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To use stains, or not?

U2.9.6 To use stains, or not? (2013)

A question I had this month was whether you could refuse to conduct a contact lens check if the patient didn’t wish to have fluorescein instilled.

This is an interesting question for the journal I thought. As with so many of the queries we receive, there is always more to it than meets the eye (no pun intended). In this case, the patient had been to another optician, who had refused to conduct a check without using fluorescein; he then visited our member and asked if the same answer would apply, in quite an aggressive manner with much mention of Trading Standards. He was also an extended wear patient.

My reply was: would you wish to use dye with any other patient in these circumstances? Would you be happy to check the cornea of an extended wear patient without using fluorescein? Our member agreed it would not be possible to conduct a full check without dye. It might well be possible to do a check-up without dye in some circumstances; perhaps an infrequent wearer with no history of problems and known to the practitioner, or an important occasion for the patient immediately after the appointment might result in you agreeing not to instil fluorescein on that occasion but not because a patient demands such action when all clinical considerations would demand using dye.

It is my opinion that patients will often push their luck, demanding something they know to be unreasonable in the hope that the practitioner will give in. It is for us to remain firm, polite but resolute; it does no-one any favours to agree to a course of action that is detrimental to the wellbeing of the patient despite what they believe. Once the standard has been set, such a patient will often be as meek as a lamb.

#contact lenses