H and s , staining and ocular response to CL wear Flashcards
Why do we conduct an aftercare for cl ?
Ensure optimum comfort and optical performance
- Minimise drop-outs
- Answer patient queries/questions
- Address any compliance issues – Safety: reduce risk of infection
- Assess the ocular reaction to a lens
What are the 2 main routines we conduct during CL appt ?
- New fit
2. Refit- if px is new to clinic but already wearing CL
How does the routine for CL appt start for a new CL fit ?
- H and S
- check the eye and palpebral conjuctiva
- following lid eversion with white light as well as fluroscein and blue light
- Preliminary measurements - HVID, VPA, K’s , pupil size
- Choose one or 2 lenses to try on one eye then put both
- after lenses settled, check VA and conduct over refraction including binocular balancing
- With slit lamp - have to check for the CL fit and staining.
- Advise and recommended for px - and teaching session is booked.
How does the routine for an aftercare CL start ?
- H and S
- Check VA and over refraction
- Check for lens fit with the slit lamp
- Ask px to remove CL , observe their CL remove and washing hands
- check anterior eye and lids with blue and white lights before your provide advice and recommendation and prescribe the CL specification for another year.
How is the history and symptoms for CL fits ?
very specific
- no need to do like clinical skills
- focus on motivation for CL wear
- why does the px want to wear CL?
- is it appropriate for them , such as :cosmetic, sport, therapeutic, special occasions
How do you ask h and s for a new fit ?
Motivation for wear?
• Px expectations
• Are the expectations
realistic?
• FT/PT wear or occasional
wear?
-need to ask what is the VA like with specs?
-Determine the presence of any issues that may affect the VA through CLs e.g. amblyopia or
presbyopia
-check for ocular health - check for symptoms, Are there any contraindications
to lens wear? (pink eye etc), Does patient require treatment prior to fitting?
-if px has any symptoms - follow up with FLOADS
How do you ask h and s for a aftercare ?
What type of visit is it? • Routine? • Unscheduled visit? Determine if there are any problems Follow up any advice that was given at the previous visit e.g. • Use of eye drops • Advice regarding wear time - need to ask How is the VA through CLs? and Through specs? -need to understand if VISUAL STABILITY like : asking any ... • Fluctuating? • If so, when? • Does blinking affect VA? • Onset of presbyopia? - Ocular health - ask \:Any new problems? COMFORT • Issues when wearing CLs? e.g. Lenses drying out, ocular discomfort, redness, pain? QUS ABOUT LENSES • Age of lens/case? • Cleaning of lenses/case? • Solution? WEAR TIMES Days (/7), hours (/24), max, average, and today, as well as comfortable -if px has any new symptoms follow up with FLOADS
When is ocular health checked ?
-asking if px suffers from any of the symptoms of photophobia, pain or vision loss.
What are the different symptoms of ocular health issues ?
important symptoms: ! Light sensitivity ! Discharge ! Pain ! Vision suddenly blurry/ loss
How to ask using FLOADS with px reporting symptoms of OH problems?
WHEN • On insertion • During wear • End of wear • After removal TRIGGERS • Beginning/end of month
ONSET
• Recent –days? Weeks? HOW
• Longstanding-check previous records. Has there been a CHANGE in symptoms?
SEVERITY • Ask px to grade on a scale of 1-10 • How long do symptoms last HOW • How does px resolve this? • Are they using drops/medications?
TRIGGERS
- What causes symptoms
• Any associations?
What can the cause of discomfort on insertion or sudden onset of CL?
foreign body damaged lens decentered lens, excessive movement conjunctival irritation corneal abrasion
What can the cause of discomfort after period of wear of CL?
lens deposits
surface dehydration, wetting problems
trapped debris
CLPC
What can the cause of discomfort after removal of CL?
corneal abrasion
SEAL
inflammation/infection
What can the cause of constant blurred vision be of with CL?
switched lenses
incorrect rx
residual astigmatism
distorted lens
What can the cause of blurred vision fluctuating with blinking with CL?
better post blink- expect lens deposit
or worse post blink- excessive lens movement
lens sitting inside out
What can the cause of blurred vision occurring over time or at the end of the day with CL?
lens deposits
lens surface drying
What can some reasons for the triggers of symptoms in CL ?
Is it the lens? The solution? The case? The patient? The eye? The environment? Or a combination of the above?
What can some reasons for the severity of symptoms in CL ?
Quantifiable, but still subjective
• May help in monitoring any improvements/changes to symptoms
What do we ask for POH for cl ?
Havetheyever suffered from any eye conditions?
• Establishifthere is anything which might limit lens wear, lens type, or require more frequent monitoring?
What do we ask px refitted with a new lens - POH?
- what went wrong with the old lens
- previous lens details
- previous problems
What do we ask px with aftercare- POH?
Check previous records and confirm
• Anything new which has
occurred since the previous visit?
What to ask with GH IN CL wearers?
Youneedtoestablishifthereareanycontraindicationsto contact lens wear or conditions that may limit wear
• Rheumatoid arthritis- cause dry eye, scleritis or uveitis
• Diabetes- cataract, glaucoma ,diabetic macular oedema, diabetic retinopathy - leading to retinal detachment , CL related dry eye
• Eczema
- allergens- itching and redness - lenses may trap allergens which can make it worse
•Theremaybeanincreasedriskofocularinfectionand/or ocular discomfort with certain systemic conditions
What to ask about medication in CL wearers ?
Does the patient take any medication that may affect the eyes?
• We are particularly interested in medications that may affect the anterior eye e.g. cornea, the tears (keratacconus)
• The British National Formulary (BNF) lists the side effects of medications
Relevant FOH/GH
• Any hereditary anterior eye conditions that may affect contact lens wear?
What lifestyle questions can we ask to CL wearers ?
Does your px smoke?
VDU? How much? ,Driver ,Hobbies Occupation
What can we recommend for px using screens ?
20-20-20 rule
-every 20 mins look 20ft away for 20seconds
What is performed after the vision check?
anterior eye health check
What do we check in CL aftercare ?
check lens fit first in aftercare