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Contact Lens: After care visit
This document discusses the purpose and process of a contact lens aftercare visit. The goals are to maintain good lens performance, check for eye health issues caused by contact lens wear, and address any discomfort or vision problems. The visit involves taking a case history, examining the eyes with and without lenses, reviewing care and maintenance, resolving any identified problems, and providing advice or treatment. Examinations check vision, comfort, lens fit, and eye health using tools like a slit lamp. Common problems addressed include blurry vision, redness, discharge, and discomfort, which can indicate issues like improper lens power or fitting, solution toxicity, or infections. The criteria for a successful visit are meeting wearing time and comfort expectations and achieving good vision
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Contact Lens: After care visit
- 1. Contact Lens: After careVisit Rabindra Adhikary ravinems@iom.edu.np
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- 3. references • 1.Anthony J.Philips,Janet Stone ▫ Contact Lenses, 3rd edition • 2. Contact Lenses :Procedures & Techniques ▫ Gerald E. Lowther • 3.Lecture notes • 4.Internet 3
- 4. purpose • to develop& sustain good lens performance • to find out ocular pathology induced by CL • to find out post wear ocular changes by CL • to find out factors responsible for discomfort 4
- 5. contents • case history •aftercare examination • review of care & maintenance • resolution of problems • discussion of findings • Success criteria • Advise & treatment 5
- 6. approach • vary fordifferent purpose; ▫ soft contact lens ▫ RGP ▫ toric ▫ therapeutic contact lens ▫ prosthetic contact lens ▫ aphakic contact lens ▫ Cosmetic contact lens 6
- 7. based on • historyof CL use, time & limitation • symptoms analysis in regard to prevalence , duration & associated circumstances • evaluation of vision performance • examination of lens fitting • examination under slit lamp biomicroscopy • reassessment of lens parameters • non-routine tests & measurements: tear film analysis, keratometry , corneal sensitivity 7
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- 9. History taking • wearingmodality ; hrs/day, days/wk • brand of soln. used • visit ; time,date,visit number • quality of vision ,comfort, ease of handling • active listening is key element 9
- 10. History taking... • blur •redness • discharge • excessive tearing • photophobia & pain • spectacle blur • glare • diplopia 10
- 11. Ocular examination 11 • withcontact lens: ▫ visual acuity ; near + distance ▫ comfort ▫ quality of vision ▫ CL fitting evaluation ; SCL ; centration, coverage, movement RGP; static –bearing , pooling : dynamic ;centration, stability, movement ▫ blinking frequency ▫ head posture ▫ Keratometry (FSK) ▫ retinoscopy & refraction ▫ binocular vision testing
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- 13. Ocular examination... •with contact lensoff: ▫ Visual acuity ▫ Biomicroscop y ; conjunctival congestion, papillae, corneal staining ▫ tear evaluation 13
- 14. 14 Ocular examination... ▫ keratometry:change in corneal curvature:>0.50D is significant edema ▫ retinoscopy & refraction ▫ other tests : pachymetry, corneal sensitivity
- 15. 15 Ocular examination… • Evaluationof Contact Lens: ▫ deposits, surface & edge inspection; scratches ▫ parameter measurement /verification -radiuscope -focimeter V-gauge
- 16. review of care& maintenance • lens handling • solution use • hygiene • Additional instruction ; traveling , sports, taking medication 16
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- 20. Symptom analysis • blur-incorrectlens power , corneal oedema,dehydration,poor fitting • Tight lens fitting –vision clear immediately after blink & vice versa for flat lens • discomfort-damaged lens, poor edge, decentred lens, FB under lens, soln. toxicity • photophobia & pain-corneal edema, SPKs • Burning –soln. toxicity, dry eye 20
- 21. Symptom analysis... • Redness–lens irritation,while insertion & removal • Discharge-infections • flare/ghost images- decentred optic zone area, inadequate pupil coverage • distortion-faulty optical quality & residual astigmatism • Cosmetics associated 21
- 22. problem encountered• bubbles–decrease vision ,increase flare • Reading difficulty – myopes have to accommodate more • Ghost images- due to poor lens wetting & lens displacement , incomplete pupil coverage • Chronic hyperemia-expose to smoke ,wind,dust or glare 22
- 23. problem encountered… • Discoloration- absorptionof amino acid , changed tear chemistry • Tear deficiency – meibomian gland secretion obstruction , insufficient blinking • corneal infiltrates-occur in response to soln. preservative • corneal edema-becoz of hypoxia; striae,fold 23
- 24. problem encountered… • GPC-dueto material/soln allergy. -Mucus discharge, itching , giant papillae • Over wear syndrome – significant edema with PMMA ; 3 a.m.syndrome- awakens at night, severe pain • SEAL(superior epithelial actuate lesion)- due to thick SCL • Smile ( Inferior arcuate lesion) 24
- 25. problem encountered… • SLK(superiorlimbic keratitis)-mechanical irritation by edge, hypoxia, soln. Preservatives • 3 & 9 O,clock staining- hard lenses • Corneal warpage • CLARE • CLPU • MK 25
- 26. problem encountered… • Vascularisation-overwear , loss of epithelial integrity,tight lens, poorly finished edges 26
- 27. problem encountered… • Glaucoma-cornealedema • Diabetes-intolerance to contact lens wear, reduced sensitivity, recurrent epithelial erosions • Hormonal factors ; edema results during menstrual cycle , during pregnancy 27
- 28. Success criteria • Wearingtime ▫ DW: 12hr/day for 5 days or more/wk ▫ EW: 6 or more consecutive nights before an overnight removal • Comfort ▫ SCL-immediately after insertion and remain for wearing period ▫ RGP-should be comfort by 1 month • Vision := / > than spectacle acuity 28
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- 31. advice/ treatment • reassuranceof the caring system • demonstration of the handling procedures • complication -discontinuation of CL -decreasing wearing duration ▫ change in lens material; water content/ thickness/ design ▫ specific treatment for specific problem 31