What should be done first if a rigid gas permeable wearer complains of poor visual acuity?

When a rigid gas permeable (RGP) lens wearer reports poor visual acuity, the initial step should be to perform an over-refraction. This process involves examining the patient's vision while they are wearing their current lenses and determining if any additional prescription adjustments can enhance their vision. This is essential because it allows the practitioner to assess whether the issue lies with the lens fit or the prescription itself.

Performing an over-refraction helps to identify if the current lenses are still appropriate for the patient's needs or if there has been a change in their refractive error that needs to be corrected. It also provides immediate feedback to the practitioner regarding the effectiveness of the current optical correction.

Choosing to change the lens fit or switch to a soft lens may be considerations following the over-refraction, but these actions are not the first steps without first confirming the visual acuity with a refraction test. Consulting a specialist might be necessary if there are underlying issues beyond simple prescription changes or if the visual acuity does not improve with over-refraction, but that comes after the initial evaluation. Thus, beginning with an over-refraction is the most logical and effective approach in this situation.