contact lens care
Getting the Most Out of the Contact Lens Dispensing Visit
BY SUSAN J. GROMACKI, OD, MS, FAAO

I received my first pair of contact lenses 20 years ago, and although my optometrist has long since retired, I still remember the dispensing visit like it was yesterday. And I can't forget the bulky care package filled with vials of contact lenses, daily cleaner, a large heat disinfection unit, saline, rewetting drops and contact lens case -- with instructions for all of them. Today, even with simplified care systems, the contact lens dispensing visit is just as important as ever.

Dispensing Visit Realities

The dispensing visit sets the tone for a patient's lifetime of lens care. For many, it's the first time wearing, handling and caring for a contact lens, so it's a chance for us to work with a "clean slate."

It's important that the staff member performing the dispensing visit is knowledgeable and conveys the seriousness of good contact lens care. As I wrote in my October 2004 column, a good contact lens tech is vital to a practice's success. And the dispensing visit is one of his most important areas of contribution. The purpose of the dispensing visit is to train patients on applying and removing lenses, review lens care and educate them in all areas.

Application and Removal Pearls

When training a patient to apply and remove his lenses, first demonstrate proper lens application, removal, recentering and handling (including inversion determination). Then ascertain that he exhibits proficiency (successful application and removal at least once and recentering of a GP lens) before allowing him to leave with the lenses. (This is important so that the patient doesn't injure himself at home with poor technique.) It's also vital that the patient can efficiently remove his lenses in the event of a foreign body, injury or contaminant.

Lens Care

Provide the patient with a sample of the solution that you're prescribing because doing so increases compliance. (Unfortunately, some manufacturers have discontinued sampling certain solutions.) It's helpful to physically demonstrate how to clean, disinfect and store the lenses with the actual solutions and case.

We still recommend rubbing the lenses just after removal "even though the box says no rub." Good rinsing removes the loosened deposits and debris (as well as the daily cleaner, if used). Review with the patient the care instructions printed on the solution's box or insert. Explain that not all lens care solutions are alike and that generic brands are often older formulations of the name brands and, as a result, may result in increased sensitivity reactions or decreased comfort. Instruct the patient not to deviate from the brand you prescribed unless he receives your approval. Lastly, instruct the patient to discard the disinfecting solution after every use and to properly clean the contact lens case.

Turn Out Educated Patients

It's important to present the contact lens as a medical device and not a commodity. Discuss good hygiene (hand washing before application and removal with fragrance-free and lotion-free soaps) and do's and don'ts (no long fingernails, no tap water, no swimming or showering while wearing lenses, etc. and, if contraindicated, no sleeping in the lenses). Explain normal and abnormal adaptive symptoms and those that necessitate lens removal and/or an immediate return to the office.

Provide handouts with graphics (many patients learn better via written material) but don't overload the patient with too much information. Lastly, provide an opportunity to review any of these items at the first follow-up visit.

Dr. Gromacki is in group practice in Burke, Virginia, and has served as a faculty member  at the University of Michigan Department of Ophthalmology and Visual Sciences.