Contact lenses can be prescribed for elderly patients to correct vision and rehabilitate the cornea, but their success is often limited by age-related physiological changes like dry eye, decreased manual dexterity, and high refractive error. A thorough assessment of anatomical, refractive, corneal, tear film, lid, and visual factors is important prior to fitting to increase the likelihood of success. Specialty lenses, careful handling, and family support may help elderly patients wear contacts.

1. GERIATRIC CONTACT LENSES
OPTOM ASKAR.PK

2. • CONTACT LENSES IN THE ELDERLY PATIENT ARE OFTEN
PRESCRIBED FOR VISUAL CORRECTION AND/OR CORNEAL
REHABILITATION
• THE SUCCESS OF CONTACT LENSES IN THE GERIATRIC
PATIENT IS OFTEN LIMITED BY SUCH FACTORS AS
ABNORMAL ADNEXAL PHYSIOLOGY, DECREASED MANUAL
DEXTERITY, HIGH DEGREES OF REFRACTIVE ERROR, AND
LOW VISION.

3. • ASSESSMENT OF THESE FACTORS PRIOR TO CONTACT LENS
FITTING CAN GREATLY INCREASE THE SUCCESS OF THESE
UNIQUE CONTACT LENS APPLICATIONS.
• INDICATIONS AND CONTRAINDICATIONS FOR CONTACT
LENSES IN THE ELDERLY, THE NEED FOR SPECIAL LENS
HANDLING AND CARE BY FAMILY MEMBERS, AND AVAILABLE
SPECIALTY LENSES WILL BE DISCUSSED.

4. • BY THE AGE OF 60, OUR BODIES BEGIN TO CHANGE. IN
REGARD TO EYE ANATOMY, MANY CHANGES IN
STRUCTURE AND FUNCTION TAKE PLACE. LIDS BECOME
LAX, TEARS CHANGE IN QUALITY AND QUANTITY,
CORNEAL SENSITIVITY DECREASES, AND CHANGES IN
CORNEAL CELL FUNCTION AND STRUCTURE ALTER
CORNEAL METABOLISM. IN ADDITION, IMMUNOLOGICAL
CHANGES AFFECT THE ENTIRE BODY

5. • ALL OF THESE NATURAL CHANGES CAN MAKE
CONTACT LENS WEAR MORE CHALLENGING FOR
OLDER PATIENTS.

6. ANATOMICAL CHANGES
• REFRACTIVE CHANGES
*BEST CORRECTED ACUITY CHANGES AS WE AGE DUE TO CHANGES IN THE LENS.
TIGHT REFRACTIONS ARE ESSENTIAL FOR OLDER PATIENTS.
*A RIGID CONTACT LENS HAS THE BEST POTENTIAL TO GET THE PATIENT TO BEST
ACUITY.
*BY THE AGE OF 60, LOSS OF ACCOMMODATION CAN BE SIGNIFICANT AND
MACULAR FUNCTION MAY BE SERIOUSLY REDUCED.

7. *TRY A MULTIFOCAL DESIGN, MONOVISION IF
POSSIBLE
* THE NEED FOR INCREASED ILLUMINATION TO
HELP GET THE MOST OF THEIR ACCOMMODATION.
*COUNSEL THEM ON REALISTIC EXPECTATIONS.

8. CORNEAL CHANGES
• ALL LAYERS OF THE CORNEA GO THROUGH CHANGES AS
AGING PROGRESSES. ENDOTHELIAL CELL COUNT DECREASES
AND THE REMAINING CELLS BECOME POLYMEGETHOUS (IN-
CREASED VARIATION IN CELL SIZE) AND PLEOMORPHOUS
(INCREASED VARIATION IN CELL SHAPE)
• DECREASED CORNEAL CELL FUNCTION AND A DELAYED
HEALING RESPONSE MAY POSE A CHALLENGE FOR THIS
GROUP WITH LENS HANDLING.

9. • INSTRUCT THE PATIENT ON CAREFUL LENS INSERTION
AND RE-MOVAL TO AVOID ABRASIONS.
• LIMIT EXTENDED-WEAR EXCEPT IN THE MOST IDEAL
CANDIDATES. AGAIN, BECAUSE THE IMMUNE SYSTEM
FUNCTION DECLINES WITH AGE, MONITOR GERIATRIC
PATIENTS VIGILANTLY FOR POTENTIAL INFLAMMATORY
EVENTS AND INFECTIONS

10. TEAR FILM INSTABILITY AND DRY EYE
• CONTACT LENSES ALTER THE ABILITY OF THE LIDS TO
RESURFACE THE EYE WITH TEARS DURING A BLINK, FURTHER
DISRUPTING NORMAL TEAR FILM
• A RECENT STUDY SHOWS CORNEAL TRAUMA FROM
CONTACT LENS WEAR CAN ALTER LACRIMAL GLAND
FUNCTION, ESPECIALLY IN THE ELDERLY.
• THESE CHANGES INCREASE PRE-LENS TEAR FILM
EVAPORATION.

