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  • You should inform patients who wear contact lenses overnight of the increased risk of complications.
  • Check-ups should be more frequent for those patients wearing contact lenses overnight because of the increased risk of complications.
This Guidance does not change what you must do under the law.
When examining a patient who wears contact lenses overnight you should assess the general ocular status of the patient or seek assurances that another practitioner is making such assessments.
If you fit a patient with contact lenses for extended wear you should: 
  1. make them aware that extended wear increases their risk of microbial keratitis
  2. tell them the signs of possible complications to look out for and what to do in these circumstances
  3. ensure they attend for regular contact lens check-ups
  4. provide them with an out-of-hours contact number for emergencies, as well as the number of the local eye casualty department.
You must teach the patient how to remove their contact lenses. If the patient has extended wear contact lenses and, because of a disability, is unable to handle them, you must teach their carer how to remove the lenses.160
The frequency of contact lens check-ups depends upon factors including the patient’s:
  1. clinical status
  2. history
  3. type of contact lens
  4. modality of wear.
Because of the increased risk of complications, you should carry out contact lens check-ups for patients wearing lenses on an extended wear basis more frequently than those wearing contact lenses on a daily wear basis.
Patients wearing therapeutic contact lenses often have corneas that are compromised. In these cases you may sometimes fit the contact lenses at the request of an ophthalmologist. You should write to the ophthalmologist and to the patient’s GP, if appropriate. 
You should explain the benefits and discuss the risks with the patient, or their parents if appropriate, so the patient can make an informed decision whether to be fitted with orthokeratology contact lenses. You should explain the increase in risk of complications associated with overnight wear.
You should explain to patients that infectious keratitis is a sight threatening complication of overnight wear and tell them about: 
  1. the importance of contact lens hygiene
  2. signs and symptoms to look out for
  3. the need for prompt medical care
  4. the importance of attending for regular aftercare
  5. an out-of-hours contact number for emergencies, as well as  the number of the local eye casualty department.
You should carry out an overnight trial fitting to confirm the patient’s physiological response before beginning the treatment.
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