OPT506 - L05 - Introduction to Contact Lens and History and Symptoms 2024-25 PDF

Baseline measurements & Keratometry feedback Remember:  Be eye level with your patient  Align canthus  Adjust Px for comfort  Lights off when performing Ks  Keep hand on the joystick  Meridians may not be at 180 and 90 deg  Record Hz meridian first then vertical Curvature and...

Baseline measurements & Keratometry feedback Remember:  Be eye level with your patient  Align canthus  Adjust Px for comfort  Lights off when performing Ks  Keep hand on the joystick  Meridians may not be at 180 and 90 deg  Record Hz meridian first then vertical Curvature and Curvature achieved but Curvature and meridian not achieved meridian not achieved meridian achieved Baseline measurements & Keratometry feedback Not measuring central Too far left Too far right of cornea Introduction to Contact Lens and History & Symptoms Dr. Asma Zahidi Lecture Outline - Introduction to Contact Lens Brief history of contact lens Types of Contact Lens Benefits of Contact Lens Advantages of SCL and RGP Contact Lens Parameters Fitting Contact Lens Contact Lens Fitting Routine A brief history of contact lenses Leonardo da Vinci’s idea to alter corneal power Fluid-filled tube described by Eye cup design of Thomas ‘Animal jelly’ sandwiched Rene Descartes Young between spherical capsule of glass and cornea Evolution of contact lenses Anti- Glass Plastic Silicone- Contact Soft Disposabl allergy scleral corneal hydrogel lens flat lenses e lenses contact lenses lenses lenses pack (1972) (1988) lens (1888) (1948) (1998) (2011) (2021) 1890 1900 1930 1940 1950 1960 1970 1980 1990 2000 2010 2020 Plastic Silicone Rigid Gas- Daily Myopia Photochro- scleral Elastomer Permeable disposable control mic contact lenses lenses lenses lenses lenses lenses (1936) (1965) (1974) (1994) (2010) (2019) Types of contact lenses Soft hydrogel lens Silicone hydrogel (SiHi) Material RGP PMMA Hybrid Daily Disposable Replacement Biweekly disposable schedule Monthly disposable Planned replacement Prosthetic lenses Therapeutic lenses Function Scleral lens Special effect 8  No edge blurring Natural perception Better vision What are the benefits of CL No compared to Larger field weight/pressure glasses? of view on nose Cosmetic No fogging of lens 9 What are the benefits of wearing contact lens? Advantages of SCL and RGP Soft lenses RGP Spontaneously acceptable Stable optical imaging (no shrinkage, Continuous wear up to 4 weeks stable wettability) Color change of the eyes possible Healthier lens wear for a long time possible (long-term compatibility) Disposable lenses: no care necessary Excellent for high or irregular astigmatism Lens wear during the night - no correction needed during the day(Ortho-K) Contact lens fitting – Lens parameters Edge thickness Base curve (SCL) Central thickness BOZR (RGP) (tc) Contact lens fitting – Lens parameters Contact lens fitting – Lens parameters Material Oxygen transmissibility (Dk) Water content (%) Power  Spherical  Toric (Cyl & Axis)  Multifocal Lens Design  Tricurve  Bicurve  Aspheric  Toric  Multifocal ACLM Year book ACLM Year book ACLM Year Book Daily disposables BC : 8.4 TD : 14.0 Material: Silicone Hydrogel Fitting contact lenses Key points Only registered optometrists, doctors or contact lens opticians may fit contact lenses. You should avoid occasional contact lens practice. A290 You should avoid occasional contact lens practice, especially in specialist areas such as therapeutic contact lens fitting. You should discuss options with patients to help them make informed choices. You should give patients wearing powered or zero powered contact lenses the same degree of care; they are exposed to the same risks to their ocular health. Patients wishing to wear powered contact lenses must have had a recent sight test (within two years, or earlier if an earlier date is specified on the patient’s prescription). Fitting contact lenses Key points Patients wishing to wear zero powered contact lenses should have had a recent sight test. You must record all the relevant information in the patient notes. You should not fit yourself with contact lenses. You must provide the patient with appropriate advice and written information to wear, clean and maintain their lenses. 19 Contact lens fitting – routine  Information you need for lens selection History & symptoms Baseline measurements Keratometry Anterior eye assessment Information obtained Lens selection Purpose Lens type Frequency Material Lifestyle Wearing modality Environment Care system Motivation Refractive power Ocular condition Refractive error Parameters History and symptoms History and Symptoms What is History and Symptoms? Why is H&S important Indications and Contraindications of CL wear The Case History  Asking the questions  New lens wearers  Existing lens wearers Patient Education Record Keeping What is history and symptoms? The initial assessment of a prospective CL wearer Objective: 1. To determine suitability of CL wear based on An analysis of patient specific indications and contraindications A risk/benefit assessment for individual Px 2. To provide introductory Px education and likely suitability 3. To record baseline info For future management Justification of clinical decision-making Why is H&S important? Detailed case history is the basis for all future clinical decisions Must be thorough and well documented Gives an idea of expected findings during examination Allows you to form structure for examination procedures Provides insight on how to manage the patient Indications & contraindications of CL wear Patient age Anatomical Ocular health General health  Allergies  Chronic infection  Metabolic disorders  Pregnancy, lactation, hormonal changes Systemic medication Psychological factors including motivation Lifestyle/occupational issues Financial considerations  Decreased tonus of upper Increased glare and lower eye sensitivity lids Reduced palpebral Reduced CS aperture The effects of Decreased Effects from