A contact lens fitting is a multi-step process that involves many important considerations, but perhaps the most important step is the one that precedes it all; determining if your patient can or can’t wear contact lenses.
In this article, I will walk you through the process of determining who can’t wear contact lenses & who shouldn’t wear contact lenses. In Part 2, I will discuss who can wear contact lenses and who should wear contact lenses.
*Note: This article will only deal with soft contact lenses. It’s possible that some of the things I say don’t apply to rigid gas permeable (RGP) contact lenses, hybrid contact lenses or scleral contact lenses.
Who Can’t Wear Contact Lenses
These are the people who you just have to turn down if they ask you to fit them with contact lenses.
If your patient or customer has a corneal disease which would be aggravated by the use of contact lenses, DO NOT put contact lenses in their eyes.
Active Corneal or Conjunctival Infections
Most of us have had some sort of eye infection at some point in our lives. While having experienced such as thing does not disqualify someone from wearing contact lenses, if someone is currently dealing with an eye infection – whether it be conjunctival or corneal – they DO NOT put contact lenses in their eyes.
This goes for any kind of eye infection. It doesn’t matter if it’s viral, bacterial, fungal, etc.
Very High Prescriptions
Contact lenses have limits as to what strength of prescriptions they can correct. This is mostly true for astigmatism correction. If the strength of a person’s astigmatism is -5.00 or higher, or if the strength of their near/farsightedness is higher than +/-10.00D in addition to any amount of astigmatism, there are no contact lenses that can correct these types of prescriptions.
Limited Dexterity/Fine Motor Skills
Wearing contact lenses requires people to perform several specialized tasks with their hands. If a person is afflicted with a condition that makes them unable to open a contact lens blister pack, pick up a fallen contact lens, manipulate a contact lens into position on their finger, hold their eyelids while approaching their finger to their eye, or pinch a contact lens off of the eye, then they will not be able to wear contact lenses.
Of course, I’m talking about people who are living independently here. If there is a caretaker who can do this for your patient or customer, then it is possible.
And then there’s Jessica Cox so… I stand corrected.
Sometimes you just have to know when you’re outmatched by a patient or customer’s expectations. If you’re faced with someone who has moderate myopic astigmatism and advanced presbyopia, and they expect to be able to see perfectly well in contact lenses at all distances without any fluctuations in their vision, you just have to explain to them why it will not be possible.
Who Shouldn’t Wear Contact Lenses
These are the people who ideally shouldn’t be wearing contact lenses, but in certain situations, it could be permissible.
Chronic Dry Eyes
Having chronic dry eyes was once a death sentence for wearing contact lenses. For some, it will still be. The good news is that contact lens manufacturers have figured out how to make contact lenses feel really comfortable. For some, this will mean that despite their dry eyes, they may still be able to wear contact lenses from time to time.
Naturally, you may be curious about what the most comfortable contact lenses are. In my opinion, it is the DAILIES TOTAL1 brand by Alcon. No, Alcon did not pay me to write that. Some close seconds are ULTRA by Bausch + Lomb and Acuvue Oasys With HydraLuxe (not HydraClear Plus) by Johnson & Johnson.
Smoking does not mean that you cannot wear contact lenses. However, many published studies (such as this one) show that smokers who wear contact lenses are at greater risk of getting corneal ulcers compared to non-smokers who wear contact lenses.
If someone’s allergies affect their eyes and they do not have them under control, they are not going to do well with contact lenses. If you have an allergy suffering patient or customer asking for contact lenses, make sure you help them with their allergy symptoms before you even try contact lesnes.
Sometimes it is just best to stop wearing contact lenses during one’s specific allergy season.
People Who Are Immunocompromised
One of the considerations we always have to keep in mind for people wearing contact lenses is the risk of infection. Putting contact lenses in your eyes increases the risk of eye infections, end of the story. For the majority of people, the immune system can quickly quash any would-be bodily intruders. However, if the immune system is suppressed by medication or illness, the body’s defense is not as strong.
There are many ways one can become immunocompromised. I recommended this article to learn more about them.
This is a bit of a broad and vague category, but it’s a good one to be aware of. Success in wearing contact lenses depends heavily on knowing how to care for contact lenses. If you’re explaining the process of caring for contact lenses to your patient or customer and they seem wholly uninterested, that should be a red flag.
Scientific studies have shown that males encounter contact lens complications at higher rates than women, probably due to their propensity to disregard proper techniques on how to care for contact lenses.
People Asking For ‘Sleeping Contact Lenses’
If your patient or customer is asking you for contact lenses that they can sleep in (extended wear contact lenses), proceed with caution. Extended wear contact lenses exist and some people can sleep with them without problems but for most people, this type of contact lens wear is not suitable.
The contact lens brand Air Optix Aqua Night & Day was developed by Ciba Vision (now Alcon) as an extended wear contact lens brand when the idea of sleeping with contact lenses become somewhat of a craze. In that same era there were also a handful of other brands approved for overnight wear, but by and large, it didn’t work out and the industry has now given up on the idea (and so should you – probably).
Who Can and Should Wear Contact Lenses
Now that you know who cannot wear contact lenses, let’s explore the type of people who can.
If you also want to suggest who can’t wear contact lenses, please add it in the comments section below!