In last month’s article we looked at the different types of contact lenses, and some general advantages and disadvantages of each type. This month we will look at additional factors that can determine lens type and the frequency of lens replacement, some common questions patients may have, and how to instruct a patient to insert and remove a lens.
Everyone is different, and patients will have different requirements, and it is these requirements that help to determine lens suitability. This is a conversation the contact lens optician will have in detail with the patient, but it is always helpful if the optical assistant can answer some questions the patient may have ahead of the appointment.
Some points for the patient to consider include deciding how often they would like to wear the lenses, and whether they want to clean and store their lenses after each wear. Some patients will want to wear their lenses every day, whereas others may only want to wear them two or three days each week.
Cost is also something that should be discussed with the patient, although care is needed not to give a definite price at the enquiry stage – as some lens types may not be suitable and costs may vary.
Patient hygiene is important when it comes to handling contact lenses, and hands and fingernails should be kept clean. Fingernails should be short to avoid damaging the eye when inserting or removing a contact lens. If a patient has dry eyes, this can make wearing lenses difficult, especially for long periods of time, but some lens materials are better than others. Some patients build up deposits on their lenses more frequently than others, so this may influence the frequency of lens replacement.
Patients are often worried that they may not be able to get the lenses on their eyes or be able to take them out. Some patients are able to manage this very quickly, although for others it may not be such an easy process. Most patients will manage this eventually, but a great deal of patience may be needed in order to help the patient achieve this.
Inserting and removing lenses
As an optical assistant, you may be asked to help patients with inserting and removing their lenses. There are a few different methods, but the following is a popular method for soft lenses.
For both inserting and removing lenses, it is important to explain to the patient that they need to wash their hands with an anti-microbial soap, and dry them on a lint free towel, to prevent small fibres adhering to the lens. A magnifying mirror can be useful, especially for presbyopic patients, and the patient should be seated at a desk or table.
The lens should be placed on the first finger of the dominant hand and checked to ensure it is the right way round. If the edges stand up like a bowl, it is the correct way round, but if the edges turn out like a saucer, it is inside out.
The patient then pulls their lower lid down with the middle finger of the dominant hand and lifts the top lid with the first finger of the non-dominant hand. The lens can then be carefully placed on the eye. Advise the patient to look left and right, and up and down to help centre the lens – and then the lids should then be released slowly, the lower lid first. If this is done too quickly, the lens can pop out.
To remove the lenses, first check the lens is still on the eye by looking for the reflection off the lens edge in the mirror. It is then important to ensure both lids are firmly held apart by holding the bottom lid with the second finger of the dominant hand, and the top lid with the first finger of the other hand. Then carefully slide the lens towards the lower lid, and with the thumb and forefinger the lens can be lifted out of the eye.
Hopefully this will help the OA to answer some questions patients might have when enquiring about contact lenses. But always remember to let the patient know that nothing can be decided until they have had a consultation with the contact lens optician or the optometrist.
Next month we will look at some of the legal issues commonly encountered in practice.
Sue Deal FBDO R is a practising dispensing optician, ABDO College examiner, senior tutor and supervisor for dispensing opticians. She is also a practice visitor and external moderator for ABDO. She was recently awarded the ABDO Medal of Excellence for her outstanding services to the profession.