NHS Contact Lenses

Hospital Optometrist Information Series - Clinically Necessary Contact Lenses
The contents of this document were written by the Association of Optometrists Hospital Optometrists Committee Hospital Optometrists Information Series. It is not intended as a definitive statement but rather as a general guide. Although great care has been taken in the compilation and preparation of Clinically Necessary Contact Lenses to ensure accuracy, the publishers cannot in any circumstances accept responsibility for any errors or omissions.

Hospital supply of contact lenses
Individual patients of hospital eye departments / units are eligible to be supplied with contact lenses, under the NHS, where there is a clinical necessity.  Statutory NHS patient charges, exemption / remission from charges arrangements apply.  DoH guidance Click here and annual updates in optical charges should be referred to regarding current patient charges and exemption/remission from charges Click here.  The cost of providing optical devices should also be considered by NHS commissioners.

These notes are intended to assist practitioners when considering the clinical necessity.  The notes are not, however, meant to be prescriptive or exhaustive.

Clinical necessity will normally be demonstrated when a contact lens is deemed, by the reponsible ophthalmologist / hospital optometrist, as necessary to achieve best therapeutic, prosthetic or visual function.
Subject to demonstrable clinical improvement (see notes below), clinical necessity would not normally be in doubt in the following circumstances: -

  • Reduction in best corrected visual acuity secondary to
    • Marked corneal irregularities e.g. corneal scarring, significant keratoconus, keratoplasty
    • Hypermetropia of +10 Dioptre or more
    • Myopia of -15 Dioptre or more
  • Spectacle intolerance secondary to
    • Anisometropia of 5 dioptre or more.
    • Astigmatism of 5 dioptre or more
  • Albinism, aniridia, coloboma, ptosis with reportable improvement in subjective or objective visual function.
  • Therapeutic (bandage lens) applications
  • Ocular cosmetic disfigurement 
  • Facial or dermatological conditions causing spectacle intolerance

NOTES

  1. In all cases contact lenses should be prescribed to achieve maximum clinical benefit while placing the patient at minimum risk. Spectacles or other conservative management should always be considered.
  2. Except in therapeutic (bandage) or prosthetic/cosmetic indications, contact lenses should achieve an improvement in visual function compared to spectacles. There should be either a measurable improvement in visual acuity, the patient demonstrates improved visual function and/or an improvement in visual field with a contact lens compared to spectacles.
  3. Patients with unilateral corneal irregularity frequently abandon contact lens wear.
  4. Referrals for fitting CL fitting for psychological reasons should be backed up by a report from a clinical or educational psychologist or psychiatrist, and eligibility reviewed annually.
  5. Referrals for contact lenses where the patient has severely limited fusional reserves should be backed up by orthoptic and ophthalmological request following intolerance to spectacles. 
  6. Some conditions in children are likely to be amblyogenic if a child refuses to wear spectacles (or contact lenses).
  7. These guidelines are based on the limited evidence available. We would welcome a review following research into improved visual function with contact lenses for the correction of hyperopia.

 

Aftercare products

Patients must be given advice regarding the use of appropriate aftercare products. The Department of Health has issued guidelines to the effect that Hospital Trusts should ensure that provision is made for contact lens care products to be made available to all patients for whom they have prescribed clinically necessary contact lenses. Click here