s look at the situation for a contact lens optician (CLO): such a practitioner has the skill to remove a misplaced or stuck contact lens from a patient’s eye and they certainly have a duty of care to their own patient. But what if it were a stranger just wandering in? Would that also be under your duty of care? No, I don’t think so.
You obviously want to help someone with a problem but if it’s a busy day with a full appointment diary, it is unreasonable to expect a CLO to make another patient wait while they retrieve a lens. Don’t be tempted down the ‘quick look’ route either; if you don’t have time to do a proper, thorough check for possible corneal abrasions or likely infections, don’t start.
Such a patient must be directed to their own optician if possible, or the nearest A&E department. It feels harsh, and we all wish to be of service, but if there isn’t time to do a proper job, resist the temptation to dabble. You may, of course, rebook them to come back in your lunch break but I think you’ll find most people in these circumstances want to be seen immediately or not at all and rarely return.
Now the situation is very similar for a dispensing optician. All DOs have covered contact lenses in their training or CET, as it is part of the core competences; but this is often theoretical knowledge not hands-on practical skill. Many are contact lens wearers themselves and would be happy to remove a lens if a patient were in distress, but the same rules apply as with a CLO.
Do you have the skill to know if there is a corneal abrasion from poking themselves in the eye, or if an infection is likely to follow? If you are happy to provide this level of care – then fine. But if not, it is best to rebook with someone who is competent and has the time to deal with the possible consequences of corneal trauma.
In the 24/7 world we live in, when practices in busy shopping malls are open late evenings or Sundays, a registered DO may be the only professional member of staff around and there can be extra pressure on them to ‘help out’. This is a good subject to discuss at staff briefings; for instance, what is expected of you by the management? It is best to be prepared in the knowledge that these things happen when you are least expecting them.
If you do feel competent to help, ensure that your PII, or that of your employer, covers you for such actions. If you are not confident to do such work, ensure that you know where the nearest A&E department is located or if another optician in the area would be more likely to help out. By giving clear, concise advice to such a patient you can often calm a situation down. Such phrases as, “I’m sorry I am unable to help you with your problem now. May I rebook you for another occasion?” and, “I recommend you visit the A&E department of Anytown Hospital. Do you know where that is?” will be useful.
Assistance can take many forms and doesn’t need to be hands-on removal by you. Sometimes a patient with an irritated eye can be helped by offering them a quiet area where they can wash their hands and use a convenient mirror to remove the lens themselves.