Aftercare visits for contact lens wearers are important to monitor for any complications and ensure long term successful wear. The first visit should be 2-3 weeks after initial fitting to assess vision, lens fit and comfort. Regular follow ups allow objective examination of the eye with and without lenses and monitoring for issues like dryness, deposits, corneal staining or changes in vision. Abnormal signs are managed by addressing lens fit, care or replacing lenses if needed to maintain healthy contact lens wear.

1. Aftercare and Follow-up Visits
of Contact Lens
Tariq Al Fayad. M
tariqalfayad.com 1

2.  Aftercare examinations should be undertaken
routinely on all contact lens wearers, on the
basis that ‘prevention is better
than cure’.
 The first aftercare examination should ideally
take place after 2–3 weeks.
tariqalfayad.com 2

3. Why Aftercare is important?
• CL are generally tolerated by majority of pts.,
but aftercare of cl pt. is essential to ensure
that long term success is maintained.
• Aftercare – Important
– Lens fitted initially may develop unanticipated
complications.
tariqalfayad.com 3

4. Don’t forget
• After care, should include both subjective and
objective assessment.
• Review the previous records.
• Ensure proper maintenance of records for
future use and reference.
tariqalfayad.com 4

5. Aftercare
Subjective Patients
Discussion
Objective
With CL
Visual Acuity
Slit lamp
Over Ref.
Over-
Keratometry
Without CL
Slit lamp
Keratometry
Refraction
Dry Eye Test
tariqalfayad.com 5

6. tariqalfayad.com 6

7. Patient Discussion
Start with History — Ask Questions.
Be Specific and Open.
Before Examining ensure to check the following:
– Wearing time.
– Wearing habits.
– Review the lens care system.
– Presence of problem.
tariqalfayad.com 7

8. Wearing habits and time
• How many hours during the day does one
wear lens?
• How many days during the week?
• Does one sleep with lenses on?
tariqalfayad.com 8

9. Review lens care system
• Ask patient to demonstrate.
• Ask the patient to insert and remove the lens
in front of you.
• Observe his habits and compliance then.
• Check that he does wash hands; the nails are
trimmed.
• Use solutions in proper way and steps.
tariqalfayad.com 9

10. Objective Assessment – With the CL
Visual Acuity
• Record Distance, Near VA, Monocular and
Binocular.
If the patient complains of blurred visual acuity
after some hours of wear, rule out corneal
edema.
tariqalfayad.com 10

11. Retinoscopy Over the Lenses
• Over Ref. will guide if there any difference of
power, any over correction, and residual
astigmatism.
• It also hints about the fitting (clear reflex
before and after blink – Optimal fit).
• The reflex through the lens will show deposits
and the dirty lens – Indication for lens
replacement.
tariqalfayad.com 11

12. Over- Keratometry
tariqalfayad.com 12

13. tariqalfayad.com 13

14. Slit-lamp Examination
• Examine surface integrity, deposits, lens
surface and edges.
• Review the lens fit.
– Evaluate both static and dynamic fit with RGP lens.
– In SL, lens parameters change with time, Changes
lead to steeper fittings later.
tariqalfayad.com 14

15. Lens Deposits on GP
tariqalfayad.com 15

16. Red Eye with SLs
tariqalfayad.com 16

17. Torn Lens
tariqalfayad.com 17

18. Lipid deposits on CL
tariqalfayad.com 18

19. Debris (Mucin balls under cl)
sign of poor tear film exchange or a tight fit.
tariqalfayad.com 19

20. Conjunctival haemorrhage in the eye of a SL
wearer
Note the clear avascular zone around the limbus.
tariqalfayad.com 20

21. Combination of limbal and bulbar conjunctival
redness in a RGP wearer
Possibly due to 3 and 9 o’clock staining (i.e . corneal
involvement) and conjunctival desiccation (i.e . conjunctival
involvement). tariqalfayad.com 21

22. Without Cl
Slit Lamp
• Check the corneal integrity, stain the cornea
and look for any aberrations and staining.
• Make an optical section of the slit and look for
any edema.
• Specular reflection utilized- endothelial
changes.
• Evert the upper lid now to examine the upper
tarsal conjunctiva.
• Look for CLPC.
tariqalfayad.com 22

