Lens Dispensing Notes

Ulster University - Lens Dispensing

Learning Outcomes

A successful student will be able to:

Outline the legal and professional requirements of the optometrist in fitting and supplying contact lenses.
Discuss in detail the important elements of lens handling, wear, and care which must be explained to the patient.
Recognize the need to encourage compliant lens wear and care behaviors in patients.

Soft Lens Fitting Procedure

The soft lens fitting procedure includes:

Pre-Fitting Assessment
Trial Lens Selection
Lens Insertion
Adaptation
Evaluation of Lens Fit
Modifying Lens Fit
Over-Refraction
Lens Ordering
Lens Dispensing
Aftercare

Legal Requirements

According to the Opticians Act (1989) Section 25.5, a person fitting contact lenses must:

Provide instructions and information on the care, wearing, treatment, cleaning, and maintenance of the lens to the individual.

Lens Dispensing

Also known as the Collection Appointment or I & R Appointment.
Lens dispensing often occurs at the same time as the lens fitting appointment as practices hold lens stocks.
Some aspects may be delegated to non-regulated staff/optical assistants, but the legal responsibility remains with the fitting clinician.
Ensure staff are appropriately trained.

Lens Dispensing Procedure

The lens dispensing procedure includes:

Slit Lamp Assessment
Fitting Assessment – Is the fit as originally intended?
Visual Assessment – Visual Acuities (VAs) should be the same or better than those recorded at the initial fitting.
Lens Handling / Insertion & Removal
Lens Care Advice
Lens Wearing & Replacement Schedule
Symptoms & Precautions
Aftercare Schedule / Appointment
Patient Declaration

Lens Handling

Hand Hygiene is crucial.
Lens identification (correct & incorrect).
Lens insertion & removal techniques.
Handle one lens at a time and develop a routine for the right eye (RE) & left eye (LE).
The lens case, containing solution, should be carried at all times.

Lens Care Advice

No Tap Water!!! Contact lenses and water don't mix because of the risk of microbial contamination.
Importance of proper lens care for Non-Daily Disposable (DD) Lenses.
Method of lens cleaning, storage, and disinfection.
Lenses should be cleaned and disinfected daily, immediately after lens removal.
Demonstration of lens care regime.
Use Multi-Purpose Solution (MPS) – Rub & Rinse method.
Use fresh solution - don’t top up!!
Replacement of lens case at regular intervals - usually monthly!
Do not change brand or type of solution without consulting practitioner.

Lens Wearing Schedule

Wearing Times – Dependent on patient’s intended usage – Initial adaptive wear.
Consider an initial adaptive wear schedule before establishing a maximum limit prior to the first Aftercare (A/C) appointment.
Lens Replacement Schedule.
Use reminders / apps to manage the schedule!

Potential Symptoms Advice

Eyes should not become unduly red or sore.
Lens comfort should be similar, if not better, than that experienced at trial fitting.
Some patients may experience adaptive photophobia.
Sudden acute discomfort is probably caused by a foreign body.
Dry and/or smoky environments will generally make the lenses/eyes feel irritable or uncomfortable.
Falling asleep in lenses may result in temporary lens adhesion; use saline to lubricate lens before removal.

Precautions

Soft lenses should not be worn while eye-drops or ointment are used (unless ocular lubricants) - wait 1 hour for eye-drops and 4 hours for ointment or follow instructions.
Patients may wish to avoid wearing lenses on long flights because of the dry atmosphere.
Swimming is unwise with contact lenses of any type – consider prescription goggles.
Provide written/video instructions (lens handling and care systems).
Refer to College of Optometrists Videos.
Provide Emergency / Out of Hours contact details.

Daily Check

Ask Yourself…

Do my eyes feel good with my lenses? - No discomfort
Do my eyes look good? - No redness
Do I see well? - No unusual blurring with either eye

“If in doubt - take them out”

Love Your Eyes, Love Your Lenses

BCLA Factsheet (DD & Monthly available)

DO:

Discard daily disposable lenses after each wear. Where available recycle lenses at an approved recycle point
Have regular check-ups as advised by your eye care practitioner
Always wash and dry your hands prior to handling your lenses
Always apply the same lens first to avoid mixing them up
Check the lens is not inside out before applying
Check the lens is not damaged before applying
Handle carefully to avoid damaging the lens
Apply your lenses before putting on make-up
Remove lenses then remove make-up
Keep your eyes closed when using hairspray or other aerosols
Discard lenses and solutions that are past their expiry date
Wear only the lenses specified by your eye care practitioner
Stick strictly to the recommended wearing schedule and replacement frequency
Make sure you have an adequate supply of replacement lenses
Have an up-to-date pair of spectacles for when you need to remove your lenses

DON'T:

Use tap water, or any other water, on your lenses or lens case
Use your lenses for swimming, hot tubs, or water sports
Sleep in your lenses, unless specifically advised to by your eye care practitioner
Touch the inside of the lens (the side that touches the eye)
Share contact lenses or wear any lenses not specified by your eye care practitioner
Wet your lenses with saliva
Put a lens on the eye if it falls on the floor or other surface
Wear your lenses when showering
Use any eye drops without advice from your eye care practitioner
Apply a lens if it is dirty, dusty, or damaged
Continue to wear your lenses if your eyes don't feel good, look good, or see well

Aftercare

Essential part of contact lens practice, enabling practitioner to monitor lens fit and ocular health.
Patient to attend for aftercare wearing lenses, unless there is a problem.
Bring both lens case and spectacles to aftercare appointment.
Arrange appointment.

Patient Declaration

The patient confirms they have been taught and understand how to insert, remove, and care for their contact lenses.
They have received both verbal and written instructions.
They understand that periodic (aftercare) examination is important for continued satisfaction with their contact lenses and for their ocular health.

Summary

Lens dispensing is an important appointment, often now delegated to auxiliary staff.
It's an opportunity to inform patients about the importance of lens wear and care and encourage positive behavior patterns from the outset.
It involves communication of a significant amount of information, which patients may forget.
Written instructions (legal requirement) may be supplemented with media support.