Regular contact lens after-care is essential

We see many patients in our practice – especially those with keratoconus or those who have undergone corneal graft surgery – for whom contact lenses are the only means of refractive correction.  Generally, these patients have an irregular corneal shape so the improvement in vision obtained with spectacles is minimal and hence they are generally dependent on rigid contact lenses (or similar) to achieve levels of vision that allow them to manage with normal activities of daily living.

 

If a situation arises whereby contact lens wear must be stopped for an extended period due to some contact lens-related ocular complication, these patients are often in a position where they cannot work, drive, study, etc. which obviously then impacts greatly on their life.  Unfortunately, we see this scenario far too often in our practice.  The frustrating thing is that this type of problem can – in most cases – be prevented by the patient attending for contact lens follow up on a regular basis.  Routine contact lens after-care allows us to detect if the contact lenses are still an optimal fit, remembering that keratoconus is a progressive disorder and corneal grafts can also change over time.  It also enables us to confirm that there are no signs of any ocular pathology attributable to the contact lenses.  Even well-fitted contact lenses can cause problems, especially if the lenses are old and have significant protein deposition that can be antigenic to the eye and potentially cause the eye to have an inflammatory or immune reaction.  Finally, regular optometric assessment can ensure that other ocular problems that are not contact lens-related – such as corneal graft failure, glaucoma, or age-related macular degeneration – are detected at an early stage.

 

Too often patients – who have not attended for a routine contact lens after-care for many years – will call (for an urgent appointment) when they are very symptomatic.  We will always see these patients at short notice given the potentially serious nature of their ocular predicament and the very real potential that it may be sight threatening.  In most cases, the presenting problem can be managed successfully, however it usually requires refitting with new contact lenses and sometimes also instructing the patient that they must cease wearing their contact lenses for a certain period.  This latter requirement can obviously cause significant disruption to the patient’s life, especially if they are dependent on contact lenses to function normally.  It is also very annoying from my point of view as a contact lens practitioner, as this type of problem can usually be prevented if the patient – even if they are asymptomatic – returns for regular follow up on at least a yearly basis.  This applies even if the patient is asymptomatic as contact lens-related problems may not initially be associated with any signs or symptoms.