A patient comes in for a contact lens fitting. He has never worn contact lenses. You refract the patient and the manifest refraction is -2.00 in both eyes. The doctor examines the patient and asks you to go get some -2.00 contact lens trials to put on the patient. You get the lenses and put the lenses onto the patient's eyes. What is the next step in the process?
Contact Lenses
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The process for contact lens fitting is to first get a good manifest refraction and cycloplegic refraction. Once you have the manifest refraction, you are able to guess the prescription of the contact lenses. For highly myopic patients, the prescription of the contact lenses will be a little less than the manifest refraction. For instance, a -10.0 sph would need about a -9.25 sph contact lens. Once you put in a contact lens, you need to put the patient back into the phoropter and refract the patient again. This is called the over-refraction. The over-refraction checks to make sure that the patient's vision is as good as it can be. For the patient in the exam above, the patient has a manifest refraction of -3.00. You correct it with a -2.00 contact lens. This means that there is about -1.00 sph of myopia remaining. If you over-refract and find it to be a -1.00, you would add this to the -2.00 contact that is already in the eye and this would mean that you would need a -3.00 to get the best vision. Once the over-refraction is done and contact lenses are adjusted properly, the doctor can examine the fit of the contact lenses and go over lens hygiene. After this, the technician often teaches the patient how to take out and put in the contact lenses. The patient then generally trials the contact lenses for one to two weeks and follows up to make sure the lens is fitting properly. After this visit, the lenses are generally dispensed.
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