LETTER TO A PATIENT EXAMINED AND/OR FITTED FOR CONTACT LENSES
BUT WHO HAS NOT HAD MEDICALLY NECESSARY FOLLOW-UP EXAMINATION 

(Physician’s Letterhead)

(date)

Dear   (Patient):

You have requested a copy of your contact lens prescription based on an initial examination [and/or] contact lens fitting. [Or We have received a request from _____ for a copy of – or a request to verify – your prescription for contact lenses.] It is important that you understand the differences between a spectacle prescription and contact lens prescription. It is usually possible to arrive at a valid eyeglass prescription at the completion of the initial eye examination. However, the initial eye examination does not include the additional testing and diagnostic lens fitting evaluation necessary to determine an appropriate contact lens prescription. Follow-up exams are necessary because lens design modifications may be needed before I can arrive at a final contact lens prescription. 

In addition, there are eye conditions that may keep you from wearing contact lenses. These conditions may only be discovered during follow-up exams. Some of the conditions that might keep you from wearing contact lenses are: frequent eye infections; severe allergies; and dry eye (improper tear film). An ophthalmologist is the physician specialist who can diagnose and treat conditions that may prevent optimal contact lens wear.

There are also certain environmental conditions or personal practices revealed during follow-up exams that may prevent you from wearing contact lenses, such as: a work environment that is very dusty or dirty or your improper handling and care of the lenses. An important aspect of contact lens wear is learning how to properly wear the lenses and how to disinfect and clean them. Even if you have worn contact lenses before, I believe it is important for my office to evaluate or reevaluate your proper handling and care of the lenses. We can also advise you regarding the use of appropriate cosmetics. Improper use of cosmetics can lead to eye irritation as well as infection.

For the health of your eyes, I am unable to provide you with a prescription for contact lenses at this time. [Or … I am unable to provide ______ a copy of – or a verification of – your prescription for contact lenses.] After we have completed your medically necessary follow-up examination, however, I would be happy to provide you with your contact lens prescription. 

Sincerely,

						, M.D.

LETTER TO A PATIENT EXAMINED AND FITTED FOR CONTACT LENSES WHO
HAS REQUESTED A COPY OF THE PRESCRIPTION

(Physician’s Letterhead)

(date)

Dear   (Patient):

In compliance with the Fairness to Contact Lens Consumers Act, I am providing you with a copy of your contact lens prescription [Or I am providing a copy of – or verifying – your prescription for contact lenses to ____________.] Your prescription for contact lenses is based on an initial examination and contact lens fitting [and follow-up examination, if applicable]. It is important that you understand that continued follow-up exams are necessary to your eye health. Lens design modifications may be needed and it may be necessary to change your prescription.

In addition, there are eye conditions that may keep you from wearing contact lenses. These conditions may only be discovered during follow-up exams. Some of the conditions that might keep you from wearing contact lenses are: frequent eye infections; severe allergies; and dry eye (improper tear film). An ophthalmologist is the physician specialist who can diagnose and treat conditions that may prevent optimal contact lens wear.

There are also certain environmental conditions or personal practices revealed during follow-up exams that may prevent you from wearing contact lenses, such as: a work environment that is very dusty or dirty or your improper handling and care of the lenses. An important aspect of contact lens wear is learning how to properly wear the lenses and how to disinfect and clean them. Even if you have worn contact lenses before, I believe it is important for my office to evaluate or reevaluate your proper handling and care of the lenses. We can also advise you regarding the use of appropriate cosmetics. Improper use of cosmetics can lead to eye irritation as well as infection.

Please contact my office if you would like to schedule a follow-up appointment. The health of your eyes is our main concern and should be yours.

Sincerely,

						, M.D.