Following on from our consultation on our COVID-19 guidance, we have updated our advice on non-medical contact lens fitting. This can now take place during the amber phase of the pandemic.
As for all aspects of practice, if you wish to fit a patient with contact lenses you should risk assess whether and how to do this safely. In addition to scrupulous infection control procedures and the practitioner wearing appropriate PPE (see BCLA guidance on the use of gloves), we would advise that when fitting contact lenses:
- The patient should wear a face covering.
- Contact lens application and removal teaching should be done in a socially distanced way. For example by:
- The patient watching a video on application and removal, and practising in a quiet area of the practice, away from others, with the contact lens practitioner on hand to manage any difficulties such as a stuck lens.
- A transparent plastic screen being put up in the ‘teaching’ area to separate the patient from the teaching practitioner.
- Contact lens practitioners should individually assess whether they feel comfortable undertaking this procedure.
The College initially advised that the fitting of non-medical contact lenses to new patients should not take place until the ‘green’ phase of the pandemic. We have always advised that fitting of contact lenses for ‘essential purposes’, such as enabling someone to wear personal protective equipment (PPE) can take place during all phases of the pandemic.
To ensure we stay responsive to the changes in optometric practice, and the needs of our members and their patients, we held a roundtable on our COVID-19 guidance on 29 July, and consulted more widely with members and the sector between 16 and 31 July. We also constantly review evidence to inform our recommendations.
The consultation highlighted ways to mitigate risk during the contact lens application and removal teaching. This, together with recent evidence around the low risk of infection via the tear film, means that we now believe that contact lens fitting can be undertaken safely. We have asked the public health authorities for their view on whether contact lens fitting is safe to resume for non-medical reasons and are awaiting their view on this. However, in the meantime, we are removing the recommendation that new contact lens fittings – for patients who do not need them for ‘essential’ purposes – should not take place until the green phase of the pandemic. In view of the feedback from our members, we feel it is appropriate to revise our guidance on this now, rather than waiting for the whole COVID-19 guidance to be updated later this month.
The reason we initially advised against non-essential contact lens fitting during the pandemic was severalfold. Firstly it was because the contact lens practitioner would need to get closer to the patient than during a sight test, and would need to touch the patient – at least once – to insert the lenses. Secondly, the nature of the fitting and teaching process for novice wearers means that patients would need to be in the practice for longer, and return to the practice more often, than would be needed for a sight test. All of these factors would increase the time that patients and practitioners are in close contact.
Practices have now made adaptations that make such close contact safer. These include using clear plastic screens to separate practitioner and patient during application and removal teaching and using videos to help show patients how to handle their lenses.
Finally, there was concern about the risk of COVID-19 in the ocular fluids. Recent evidence has concluded that the risk of SARS-CoV-2 transmission through tears is low (Lawrenson JG and Buckley RJ, COVID-19 and the eye, Ophthalmic and Physiological Optics). It should be noted that while low, there is a potential risk that SARS-CoV-2 can be transmitted through tears, and so a thorough risk assessment must be performed and all infection control procedures scrupulously followed to minimise the risk as much as possible.
This advice is current as of 7 August 2020, but this is a rapidly changing environment and so this advice may change as new information comes to light. Practitioners should check back regularly for up to date information.