Legal Aspects of CL Practice Flashcards
What equipment is needed in CL Practice?
- Essential Equipment to allow CL Practice:
o SL (ideally with mag or at least 25x)
o Keratometer or another calibrated instrument for corneal curvature – e.g. topographer
o Infection control procedures - Recommended Equipment:
o Diagnostic lenses – appropriate range based on the lenses you provide – RGP banks are v useful
o Lens care systems – selection of solutions, artificial tears etc
o Appropriate topical drugs & diagnostic agents – fluorescein, lissamine green (becoming more popular), anaesthetic (some like for RGPs)
Who can legally fit CLs?
o Registered optoms
o Doctors
o CL optoms – ophthalmic dispensers who have undergone extra training
o Trainees under appropriate supervision (supervisor must be in one of other 3 categories & must be on the premises)
What legally needs checked before fitting CLs?
o ST within 2 years – essential for powered lenses, recommended for zero powered lenses
o Detailed H&S with info on previous wear, occupational & recreational needs, hx of allergies & systemic disease, environment lenses will be worn in
o Detailed anterior eye exam including slit lamp, corneal curvature, diagnostic stains, tear film & handling ability/hygiene
o Discuss if px is or isn’t suitable and any reason – has something flagged up? Extensive corneal staining? Corneal scar?
o Record all relevant information on record card – including negative results – e.g. cornea is clear with NaFl
What must you legally do when fitting CLs?
o Ensure the type & brand of CL & care regimen are suitable for px – not giving an EW continuous 28 days w/o a break lens to someone who has neovascularisation
o Tell px how to wear & care for the CLs safely & hygienically
o Record any information or advice you have given the patient
o Recommend a wearing schedule that is in line with manufacturer’s labelling instructions – double check the manufacturer’s guidelines to check what lens is licensed for
What must you legally tell the px how to do when fitting CLs?
o Apply & remove their CLs
o Care for (store, treat, disinfect & clean) their CLs
o Be very clear with px on schedule the wearing & replacement intervals of their CLs
When should you tell the px to seek professional advice?
o If they experience discomfort, redness, watering, visual disturbance or other problems
o Before changing to a solution which has not been recommended by you
o Before accepting a supply of substitute CLs – e.g. they buy online & lenses become out of stock – lenses cannot just be used interchangeably – differences between them that have an effect
What should the CL specification include?
- Just like w/ spec Rx, you must issue a CL specification on completion of the fitting – when the trial has concluded
- This is a must for powered lenses & advised for zero powered lenses
- Material of lens – not just hydrogel or SiHy – the actual material
- Px has right to go away & buy their lenses elsewhere
- Expiry date is down to your clinical judgement
o If px is EW – 28 nights a month – probably keep them on shorter recall – so specification may expire in 6 months
Px cannot get lenses beyond that point from anywhere
o If px wears occasional daily disposable for dinner out once a month – you may have them on 2 year recall
o If you are including a clinical review earlier than expiry date of specification then you should include both dates on the specification e.g. a dry eye review
o Advise the px that they will need to have their next aftercare before the expiry date if they want an uninterrupted supply of lenses - CL specification expiry date when you no longer want that px to be able to get lenses when they’ve not come in for a check up be clear on this – it varies px to px
What are the legal instructions around CL Supply?
- Lenses must match the specification – do not substitute
- Specification must be valid & in date
- Anything else would be considered a re-fit & the fitting principles apply – if want to do a different lens
- If you supply lenses you must make arrangements for an aftercare
- Supply an amount of lenses appropriate to the expiry date of the specification
What must legally be checked at CL check-ups?
- History:
o Assess wearing patterns, comfort & handling
o Identify any symptoms or signs they notice during or after CL wear – any redness, itching, discharge, any change in vision - Record care system (may not be what you issued)
- VA & over-refraction – monocularly & binocularly
- Assess lens fit & condition
- Assess condition of eye on lens removal with a SL & appropriate diagnostic agents (NaFl)
- Additional tests such as keratometry, meibomian gland imaging
- Spec VA if appropriate – if VA not matching what you think it should
- Compliance with care system & hygiene
- Tap water reminder – tap water & CLs do not mix
- Discuss findings & date of next visit – may be since CL specification is going to expire or because you have noted something you’d like to review
What must you legally do in CLs for overnight wear?
- Make px aware of risks of MK
- Tell them signs of complications & what to do if it happens – redness, pain, discharge – come see us straight away and bring case & lenses too
- Regular check-ups (more frequent)
- Out of hours number for emergencies/local hospital
- Still have to teach handling even if continuous wear
Describe the legal view and the College’s view on ‘buying lenses elsewhere’?
- Pxs may buy their lenses from any supplier as long as the sale is by, supervised by or under the general direction of an appropriate practitioner
- Advise pxs that prices may not include aftercare & they may have to pay for that in addition
o Overseas suppliers have no obligation to ensure ongoing care - Suggested College statement:
o “As someone who wears CLs you need continuing professional care to make sure your CLs are right for your eyes, now & in future. It is most important that you ensure that you have regular check-ups & understand what to do in event of anything going wrong with your eyes or your CLs. You should be clear whether the amount you pay includes extra consultations if you have any problems and how much they will cost if they are not included.” - Px has every right to buy lenses online and then pay you for ongoing care appointments
- You may be asked to confirm a specification
o You should request what is required in writing & only provide this if px consents. Keep a record of these requests
Watch out for frequent requests - If the other supplier wants you to verify a specification & everything they read out is correct you can say “yes” but provide no other information without consent
