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Contact Lens Clinic Guidelines

To assure proper patient care, all Clinical Faculty and student clinicians in the Contact Lens Clinic must follow Clinic regulations strictly.

General Rules

  • Students and instructors shall arrive on time and remain in Clinic during their entire assigned time.
  • Students are to come prepared with necessary equipment only.
  • Instructors and student clinicians are to maintain proper hygiene and attire, including lab coats and identification tags.
  • Eating or drinking is permitted during the lunch hour in the conference room only.
  • Examination rooms and all working areas will be maintained in a clean and orderly manner, including Patient-waiting areas.

Scheduling

  • Patients are to be seen in Clinic by appointment only, except in the case of an emergency.
  • All patient visits must be added to the computer schedule.
  • Contact lens patients are to be seen in the Contact Lens Clinic only during the hours of clinic operation.
  • Every effort will be made to schedule contact lens patients in the Contact Lens Clinic as a first choice.
  • It is in the best interest of good patient care and a proper educational experience that the student who does the examination and fitting continues to work with that patient until the patient is discharged.
  • Patients under the care of a particular student clinician will be appointed only during the student clinician’s assigned time in clinic except in the case of an emergency.

The Visit

  • An examination record is to be made for each visit. Refer to the section Contact Lens Examination for details.
  • Verify patient’s personal information, such as their name, title, and address (with correct spelling), telephone number and gender.
  • Record all aspects of visit or other dealings with patient, including treatment and advice given patients.
  • Students will not advise the Patient unless the instructor has verified that it is appropriate.
  • When asking an instructor to aid you, first summarize the case for the instructor (history, observations, diagnosis) and be clear about what you want verified.
  • The patient must receive and sign a fitting policy on the day of a new fit or refit.
  • The policy is to be scanned into the patient’s record.  A copy may be given to the patient if requested.

Inform the Patient

  • Advise all contact lens patients to bring their contact lens cases and glasses with them to progress examinations since you will be instilling fluorescein as part of the routine evaluation procedure on all patients regardless of lens type worn at each and every visit.
  • Patients will be informed that modification of rigid lenses not obtained/purchased from our clinic will be done at their own risk due to possible breakage.
  • Discuss Clinic policy, procedures, requirements, fees, and fitting policy with patient during each pre-fitting evaluation.

Record-Keeping

  • Proper record keeping is vital to our efforts to ensure operation of an effective and efficient Contact Lens Clinic. For each patient visit:
      • After all observations are made, summarize each visit in the EMR.Assessment, evaluation and diagnosis, including diagnostic codes.
      • Plan, treatment, advice, warnings.
      • Disposition (always indicate wearing schedule and when patient should be seen for next examination).
      • Any lenses dispensed to a patient, including trial lenses, should be entered in the computer in the “Contacts” tab.
      • Release a copy of the contact lens prescription to the patient when final.
  • Student clinicians must fill out a fee slip for each patient indicating the services and materials rendered.  The instructor must sign off this fee slip before checking the patient out at the front desk.
  • Each patient visit must have a corresponding entry in the patient ledger for the same day, even if it is a “no charge” or an insurance payable.
  • Each patient visit record must be signed off by the student clinician and instructor.

Contact Lens Examination

The patient will present for the appointment with a fee slip, HIPPA forms and health history forms from the Front Desk.

General

  • Verify the patient’s name, address, telephone number, birth date, gender, etc. and enter the requested information onto the Examination Record.
  • Make sure patient has read and signed the “Contact Lens Fitting Information and Policy” form prior to placing any lenses on the patient’s eyes.  Scan this form into the patient’s record.

Consultation

  • History
  • Review of patient’s record, especially the most recent examination findings.
  • Record all pertinent information in patient’s chart.
  • Do a brief screening to determine patient’s acceptability as a contact lens wearer (consult with the instructor if necessary).
  • Record the main reason and chief complaint prompting the current visit.
  • Record any other symptoms or problems in detail.
  • Note habitual contact lens wearing time and wearing time just prior to this visit.
  • Verify and record the care regimen used by the patient.
  • Record general health, eye health, injuries, medications taken and why, type of lenses worn, years of lens wear, past problems, etc.
  • Discuss lens options (advantages, disadvantages, clinic procedures, requirements, fees and refund policy) with patient.

Examination

  • Prior to any other tests, record visual acuity, OD, OS, and OU. Note if this is with contact lenses, with spectacles, or without correction.
  • After visual acuity is taken, do refraction over contact lens (if worn). Note added correction and MVA. Note binocular coordination, etc.
  • Observe the lenses on the patient’s eyes using white light. Note blinking, lens position, centration, movement, and condition.
  • Instill fluorescein if patient is an RGP lens wearer. Note bearing relationship, lens position and movement. Record all observations.
  • Before the lenses are removed, check the patient’s eyes (anterior segment) and lenses with the biomicroscope.
  • After lens removal, instill fluorescein and recheck the biomicroscopy on all patients at all visits! Record observations in detail.
  • Keratometry (note quality of mires and any distortion) or topography.
  • Do a refraction and MVA after lens removal, binocular vision evaluation, accommodation, etc.
  • Perform DFE, visual fields, tonometry, and other testing as appropriate, given time elapsed since last complete exam and current symptoms.
  • Inspect contact lenses and measure parameters for RGPs.
  • Do any other tests indicated by patient’s history and/or your observations. Remember, contact lens wearers can have problems unrelated to their contact lenses.

Verification of Lens Dimension

  • Check all measurable dimensions and record.
  • If not within tolerance, either reject outright or wait until lens is evaluated on patient’s eyes (consult with instructor).
    • Note unacceptable dimensions or other reason for rejection.
    • Prepare and print new order form.
    • Have instructor sign record and order form.

