This document provides information about scleral lens fitting, including:
1) Scleral lenses are large diameter rigid contact lenses that cover the entire corneal surface and rest on the sclera, providing vision correction, protecting the ocular surface, and comfort.
2) Scleral lenses come in different types depending on their bearing area on the cornea and sclera, and are used to treat conditions like keratoconus as well as postoperative complications.
3) Fitting scleral lenses requires determining clearance, and can be time-consuming due to potential refits and frequent visits, but benefits include decreased pressure on the sclera and improved comfort and stability.
SOFT CONTACT LENS FITTING
1. Alternative names of soft contact lens.
2. Need to know fitting requirement and performance requirements.
3. Centration and decentration of soft contact lens. -- There are cartesian system and binasal system.
4. what governs fitting of lens.
5. There are need to know about physical properties of soft contact lens.
6. Now, what is sag and sagital depth.
7. Finally, SAME SAG AND SAME DIAMETER but DIFFERENT DESIGN AND DIFFERENT BEHAVIOUR.
8. Parameters of soft contact lens -
total diameter
back optic zone radius
centre thickness
front optic zone radius
water content
9. There are two types of prescribing methods -
empirical prescribing
trial fit prescribing
10. Effect of a blink with soft contact lens - too flat and too steep.
11. Requirements of lens movement.
12. Lens lag position - primary gaze, up gaze and lateral gaze position.
13. Compulsory of lower lid push up test.
14. Ranges of fitting of soft contact lens - either too fit or too loose or ideal fitting.
15. All step of soft contact lens fitting is done.
Contact lens for congenital aphakia and other eye conditions for infants and toddlers. The slide presentation encompasses indications for CL fitting in paediatric, contact lens options, fitting techniques, challenges and contact lens as myopia control.
Scleral lens is a large rigid contact lens with a diameter range of 15mm to 25mm. Its resting point is beyond the
corneal borders, and are believed to be among the best vision correction options for irregular corneas. Wearing scleral lens also can postpone or even prevent surgical intervention as well as decrease the risk of corneal scarring.
SOFT CONTACT LENS FITTING
1. Alternative names of soft contact lens.
2. Need to know fitting requirement and performance requirements.
3. Centration and decentration of soft contact lens. -- There are cartesian system and binasal system.
4. what governs fitting of lens.
5. There are need to know about physical properties of soft contact lens.
6. Now, what is sag and sagital depth.
7. Finally, SAME SAG AND SAME DIAMETER but DIFFERENT DESIGN AND DIFFERENT BEHAVIOUR.
8. Parameters of soft contact lens -
total diameter
back optic zone radius
centre thickness
front optic zone radius
water content
9. There are two types of prescribing methods -
empirical prescribing
trial fit prescribing
10. Effect of a blink with soft contact lens - too flat and too steep.
11. Requirements of lens movement.
12. Lens lag position - primary gaze, up gaze and lateral gaze position.
13. Compulsory of lower lid push up test.
14. Ranges of fitting of soft contact lens - either too fit or too loose or ideal fitting.
15. All step of soft contact lens fitting is done.
Contact lens for congenital aphakia and other eye conditions for infants and toddlers. The slide presentation encompasses indications for CL fitting in paediatric, contact lens options, fitting techniques, challenges and contact lens as myopia control.
Scleral lens is a large rigid contact lens with a diameter range of 15mm to 25mm. Its resting point is beyond the
corneal borders, and are believed to be among the best vision correction options for irregular corneas. Wearing scleral lens also can postpone or even prevent surgical intervention as well as decrease the risk of corneal scarring.
Scleral contact lenses , types, uses in various ocular conditions.
An in-depth and unbiased details of these lenses as a therapeutic and also as a drug - delivery system in modern ophthalmology.
A must read for all Ophthalmologists and Optometrists.
It contains Examination Protocol for Contact Lenses along with information about pre-requisites for fitting a Contact Lens. A helpful guide for all Students, Eye Care Practitioners (Optometrist, Ophthalmologist).
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Empowering ACOs: Leveraging Quality Management Tools for MIPS and BeyondHealth Catalyst
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The dimensions of healthcare quality refer to various attributes or aspects that define the standard of healthcare services. These dimensions are used to evaluate, measure, and improve the quality of care provided to patients. A comprehensive understanding of these dimensions ensures that healthcare systems can address various aspects of patient care effectively and holistically. Dimensions of Healthcare Quality and Performance of care include the following; Appropriateness, Availability, Competence, Continuity, Effectiveness, Efficiency, Efficacy, Prevention, Respect and Care, Safety as well as Timeliness.
CHAPTER 1 SEMESTER V - ROLE OF PEADIATRIC NURSE.pdfSachin Sharma
Pediatric nurses play a vital role in the health and well-being of children. Their responsibilities are wide-ranging, and their objectives can be categorized into several key areas:
1. Direct Patient Care:
Objective: Provide comprehensive and compassionate care to infants, children, and adolescents in various healthcare settings (hospitals, clinics, etc.).
This includes tasks like:
Monitoring vital signs and physical condition.
Administering medications and treatments.
