A member recently phoned to ask advice about a contact lens situation. His patient was disabled by cerebral palsy but was very keen to have contact lenses. Her disability made handling the lenses very difficult and he asked if her daily carers could handle the lenses for her. This is the kind of question that requires the answer – ‘maybe or maybe not’. Every case has to be considered on its merits, what is acceptable in one situation may not be in another.
The basic reasoning behind all such decisions has to be the well-being of the patient. It is not unreasonable for a young person, disabled or not, to want to wear contact lenses. Contact lenses may well improve the quality of life for such a patient and should be given serious consideration. The other side of the equation is that some harm could be done to the patient’s eyes through contact lens wear, which would not be acceptable.
In this particular circumstance I advocated caution, as I often do. If the eyes are unremarkable and contact lenses would be recommended to another, similar patient, and the concern is purely handling, the situation requires careful consideration. The actions of a CLO cannot be seen to be discriminatory by a patient on grounds of disability. You may not say for example, ‘I haven’t got time to waste teaching you to handle lenses, it would take too long’.
For an able bodied patient, the inability to handle lenses is a contra-indication to contact lens wear. We’ve all encountered such patients who simply cannot overcome the fear of putting something in their eye and no amount of reassurance or tuition can resolve the problem. These patients cannot have contact lenses; it is essential that all patients are able to both insert and remove (and re-centre) their contact lenses before they leave the premises.
But, surely if carers are prepared to do this service there can be no problem? This is where I’m not so sure. Carers come and go; some may be competent while some may not. Could the practitioner guarantee that the patient would have their lenses inserted and removed safely on every occasion?
There have been occasions in my practice when a parent has offered to remove or insert their child’s contact lens “if they can’t manage them”. I always decline, if the child cannot handle the lenses they can’t take them. The obvious exception is when the contact lenses are for therapeutic use and the child in question is too young to have the dexterity to handle lenses. Contact lenses for cosmetic or social use are different again.
You can well understand the problem our member had and why ABDO was consulted. They have a disabled patient, wanting contact lenses, possibly being denied the opportunity to improve the quality of their life. It’s not going to be well received, is it?
I think the solution might be to teach the patient to handle their lenses to the best of their ability with the help and supervision of a carer (ideally a parent). It is important that the carer is present on every occasion that lenses are handled, and is willing to sign a document to that effect. If the patient finds that handling is beyond their ability and appreciates the difficulties, they may well accept that contact lens wear is not for them.