Evaluation of Lenses on Patient’s Eyes

  • Verify all RGP lenses before putting on patient’s eyes.
  • Place lenses on patient’s eyes and let settle (5-10 minutes for most lenses).
  • Record the following:
    • Parameters for all lenses placed on patient’s eyes (type-RGP or SCL, brand, B.C., diameter, OZD, power).
    • Patient’s reaction
    • V.A. with contact lenses
    • Over-refraction and maximum V.A.
    • Evaluation of lens fit (positioning, movement, bearing relationship, comfort).

Teaching Lens Care and Handling

  • Give the patient oral, written and practice instruction on lens insertion, removal and re-centering, and use of solutions. Have patient practice techniques and demonstrate competence in lens care and handling.
  • Emphasize proper hygiene, including hand washing.
  • Give and demonstrate care kit and solutions.
  • Indicate on record that patient was taught lens care and handling and what care kit and solutions were given.

Wrap-up

  • Slit lamp examination with fluorescein after insertion and removal training
  • Summary of visit must be completed before patient leaves (SOAP)

    S – Reason for visit
    O – Evaluation and diagnosis
    A – Assessment
    P – Plan, treatment

  • Record disposition and prognosis
  • Give the patient your name and clinic phone numbers, and instruct them about what to do in case of an emergency.
  • Inform the patient of their wearing schedule and have them call immediately if problems arise.
  • Accompany patient to the cash register to charge out their services and materials. Patient can be released if there are no charges. However, a no-charge ledger entry is still necessary and can be processed by the front desk without the patient.
  • Complete the computer record for the visit.
    • Record Levels of Service (examination and contact lens), Diagnoses, CL Rx, care regimen (if appropriate), and Plan.
    • The first diagnosis should be medical, non-refractive diagnoses. Consult with your instructor if in doubt.
    • Enter any contact lenses trialed in-office, ordered, or dispensed for trial, in the computer “Contacts” tab.
  • Complete the final contact lens Rx in the computer, print any orders, and obtain signatures of instructor.
  • The contact lens Rx must be released after the contact lens fitting has been completed and the patient is responding satisfactorily to the lenses. The spectacle Rx should be released.
  • To order lenses, submit the order form to the front desk.  Be sure to click either “Ship to Patient” or “Ship to Clinic” and specify if a dispense appointment is required.
  • Each patient visit record must be signed off by the student clinician and instructor.

Follow-up Care

  • Accompany patient to the Front Desk to make an appointment for their first progress examination, generally in 1-2 weeks.  Instruct the patient to wear lenses 2-3 hours prior to the appointment.
  • If the current appointment completes patient’s fitting, remind patient they should make an appointment for an examination in Contact Lens Clinic in 6 to 12 months, depending upon the type of lenses and their history.

Contact Lens Orders

  • All contact lens orders, including trials, will be entered into the computer and will include:
    • The Lab/manufacturer
    • The Patient’s name
    • The Date
    • The Lens specifications
    • Number of lenses or boxes ordered
    • Expiration date of Rx
    • “Ship to Patient” or “Ship to Clinic”
    • Whether lenses can be dispensed with or without an appointment
  • The instructor must sign the printed order.
  • The signed order is submitted to the front desk.
  • A redo for contact lenses must be entered as a new contact lens order on the computer. The reason for the redo and any specific information required by the lab must be included.
  • All product defects must be returned in the original vial or case with an exact explanation of how the lens is defective.
  • Most lenses are only covered for defective exchanges or parameter changes for a certain period of time. Re-orders should be placed promptly to avoid going past this exchange deadline. Check with the Clinic Assistant for specific information about the exchange and return policies for a specific lab or company.

What is a Contact Lens Prescription?

  • A contact lens prescription is not the same as a prescription for glasses. In addition to the optical correction of the eye, a contact lens prescription contains detailed information about the design features of the contact lenses, including the specific lens material and fitting parameters. The ultimate goal is for the contact lens wearer to see well, be comfortable and not harm his/her eyes by wearing the lenses.
  • Let us illustrate the difference between a spectacle prescription and a contact lens prescription. This is an example of a patient’s prescription for a spectacle lens:-3.00 – 1.00 x 180
  • This is an example of this same patient’s possible prescription for a rigid gas permeable contact lens:
    Type/Lab: FluoroPerm 30
    PCCR or Series: 7.46
    POZD: 7.8
    PSCR: 8.4
    PSCW: 0.4
    Blend: 9.7
    PPCR: 11.0
    PPCW: 0.3
    AOZD: 7.8
    APCR or Edge: 0.10
    Diameter: 9.2
    Thickness: 0.15
    Power: -3.25DS
    Color: Blue
  • And now an example of this same patient’s possible prescription for a soft contact lens:
    Type/Lab: Alcon Air Optix Aqua
    PCCR or Series: 8.6
    Diameter: 14.2
    Power: -3.50DS
  • These examples are not designed to overwhelm the student clinician, but merely to demonstrate that a spectacle prescription and a contact lens prescription can differ significantly. In fact, they have few, if any, similarities.
    • The important differences in a contact lens prescription can only be determined through special measurements and evaluation of the eyes for contact lenses.
    • The testing necessary to determine a contact lens prescription is not done as part of a routine eye examination. A thorough diagnostic fitting with contact lenses on the eyes and appropriate follow-up evaluations to determine that the prescribed lenses are optimal for the patient are required before a contact lens prescription can be finalized.
    • With some patients, lens design modifications may be needed before the practitioner can arrive at a final contact lens prescription.