Contact Lens Aftercare Notes

Ulster University Contact Lens Aftercare

Learning Outcomes

  • A successful student will be able to:
    • Recognize the importance of CL aftercare
    • Identify the professional requirements for CL aftercare specified by the College of Optometrists
    • Outline important factors in determining timing and frequency of aftercare
    • Discuss in detail the component parts of an aftercare routine
    • Reflect on how they might seek to apply their knowledge within a clinical context

College of Optometrists Guidance for Professional Practice

  • Practitioners must arrange for aftercare for patients supplied with contact lenses, as far as and for as long as is reasonable.
  • Regularly assess the general ocular status of contact lens wearers or seek assurances that another practitioner is doing so.

Adequate Assessment for Contact Lens Wearers

  • When examining a contact lens wearer, conduct an adequate assessment:
    1. Assess wearing patterns, wearing times, and how the contact lens performs against expectations (comfort, handling).
    2. Identify any symptoms experienced while wearing contact lenses or any signs noted during wear or after contact lens removal.
    3. Record the patient’s current care system.
    4. Measure refractive status and acuities with the contact lens on, including astigmatic elements as appropriate.
    5. Assess the contact lens fit and the condition of the contact lenses themselves.
    6. Upon lens removal, examine the eye and adnexa using a slit lamp to detect any contact lens-related adverse effects, including the use of appropriate topical drugs and diagnostic agents.
    7. Include additional tests indicated by the patient's history, risk factors, or other information.
    8. Perform other tests such as keratometry, as required to identify changes from baseline.
    9. Determine the best spectacle visual acuities following contact lens removal, if appropriate.
    10. Assess the patient’s compliance with the care system and general contact lens-related hygiene, irrespective of contact lens type.
    11. Remind the patient of the importance of avoiding contact with water.
    12. Discuss clinical findings and advise the patient on the need for:
      • Regular follow-up care.
      • A contact lens assessment before the contact lens specification expires (essential for further supply of contact lenses).

Contact Lens Aftercare

  • Essential part of contact lens practice, enabling the practitioner to monitor lens fit and ocular health.
  • Ensure that patients understand the importance of ongoing and regular aftercare.
  • Good communication is essential.
  • Careful observation and detailed record keeping is a necessity.

Aftercare Timing & Frequency

  • Patient Dependent
    • First aftercare appointment for a neophyte is typically after 7-14 days.
    • Subsequent frequency of aftercare depends on:
      • Lens type, wearing schedule, individual factors
      • Daily wear patients – ideally should be examined in the afternoon, after several hours wear
      • Continuous wear patients – ideally examined as soon as possible after waking
      • Patients should attend wearing lenses, unless there is a reason not to do so
      • Should bring contact lens case and spectacles

The Aftercare Routine Elements

  • Patient Discussion
  • Visual Assessment
  • Fitting Assessment (CLs in situ)
  • Ocular Assessment ( CLs removed)
  • Supplementary Examination
  • Clinical Action
  • Final Discussion & Advice

Patient Discussion ‘Progress Report’

  • Wearing Habits
    • Frequency of wear?
    • Wearing times?
    • Is the schedule being followed?
  • Lens Handling
    • Hand washing
    • Insertion & removal
  • Lens Care
    • Are solutions being used correctly?
    • Demonstrate procedures
  • Vision
    • Any Problems
      • Are both eyes affected?
      • Duration/Constant/ Intermittent?
      • Does the problem persist after lens removal?

Visual Assessment

  • Visual Acuity with CLs
    • Monocular
    • Binocular
    • Distance & Near
  • Visual Quality
  • Over Refraction
    • +/- ve lenses

Fitting Assessment CLs in Situ

  • Slit Lamp
  • White Light Assessment
  • Fluorescein Assessment (GPs)
  • Lens Condition
  • Lens Wettability

Ocular Examination Slit Lamp, CLs Removed

  • Corneal Staining
    • Location/ Type / Extent / Depth
  • Corneal Oedema
    • Type / Extent
  • Bulbar Conjunctival or Limbal Redness
    • Conjunctival Compression
  • Neovascularization
  • Palpebral Conjunctiva
    • Lid Eversion
    • CLAPC
  • Tear Film

Supplementary Examination

  • Might include…
    • Keratometry / Topography
    • Tear Assessment
    • Lissamine Green Staining
    • Lens Condition
    • Refraction
    • Volk Lens / Ophthalmoscopy
    • As Necessary

Clinical Action Options

  • Alterations to lens power
  • Alterations to lens fitting
  • Refit with different material / lens type
  • Alterations to lens care system
  • Alterations to wearing schedule
  • Management of a specific condition or finding, for example, dry eye
  • Referral (to whom, urgency)
  • Advise patient accordingly

Final Discussion

  • Reassurance
  • Explanation
  • Education
  • Recommendations
  • Questions
  • Next Aftercare Appointment

Summary

  • Aftercare is a vitally important aspect of contact lens practice
  • Develop a full and thorough routine
  • Good communication skills are essential
  • The importance of clear and detailed record keeping cannot be overstated

Issuing CL Prescriptions

  • Opticians Act (1989) Section 25.5 & 25.7
    • Subsection 5(a) A person … who fits a contact lens to an individual must on completion of the fitting, provide the individual with a signed, written specification of each lens fitted sufficient to enable the lens to be replicated unless, having carried out the assessment….he is of the view that a contact lens is not appropriate
    • Subsection 7 a specification issued in accordance with subsection (5) above must state the period during which the specification remains valid and its expiry date

Issuing CL Prescriptions

  • College of Optometrists Professional Guidance
    • A383 When the fitting is complete, you must give the patient their contact lens specification.
    • A392 Must provide the patient with a signed, written specification of each powered contact lens once you have completed the fitting.

Issuing CL Prescriptions

  • College of Optometrists Professional Guidance A393
    • The specification must contain key information, including:
      • Patient’s name, address and DOB (if <16yrs)
      • Your name and GOC number
      • Your practice name and address
      • Date you completed the fitting
      • Sufficient details of any contact lens fitted to enable the lens to be replicated. This would normally include some or all of the following information:
        • BOZR/TD/BVP
        • Material
        • Design (including generic brand) of the contact lens(es)
      • Date the specification expires
      • Any clinical information that should be taken into account by a supplier.

Further Reading

  • Veys J, Meyler J & Davies I (2002). Essential Contact Lens Practice. Butterworth Heinemann Optician
  • Gasson A & Morris J (2010) The Contact Lens Manual 4th Edition. Chapter 28 Aftercare. Butterworth Heinemann Elsevier
  • Efron N (2024) Contact Lens Practice 4th Edition (Chapter 37 Aftercare) Elsevier
  • Efron N & Morgan PB (2017). Rethinking Contact Lens Aftercare. Clin Exp Optom;100:411-431
  • College of Optometrists Guidance for Professional Practice - Knowledge, Skills & Performance section (relating to CL fifing and supply)