Welcome to Question of the Day #98

Welcome to Question of the Day #98

One of my patients only has one eye that sees well. The vision in the other eye was due to untreated anisometropic amblyopia. He is 22 years old and want to wear contact lenses to correct -5.00 DS in his seeing eye for full-time wear. Should I fit him with a contact lens?

The short answer is, if he can be trusted to follow the hygiene rules then yes. Just because he has only one seeing eye does not make him more susceptible to a serious contact lens related infection than a person with two seeing eyes. It’s just that the consequences of an infection for him are more severe than for a person with two seeing eyes. If he has a serious corneal infection in his good eye and this causes corneal scarring then he will be functionally blind unless he is suitable for a corneal transplant. A person with two seeing eyes has another eye to rely on if they lose the vision in one eye.

My suggestion would be to explain the seriousness of the consequences and if the patient wants to go ahead with contact lens wear to write the possible consequences on paper and have the patient sign it agreeing that they understand the possible consequences of a serious corneal infection in their only seeing eye. Keep this note in the clinical records and give the patient a copy.

I also suggest that the patient is fitted with a daily disposable contact lens as this means that the chance of an infection from a dirty contact lens is reduced. I also suggest the lens material is silicone hydrogel for good oxygen supply to the cornea. Finally, I would advise the patient that if they have any red eye and/or discomfort to remove the lens and to come back to my practice immediately or to seek advice at an accident and emergency hospital.

People with only one seeing eye should not be disadvantaged by being prohibited from wearing a contact lens but they should be fully aware of the possible consequences and be able to make an informed choice.