CL Preliminary Examination

Question 1

What questions would you ask a new CL wearer?

Answer 1

Q’s depend on if you did their ST and how recent it was
1. Reason for visit –> find out px’s motivation
2. Info about current specs -> all CL wearer need up to date glasses
a. Need to know vision w/ specs e.g. if px is amblyopic to avoid wasting time trying to fix that with CLs
3. Dist/Int/Near vision
4. Hx. Of flashes/floaters/diplopia/headaches – depends how recently saw px
5. Hx. Of HES – especially infections
6. General health – especially allergies
7. Meds
8. FGH – diabetes (could have dry eye or ↓ corneal healing) and allergies are most important
9. Occupation
10. VDU use
11. Hobbies/driver/smoker

Question 2

What additional questions would you ask CL wearer?

Answer 2

• Allergies -> preservative free options of solutions
• Specific meds that cause dry eye:
  o Oral contraceptive pill (OCP)
  o Beta blockers – HBP, anxiety etc – ending in lol
  o Antihistamines
  o Anti-depressants
  o HRT – hormone replacement therapy
• Hx of dry eye diseases (DED)/red eye/infections
• Any previous CL wear?
• Why do you want to try lenses? – find out motivation
• Are you looking for Full Time (FT)/ Part Time (PT)/ Extended Wear (EW – don’t offer this option straight away)
  o Helps you figure out pxs who are likely to over wear lenses
• Would you be happy cleaning and looking after lenses? – if no, looking at daily disposable lens

Question 3

What questions would you ask an existing CL wearer?

Answer 3

• Do you know name of lens you’re wearing? – Can bring box with them
• Name of solution – if applicable?
• How do you clean and store your lenses? (If applicable)
• How long have you been wearing lenses?
• How often do you wear lenses?
• Do you sleep in you lenses?
• Have you ever had any problems with your lenses?
• Any infections?
• When was your last aftercare? (And sight test)
• Are you happy with these lenses?

Question 4

What questions would you ask a lapsed CL wearer?

Answer 4

• Why did you stop wearing lenses? – e.g. couldn’t afford it or had really bad infection
• When did you stop wearing lenses?
• Do you know name of lens you wore?
• How long did you wear lenses for?
• How often did you wear your lenses?
   Need to figure out what went wrong to find best solution for px

Question 5

What questions would you ask a previously tried & failed w/ CLs?

Answer 5

• Squeamish about lenses?
• Couldn’t manage I&R – often young child
• Cost?
• Comfort?
• Vision not satisfactory?
  o Why did you stop your CL trial?
  o Do you know name of lens tried?
  o How long did you try lenses for?

Question 6

Which meds cause dry-eye?

Answer 6

o Beta-blockers: for HBP, anxiety etc – ending in -lol
o Antihistamines
o Contraceptive pill
o Acne meds – especially Roaccutane
o Anti-depressants
o HRT – hormone replacement therapy

Question 7

What do you need to tell a px to manage their expectations when they are wearing CLs?

Answer 7

• Must be reasonable
• Vision can be fraction worse due to CL movement (especially rotation), tear quality
• Pxs often expect miracles – if don’t think px got message, write it down and make them sign it on record card
• Careful with parents of young pxs – child MUST want the lenses

Question 8

Which measurements do you need to take for CLs?

Answer 8

Keratometry (higher the number, flatter the corneal surface - 0.25DC for every 0.05mm difference)
Horizontal Visible Iris Diameter (HVID)
Vertical Visible Iris Diameter (VVID - use eyelids)
Pupil size in light and in the dark
Ocular health checks (w/ NaFl) including lid eversion