- Only registered optometrists, doctors, contact lens opticians or trainees under appropriate supervision, 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 as 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 and care for their lenses.
A374
This Guidance does not change what you must do under the law.
A375
You should avoid occasional contact lens practice in specialist areas such as orthokeratology, scleral, keratoconic and therapeutic contact lens fitting.
A376
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:
- 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 on how to wear and care for contact lenses safely
- the advantages and disadvantages of available contact lens types, those that are most appropriate and the reasons for this
- any contraindicated lens types and the reasons for this
- care systems of different contact lens types and the risks of incorrect use of appropriate care systems and non-compliance with general contact lens related hygiene and replacement schedules
- total estimated costs.
A377
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 an eye examination or sight test within the past two years (or within the timescale recommended at the patient’s last eye examination or 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 eye examination or sight test), and you have the particulars of the prescription that was issued as a result137.
A378
You must conduct an adequate assessment.138 When assessing patients for contact lens wear you should:
- include any additional tests indicated by:
- symptoms
- ocular and medical history
- pre-disposing factors
- 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
- the environments in which contact lenses will be worn
- 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
- other factors, including the patient’s ability to handle and care for the contact lenses safely and hygienically
- discuss with the patient why you find them unsuitable for contact lens wear, if this is the case
- record all relevant information in the patient notes.
A379
You must not fit a patient with contact lenses if they are not able to use them safely.139
References
137 Opticians Act 1989 s25(1A) [Accessed 1 Nov 2023]138 General Optical Council (2016) Standards of Practice for Optometrists and Dispensing Opticians para 7.1 [Accessed 1 Nov 2023]
139 General Optical Council (2016) Standards of Practice for Optometrists and Dispensing Opticians para 2.5 [Accessed 1 Nov 2023]
A380
Only optometrists, doctors and contact lens opticians may fit contact lenses.140, 141
A381
When fitting contact lenses, you must:
- ensure the type and brand of contact lens and care regimen are suitable for the patient
- tell the patient how to wear and care for the contact lenses safely and hygienically
- record any information or advice you have given the patient
- recommend a wearing schedule that is in line with manufacturer’s labelling instructions.
A382
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 contact 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 This can vary, depending on:
- contact lens type and modality of wear
- how quickly the patient adapts to the contact lenses
- the likelihood of a change in the patient’s ocular health
- other clinical findings
- tell the patient if the fitting will take longer than expected and record the reasons for this on the patient record.
A383
When the fitting is complete (see paragraph A352a), you must give the patient their contact lens specification.142
A384
You should not fit yourself with contact lenses because you cannot conduct the appropriate examinations on yourself.
A385
After fitting powered or zero powered contact lenses you must explain the care, wearing, treatment, cleaning and maintenance of the contact lenses to the patient, and provide written information.143, 144
A386
You must tell the patient how to:
- apply and remove their contact lenses
- care for (store, treat, disinfect and clean) their contact lenses,
- schedule the wearing and replacement intervals of their contact lenses
A387
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
- before accepting a supply of substitute contact lenses.
References
140 Opticians Act 1989 s25(1) [Accessed 1 Nov 2023]141 General Optical Council (1985) Rules on the Fitting of Contact Lenses. SI 856 [Accessed 1 Nov 2023]
142 Opticians Act 1989 s25(5)(a) [Accessed 1 Nov 2023]
143 Opticians Act 1989 s25(5)(b) [Accessed 1 Nov 2023]
144 Council Directive 93/42/EEC concerning medical devices [1993] OJ L169/1 [Accessed 1 Nov 2023]
A388
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.
A389
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.
A390
If you refer a patient to a colleague for contact lens fitting:
- you should provide the colleague with all relevant information. See section on Working with colleagues
- the colleague will take over responsibility for that part of the patient’s care
- the patient should still receive a full eye examination at appropriate intervals, as judged by the prescribing optometrist.
The British Contact Lens Association has information for consumers on its website and a do’s and don’ts factsheet for healthy contact lens care [Accessed 1 Nov 2023]
The College of Optometrists. Higher qualifications in contact lens practice [Accessed 1 Nov 2023]
The College of Optometrists: information and guidance on myopia management [Accessed 1 Nov 2023]
The College of Optometrists and The Royal College of Ophthalmologists (2011) Rules and Regulations on Sight Testing and Contact Lens Fitting and Supply [Accessed 1 Nov 2023]
Efron N and Morgan PB (2017). Rethinking Contact Lens Aftercare. Clin Exp Optom;100:411-431 [Accessed 1 Nov 2023]
