CL 2-1: Intro to GPs

Question 1

1. GPs: Better Vision than SCL or SRx at Distance/Near?

2. CSF: GPs were best at what?

Answer 1

1. Distance

2. Middle and High Spatial Frequencies (then SCL then Spectacles)

Question 2

O2 to Cornea

1. Why do they provide more O2 than SCL?

Answer 2

1. GPs Move more than SCL, and are less reliant on Material Dk to provide O2 to the Eye

So you get LESS HYPOXIA (neo and corneal edema)

Question 3

Stability and Durability

1. Tearing?
2. How often are they replaced?
3. Deposits on the Lens?

Answer 3

1. None
2. usually every year or prn
3. No. LESS. (Smooth finish and lack of Water Retention = they harbor fewer deposits)
   * More stability/durability means better value for patients while still maintaining a high profit margin.

Question 4

1. 3 Main types of IRREGULAR ASTIGMATISM GPs can correct?

Answer 4

1. Corneal Scarring
2. Keratoconus
3. Pellucid Marginal Degeneration

Question 5

Corneal Reshaping (Ortho-K)

1. Lenses create pressure on the cornea: what does this do?
2. Goal for vision is to stay clear enough throughout the day so lenses are only needed when?

Answer 5

1. Compresses the Epithelial Cells Indirectly
   a. MYOPIA: CENTRAL Flattening
   b. Hyperopia: PARACENTRAL Flattening w/relative Central Steepening
2. At Night

Question 6

Why are CLs better than GPs? (3)

Answer 6

1. Pt looks thru Optical Center more often
2. Less Chromatic/Spherical Aberration
3. Elimination of Prismatic Effect

Question 7

GP Comfort

1. Lens Awareness: Driven mostly by what?
   a. Lens awareness is not as much due to what?

Answer 7

1. By the EYELID Sliding over the edge of the CL

a. Not as much due to CORNEAL Sensation

Question 8

Language

1. What 3 things shouldn’t be said?
2. What should the patient say?

Answer 8

1. Rigid Lenses; Hard Lenses; Rigid Gas-permeable CLs (RGPs)

2. Gas-Permeable CLs (GPs)!!!

Question 9

Patient Presentation

1. Terms to Avoid (what should be used)
   a. Hurt
   b. Pain
   c. Discomfort
   d. Irritation
   e. Uncomfortable

Answer 9

1. a. Initial Sensation
   b. Edge Awareness
   c. Lid Sensation
   d. Itching
   e. Lid Awareness

Question 10

4 Pros of Using Anesthetic during the fitting

Answer 10

1. Greater Pt satisfaction
2. Improved Initial Comfort
3. Less Initial Chair time
4. Less Reflex Tearing

Question 11

4 Cons of using Anesthetic during the fitting (DEMS)

Answer 11

1. Does not help w/lid sensation
2. Eye Rubbing
3. Misleading
4. Staining

Question 12

Assessing GP Candidacy

1. Good GP Candidates (5)

Answer 12

1. Current/previous GP wearer
2. Failed SCL wearer (depends on reason)
3. Pts prone to SCL complications (GPC; Inflammation/infection; SEAL)
4. Pts desiring sharper vision
5. Pts w/Astigmatism

Question 13

Pre-Fit Exam

1. BCVA: Special consideration needed if BCVA is what?
2. Good Refraction: Why is this needed?
3. What determines INITIAL diagnostic GP?

Answer 13

1. is reduced in 1 eye or both (INFORMED CONSENT)
2. Reduces fitting time; and Enhances Results
3. K-Values

Question 14

K-Values

1. If Cornea is TOO STEEP: What do you do?
2. If TOO FLAT, what do you do?

Answer 14

1. Put in a +1.25 D on Obj side of Keratometer, then Approximate by ADDING +8.00 D to reading
2. Use -1.00 D lens, and SUBTRACT -6.00 D from reading

Question 15

Persistently Irregular Mires indicate Irregular Astigmatism. (what 4 are the main ones?)

Answer 15

1. Corneal Scarring
2. Corneal Dystrophies
3. Keratoconus
4. Pellucid Marginal Degeneration

Question 16

Upper Lid Position

1. Above upper limbus
2. At Upper limbus
3. Below upper limbus

Answer 16

1. Interpalpebral (Smaller Diameters)
2. Interpalpebral (Smaller diameters)
3. Lid Attachment

Question 17

Vertical Palpebral Aperture

1. Why would Smaller Palpebral Apertures may Benefit from GP CLs?

Answer 17

1. cuz they’re usually smaller than SCLs (8.0-10.00 mm vs. 14-15 mm)

Question 18

Eyelid Tension

1. Affects what 3 things?

Answer 18

1. Lens positioning, GP removal, and Near Vision in Translating (mainly affected by upper lid tension) Multifocal GPs

Question 19

2 Bottle Cleaning Systems

1. 4 of them. What are they?