11. • IN THESE CASES, THE LENS FIT GENERALLY BECOMES
STEEPER AND MOVEMENT DECREASES AS THE LENS DRIES
OUT. DECREASED TEAR EXCHANGE MAY LEAD TO
MECHANICAL AND METABOLIC CHANGES TO THE
CORNEA.

12. • SILICONE HYDROGELS ARE A GOOD CHOICE FOR THESE
PATIENTS BECAUSE THEY EXCEED THOSE VALUES.
• LID HYGIENE IS OF PARAMOUNT IMPORTANCE IN THESE
CASES. THERATEARS NUTRITION FOR DRY EYE IS OFTEN
HELPFUL AND HAS A FLAXSEED OIL COMPONENT. HOWEVER,
THIS SUPPLEMENT IS CONTRAINDICATED IN PATIENTS WHO
HAVE HAD GALL BLADDER SURGERY OR A HISTORY OF
BREAST CANCER.

13. • IF THESE OPTIONS DONT WORK, CONSIDER PUNCTAL PLUGS TO INCREASE TEAR
PRODUCTION. SOME PATIENTS JUST SHOULDN’T WEAR CONTACT LENSES.
• BLEPHARITIS:ELDERLY PATIENTS ARE PARTICULARLY PRONE TO BLEPHARITIS.

14. LID LAXITY
• LIKE ALL SKIN, THE LIDS LOSE TONE AS WE GET OLDER, CAUSING AN
ALTERATION IN THEIR APPOSITION TO THE GLOBE.
• THIS DECREASES THEIR ABILITY TO SPREAD TEAR FILM EVENLY AND
COMPLETELY.
• THE MAIN LACRIMAL GLAND, MEIBOMIAN GLANDS AND ACCESSORY TEAR
GLANDS DECREASE IN FUNCTION WITH AGE AND CONTRIBUTE TO DRY EYE

15. DIFFICULTY WITH LIGHT LEVELS.
• GLARE MAY BE AN ESPECIALLY BOTHERSOME
PHENOMENON FOR GERIATRIC PATIENTS. SOFT LENSES
ARE GENERALLY THE BEST CHOICE AS THEY RARELY
CAUSE ADDED GLARE. IF YOU CHOOSE GP LENSES, URGE
THE PATIENT TO WEAR SUNGLASSES WHEN OUTSIDE.

16. LENS HANDLING
• THERE ARE IN-STANCES IN WHICH YOU MAY QUESTION A
PATIENTS ABILITY TO HANDLE THE LENS OR THEIR
PERSONAL HYGIENE DUE TO DECREASED MENTAL
FUNCTION.
• FOR EXAMPLE, ARTHRITIS MAY POSE PROBLEMS WITH
INSERTION AND REMOVAL.

17. POST-CATARACT
• HOUGH IT IS LESS COMMON TODAY, SOME PATIENTS
MAY HAVE COMPLICATIONS FROM CATARACT SURGERY
THAT CAN BE ALLEVIATED WITH A CONTACT LENS. IF
THE SURGEON WAS UNABLE TO PLACE A POSTERIOR LENS
IN THE EYE, THE PATIENT MAY BENEFIT FROM AN
APHAKIC CONTACT LENS.

18. PAY SPECIAL ATTENTION!!!
• IN ADDITION TO YOUR REGULAR CONTACT LENS WORK-UP, PAY
SPECIAL ATTENTION TO THE APPOSITION OF THE LIDS TO THE
GLOBE, THE APPEARANCE OF THE MEIBOMIAN GLAND ORIFICES
AND THE TEAR MENISCUS IN THE ELDERLY.
• CAREFULLY ASSESS THE TEAR FILM FOR QUALITY AND QUANTITY
AND RECORD TEAR BREAK-UP TIME AND ANY FLUORESCEIN
STAINING. ASSESS THE CONJUNCTIVA, BOTH BULBAR AND TARSAL,
AND THE CORNEA FOR ANY ABNORMAL FINDINGS.

19. • LASTLY, THE IRIS NEEDS TO BE EVALUATED FOR COLOR,
PROFILE AND PUPIL APPEARANCE AS WELL AS ATROPHY,
PIGMENT LOSS AND TRANSILLUMINATION DEFECTS TO
RULE OUT OCULAR PATHOLOGIES. IF ALL FINDINGS ARE
NORMAL, PROCEED TO THE DIAGNOSTIC FIT.

