In addition to a full eye examination, there are a few key observations that should be undertaken prior to fitting a patient with contact lenses. Certain health issues, such as allergies, medications, sinus and other upper-respiratory tract problems, general hygiene and whether or not the patient smokes, should also be taken into consideration at this stage.
It is also essential to discuss what the patient's expectations are regarding the lenses, as these can vary widely, from the bride-to-be who wants them just for her big day, to the early presbyope who wants full-time wear but does not wish to wear glasses.
Having established the patient's requirements and expectations, the ECP should clearly explain what can be achieved, then agree an acceptable plan with the patient.
We then move on to the eye examination.
If a graticule is fitted to the slit-lamp, the Horizontal Visible Iris Diameter (HVID) should give an indication of corneal size, bearing in mind that the corneal diameter will be larger than the HVID. Palpebral aperture should be recorded as well as the position of the lower lid in relation to the cornea in primary gaze. Topography, if available and keratometry readings should also be recorded, as they are essential for rigid lens fitting and ortho-keratology (ortho-k) as they also serve as a baseline reading for future reference, even if the patient will only wear occasional daily soft lenses.
Tear quality and quantity should be assessed, along with particular observations of the lids - there are various techniques for these. A less than ideal assessment should not deter the ECP from proceeding, but the patient should be cautioned as to the possible limitations that can be achieved. A true assessment of the possible outcome can best be revealed with a lens on the eye. Many patients report being told by an ECP that they had dry eyes and were not suitable for lenses, but further questioning revealed that they had not had a contact lens fitting. After trying a lens, many went on to wear them quite successfully despite their previous diagnosis of "dry eye".