Answer 19

1. Boston Original
2. Boston Advance Comfort
3. Menicare GP
4. Optimum by Lobob

Question 20

2 Bottle Cleaning Systems: Boston Original

1. Type of Cleaner?
2. Conditioner: Has what 2 Preservatives?
3. Compatible w/what?

Cleaning

4. Remove lenses when?
5. Clean w/what cleaner?
6. Rinse with what?
7. Soak in what? (Min Soak?)
8. Then what?

Answer 20

1. Abrasive cleaner
2. Chlorhexidine, and EDTA
3. Weekly Boston 1-Step Liquid Enzyme
4. At Night
5. with Red CAPPED cleaner
6. Saline
7. BLUE CAPPED Conditioner overnight (MIN 4 Hrs)
8. Insert Lenses in the morning

Question 21

Purpose of Cleaner

1. Remove foreign Material (what 3 things)
2. Remove Cellular Debris (what 3 things)

Answer 21

1. Lipid, Mucus, Protein

2. Tear Film constituents, Environmental Debris, and Contaminants from Pts Hands

Question 22

Purpose of Conditioner

1. Cushioning Properties are DIRECTLY related to what?
2. Best cushioning solutions provide cushioning w/o affecting what?
3. Acts as what kind of buffer? Between what 2 things?

Answer 22

1. to VISCOSITY
2. Vision or being too “goopy”
3. Mechanical Buffer; B/W Cornea and Lens

Question 23

2 Bottle Cleaning System: Boston Advance Comfort

1. Type of Cleaner
2. Conditioner: What 3 things?
3. Compatible with what?
4. Remove lenses when?
5. Clean with what?
6. Rinse with what?
7. Soak in what?
8. Insert Lenses in what?

Answer 23

1. Abrasive
2. Chlorhexidine, EDTA, PHMB
3. with Weekly Boston 1-Step Liquid Enzyme
4. at Night
5. with RED CAPPED Cleaner
6. SALINE
7. BLUE CAPPED conditioner (min 4 hrs)
8. in the morning

Question 24

2 Bottle: Optimum (Lobob)

1. CDS: What is it?
2. ESC: What is it?
3. WRW: What is it?
4. Preserved with what?
5. Remove lenses when?
6. Clean with what solution?
7. Rinse in what?
8. Soak in what? (Min hrs?)
9. Rinse with what?
10. Apply what?
11. Insert lenses when?

Answer 24

1. Cleaning, Disinfecting and Storage Solution
2. Extra Strength Cleaner
3. Wetting ReWetting Drops
4. with Purified Benzyl Alcohol
5. at Night
6. RED CAPPED CDS
7. SALINE
8. RED CAPPED CDS overnight (min 6 Hrs)
9. SALINE
10. WHITE CAPPED WRW
11. in the morning

Question 25

2 Bottle Cleaning Systems: Optimum "2 Bottle System) 1. 2 Bottles used for routine care? 2. Third Bottle: What is it? a. May be used when?

Answer 25

1. CDS, WRW 2. ESC: Only used for STUBBORN DEPOSITS a. PRN

Question 26

2 Bottle Cleaning Systems: Menicare GP (Menicon) 1. What 2 bottles? 2. Preserved with what? 3. Formulated for use with what materials?

Answer 26

1. CDS; WRW 2. with Benzyl Alcohol 0.3% and Disodium Edetate 0.5% 3. with Menicon Materials

Question 27

2 Bottle Cleaning Systems: Menicare GP (2) 1. Remove Lenses when? 2. Clean with what? 3. RINSE with? 4. Soak in what? 5. Rinse? 6. Apply with what? 7. Insert lenses when?

Answer 27

1. at night 2. RED CAPPED CDS 3. SALINE 4. RED CAPPED CDS overnight (min 6 hrs) 5. with SALINE 6. with WHITE CAPPED WRW 7. in the Morning

Question 28

1 Bottle Systems 1. What 2 are they?

Answer 28

1. Boston Simplus | 2. Unique pH

Question 29

1 Bottle Systems: Boston Simplus 1. Single bottle (cleaning/rinsing/soaking): Type of Cleaner? 2. Preservatives? 3. Remove lenses when? 4. Soak in what? (min) 5. In the morning, clean and rinse lenses with what? 6. then insert lenses.

Answer 29

1. Non-Abrasive 2. Chlorhexidine 3. at night 4. WHITE CAPPED SIMPLUS overnight (min 4 hrs) 5. with WHITE CAPPED SIMPLUS

Question 30

1 Bottle Systems: Unique pH (Menicon) 1. Cleaner type? 2. Preservatives? 3. Clean and rinse lenses with what? 4. Soak in what?

Answer 30

1. Non-Abrasive 2. EDTA, Polyquad 3. WHITE CAPPED Unique pH 4. White Capped Unique pH overnight (min 4 hrs) * insert lenses in the morning

Question 31

Oxidative Lens System: Clear Care (Alcon) 1. Approved for what? 2. Preservatives? 3. Great for what? 4. Remove lenses at night, and RINSE with what? 5. Soak in what? 6. In the morning, do what?

