5.2.2 Manages aftercare of pxs wearing RGP CLs Flashcards
What to ask in RGP aftercare?
H&S: RFV? LEE? LAC?, Specs up to date? Vision c CLs D&N? How long worn CLs for?
Current CLs: which lens? brand & motility? how old is current pair? WT? Days per week? Vision in CLs? Comfort? Irritation/redness/dryness? Swim/sleep/shower in lenses?
Handling: talk me thorugh taking lenses out and in? How do you store lenses? Often change soln? Change case? Replace lenses?
GH: health conditions? meds? allergies? HBP? DM? Smoker? Any HES?
Lifestyle: occupation? VDU use? Hobbies? Driver?
What do you need to do for over Rx in RGP lenses?
distance VA
+-0.25 & +-0.50 flippers
Near VA
How do you assess RGP CL fit?
Dynamic fit:
- Centration, comfort
- Position of lens in relation to lids: lid-traction, inter-palpebral, low-riding
- Movement on version: crosses limbus, touches limbus, doesn’t cross limbus
- Movement on blink: normal fit 0.8mm, more than 1mm: steepen BC, less than 1mm: flatten BC
Static fit:
- Observer angle 0°
- Illumination angle: 0° or 30°
- Slit: width/height maximum
- Dye: NaFl and cobalt blur light , wratten filter
- Magnification: 10 to 16x
- High illumination
How do you grade RGP fittings?
- apex: apical alignment, apical pooling, apical touch
- mid-periphery: alignment, pooling, touch
- periphery: minimal, moderate, high/excessive
Steep fitting lens: -good centration, stable vision, minimal lens movement on blink, central pooling, relatively comfortable
Flat fitting lens: poor centration, excessive movement on blinking, crosses limbus on excursions, unstable vision, central touch, uncomfortable
How do you assess health assessment of RGP lens?
- diffuse, x16mag: conj redness, bleph, MGD
- indirect retro, x25mag: limbal redness, neovasc
- parellipied & optic section, x30mag: corneal ulcers, tear quality
- sclerotic scatter, x25mag: corneal infiltrates
- tear prism height, measure using beam or 1mm dot: G1 >0.3mm, G2 0.2mm, G3 <0.1mm
NaFl: binds to epithelial cells w/ increased permeability, suggesting they are dead or damaged
Cobalt blue 16x-25x: TBUT >15s CLs suitable, 10-15secs CLs suitable, 5-9s CLs limits, <5 CLs contraindicated
Corneal staining, Conj Staining
Flip lids: papillary conj
When should you make a change to the RGP lens?
- over rx
- health
- H&S management
- Fit: flatten add plus, steepen add minus, every 0.05mm change in BOZR is equivalent to +/-0.25D
- recall
- care advice
What is 3&9 o’clock staining - what to do?
- superficial punctate epithelial erosions at 3&9 o’clock typical of RGP wearers due to non-wetting of cornea as lens edge pushes lid away/incomplete blinking
- G2: remove lenses for 24hrs, G3: remove lenses for 3 days, G4: remove leneses for 7 days
- Refit with SCL if necessary
- Decrease thickness of lens edge
- Refit with smaller TD
- Ocular lubricants
- Blinking exercises
Describe dellen and what to do?
- Dessication at periphery of cornea - due to dehydration of cornea which causes layers to compact together (causes thinning in this region & resulting in a dip)
- Can be asymptomatic, can prevent with irritation & dryness
- Localisd thinning of cornea - saucer like depression
- Can pool with NaFl
- Epithelium usually intact
- Layers appear squashed
Management: - manage dry eye - remove lenses for few days
- re-wetting drops
- blinking exercises
- decrease wear time
- refit with soft CLs
Describe dimple veiling - what to do?
- Focal areas of NaFl pooling/air bubbles trapped under lens
- Leaves pits/small indents in epithelium
- Pools w/ NaFl
- Seen centrally or peripherally
- Caused by excessive corneal clearance/edge clearance so can be due to steep or flat lens
- Usually asymptomatic
- REduced vision if central, numerous, large
Management: - flatten lens - change to toric back surface
- refit a hard lens with better alignment
- steepen if bubbles peripherally - reduces edge clearance
- flatten if bubbles centrally - reduces central clearance