20. • OLDER PATIENTS PRESENT WITH UNIQUE PROBLEMS. AGAIN, THE OLDER EYE
TENDS TO BE DRIER AND LESS SENSITIVE, SO PAY SPECIAL ATTENTION TO
SUBJECTIVE COMPLAINTS ABOUT COMFORT AND VISION.
• YOUR SLIT LAMP EVALUATION NEEDS TO BE EVEN MORE RIGOROUS, TO GUARD
AGAINST EDEMATOUS CHANGE

21. • THESE PATIENTS CAN BE FITTED WITH CONTACT LENSES, OR CONTINUE TO
WEAR LENSES, AT ALMOST ANY AGE. THE KEY IS TO START OFF WITH A SOLID
PLATFORM OF EYE HEALTH, EDUCATE PATIENTS CONTINUOUSLY AND MONITOR
PROGRESS DILIGENTLY.
• THIS APPROACH WILL KEEP THEM HAPPY AND HEALTHY AND MAKE YOUR
PRACTICE MORE FULFILLING.

22. WEARING CONTACT LENSES FOR AGED
PEOPLE
• 1.DIFFICULTY OF PUTTING AND REMOVING THE
CONTACT LENSES
THERE ARE CASES THAT ELDERLY PEOPLE HAVE PROBLEMS WITH
COORDINATION OF MOVEMENT. THEN THE USE OF LENSES IS
IMPOSSIBLE.

23. 2. AGE-RELATED NEAR-SIGHTEDNESS
PRESBYOPIA IS NOT A CONTRAINDICATION FOR WEARING CONTACT LENSES. WITH
THIS VISION PROBLEM, MULTI FOCAL CONTACT LENSES ARE USED.
THESE LENSES HAVE AT ONCE THREE ZONES OF VISION: FOR DISTANCE, NEAR AND
AVERAGE REMOTENESS OF OBJECTS. CONTACT LENSES FIT PERFECTLY ON THE
EYES AND DO NOT RESTRICT FREEDOM OF MOVEMENT

24. 3.DRY EYE SYNDROME
• DRY EYE SYNDROME" IS A RELATIVE CONTRAINDICATION TO WEARING
CONTACT LENSES; IT ALL DEPENDS ON THE SEVERITY OF THIS DISEASE.
• IN MANY CASES, WITH "DRY EYE SYNDROME", LENSES CAN BE USED TOGETHER
WITH SPECIAL MOISTURIZING DROPS.

25. 4.CATARACT AND GLAUCOMA
• HOWEVER, WEARING CONTACT LENSES WITH CATARACT AND
GLAUCOMA FOR CORRECTING MYOPIA IS NOT PROHIBITED. ONE
SHOULD ONLY REMEMBER THAT THE LENSES ARE PRESCRIBED BY
THE DOCTOR, AND EACH CASE OF THESE DISEASES IS TREATED
INDIVIDUALLY. AFTER SURGERY TO ELIMINATE GLAUCOMA,
CONTACT LENS WEAR IS CONTRAINDICATED.

26. • UNEXPECTED REFRACTIVE CHANGE: ALTHOUGH CATARACT
SURGERY HAS BEEN IMPROVED THROUGH THE YEARS, PATIENTS
MAY STILL HAVE POST-SURGICAL COMPLICATIONS, SUCH AS
UNEXPECTED REFRACTIVE CHANGES.
• CONTACT LENS WEAR CAN OFTEN CORRECT THESE
COMPLICATIONS. FOR INSTANCE, CONTACT LENSES CAN HELP
CORRECT THE SYMPTOMS OF POST-SURGICAL ANISOMETROPIA,
SUCH AS ANISOKONIA AND/OR THE NEED FOR SLAB-OFF PRISM IN
THE BIFOCALS.

27. 5.PRESBYOPIA IS THE RESULT OF EYE
DETERIORATION.
• THE SOLUTION IS MULTI FOCAL OR BIFOCAL CONTACT
LENSES.
• WHETHER YOU WANT TO LOOK INTO THE DISTANCE OR
READ A NEWSPAPER, WITH MULTI FOCAL LENSES YOU
CAN SEE FAR AND NEAR SHARP.YOU CAN
HAVE DAILY OR MONTHLY LENSES BASED ON YOUR
PREFERENCE.

28. 6.CONTRAST SENSITIVITY.
• AGE-RELATED MACULAR DEGENERATION (AMD)
(ESPECIALLY IN CAUCASIANS) NOT ONLY IMPAIRS VISION
IN THE ELDERLY, BUT ALSO REDUCES CONTRAST
SENSITIVITY.
• MULTIFOCALS, WHICH FURTHER REDUCE CONTRAST,
MAY NOT BE THE BEST CHOICE, AS COMPARED WITH
SINGLE VISION CONTACT LENSES AND READERS.

29. WHICH CONTACT LENS CAN BE A SUITABLE
CHOICE FOR AN ELDERLY PATIENT?
• HYBRID CONTACT LENSES:
THIS TYPE OF LENS HAS A RIGID, GAS-PERMEABLE CENTER
SURROUNDED BY A SOFT EDGE FOR COMFORT. THEY
PROVIDE THE BENEFITS OF GAS PERMEABLE AND SOFT
LENSES IN ONE PACKAGE.

30. FITTING CONTACT LENS FOR PRESBYOPES
• PAGE NO :143 TO152
• CONTACT LENS PRIMER