Contact Lens 1-2: Bandage SCL

Question 1

Contact Lens: Definition

Answer 1

Considered medical devices and can be worn to CORRECT VISION, for COSMETIC or THERAPEUTIC REASONS!

Question 2

Therapeutic CL

1. What is it?
2. 3 Types

Answer 2

1. Lenses that are used for the TREATMENT of ACUTE or CHRONIC CORNEAL PATHOLOGY
2. a. Bandage SCL (referred to as “therapeutic SCL”)
   b. Corneal or Scleral GP
   c. Collagen Shield

Question 3

Bandage SCL

1. Goals: 2 things
2. Only certain brands are approved as Bandage Lenses: What 4 are there?
3. BUY PLANO CLs SPECIFICALLY for this

Answer 3

1. Provide Pt comfort and Promote Corneal Healing
2. a. Alcon: Air Optic Night & Day Aqua (30 day)
   b. B+L: Purevision (30 day)
   c. Unilens Corp: SOS-Form 55 EW (7 day wear)
   d. Vistakon: Acuvue Oasys (7 day wear)
3. Possibility of audit and losing reimbursement by billing for non-purchased CL

Question 4

Bandage SCL

1. 5 uses?

Answer 4

1. Increased Comfort
2. Mechanical Protection
3. Wound Healing
4. Vehicle for Drug Delivery
5. Maintain Ocular Surface Hydration

Question 5

Lens Material Selection

1. Wearing Schedule
   a. Bandage SCL generally worn on what basis?
   b. Promotes what?
   c. Minimizes what?
2. Acute Condition
   a. Duration of Use
   b. Material
3. Chronic Condition
   a. Duration of Use
   b. Material

Answer 5

1. a. on an EW Basis
   b. Corneal Healing
   c. Minimize Disruption on I&R
2. a. Less than or equal to 3 days
   b. Hydrogel
3. a. More than 3 days
   b. SiHy

Question 6

Lens Material Selection

1. Use of Pharmaceutical Agents Concurrently
   a. Drug uptake/release is a function of lens material’s what?

b. Uptake/release better in what?

2. Pharmaceutical Use
   a. YES for what material?

Answer 6

1. a. Ionicity, Water, and Silicone Content
   b. Hydrogel > Si-Hy
2. for HYDROGEL

Question 7

Lens Material Selection

1. Pt Dexterity
   a. Modulus is greater in what?
   b. Easier Handling w/Higher/Lower modulus?
2. Good Pt Dexterity with what Material

Answer 7

1. a. in Si-Hy than Hydrogel
   b. with HIGHER MODULUS
2. Good for HYDROGEL
   * Poor for Si-Hy

Question 8

Lens Modulus

1. Lowest in what one?
2. Highest?

Answer 8

1. Acuvue Advance
2. Night and Day
   * Lower modulus = more likely the lens will contour the cornea.

Question 9

Fitting Goals of a BCL

1. Coverage
2. Centration
3. Movement

Answer 9

1. FULL
2. Decentration OK as long as there is FULL LIMBAL COVERAGE
3. MINIMAL is DESIRABLE; Minimize Corneal Disruption; and Promote Epithelial Healing

Question 10

Some conditions where BCLs are used? (4)

Answer 10

1. Epithelial Defects
2. Recurrent Corneal Erosion
3. s/p PRK
4. BULLOUS KERATOPATHY

Question 11

Epithelial Defects (1)

1. Short-term Use –> consider what?
   a. If defect is small or patient not experiencing much discomfort, is a BCL needed?
2. Determine what?
3. How long does it take for Re-epithelialization?
4. Once BCL has been applied, it should only be removed by you!: What 3 things do you need to tell the patient?
5. Consider Adjusting dosage of meds…

Answer 11

1. Material considerations
   a. Not necessarily
2. Cause of Defect (vegetative matter?)
3. 24-36 hrs
4. Advise pt not to touch the lens; Don’t reapply if lens falls out; and Return for follow up
5. Delayed & Prolonged Release

Question 12

Epithelial Defects (2)

1. Follow up in how many hours?
2. Re-epithelialization should be at least what?
   a. If not?
3. If wound has re-epithelialized, what do you do?

Answer 12

1. 24-48 hrs
2. 75%
   a. Keep BCL on for another 24 hrs; replace BCL if needed
3. Remove BCL; Slide onto conj before peeling off and May use Silicone Tipped Forceps

Question 13

Recurrent Corneal Erosion (RCE)

1. What should you use?
2. Long term overnight wear?
3. When should they return to office?

Answer 13

1. BCL and Ocular lubricants for 6-8 wks!
2. MORE THAN 3 DAYS: Material…
3. 1 Week for Lens replacement

Question 14

Photorefractive Keratectomy (PRK)

1. How long do you keep the BCL on?
   a. What is applied over Lenses?
2. Day 1: What do you expect?
3. Day 3 or 4: What do you do?
   a. IF 90% or greater of treatment zone has reepithelialized, what do you do?

Answer 14

1. 4-7 days
   a. Topical Antibiotic & Steroids applied over Lenses
2. Expect MINIMAL BCL Movement
3. Remove Lens, Check for Re-epithelialization
   a. Leave BCL off: Otherwise, replace BCL and follow up in 1 or 2 days

Question 15

Bullous Keratopathy

1. What is it?
2. Causes? (3)
3. Pt Symptoms:
4. What kind of BCL is needed?
   a. Why?

Answer 15

1. Failure of Endothelium; Corneal Edema; Bullae Formation
2. Fuch’s, Trauma, Pseudophakic
3. Discomfort; Decreased VA/Glare/Photophobia; Bullae Rupture –> Pain –> Risk of Infection
4. High Water Content BCL
   a. Draw moisture from the Cornea

Question 16

CIs to BCL

1. 3 things?

Answer 16

1. CL Wearers
2. Refusal to Follow Up
3. Suspected Infection (Trauma w/Vegetative Matter)

Question 17

Billing and Coding for BCL

1. What is the Procedural Code?
2. BCL Fitting Code?
   a. Modifiers?
3. Report Supply of BCL separately
   a. Supplies and Materials
   b. Replacement of CLs
   c. CLs other, Type
4. Considerations for Billing > 1x/month

Answer 17

1. 9921x
2. 92071
   a. -RT; -LT; -50
3. a. 99070
   b. 92326
   c. V2599
4. Medicare will only pay for it once. May have to set up separate pay with patient

Question 18

Collagen Shields

1. Made of what?
2. Comes hydrated/dehydrated?
3. Available in various dissolution rates
   a. What are they?
   b. What happens during manufacturing?
4. Use?
   a. Dissolves into what?
5. Is it a Reimbursable procedure?

Answer 18

1. Natural Protein (Porcine or Bovine Collagen)
2. Dehydrated (Hydrate prior to use)
3. a. 6, 12, 24, or 72 hrs
   b. Collagen Crosslinking w/UV during manufacture
4. Ocular Lubrication, Corneal Wound Healing, or Continuous Drug Delivery
   a. Into a Gel-Like Liquid
5. Nope