1. Aftercare Flashcards
1
Q
What are symptomatic issues?
A
Issues seen in the eye but do not cause any problem.
2
Q
What are the LOFSEA Questions?
A
- Location -where, which eye?
- Onset -when did it first start happening?
- Frequency -how often? Is it at the end of the day?
- Type – What type of pain, sharp or dull?
- Severity -serious pain, or neglectable pain?
- Effective treatment -what has the patient tried to solve the issue? Drops? Reduced wear time? Glasses helping or not?
- Alleviating/ aggravating factors -what has made it better or worse?
Sharp pain: might be dry eyes or dull throbbing pain indicates microbial involvement.
3
Q
Patient complains of recent reduction in vision - how to check if this is a refractive cause or pathology?
A
Pinhole is used if px complains reduction in vision recently, to rule out refractive issue vs pathological issue of the fundus.
4
Q
If a patient has never had any issues with the lenses- and this is the first time they are complaining of something- it is likely to be related to?
A
Related to the lens or solution rather than the eye.
5
Q
“I can’t see properly in my lenses.” - What questions are asked?
A
- Distance or Near vision?
- One eye or both eyes?
- When did it start?
- On insertion or later in the day?
- Constant or intermediate?
- Reduced clarity or stability of vision?
- How blurry- rate vision out of 10?
- Vision with specs? -To identify if CL issue only or change in overall power.
- Any associated factors? Example when using VDU (suggests dry eye). If dry when outside on in the car- wind or air comings from the vents is the issue.
- Other symptoms?
6
Q
If patient reports reduction in vision when using VDU while wearing lenses what does this suggest?
A
Px has dry eyes
7
Q
Vision is blurry when patient blinks- what does this suggest?
A
Could suggest lens doesn’t fit well.
8
Q
Px reports blurry vision, what is tested?
A
- VA
- Over-refraction
- Lens fit
- Lens condition
- Ocular health
9
Q
Possible causes of reduced vision on application of lens?
A
- Correct eye?
- Uncorrected sphere?
- Uncorrected cyl?
- Badly fitting lenses?
- Dirty lenses?
- Damaged lenses?
- Faulty lenses?
10
Q
Possible causes of unstable vision?
A
- Lenses inside out?- lens move rapidly.
- Poor fit? -If keratoconus, disease progressing?
- Toric swivel?- Toric lenses rotating to much?
- Over minuses? -stimulates accommodation, when accommodation relaxed, vision gone then especially at near.
- Dry lens surface?
- Dirty lenses?
- ‘Smeary’ tears? Lipid/ Mucin
11
Q
Effect of over minused lenses?
A
Over minus stimulates the accommodation. When accommodation is tiring and px is no more accommodating than vision is affected mostly effects near vision more.
12
Q
Implication of lens surface not being clean on vision?
A
Tears break up on lens surface and cause unstable vision after blinking.
13
Q
Compliance issue- how is it resolved?
A
Px education
14
Q
Does lens fit change over time for keratoconus patients?
A
Yes. As the disease progresses- lens fit changes overtime.
15
Q
Vision is better after blinking- what does this mean?
A
Dry eye
16
Q
“My vision is fine with glasses. I just can’t see with my contact lenses.” What is considered?
A
- Power change?
- Toric might have rotated
- Lens solution could be causing the problem
- Lens material/ modality is the problem
17
Q
How to suggest a better lens for a patient?
A
“These lenses are more modern lenses and are designed for eyes are like yours, would you like to try them?”
18
Q
“My eyes are red when I wear my lenses.”
A
- Unilateral/ bilateral?
- Location?- particular part or the whole eye is red?
- Onset and duration?
- As soon as the lenses go in? OR As the day goes on?
- How often? Everyday?
- How severe? – how bad is the redness? Is it really obvious?
- Associated symptoms?
- Pain
- Vision loss
- Discharge
- Photophobia
- Triggers -Hayfever is the trigger?
19
Q
“My eyes are red when I wear my lenses.”- what assessments are done?
A
- Vision
- Lens fit/ condition.
- Anterior eye exam with NaFl and lid eversion.
- Corneal integrity – ulcer developing? scratch? lens spilt?
- Assess under the eyelids- anything trapped?
20
Q
Red eye- bilateral problems could be caused by?
A
- Something on their hands?- soap?
- Insertion technique? – aggressive?
- Solution problem?
- Severe CLIPC?