23. Corneal Oedema
tariqalfayad.com 23

24. Small conjunctival haemorrhages observed
in a patient wearing SL.
tariqalfayad.com 24

25. (A) Rigid lens fluorescein pattern at initial lens dispensing,
showing apical clearance . (B) Same patient and lens as in
(A), seen at an aftercare visit 2 weeks later, after adapting
somewhat to lens we ar. Note that mild corneal touch is
now evident; this may have been masked by excessive
tearing during lens fitting.
tariqalfayad.com 25

26. Contact Lens Induced Papillary
Conjunctivitis
tariqalfayad.com 26

27. Keratometry
Should be repeated and recorded on follow up
visit to see if there is any effect of lens wear
on the cornea.
tariqalfayad.com 27

28. Refraction
• Do after about 30 minutes of lens removal.
• Marked changes like myopic shift or increasing
astigmatism will warn against the corneal
changes happening with the lenses.
tariqalfayad.com 28

29. Dry Eye Tests
• Dryness is the most common complaint, more
with soft lenses.
• Schirmer and BUT should be done after
removing the lenses.
tariqalfayad.com 29

30. Follow-up Visits
Aftercare schedules will be based on
– Lens type.
– Mode of wear.
– Corneal physiology.
tariqalfayad.com 30

31. For Example
DW pts should be examined during afternoon
following several hours of cl use.
EW pts should be seen in the morning so that
any overnight effects can be observed.
tariqalfayad.com 31

32. Abnormal
signs/sympto
ms on follow
up
Probable cause Actions Taken
 Discomfort
on
insertion
or sudden
onset
 Discomfort
after a
period of
wear
Foreign body
Damaged lens
Decentred lens
Conjunctival irritation from
chemical contamination
Excessive lens movement
Corneal abrasion
Lens deposition
Lens surface dehydration
Poor lens wetting
Trapped debris under lens
Toxic reaction to solution
CLPC
Remove lens, rinse and re-insert
Replace lens
Re-centre – if recurs, check lens fit
Remove lens, rinse and re-insert
 Lens inside out – correct
Cease lens wear for 24 hours and re-insert.
If symptoms recur, seek immediate advice
Replace lens – consider refit with new
material/more frequent replacement
Replace lens – consider refit with new
material/more frequent replacement
Replace lens – consider refit with new
material/modailty
Remove lens, rinse and re-insert
Change care system
 Increase lens replacement frequency
tariqalfayad.com 32

33. Discomfort
after lens
removal
Discomfort
periodically
Blurred
vision
constant
Corneal abrasion
SEAL
Corneal
inflammation/infection
Lens surface drying
Environmental factors
– smoke
– low humidity
 Lenses switched eyes
 Incorrect prescription
 Residual astigmatism
 Distorted lens
Remove lens, resolve cause
Refit lens with different design/lower
modulus
Remove lens, seek immediate
ophthalmological advice
Blinking exercises if due to incomplete blink
Consider refit with new material
Refit with moisture retentive material
Avoid these environments
 Use humidifier
Re-switch back
Refract and provide new prescription
Refit with RGP or toric soft
Replace lens
tariqalfayad.com 33

34. Blurred vision
fluctuating with
blink
– better
post-blink
– worse
post-blink
 Blurred
vision over
time, Worse
towards end
of day
 Fluctuating
vision from
day to day
Lens deposits
Excessive lens
movement/loose lens fit
Lens inside out
Lens surface drying
Lens deposits
CLPC
Environmental factors
– smoke
– low humidity
Replace lens
Refit
Correct
Clean and/or replace lens
Replace lens
Increase lens replacement frequency/if SiH
refit with lower modulus material
Refit with moisture retentive material
Avoid these environments
Use humidifier
tariqalfayad.com 34

35. Flare
(reflections,
ghost images,
diplopia)
None
Decentered lens
BOZD too small
Uncorrected or residual
astigmatism
Severe deposition
Corneal staining
Vascularization
Low to moderate grade
oedema
Refit
Refit, larger BOZD
Refit with soft toric or RGP
Replace lens
Remove lens, resolve cause
Check lens/solution compatibility
Refit with higher oxygen permeable lens
Refit with higher oxygen permeable lens
tariqalfayad.com 35

36. tariqalfayad.com 36

37. THANK YOU
tariqalfayad.com 37
For more:
Simply drop mail: mail@tariqalfayad.com
Website: https://tariqalfayad.com/blog/contact/