Performing procedures as directed by doctors.
Assisting with daily living activities (bathing, feeding).
Providing emotional support and pain management.
2. Health Promotion and Education:
Objective: Promote healthy behaviors and educate children, families, and communities about preventive healthcare.
This includes tasks like:
Administering vaccinations.
Providing education on nutrition, hygiene, and development.
Offering breastfeeding and childbirth support.
Counseling families on safety and injury prevention.
3. Collaboration and Advocacy:
Objective: Collaborate effectively with doctors, social workers, therapists, and other healthcare professionals to ensure coordinated care for children.
Objective: Advocate for the rights and best interests of their patients, especially when children cannot speak for themselves.
This includes tasks like:
Communicating effectively with healthcare teams.
Identifying and addressing potential risks to child welfare.
Educating families about their child's condition and treatment options.
4. Professional Development and Research:
Objective: Stay up-to-date on the latest advancements in pediatric healthcare through continuing education and research.
Objective: Contribute to improving the quality of care for children by participating in research initiatives.
This includes tasks like:
Attending workshops and conferences on pediatric nursing.
Participating in clinical trials related to child health.
Implementing evidence-based practices into their daily routines.
By fulfilling these objectives, pediatric nurses play a crucial role in ensuring the optimal health and well-being of children throughout all stages of their development.
Explore our infographic on 'Essential Metrics for Palliative Care Management' which highlights key performance indicators crucial for enhancing the quality and efficiency of palliative care services.
This visual guide breaks down important metrics across four categories: Patient-Centered Metrics, Care Efficiency Metrics, Quality of Life Metrics, and Staff Metrics. Each section is designed to help healthcare professionals monitor and improve care delivery for patients facing serious illnesses. Understand how to implement these metrics in your palliative care practices for better outcomes and higher satisfaction levels.
Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
2. SCLERAL LENS
Scleral lens also known as : Haptic lens
haptic = sense of touch
A large diameter rigid contact lens that cover the entire surface of the cornea and
rest on sclera.
Have minimum or no contact on the cornea.
The maximum diameter a scleral lens can have is 24mm.
3. TYPES OF SCLERAL LENSES
Lens type Description Definition of bearing area
Corneal Lens rests entirely on the cornea
Corneo - scleral Lens rests partly on the cornea, partly
on the sclera
Scleral Mini scleral
Lens is up to 6mm larger than HVID
Large scleral
Lens is more than 6mm than HVID
Lens rests entirely on the sclera
8. CONTRAINDICATIONS
Expensive
Large lens diameter
Difficult to fit
Fragile
Lack of expertise to fit
Complication when patient wear it overnight
9. FITTING SCLERAL LENSES
Determination of clearance values
Fitting can be time consuming
Re-makes and frequent visit
Complications
Debris in reservoir and surface issue
Patient comfort
Centration
10. SCLERAL LENS ZONES
OPTIC ZONE :
o Houses the optical system
o Base curve
o Power
o Optical toricity
o Asphericity / multifocality
o Controls sagittal depth
TRANSITIONAL ZONE :
o Controls sagittal depth/vault
o Can be reverse geometry
HAPTIC ZONE :
o Landing zone on the conjunctiva
o Supports the weight of the device
Back toric lens design
11. FITTING PRINCIPLES: TORIC PERIPHERY
Toric Peripheral Curves
o Better match natural toric nature
of the sclera.
o Better centration alignment, and
help decrease air/debris under
lens.
Assess need for toric curves
o Instil NaFL and watch it enter the
lens chamber. If happens in one
meridian, consider toric
peripheral curves
o Chamber debris
o OCT evaluation
12. BENEFITS OF BACK SURFACR TORIC
DESIGNS
Decrease localized pressure on the
sclera
Comfort
Increased wear time
Reduced debris
Rotational stability
Prevent bubble formation
Reduce flexure on the eye
13. CHALLENGES
Determination of clearance values.
Fitting can be time consuming
Re-makes and frequent visits
Complications
debris in the reservoir and surface
issues
Patient comfort
centration
14. FITTING GUIDE
LENS PREPARATION
Wash your hands
Wash and clean lenses as with GP lenses
Both plungers available
Large DMV plungers-insertion
Small DMV plunger-removal
21. INSERTION
Place on a large or medium DMV suction cup up or use the tripod method using
the thumb, index finger and middle finger to hold the lens.
Fill with non-preserved saline solution.
Instruct the patient to lower head so that the face is parallel to the floor.
Hold both upper and lower lids wide open.
Patient may hold their lower lid
22. INSERTION
Move quickly!
Squeeze the suction cup so that the lens releases onto the eye.
Have the patient close their eyes. Make sure the patient has a paper towel under
their eye to catch the overflow of saline and fluorescein during insertion.
Check for bubbles
If patient, remove the lens and reinsert again.
27. LENS REMOVAL
Small DMV suction device.
Have patient look down with his head upright and against the headrest.
Hold the patient’s upper eyelid.
Place the suction cup on the superior portion of the lens, as close to the edge as
possible.
Have the patient look up after suction is released to remove the lens off the eye.