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    Tips to become a better contact lens technician


    Extended wear follow-up

    When extended lenses are dispensed, it should be emphasized to the patient that “extended wear means extended care,” and they should be told to:

    • Instill saline or rewetting drops in each eye upon awakening

    • Ask themselves:

    • Do I look well?

    • Do I feel well?

    • Do I see well?

    • Instill saline or rewetting drops at bedtime and as needed during the day.

    Extended wear follow-up visits should be scheduled early in the day because most problems appear upon awakening. Patients should be asked whether they have experienced episodes of redness, pain, discharge, unusual light sensitivity, or blurred or foggy vision on awakening since their last visit. 

    Related: How to be a the tech your doctor can’t live without

    Turning telephone shoppers into patients

    Most telephone shoppers are looking for price, rather than quality of care. Many regard contact lenses as a commodity, rather than a medical device that requires careful fitting, thorough wear and care instruction and regular follow-up visits.

    When prospective patients inquire about price, the technician should inquire about previous lens wear, including problems with vision, comfort, and handling; satisfaction with current lenses; and whether the patient is interested in a different modality, such as lenses for astigmatism, multifocals, or daily disposables.

    The fitting skills of the doctor and the quality of care should be emphasized, as well as the many choices of lenses and care systems that would provide the optimum fit and comfort. Fees should be discussed last, with an explanation to the patient that fees vary according to lens type, prescription, and lens-wearing history.

    Recycled/unsuccessful patients

    Some practices offer a reduced fitting fee for previous contact lens wearers. While these patients may save time by not needing instructions on lens application and removal, some patients will require added doctor time due to poorly fit lenses, irregular astigmatism, dry eye syndrome, giant-cell papillary conjunctivitis (GPC), a history of corneal infections and ulcers, or a corneal dystrophy.

    Other patients may need more technician time in wear and care education because of a history of non-compliance. It is best to let the doctor determine the fitting fee after all information has been gathered.

    Not all patients are successful candidates for contact lenses. They may not achieve the level of comfort or vision that they anticipated, or they may not master lens application and removal. Some patients may have severe corneal irregularities that make them impossible to fit.

    A refund policy should be established based on material cost and time spent. Generally, fitting fees are non-refundable because a great deal of time has been spent with an unsuccessful patient.

    If diagnostic disposable lenses were used, no material costs are involved. However, if several pair of custom toric or gas permeable lenses have been ordered and tried, there are mailing costs and restocking fees to factor into the refund.

    On the other hand, think about future referrals and remember that a rigid refund policy may hurt the practice more than a small refund to an unsuccessful patient. It helps to maintain patient goodwill by applying part of the retained fitting fee to a future contact lens trial.

    Related: The technician’s role with anesthesia

    Requests for prescription release

    According to Public Law 108-164, signed into law in December 2003, contact lens fitters must provide patients with a copy of their contact lens prescriptions. The patient should receive the copy when the contact lens fitting is complete so they can obtain lenses from their supplier of choice, even if patients don’t ask for it.

    “Fitting” is described as “the process that begins after the initial eye exam and ends when a successful fit has been achieved.” In the case of renewal prescriptions, the fitting is achieved when the prescriber determines there is no change in prescription.

    If a third-party supplier requests a prescription, the prescriber must confirm its accuracy by direct communication with the seller­ or inform the seller that the prescription is not correct and provide the accurate information. A reason must be given for an invalid prescription (e.g., “expired”).

    Non-confirmation is confirmation! If the prescription is not confirmed within eight business hours, the supplier is legally permitted to fill the prescription.

    It is important for the contact lens technician to ensure that every request from a third-party supplier is confirmed in a timely manner. Non-confirmation of an expired or invalid prescription could expose the technician and/or the fitter to malpractice.

    Prescriptions are valid for a minimum of one year, except in cases in which the prescriber thinks that the ocular health of the patient is at stake such as keratoconus, giant-cell papillary conjunctivitis (GPC), recurrent infections or ulcers, and therapeutic lenses or bandage lenses.

    Short expiration dates must be supported by accurate records of medical necessity. The prescriber must include the original prescription and expiration dates and can limit the quantity of even ordinary lenses to be purchased if the expiration date is near.

    The scope of practice for contact lens technicians is extensive. On-the-job training, journals, interaction with contact lens and solution sales reps, and conferences (e.g., American Optometric Association [AOA], Southeastern Council of Optometrists [SECO], American Academy of Ophthalmology, and Vision Expo East and West) offer courses to help technicians expand their knowledge base and develop skills that will enhance their value, increase their professionalism, and turn their jobs into careers.

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    Phyllis L. Rakow, COMT, NCLM, FCLSA(H)
    Phyllis Rakow, COMT, NCLM, FCLSA(H) is a JCAHPO-certified ophthalmic medical technologist, at a large three-location group practice in ...


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