I’m still surprised when the people I’ve tested pick up their glasses and they can see with them.  At uni, I would test someone and they would take their prescription and either be booked into a dispensing clinic or wander down the street to a multiple.  I never got to see the full journey.

I think this is why I like contact lenses so much.  There’s instant feedback.  You pop a lens in someone’s eyes and they can see.  When they get specs, we have to place the order and wait five days until the glasses turn up and, even if the patient comes in as soon as the glasses arrive, I might not be around to see them.  I like to know that something has worked straight away.  I’m impatient like that.  

One of our optical consultants asked how we choose contact lenses for our patients.  She was asking because there’s a huge range of lenses and I think she assumed we look at someone’s eyes and immediately think of a lens that will suit them.  Now, of course, there are things we think about when we are fitting: base curves, diameters, lens modality, material… lots of things which narrow down the choice of lens.  Even taking all these things into consideration, there are usually several lenses that would suit the patient but we have our favourites.  I told the OC that I usually think about all these things then just “bang a lens in and see what it does”, which, given the surprised laugh I got in reply, was probably not the answer she was expecting.

Truth be told, even if you choose the “perfect” lens for a patient based on all of the above, it doesn’t mean they will like it.  I had one patient reject lenses for being “too flimsy” – she found them difficult to handle herself so wanted to change to a “thicker lens”.  I’ve had another patient complain about the lens tint – he couldn’t see the lenses in the contact lens case so wanted to change to something with more of a tint.  I’ve also had patients express a preference for the type of toric stabilisation (one lady got on very well with a prism ballast lens but didn’t like the J&J stabilisation).

I’ve tried most of the lenses that are currently on the market (well, except the toric ones since I’ve got very small cyls).  I should probably mention that I have severe dry eye.  On a good day, I can muster a FTBUT in my right of 3s, on a bad day it’s less than 1s.  I have MGD and blepharitis.  I am the contact lens patient we all know and hate.  I’m very particular about comfort and I deposit.  My tear film is like the Thames.  

I’m currently wearing Air Optix Night and Day.  I used to wear Purevision but when I switched from one well-known multiple to my current employers, I had to change.  I love my extended wear lenses.  When I take them off, my eyes hurt so they are basically bandage lenses.  I don’t understand why people don’t like extended wear.  Yes, there is a very very small chance of microbial keratitis versus a very very very small chance with “normal” lenses.  As I’ve had great experiences with EW, I do tend to fit them quite a lot and my supervisor is the same.  

There’s also a big difference in attitudes towards children and contact lenses.  Now, in an ideal world, we would have more child friendly lenses – smaller diameters (the smallest I can think of in a soft is Alcon’s 13.8mm lenses) – and maybe some child friendly leaflets about looking after their lenses.  I’ve personally fitted 7 year olds with lenses (one of them, T, is one of my favourite patients ever).  

T came in for an eye test and had high cyls (around -3.50DC in each eye).  She really wanted to wear “normal” sunglasses and to be able to dance and do gymnastics without her glasses getting in the way.  My supervisor ordered the lenses for her to try (I think they were Proclear XRs) and I did the fit, the I&R and her subsequent aftercare.  Now these lenses were challenging.  Challenging is the nicest word for them.  They were an absolute nightmare for me to handle because of the cyls and I have quite a bit of experience with contact lenses.  Her vision with them was great and the fit was good but I was so worried about her seven year old hands trying to get these massive, drunk lenses in her little seven year old eyes.  It was at the I&R that I discovered what a determined 7 year old girl is like and she is fierce.  These silly, floppy lenses that had almost defeated me were met with steely determination and she did it.  I think this was the first under 12 I had fitted with contacts but seeing how much of a difference these made to T and seeing how careful and responsible she was in handling her lenses, I felt a bit annoyed that some optoms would see her age as a barrier rather than her maturity.  

The 11 year old boy I wrote about yesterday – the one who was in for an I&R but was struggling – came back today.  We had half an hour at the end of the day for the I&R.  When he arrived, there was a spring in his step.  “How do you feel?” I asked. “Great, I’m going to get them in and out today,” he told me.  The change between his attitude when I saw him yesterday (“I’m going to try one more time and then give up”) and today was amazing.  His confidence when handling the lenses was great.  He was a natural mimic (I take my lenses out and put them in just to show patients how I do it and also, it helps to make it look both safe and easy so they go in with a can do attitude).  Everything was great… apart from the fact his eyelids/eyelashes/hands kept getting in the way.  After 25 minutes of almost getting the lens in, I was thinking about how to say “Maybe we should wait until next year and try again” without deflating him.  Then he goes and gets one lens in.  I was so happy but we’d ran out of time (and lenses, whoops).  He’s coming back next week, after I order some more dailies in for him (between the two of us, we dropped about 8 on the floor).

So, that’s my happy ending for today.  I’m realising this blog is slowly morphing into a blog about contact lenses rather than one about pre-reg.  Oops.

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