pre fitting assesment

1. {
Pre-fitting Assessment
Md. Nooruz Zaman
M.Optom, FIACLE

2. 1. Patient screening
2. Preliminary examination & relevant measurements
3. Trial CL fitting
4. Final CL selection
5. Patient instructions
6. CL dispensing
7. After-care
CL Fitting: Steps

3. 1. Establish why the patient wants CLs
2. Is the patient suitable for CLs ?
3. Obtain baseline information (all aspects)
4. Advise patient of their options
Patient Screening: Aims

4. 1. Inconvenience of glasses
2. Cosmesis
3. Improved vision
4. Sports/recreation
5. Occupation
6. Vision therapy
7. Colour vision defects
8. Therapeutic purpose
Reasons for CL Wear (Ranked [Descending Order])

5. 1. Anatomical & physiological
2. Psychological- motivation
3. Pathological
4. Personal & occupational needs
5. Refractive
6. Binocular vision status
7. Manual dexterity
Patient Screening: Factors to Consider

6.  General health (including smoking)
 Family history
 Ocular health
 Medication, allergies
 Ocular history (surgery, infection, trauma, other)
 CL history (if any)
 Occupational, recreational, & environmental factors
History

7. o Type of CL (soft vs GP)
o Current CLs (Brand? If soft: HEMA, other hydrogel, or SiHy?)
o Wear regimen & replacement schedule (Recommended & actual)
o Symptoms ? Satisfaction ?
o CL care products used (even if DD CLs are in use…)
o Reasons for discontinuation(s), if any
o History of CL-related problems
o Compliance (hygiene, CL case, care solution(s), adherence to CL
replacement schedule, etc.)
CL History

8.  Suitability
 What can be expected from CLs
 any limitations relevant to the individual’s circumstances
 Wearer responsibility with respect to;
 hygiene, compliance, follow-up/after-care appointments, etc.
Patient Screening & Exam Results: Advise of…

9.  Slit-lamp examination of the anterior segment
 Measurement of ocular dimensions
 Assessment of the ocular surface, tears, & tear film
 An accurate spectacle refraction
Preliminary Examination & Measurement

10.  Horizontal Visible Iris Diameter= HVID
 Pupil diameter
 Palpebral Aperture Height/Palpebral Aperture Size (PAS)
 Lid position
 Lid tension - from +3 (very tight) to –3 (very loose)
 Blink rate & blink completeness
Anatomical Measurements

11. LID POSITIONS

12.  Diagnostic (trial) CL fitting
 Final CL order
Trial Fitting: Routine

13.  CL trial sets
 CL care solutions
 Slit-lamp
Trial Fitting: Requirements

14.  Ocular vital dyes/stains (Sodium fluorescein, cobalt
blue exciter filter, & yellow barrier filter)
 Documentation (pro forma records: printed,
electronic)
 photo documentation system?

16. o Back optic zone radius
(BOZR)
o Total diameter (TD)
o Centre thickness (tC)
o Water content
o Oxygen transmission (Dk/t)
Trial Fitting: CL Selection
• CL design
• CL type
• CL material
• Back vertex powers
(BVPs)
• CL surface properties

17.  Initial CL selection – based upon baseline measurements
 Trial CL fitting & vision assessment
 Over-refraction, if needed
 Subsequent trial CL selection if initial choice proves
unsatisfactory
Trial Fitting: Procedure

18. Trial Fitting: Desired GP CL Fit

19. Trial Fitting: Desired SCL Fit

20. 1. CL parameters
2. CL material & type
3. Special requirements
4. Delivery date required
Trial Fitting: Final CL Order - Specifications

21. o Inform patient of the CL type selected & why
o Inform patient about the CL care regimen to be implemented
o Provide either manufacturer’s literature, in-house developed
instructional material, or both – preferably illustrated profusely
o Direct them to on-line sources of reliable information including
the practice’s own website
o At time of dispensing, they will be primed for further
instructions
Patient Instructions: Providing Background
Information

22. o  CL care regimen information
o Practice insertion & removal techniques
o  information on adaptation
o  information on signs of complications
o Educate on hygiene & compliance with CL wearing schedule
o After-care visit schedule advice
o Provide a summary just before departure from the practice
CL Dispensing

23.  Investigate complaints
 Perform a general ocular examination:
 over-Rx
 slit-lamp biomicroscopy
 other tests relevant to the particular patient
 Assess CL fit
 Review hygiene (hands, CL case, CL handling environment, etc.)
 Review compliance (care, wearing schedule, replacement)
 Schedule next after-care visit
After-care

24.  Low spectacle Cyl Sph SCL
 Spec. Cyl = K Cyl Sph GP or toric SCL
 Irregular K Sph GP
 Medium - high Rx Sph GP
 High Rx Sph SCL
 Internal Cyl Toric SCL
 High K Cyl Bitoric GP
 High VA/High O2 GP
Choice of CL Type

25.  High Rx High water
 Dry eye/dryness Low water/thick tc*
 Dryness + high Rx Low water/thin tc
 Incomplete blink Low water/mid tc
 Toric + high Rx High water
 Low Rx Low water/thin tc
SCLs: Suggestions – Water Content & tC

26.  High Rx Non-ionic
 Dry eye, dryness Non-ionic
 Allergy Non-ionic
 Incomplete blink Non-ionic
 Toric + high Rx Ionic or non
 Low Rx Ionic or non
SCLs: Ionicity

27. • Part-time wearer
• Special parameters
• GP CLs
• Special tint required
Replacement Schedules
• Part-time
• Compliant
• Full or part-time CL wear
• Dry eye
• Poor compliance
• Part/full-time wear
• Non-compliant
• Avoids proper CL care
• Dry eye
Conventional CLs 2 - 4 Week Disposable CLs
3 - 6 month FRP 1 day

28. Write importance of each
steps of your case sheet?
Assignment

29. Use your creativity
1. Write do’s and don’t about Contact lens use. (1-5)
2. Advantages and disadvantages of Contact lens. (6-10)
3. Advantages and disadvantages of spectacle. (7-15)
4. Advantages of soft contact lens. (8-20)
5. Advantages of RGP lens (21-25)
6. Prepare a working model Optokinetic drum (26-30)
7. Prepare a working model of placido disc (31-35)

30. Practical Ahead..