21
Q
Red eye- unilateral problems could be caused by?
A
- Damaged lens? – check with slit lamp, lens edge.
- Insertion technique?
- Corneal problem?
22
Q
CLAPC Full form?
A
Contact lens induced papillary conjunctivitis
23
Q
What is CLAPC?
A
Is an inflammatory condition of the upper tarsal conjunctiva, presenting with hyperaemia and roughness of the conjunctival surface in response to contact lens wear.
24
Q
Predisposing factors of CLAPC?
A
- increases with duration of wear
- more common in re-useable lenses compared to daily lenses
- common in high modulus lenses- SiH –> Increase frictional irritation on tarsal plates
25
CLAPC Symptoms?
Itching and non-specific irritation e.g. burning, foreign body sensation.
May increase after lens removal.
- Mucus discharge
- Increased lens movement
- Loss of lens tolerance
- Decreasing comfort (may abandon wear)
- Blurred vision
26
CLAPC management?
Treatment for CLAPC initially consists of improving contact lens hygiene, optimising lens fit and replacing lenses more frequently. Eye drops such as anti-histamines or mast cell stabilisers are often required to relieve symptoms and improve clinical signs. In more severe cases it may be necessary to use steroid eye drops for short periods.
27
Acute redness (redness in one segment) is related to?
* Pointing at an infiltrate?
* Traumatic?
* Damage lens edge?
* Episcleritis?
* Subconjunctival hemorrhage?
28
Central epithelial problem bs periphery - why does this matter?
More central an epithelial problem is more likely it is to be MK (microbial keratitis)
Periphery it is likely to be a sterile ulcer.
29
Subconjunctival hemorrhage is related to ?
Systemic problems
30
Why does it sting when I put my lenses in?
1. One eye or both eyes?
2. How long does it last?
3. How long has it been happening?
4. Have you changed the solutions?
5. Do you use hand creams?
6. Fluffy towels?
7. Does it resolve without contact lenses?
31
4 Causes of lens intolerance?
1. Poor lens quality
2. Poor tear film
3. Lens deposits
4. Lid interaction
32
“Why do my eyes feel dry/tacky in the lenses?”
Dryness:
1. One eye or both?
2. How long after lens insertion does it occur?
3. Does your vision vary?
4. Does reading/ VDU/ driving make it worse? – to identify if something aggravates it?
5. Do you wake up with uncomfortable eyes? – to identify if it is a general dry eye or contact lenses induced dry eye?
6. Do you experience dry mouth? -Symmetric effects like Sjogren’s disorder- “this are generally dry px’s with a dry mucus membrane, dry nose and mouth as well as dry eyes.”
7. GH- rheumatoid arthritis, thyroid problems, diuretic meds etc., anti-depressants also cause dry eyes.
33
Sjogren’s disorder is related to?
Dry mucus membrane- dry mouth and nose hence-- causes dry eyes.
34
What is assessed in patients with dryness?
1. MGD/ blepharitis
2. Corneal staining -Is epithelium okay?
3. Tear film/ TBUT -Within tolerance?
4. Lid wiper
5. Blinking -Regular blinking or less/reduced blinking?
6. Lid apposition to globe
7. Lens material and condition
35
3 pathologies related to dry eyes?
1. MGD
2. Bleph
3. LWE
36
When are comfort drops given to patients with dry eyes?
Once everything is ruled out- this is the last option.
37
3 asymptomatic signs seen in px's that complain of dry eye?
1. Staining
2. FB tracts
3. Neovasc
38
How to explain neovasc?
“Lenses only allow a certain amount of oxygen in if you wear them to much its starves the eye for oxygen and cause blood vessels to grow. Which will mean that later in life so much.”
39
Most obvious vs severe cause for -- I just rubbed my eyes and now it is really uncomfortable, particularly when I blink?
Most obvious cause is the lens has split.
Severe cause: rubbing the eye could have scratched over an ulcer.
40
4. If vision of px is blurry after the px blinks -- this suggests?
Suggests that the lens doesn’t fit well.
41
Infiltrates with limbal redness - referral is?
Urgent
42
Redness in only 1 segment is due to?
Trauma
43
What is required to find out when making lens choices?
1. Rx/ Ks/ Baseline measurements
2. Health (ocular/ general)
3. Wear time/ frequency
4. Environment/ lifestyle
5. Reliability/ compliance
6. Visual expectations
7. Budget
44
Dk relates to?