lacrimal aging of the systemic drugs secretion eyes Reduced tear Increased pupil stability diameter Corneal Ocular media changes changes Possible effects of systemic medications and general health status on contact lens wear Condition Potential problem Medication Potential problem Advice Atopic conjunctivitis One-day disposable contact lenses Preservative reactions Contact lens associated papillary or non-preserved systems with frequent replacements Allergies Atopic reaction to deposit Antihistamines conjunctivitis lenses build-up Reduced contact lens tolerance Monitor — check for dry eyes Excessive deposits One-day disposable or frequent replacement lens Skin condition Thin edge design (e.g. eczema) Lid irritations Blepharitis Avoid contact lens wear until clear Punctate keratitis Monitor — do not fit if clinically significant Diabetes Reduced epithelial healing Close monitoring Tear deficiency and poor Thyroid dysfunction Avoid contact lens wear blinking Mucus deficiency deposit build Vitamin A deficiency Monitor — possible soft, frequent replacement up ß-blockers, Systemic hypertension Dry eye Monitor diuretics Monitor — contact lens wear Psychosis Contact lens adaptation Psychotics Dry eye possibly contraindicated Hormone changes, e.g. Dry eye birth control, pregnancy, Corneal contour changes Oral contraception Dry eye Monitor menopause, Viagra Changes in corneal sensitivity The case history – Asking the questions Build rapport with your patient Use open ended questions Have a clear idea of how the information will either assist in the choice of lens or help in the future monitoring of the contact lens wearer Keep eye contact Inform Px of procedure being conducted throughout session and decisions made An informed Optometrist is a better Optometrist An informed patient is a better patient The Case History – Non-CL wearers Previous use of CL (if any) Reason for visit Brand/type of lens Why are they here to see you? Modality of wear Daily wearing time Days worn per week Comfort End of day dryness Ocular Health Care system used Current Rx Reason for stopping lens wear  Power  Onset  Wearing habits General Health Eye conditions How is your general health Problems with vision Allergies Surgeries Diabetes Infections Thyroid problems Visit to GP/ hospital regarding Systemic inflammatory eyes conditions Discomfort/pain Skin conditions The Case History – Non- CL wearers Medications Lifestyle Are you on any medications? Occupation If YES Visual tasks  Name of medication? Daily environment  How often (frequency)? Hobbies  What is the dose? Typical working distance VDU use Driving Family History Smoker Ocular health General health Expectations Why do you want to wear CL? How often you want to wear it? How long do you want to wear it each time? Budget? The Case History – Existing lens wearers Same questions to new lens wearer applies  General health  Ocular health  Medications  Family H(x)  Lifestyle Additional questions regarding lens  Type of lens  Time since fitting  Changes in lens type  Modality of wear  Frequency of replacement  Care system Evaluation of symptoms Symptoms Possible Cause Action Discomfort on Foreign body Remove lens, rinse, re-insert insertion/sudden onset Damaged lens Replace lens Decentered lens Re-center – check lens fit if reoccurs Conjunctival irritation from Cease kens wear for 24 hours and re- chemical insert Discomfort after a Lens deposit Replace lens period of wear Lens surface dehydration Wet and/or replace Trapped debris under lens Remove, rinse, re-insert Toxic reaction to solution Remove, seek medical advice Contact Lens-related Papillary Conjunctivitis (CLPC) Discomfort after lens Corneal abrasion Wet and/or replace lens removal SEAL Replace lens Corneal inflammation/infection Remove, seek medical advice Discomfort periodically Lens surface drying Blink exercise Environmental factors Refit with new material Avoid the environment Patient education Reiterate your findings from the case history Inform Px of the benefits of CL – for new lens wearers Inform Px of the risk of non-compliance Throughout assessment – inform Px of what will be done, the purpose and what can be expected Provide and explain options  Daily decision tree for CL wearer Warning signs Redness Pain Daily self assessment Continue with lens wear Blurred vision No Do my eyes look good? Yes and attend routine Tearing Do my eyes feel good? aftercare appointments as Do my eyes see well? advised Remove C L andinspect Yes Seek immediate Lens damaged? No professional advice Yes See C L practitioner for Problem persist replacement lens after removal Clean, rinse and disinfect lens No and re-insert Problem recurs Yes No Remove lens and consult Continue lens wear and report symptoms at contact lens practitioner next aftercare Record keeping IMPORTANT! Offers insight to ocular status of Px Gives credence to clinical decisions made Evidence of good clinical standards 39 Record keeping For initial appointment of a new patient: (1) General Information (History and Symptoms) (2) Detailed examination of the anterior eye (3) Keratometric information (4) Lens options discussed with the patient (5) Contraindications found in the examination (6) Trial lenses used (7) Details of lenses to beordered (8) Next scheduled appointment. 40 Record keeping 41 RGP Insertion and removal RGP Insertion Before insertion  Clean your hands  Clean and rinse the lens thoroughly HAS ANYONE EVER HAD AND RGP INSERTED BEFORE? Explain to the px what to expect when the lens go in Use conditioning solution RGP Insertion RGP fitting Allow the lens at least 15 minutes to settle before we assess the fit! RGP Removal Questions? Specialist Optometry Skills | OPT506 | Dr Daniela Oehring 50 Recommended Reading Lecture notes  History and symptoms taking Book Efron, N (2018). Contact lens practice 3rd ed. Elsevier Ltd. GOC contact lens handbook Contact lens specialty competencies 2011 Acknowledgments: Dr Daniela Oehring International Association for Contact Lens Educators (IACLE)