“What started as a skill I was trying to perfect, has now become one of my favourite aspects of optometry”

During my third year at university, one of the modules focused on conducting contact lens assessments in face-to-face sessions with patients. This was a big change from the clinics I had experienced in my second year. Not only did we have to understand the theory, but we then had to convey our learnings in layman terms when communicating with patients. Whilst initially this was quite daunting, each patient episode every week gave me something to reflect on and paved the way for how I conduct contact lens assessment to this day.

Each patient episode every week gave me something to reflect on and paved the way for how I conduct contact lens assessment to this day

From university into practice

At university, I was particularly fascinated by the contact lens modules we completed – I found it interesting to look at a spectacle prescription and apply the rules that we were taught to establish the final contact lens prescription, which may have been quite different to the starting prescription, but would still provide our patients with the best level of vision out of their contact lenses.

Although fascinated with contact lenses, during practical sessions I quickly realised that there were also feelings of apprehension. I experienced how people responded differently to contact lenses. For example, some peers were very easy to fit, while for others it would take multiple insertion attempts. This used to make me nervous ahead of seeing a contact lens patient because I wasn’t sure how they would respond, and I worried that I might struggle to insert the contact lens. This taught me early on about the importance of remaining calm in these situations. I learned that if I could keep myself calm and collected, my patients would be at ease, and that in turn would allow for easier insertion.

During my pre-registration period, I worked in a practice with a dedicated contact lens optician. I remember asking for a second opinion on multiple occasions during that year to qualification, whether it was something as simple as checking the fit of a lens or trying to understand why a multifocal may not have been giving the outcome I was expecting.

When the contact lens optician was not working, on alternate weekends, I would cover the clinic instead. This exposure to different types of contact lens patients built my confidence.

I learnt that a lot of patients were open to the idea of trying contact lenses when prompted, and that a lot of patients were under the misconception that they wouldn’t be suitable for contact lenses due to their prescription

Contact lenses on qualification

After qualifying, I moved to a practice that was single testing most days, and that didn’t have a contact lens optician. This was very different from my experience during my pre-reg period. As a result, I was seeing less contact lens patients. But I knew I wanted to keep up the skill, so I always asked my patients about contact lenses during history taking for the sight test.

I realised that a lot of patients were open to the idea of trying contact lenses when prompted, and that a lot of patients were under the misconception that they wouldn’t be suitable for contact lenses due to their prescription.

Whilst newly-qualified and working in a practice where I was the sole practitioner, I also learnt that as with anything, good communication was paramount. Improving my communication skills enabled me to build my confidence with contact lenses as I developed a routine and managed patient expectations more effectively.

For example, when fitting multifocal contact lenses, I learnt to explain to patients at the beginning that multiple appointments may be needed, so they were aware of the timeline. I also learnt the importance of setting realistic patient expectations in contact lenses. For example, multifocal contact lenses aim to give functional vision for day-to-day tasks, but if a patient wants to spend time looking at very near tasks, then explaining that additional near vision glasses may be needed.

Today, during my history taking for contact lens fittings, I ask patients why they want to try contact lenses. The answers I am given are hugely varied, and have often sparked some of the most interesting conversations I’ve had with patients. Many of my patients will tell me they want to trial contact lenses for a holiday that’s coming up and will then proceed to tell me more about their holiday – my travel bucket list keeps getting added to after these conversations.

Fitting contact lenses also allows our patients to be seen at more regular intervals between appointments, and each appointment gives rise to the opportunity for building a rapport with our patients and to truly connect to them on a personal level, which in turn makes the day more enjoyable. Further to this, patients will often ask to see the same eye care practitioner for continuity of care, and as a newly-qualified optometrist it’s a big confidence booster when a patient reports that they specifically want to see you again.

Looking back, those early days gave me a strong foundation for contact lens practice, which I now see as a rewarding part of my work. What started as a skill I was trying to perfect, has now become one of my favourite aspects of optometry.

Pearls of wisdom

Reflecting on my experience with contact lenses since I qualified, I would encourage newly-qualified optometrists to build their confidence by keeping up to date with new contact lens technologies. In the same way we don’t have the same mobile phone for 10 years, contact lens technologies are also ever evolving, and it is worth trying new contact lenses that utilise newer technologies in order to give our patients a better contact lens experience.

I would also say, don’t shy away from the complex contact lens cases, but instead embrace them. Reflect on what went well during these appointments and learn from what could have gone better to increase and build on success with complex cases in the future.

Importantly, reach out to contact lens reps: they can be valuable sources of knowledge and support. Whether this is for understanding the toric stabilisation technique a certain manufacturer uses, or better understanding a multifocal fitting guide in order to increase the chance of fitting success.

Finally, don’t be afraid to ask for help. Learning doesn’t just stop after qualification, instead seek support when you need it, and build experience over time. Attending CPD events and workshops can be incredibly valuable in understanding how other practitioners approach different contact lens cases, particularly as this is a topic where there often isn’t a right or wrong answer.

About the author

Hatim Hassanali is an optometrist, contact lens clinic supervisor at Aston University, and Alcon professional education faculty member