Lens thickness
45
How are expectations managed for patients - new CL wear in relation to specs?
Vision will be different with CLs than glasses, glasses can correct your vision better compared to CL.
46
How does having a dominant eye affect if cyl is uncorrected?
If patient right eye is dominant px is less likely the patient is to notice that they are wearing a spherical lens. If left eye is dominant and patient has uncorrected cyl, it is more likely to suffer from asthenopia and headaches.
47
What problems might occur with CL wear? (In atopic patients):
Due to aggravation of eyelids px is more likely to notice the movement of the lenes. Sensitivity is exaggerated due to the ATOPY by making the eyes more sensitive.
48
What lenses are suggested to patients with atrophy?
Daily hydrogel lenses
- Hydrogels do not rub against eyelids that much, SiH have a higher modulus hence can aggravate lids more.
49
How is routinue different in atropic px's?
PXs seen when allergy is worst to help identify what you are dealing with.
50
Frequency of aftercare increases in px's with poor hygiene- true or false?
true
51
Ocular surface complications in diabetic patients?
1. High risk for infection and longer recovery from infection.
2. Rx will not be stable if sugar levels not stable.
3. Tear film unstable- hence px might have dry eyes
4. Cornea will be less sensitive to mechanical trauma, recurrent epithelial defects (Slow healing), reduced epithelial healing, reduced recovery from corneal oedema, reduced corneal sensation- likely to get ulcers.
52
How does the routine differ in patients with diabetes?
1. Full history - duration, treatment, control?
2. More frequent aftercares
53
Does oral contraceptive have a relation to dry eyes?
Yes, they increase dry eyes
54
History investigation for Dry eye - 3?
1. Occupation
2. GH/ Meds
3. FB/ redness/ gritty/ unstable vision
55
Slit lamp assessment for dry eyes?
1. TBT
2. Corneal integrity
3. Bleph/ MGD
56
What lenses are good for dry eyes?
- Water gradient lenses
- SiH
- Mordern RGP
57
What supplement is good for dry eyes?
Omega- 3
58
How to make lens solution choice?
Preservative free solution
Same solution as lens brand
59
What advise is given to patients with dry eyes?
1. Warn potential problems
2. Regular breaks from VDU and blink more often
3. Manage underlying cause- Bleph? MGD?
4. Comfort drops- last resort
60
Risk factors with EW lenses?
Closed eye environment.
Hypoxia- Neovasc, etc.
Microbial keratitis.
CLARE
CLPU
SEAL
Lens deposits
61
Ideal lens choice for Office workers/ car driver?
Silicone hydrogels and RGP
62
Lens choice for patients with corneal diseases?
Scleral lenses are fitted because they are less likely to fly out.
62
Ideal lens choice for sports men or people that have high visual demands?
Soft lenses because they are safter
62
What is a very important assessment for px's with high visual demands?
VA
62
Ideal lens choice for emerging presbyopes ?
Aspherical useful for px’s in the late 30s-40s.
62
Why are total ones an ideal choice for diabetic px's?
The front and back surfaces are so soft they will absorb anything and float around the tears.
62
Dk values are related to what RX?
-3.00
62
Alcon lenses are good for young patients because?
Small TD
63
Antihistamines, beta blockers, diuretics and antidepressants - In relation to eyes?
This meds cause dry eyes
64
Menopause and contraceptives- in relation to eyes?
Cause dry eye
65
EW lenses never fitted in patients with ?
Never fit patients with previous inflammation history, diabetics,
66
Pupil size is always measured in what 2 px's?
RGP
Multifocal
67
Corneal topography always used in what 2 px's?
1. Ortho- K
2. Keratoconus
68
Multifocals- binocular or monocular refraction?
Monocular
69
Different types of staining?
Punctate? Diffused? Superficial? Deep? Linear? Arcuate? How deep? Does it go all the way to Bowmans layer? Over the entire cornea? Where is it?
70
What is done a collection appointment?
- I&R- patient must be able to do this without help.
- How to carefully take care of lenses.
- Wearing schedule
- What to watch out for- give written information
- What to do in case of emergency
- Consent form signed- 1 given to patient, 1 to remain in practice
- Check corneas before patients leaves.
71
What factors are looked out for in compliance history?
Hand washing
Sleep/nap/swim/shower
Tap water
Solutions
Case hygiene