Answer 31

1. GP lenses too! 2. None 3. Piggyback Systems (use 2 cases) 4. RUB and Rinse lenses w/RED CAPPED CLEAR CARE 5. in RED CAPPED CLEAR CARE overnight (min 6 hrs) 6. Insert Lenses

Question 32

Things NOT to use as Cleaners 1. WILL LIKELY NOT DAMAGE LENSES: (4) 2. WILL DAMAGE LENSES (5) 3. Which ones will impact surface wetting?

Answer 32

1. a. Coke b. Dishwashing Soap c. Laundry Detergent d. Shampoo 2. a. Acetone b. Alcohol c. Gasoline d. Kerosene e. Lighter Fluid 3. Any/All of these products

Question 33

Lab: In-Office Cleaners 1. Boston Laboratory Cleaner: What is it? 2. Fluoro-Solve (Paragon): Type of Solvent? a. What 6 things...??

Answer 33

1. Isopropyl Alcohol 2. Wax Solvent a. Adhesive Tape residue; Body Oils, Cosmetics, Deposits, Pitch; Waxy Build-up

Question 34

Enzymatic Cleaners 1. What do they HYDROLYZE? 2. Required more often with what type of lenses?

Answer 34

1. PROTEIN | 2. with SILICONE ACRYLATE (SA) LENSES than Fluorosilicone Acrylate (FSA) lenses

Question 35

Periodic Enzymatic Cleaners 1. Opti-Free Supra-Clens Daily Protein Remover (Alcon) a. What Enzyme is in it? b. 1 Drop in each lens well when? c. Does it have to be rinsed off before lens insertion? 2. Boston 1-step Liquid Enzyme a. Enzyme? b. Come as what kind of drop? c. Used when? d. Number of drops in lens well when soaking overnight? e. Does it have to be rinsed off before lens insertion? 3. What other thing?

Answer 35

1. a. Pancreatin b. NIGHTLY c. YES! 2. a. Subtilisin b. Single-use VIALS c. WEEKLY d. 2 DROPS e. YES! 3. Progent (Menicon)

Question 36

Oxidative Lens System: Progent (Menicon) 1. In office GP "Super Cleaner": Why? 2. Ampule A 3. Ampule B a. What do you do? 4. Efficacy of Protein Removal from GP surface after 30 min soak a. Artifically protein-deposited lens b. Actual patient's protein-deposited lens 5. Now available in what? a. Recommended every what?

Answer 36

1. Removes protein, Kills (bacteria, Viruses, acanthamoeba, yeast, mold); Deactivates Bovine Rotavirus, HSV I, and Adenovirus 5 2. Sodium Hypochlorite 3. Potassium Bromide a. Mix and Swirl and 30 min soak. 4. a. Almost everything gone b. Doesn't do too much. 5. w/Saline Vials for Pt Home Use a. every 2 WEEKS

Question 37

GP Rewetting Drops 1. GP Only: What 3 are there? 2. SCL and GP: What three things?

Answer 37

1. a. Boston Rewetting Drops (B & L) b. Optimum WRW c. Menicare GP WRW 2. a. Blink Contacts (AMO) b. Opti-Free Express, RepleniSH or Puremoist Rewetting Drops (Alcon) c. Theratears CL Comfort (Advanced Vision Research)

Question 38

Short-Term Lens Storage 1. WET a. Patients store lenses how? b. Soaking helps do what? c. Preservatives help to control what?

Answer 38

1. a. WET overnight b. Dissolve Hardened Deposits c. Microbes

Question 39

Long-term Lens Storage 1. DRY a. Lenses should be what before storage? b. What is the risk if you store Lenses Wet? c. Clean lenses thoroughly Prior to what?

Answer 39

1. a. Completely DRIED b. You RISK WARPAGE c. to Dry Storage. Pseudomonas and Strep can still grow on Dry Lenses

Question 40

Use of Tap Water 1. Why is it Controversial?

Answer 40

1. Association w/Acanthamoeba Keratitis Bennet and Henry: State that TAP WATER is CI in all CL care regimens including GP When educating PATIENTS, SALINE is the SAFEST RINSING RECOMMENDATION

Question 41

In-Office GP Disinfection 1. What do you do? 2. What if you are using a Diagnostic Lens: What do you do afterwards?

Answer 41

1. Clean, Rinse, Condition Lens BEFORE putting GP in Pt's EYE 2. Soak lens in case in OXIDATIVE SOLUTION for 10 MINUTES; Rinse and Clean w/SALINE; Dry lens and Case with Paper TOWEL, then STORE DRY

Question 42

Removal of GPs: 2 Hand Method 1. What is it?

Answer 42

1. Pt look down --> lift upper lid w/non dominant hand --> Instruct Pt to look straight ahead --> use index finger of dominant hand to depress lower lid BELOW the CL Edge --> Slowly bring upper and lower lids together until the lens is ejected. Lens may hang from lower lashes --> have pt close their eyes then remove lens

Question 43

What else can be used for GP removal?

Answer 43

1. DMV | * It's pretty simple. Clean DMB by washing is frequently in warm, soapy water. May Boil or Autoclave if you want.