The College of Optometrists

Specialist contact lenses

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Key points

  • You should inform patients who wear lenses overnight of the increased risk.
  • Check-ups should be more frequent for those patients wearing contact lenses overnight because of the increased risk of complications.

Principles of examining wearers of specialist contact lenses

When examining a wearer of specialist contact lenses you must regularly assess the general ocular status of the patient or receive assurances that another practitioner is making such assessments. 

Extended wear

If you fit a patient with contact lenses for extended wear you should: 
  1. make them aware that extended wear increases their risk of microbial keratitis
  2. teach them how to remove their lenses
  3. tell them the signs of possible complications to look out for and what to do in these circumstances
  4. ensure they attend for regular aftercare, and
  5. provide them with an out of hours contact number for emergencies and the number of the local eye casualty department.
If the patient has extended wear lenses because of their disability and is unable to handle them, you must teach their carer how to remove the lenses. 126
The frequency of contact lens check-ups depends upon factors including the patient’s:
  1. clinical status
  2. history
  3. type of lens, and
  4. modality of wear.
Because of the increased risk of complications, you should carry out contact lens check-ups for patients wearing lenses on an extended wear basis more frequently than those wearing lenses on a daily wear basis. 

Therapeutic contact lenses

Patients wearing therapeutic contact lenses may often have corneas that are compromised. In these cases you may sometimes fit the contact lenses at the request of an ophthalmologist. You should write to the ophthalmologist and to the patient’s GP, if appropriate. 


You should explain the benefits and discuss the risks with the patient, or their parents if appropriate, so the patient can make an informed decision whether to be fitted with orthokeratology lenses, and in particular cover the: 
  1. increase in risk of complications during overnight wear, and
  2. in the case of children, the further increase in risk.
You should explain to patients that infectious keratitis is a sight threatening complication of overnight wear and tell them about: 
  1. the importance of lens hygiene
  2. signs and symptoms to look out for
  3. the need for prompt medical care
  4. the importance of attending for regular aftercare, and
  5. an out of hours contact number for emergencies and the number of the local eye casualty department.
You should use an overnight trial fitting to confirm the patient’s physiological response prior to beginning the treatment. 

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