The College of Optometrists

Fitting contact lenses

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Sub-sections

Key points

  • Only registered optometrists, doctors or contact lens opticians may fit contact lenses.
  • You should avoid occasional contact lens practice.
  • You should discuss options with patients to help them make informed choices.
  • You should give patients wearing powered or zero powered contact lenses the same degree of care; they are exposed to the same risks to their ocular health.
  • Patients wishing to wear powered contact lenses must have had a recent sight test (within two years, or earlier if an earlier date is specified on the patient’s prescription).
  • Patients wishing to wear zero powered contact lenses should have had a recent sight test.
  • You must record all the relevant information in the patient notes.
  • You should not fit yourself with contact lenses.
  • You must provide the patient with appropriate advice and written information to wear, clean and maintain their lenses.

Working within the limits of your professional competence

A290
You should avoid occasional contact lens practice, especially in specialist areas such as therapeutic contact lens fitting.

Advising patients before assessing and fitting

A291
Before fitting powered or zero powered (plano) contact lenses, you should discuss options with patients so they have enough information to make an informed choice. In particular, you should discuss: 
  1. the risks and complications of wearing contact lenses, including the need to avoid exposure of contact lenses to water, including tap, shower, hot tub and swimming pool water, and the consequences of not complying with advice about how to wear contact lenses safely
  2. the advantages and disadvantages of available lens types, those that are most appropriate and the reasons for this
  3. any contraindicated lens types and the reasons for this
  4. care systems of different lens types and the risks of incorrect use of appropriate care systems for contact lenses and non-compliance with general contact lens related hygiene, and
  5. total estimated costs.

Assessing patients

A292
When assessing a patient who wishes to wear zero powered contact lenses you should conduct a sight test or ensure that the patient has had a sight test within the past two years (or within the timescale recommended at the patient’s last sight test). When assessing a patient who wishes to wear powered lenses you must ensure that the patient has had a sight test within the past two years (or within the timescale recommended at the patient’s sight test), and you have the particulars of the prescription that was issued as a result.103
A293
You must conduct an adequate assessment.104 When assessing patients for contact lens wear you should:
  1. include any additional tests indicated by:
    • symptoms
    • ocular and medical history, and
    • pre-disposing factors
  2. ask for, and consider, relevant information about:
    • history of allergies, including to components of contact lenses or their care products
    • history of systemic disease
    • previous contact lens wear
    • occupational and recreational needs, and
    • environments in which lenses will be worn
  3. carry out a detailed assessment of the anterior eye which might be affected by wearing contact lenses. This should include:
    • a slit-lamp examination
    • keratometry or corneal topography
    • the use of diagnostic stains
    • the assessment of tear film quality and quantity, and
    • other factors, including the patient’s ability to handle and maintain the lenses safely and hygienically
  4. discuss with the patient why you find them unsuitable for contact lens wear, if this is the case, and
  5. record all relevant information in the patient notes.
A294
You must not fit a patient with contact lenses if they are not able to use them safely.105

The fitting process

A295
Only optometrists, doctors and contact lens opticians may fit contact lenses.106, 107 
A296
When fitting lenses you must:
  1. ensure the type and brand of lens and lens care regimen are suitable for the patient
  2. tell the patient how to wear the lenses safely and how to look after them hygienically
  3. record any information or advice you have given the patient, and
  4. recommend a wearing schedule that is in line with manufacturer’s labelling instructions.
A297
You should:
  • determine and advise on the length of the fitting period. This should be long enough for you to be satisfied that the patient has adapted to the lenses and that there is unlikely to be any change in the patient’s ocular health. This will be when you decide that the patient does not need any contact lens check-ups, other than those scheduled routinely. The fitting period will usually be less than three months, and can vary depending on:
    • lens type
    • how quickly the patient adapts to the lenses
    • the likelihood of a change in the patient’s ocular health, and
    • other clinical findings
  • tell the patient if the fitting will take longer than expected and record the reasons for this on the patient record.
A298
When the fitting is complete, you must give the patient their contact lens specification.108
A299
You should not fit yourself with contact lenses because you cannot conduct the appropriate examinations on yourself.
A300
After fitting powered or zero powered contact lenses you must explain to the patient and provide written information on the care, wearing, treatment, cleaning and maintenance of the lenses.109, 110
A301
You must tell the patient how to:
  • insert and remove their lenses
  • care, store, treat, disinfect and clean the lenses, and
  • schedule the wearing of lenses
A302
You should tell the patient to seek professional advice:
  • if they experience discomfort, redness, watering, visual disturbance or other problems
  • before changing to a solution which has not been recommended by you, or
  • before accepting a supply of substitute lenses.

References

106  Opticians Act 1989 s25(1)
107 General Optical Council (1985) Rules on the fitting of contact lenses [Accessed 27 Oct 2017]
108 Opticians Act 1989 s25(5)(a)
109 Opticians Act 1989 s25(5)(b)
110 Council Directive 93/42/EEC concerning medical devices [1993] OJ L169/1 [Accessed 27 Oct 2017]

Supervision

A303
Contact lenses may only be fitted by an optometry or medical student, or a dispensing optician training to be a contact lens optician, under the supervision of a registered optometrist, doctor or contact lens optician. The supervisor must be on the premises when the fitting is taking place, use their professional skill and judgement and intervene in the fitting if necessary. See section on Working with colleagues
A304
There is no provision in law for anyone else to fit contact lenses, even if this is done under the supervision of an optometrist, doctor or contact lens optician. 

Referral

A305
If you refer a patient for contact lens fitting:
  1. you should provide all relevant information to the colleague to whom you are referring the patient. See section on Working with colleagues
  2. the colleague will take over responsibility for that part of the patient’s care, and
  3. the patient should still receive a full eye examination at appropriate intervals as judged by the prescribing optometrist.

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