These notes are intended to assist practitioners when considering the clinical necessity of supplying contact lenses in a hospital setting. However, the notes are not meant to be prescriptive or exhaustive.
Clinically necessary contact lenses
Individual patients of hospital eye departments are eligible to be supplied with contact lenses under the NHS, where there is a clinical necessity.
Statutory NHS patient charges, including arrangements for the exemption or remission of charges will apply.
The cost of providing optical devices should also be considered by NHS commissioners.
Clinical necessity will normally be demonstrated when a contact lens is deemed, by the responsible 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
- Myopia of -15 dioptre or more
- Spectacle intolerance secondary to:
- Hypermetropia of +10 dioptre or more
- 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
- 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.
- 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, with the patient demonstrating improved visual function and/or an improvement in visual field with contact lenses, when compared to spectacles.
- Patients with unilateral corneal irregularity frequently abandon contact lens wear.
- Referrals for fitting contact lenses (fitting for psychological reasons) should be backed-up by a report from a clinical or educational psychologist, or psychiatrist, and eligibility should be reviewed annually.
- 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.
- Some conditions in children are likely to be amblyogenic if a child refuses to wear spectacles (or contact lenses).
- These guidelines are based on the limited evidence available. We welcome a review following research into improved visual function with contact lenses for the correction of hyperopia.
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.
This guidance is not intended as a definitive statement but rather as a general guide.