Tips and tricks to pass the cardiovascular station for PACES exam
Insertion and Removal of Elements Hybrid Lenses
1. Insertion
• Fill lens to the brim with
saline before insertion
• Patient’s head tipped
forward
– No need to be
completely horizontal
• Balance between
fingers or
• Tripod or
• Use DMV inserter
2. Removal
• Historically the biggest problem with
Hybrids
• Patients failed on removal instruction
• Or found they got stuck after longer hours
of wear
• Greater movement should help
• Also avoid vaulting designs for eye
rubbers or enthusiastic inserters!
3. Removal - tiddlywink
• As RGP removal
– Use upper and lower
lids to manipulate lens
out
• Good for existing GP
wearers as they use
the same technique
• Tight lids and blink
doesn’t work
4. Removal - plunger
• Use a regular RGP
sucker
• Don’t put on the
centre!
• Put on periphery of
lens
– Use to break surface
tension
– Lift up and out
5. Removal - Pinch
• Use finger pads to
pinch lens out
• NOT the same action
as soft lenses
• Very dry fingers
– Don’t insert rewetting
drops
• Small pinch at 6
o’clock
– Lift up and out
Editor's Notes
The reason for inserting with solution is to avoid bubbles
This is true for all lenses
For normal eyes no need to be horizontal but do for irreg corneas particularly UH
Lids out of the way as usual
Patient holds bottom lid, if they are active then they are better behaved
DMV inserter has bottom cut off
Can’t hold suction