Factsheets Getting Contact Lenses for People with Learning Disabilities

Introduction

This factsheet considers the support people with learning difficulties may need when having contact lenses prescribed. This factsheet will also provide general advice about contact lenses for people who may have keratoconus.

A second factsheet Wearing Contact Lenses For People with Learning Disabilities will consider issues regular contact lens wearers need to know consider such as hygiene and safety.

The wearing of contact lenses requires people to have good manual dexterity and an understanding of routines, personal hygiene and problem solving.  People may need to develop a tolerance of wearing lenses as it may be uncomfortable and unsettling at first.

If a person with learning disabilities is unable to insert or take out their own contact lenses then consideration should be given to the amount of support that will be required from others.

However, people with keratoconus do receive significant benefit from contact lenses in a way that cannot be achieved with spectacles.  We would recommend personalised contact lens guidelines as agreed with your specialist hospital eye clinic (usually Moorfields Eye Hospital, London) and procedures being developed on behalf of people with keratoconus and learning disabilities and their carers and supporters.

People with Keratoconus

Keratoconus is an eye condition that happens when the normally round cornea (the front part of the eye) becomes thin and cone shaped.  The cone shaped cornea prevents the light entering the eye from being focused correctly on the retina and causes distortion of vision.

A contact lens for someone with keratoconus is designed so that the front curve of the lens is spherical (round) and smooth, similar to the shape of the 'normal' cornea, thus causing less distortion.  The inside of the contact lens corrects the shape of the cone-like cornea.

It may be advisable for people with keratoconus to attend a hospital eye clinic because fitting lenses may be difficult due to the unusual shape of the eye.

Contact lenses will also help people with Kerataconus who also have refractive errors such as short sightedness, long sightedness and astigmatism.

People with Refractive errors

Refractive Errors refer to when the eye cannot focus clearly on objects due to the shape of the eye ball and the way light reaches the back of the eye. It describes conditions such as long sight (hypometropia), short sight (myopia), astigmatism. People with refractive errors are helped by spectacles and contact lenses.

Types of Lenses

Soft lenses

• These are the most common form of contact lenses. They are available as:
  • Periodic wear lenses. These can be worn usually for a period of a month, require cleaning each night and need replacing after a month.
  • Daily wear lenses. These are worn each day and then disposed of each day after use.
• Soft lenses are more comfortable to begin with than hard lenses.  This means that people may find it easier to build up wearing time quickly.
• However, soft lenses may be more difficult to hold and insert into the eye than hard lenses. Soft lenses carry a greater risk of infection.
• Carers often find them easier to fit to other people’s eyes because the carer can slip the lens under the upper eyelid when inserting it - rather than trying to place the lens centrally on the cornea.

Gas permeable/hard lenses

• These correct the shape of the corneal surface, improving the vision.  They are usually the lenses most appropriate for people with keratoconus.

Combination lenses

• This is a term used to describe different combinations of lens material. 
• If a person is prescribed combination lenses it is important to seek more information about what types of material is being used in the lens and why.

Tinted lenses

• Most contact lenses can be produced with a slight tint to them so that they are easier to see by the person using them. 
• A tinted lens is intended to make it easier to see, they do not colour the sight of the person wearing them

Scleral lenses 

• A scleral lens is large and covers the entire white visible part of the eye (sclera).  With advanced keratoconus, the cone is steep and it would be difficult to keep a corneal lens in place.  But a scleral lens can rest on the sclera and covers the cornea. 
• Scleral lenses are surprisingly easy to insert, despite their size.  The disadvantage is the time and skill required by the optometrist in getting them to fit. 

Who will decide what sort of contact lens is needed?

The optometrist or dispensing optician will advise on the most appropriate type of lens for the individual.

Paying for contact lenses

It is important to enquire if the person will have to pay.  For people with Keratoconus, the person's prescription would be for "complex lenses".  People can use a GOS sight test voucher (if they are entitled) to help with the cost of contact lenses.

Trying out lenses

Some people with learning disabilities may find their first experience of having a contact lens fitted an unsettling experience. We advise pre-planning and sharing of information about lens fitting before considering contact lenses.

• Lenses are discussed at the end of an NHS eye examination. If the person requests or require contact lenses they will have a lens fitting session.
• When people initially have lenses fitted it will be uncomfortable and eyes may weep. People will be expected to stay in a waiting room for around half an hour before being seen again.
• The optometrist will then assess how well the lens fits, using a Fluorescein ophthalmic strip (which looks like a big matchstick). 
• The optometrist touches the white of the eye with the moistened strip, which contains an orange dye. 
• Using the Fluorescein strip allows the optometrist to examine the eye.
• They can then decide if a lens should be ordered for the person, and the type of lens that will be suitable.

Inserting and removing

Whether at the hospital or the clinic people will usually be given a teaching session which covers insertion and removal of the lens and all aspects of handling lenses and cleaning.

• The session will emphasise that lenses must be handled only with clean hands and fingernails.  Poor hand hygiene can cause serious eye infections. 

The eye care professional will:

• Tell the person how to hold his/her eye open to insert the lens while looking into a mirror.
• Pass on helpful tips and advice. 
• Be used to working with people who doubt if they will ever manage to cope with lenses!
• Discuss inserting the contact lenses with a supporter, as well as the wearer, especially if the person is always going to need supervision or help.
• Tell supporters and carers that it is easier initially to insert a lens in someone else's eye than one’s own eye.

Remember

• Removing a lens is more difficult than inserting one. 
• Sometimes it is easier to hold a contact lens on a special suction holder for insertion and removal.
• A tinted lens may be easier for a person with poor sight to see when it is placed on a flat white background, such as a hand towel.
• The eye care professional cannot allow the patient to leave the teaching session unless the patient and/or their supporter can safely remove a lens.

 June 2009

Related Information:

The Need for an Eye Examination

Eye Drops for People with Learning Disabilities

Keratoconus

Treatments and Interventions for Keratoconus 2

Treatments and Interventions for Keratoconus 3

Wearing Contact Lenses for People with Learning Disabilities