Lecture 1 - Contact lens market and legality

Question 1

Choosing the First Lens (SCLs) - what measurements are required?

Answer 1

Lens design/material/modality

Total Diameter

BOZR

BVP

Question 2

How do you assess the fit of Soft contact lens?

Answer 2

Centration
Coverage
Diameter
Blink Induced Movement
Lag on Versions
Push – Up Test (Recovery)

Question 3

On COLLECTION what would you do?

Answer 3

Check the lens fit and VA
Teach application / removal
Teach which solution to use and how to use / hygiene
Give information sheets
BCLA (British Contact Lens Association) compliance form
Arrange next appointment

Question 4

What do you do on the aftercare for soft contact lens appointment?

Answer 4

Discussion
Assess fit and behaviour of lens on eye 
Over refract
Watch lens removal
Assess eye without lens (slit lamp)
Order replacement lens if required
Advise patient re outcome / changes required
Compliance check/re-education
Issue specification
Book next appointment

Question 5

What are the Anterior eye health recording: BUCCLE recommendations

Answer 5

Record grading scale used
Record to 1 decimal place
Record live (don’t try to remember grading scales)
Grade the following at every visit:
Bulbal hyperaemia
Limbal hyperaemia
Limbal neovascularisation
Palpebral conjunctival papillary redness/roughness (white light/cobalt blue)
Blepharitis
Meibomian gland dysfunction
Corneal/conjunctival staining

Question 6

Why should you not mix water and contact lenses?

Answer 6

Micro-organisms in water bind to lens surface as it provides a route in to the eye.
Bacteria e.g. Pseudomonas
Amoeba e.g. Acanthamoeba
Fungi e.g. Fusarium
Which causes Microbial keratitis which in turn could be sight threatening

Question 7

When is the most appropriate time to introduce CL?

Answer 7

most appropriate age to introduce CLs between 10 and 12 years

Question 8

What are the main misconceptions about CLs?

Answer 8

Lenses are uncomfortable
They can be worn as a replacement for spectacles
They pose no risk to ocular health
They pose a significant risk to ocular health
They can be bought over the internet so regular clinical care is unimportant

Question 9

Who can fit CLs? (governed by Opticians Act 1989)

Answer 9

Optometrists
Dispensing opticians? NO
Contact Lens Opticians (DO with CL ABDO CL qualification)
Medical practitioners
NOT those who are unregistered
Unless they are Optometry or medical students or DOs under supervision of a registered practitioner

Question 10

To fit a patient, they must have?

Answer 10

A spectacle prescription within recall date (usually 24/12) – or criminal offence. Could be either from your own clinic records or brought from another practice

Fitting must start before the date of the next recommended eye examination
Applies to powered and plano (fun) contact lenses

Question 11

Who is legally responsible?

Answer 11

As the practitioner fitting the lenses, you are legally responsible for the patient
Not the optometrist who undertook the eye examination
If an abnormality is found, you must act accordingly, even if unrelated to CLs
Investigate
Refer?
E.g. Patient mentions floaters during CL aftercare

Question 12

What must be on the Contact Lens Specification?

Answer 12

You are required to give patients a written contact lens specification within 3 months of lens fitting (Opticians Act 1989, amended 2005)
Name and address of patient
Patient DoB if under 16 years
Name and address of practice
Name, registration number and signature of practitioner
Date fitting was completed
Details for replicating lenses
Expiry date (next aftercare 6-12 months)
Any additional clinical information deemed necessary

Fitting may take > 3 months if complex
Note on records
Fitting may involve multiple practitioners the last practitioner should issue prescription
Not required but recommended for plano lenses
Medical contact lenses or ‘fun’ lenses

Question 13

Can you give out another copy of the specification?

Answer 13

If patient requests it
If still within time before next aftercare
Must have same expiry date as original
Can charge a fee

Question 14

To supply lenses…

Answer 14

The patient must have a valid CL specification

• Determined by you during fitting
• Brought from elsewhere
• Must be in date
• If you have any concerns or are suspicious, verify with the original practitioner on the phone before supplying

Question 15

Who can supply lenses?

Answer 15

It’s a criminal offence to supply CLs unless under supervision of or under general direction of medical practitioner, optometrist or registered optician
Adults can buy lenses from any supplier under the ‘direction’ of a registered practitioner
-In person, mail order, internet
Direction means professional in the management team who can ‘verify’ the contact lens specification
-In practice, professional probably never sees specification
Supplier must advise the patient how to obtain aftercare
-Emergency number
-Where to go for appointments
-When they should go and the importance of regular check-ups

Question 16

Supplying contact lenses to children

Answer 16

Will generally have adult with them
If not, and under 16, are they competent to wear contact lenses?
You can refuse to fit if otherwise

Contact lenses can only be supplied to children and visually impaired individuals under the ‘supervision’ of a registered practitioner. Must be physically present

Question 17

For Children CL - Supervision means?

Answer 17

Checking that lenses are correct and meet the CL specification which is in date
Checking that patient knows how to deal with lenses and solutions, and knows when next aftercare appointment is
Notes are made of all activity in patient records

Question 18

Plano ‘fun’ lenses

Answer 18

‘Fun’ lenses with no prescription
Do not require a CL specification to be issued
-Recommended by CoO to give CL Rx anyway
Such lenses need to be supplied under the ‘supervision’ of a registered practitioner
In practice, there is often no supervision
-Internet sites
-Costume shops
Your responsibility to report to GOC

Question 19

What if another practice wants the specification?

Answer 19

If patients go elsewhere, the new practice will want their CL specification to avoid a refit
Need consent from patient to supply this
Advisable to only supply to the patient
-In person or by post

Question 20

What if a CL supplier wants verification of the CL specification?

Answer 20

Might be an internet seller….

• Check the patient is aware of this request
• Check the patient is under the care of a registered practitioner
• Only supply the information that was on the original specification
• Answer only ‘yes’ or ‘no’ to questions, i.e. confirm the specification, do not tell them what it is
• Make a note on the record

Question 21

The GOC and contact lenses

Answer 21

Transactions outside the UK are not covered by the legislation
CL internet company moved to Holland!
The GOC are aware of illegal sellers and the loopholes with internet sales of plano lenses
No plans to take action to amend Opticians Act
Cost
Lack of government interest
Not enough people going blind!

Question 22

Protecting yourself and your patients

Answer 22

Provide the patient with all advice in writing
Keep careful records including details of
Everything undertaken during the examination
Phone conversations
Repeat issuing of CL specification
Transactions
List of all information given to the patient
Ensure your patients understand what an aftercare involves and why it is important
Charge properly for your professional time – you can’t compete with internet CL prices