Instruction and care regime Flashcards
give 8 examples of non-compliant behaviour with contact lenses
- Poor/absent hand washing
- Poor/incorrect lens case cleaning
- Inadequate lens cleaning
- Not replacing lenses
- Showering/Swimming in lenses
- Sleeping in contact lenses
- Forgetting to attend for aftercare appointment
- Reusing/topping-up lens solutions
which type of non-compliant behaviour can increase the risk of MK
sleeping in contact lenses
list 6 consequences of non-compliance
- Lens/case contamination
- Increase in lens deposits
- Decreased comfort
- Vision affected
- Lens wear ‘drop out’
- Serious complications
in how many % does contamination of lens case occur
30-85%
which 4 microbes can contaminate a lens case and what do they form on the case
- Fungi
- bacteria
- viruses
- protozoans
- form a biofilm on the case: where the microorganisms join up and form a tough outer shell, their bonds strengthen and then like to stick to plastic cases
a biofilm can form as quick as 2 hours so must clean a dirty case
what can the contamination of a lens case from microbes cause
serious complications e.g. microbial keratitis
what may a case material react with and what can this cause as a consequence
may react with preservative and reduce solution efficacy
how quick can a biofilm form on a plastic case
as quick as 2 hours
what is a lens case material made up of and what instruction should be followed due to this
- made up of a polymer and stoic acid to soften the case
- so must use case that comes with the CL solution
list 6 possible reasons for non-compliance
- Busy lives
- Complex care systems
- Poor understanding
- Poor patient education
- Not suffered any adverse effects
- Cost
what should you do if a patient resorts to non-compliance due to a complex care system
change to dailies
what should you do if a patient resorts to non-compliance due to poor patient education
give a leaflet
what can occur if a patient who has not suffered any adverse effects from non-compliance
reinforcement bad behaviour
what 3 things can you do in order to detect non-compliance
- effective questioning
- observe the patient
- look at the CL order records
how can you perform effective questioning in order to detect non-compliance
by asking open questions and do not prompt
e.g. how do you clean your contact lenses?
what can you do when you observe a patient in order to detect non-compliance
Watch lens removal and note behaviours
do they was hands?
clean the lenses properly?
what sort of information from CL order records gives clues to non-compliance
Lack of correlation order history and frequency of wear
px may buy lenses online etc
which 2 types of patients may be non-compliant
- online purchases
- age
how can people who purchase their contact lenses online be non-compliant
- they care 3.8 x more likely to forget their aftercare schedule, causing higher risks, less advice is given to them and deposits on lenses cannot be picked up
how is age a factor of non-compliance and which age group has the highest non-compliance rate
- Adults less compliant than children
- Complications by non-compliance highest in 18-25 year olds
list 8 things that can help with dealing with non-compliance
- Regular planned replacement plans-delivery to home
- Regular aftercares
- Calendar with prompts
- Reminders on phone
- Smartphone apps e.g. by J&J
- Patient education
- Explain need to clean
- Showing photos of consequences?
list 6 things you can advise a patient about lens insertion
- Clean and short fingernails
- Wash and dry your hands
- Check lens against specification and packaging (correct BC and power)
- Check right and left lenses are correct way around (label the for px)
- Check lens expiry date
- check the lens is the correct way around
list 5 ways you can check a contact lens is the correct way around
- Sometimes there are markers on lenses
- ‘Bowl shaped’ or do edges flare out?
- VA stable?
- Excessive lens movement? (also reflex/excessive tearing)
- Is the lens uncomfortable?
what three points should you remember when teaching a patient on lens insertion
- give clear instructions: say how it will feel
- reassure the patient: no pain, lens can’t get lost behind the eye
- be confident
what three things should you have in your surroundings when teaching the patient to do their own lens insertion
- work over a flat surface
- Magnifying mirror: esp for a presbyope
- Tissues: a tinted lens will fall on the white tissue and also used for reflex tearing
list the 6 steps for a patient to follow when teaching SOFT lens insertion
- Hold LE upper lid from under the lashes (not the brow) with left index finger
- Use right hand middle finger to pull down lower lid
- If patient doing insertion, they should look into the mirror
- Use right index finger for insertion.
- After soft lens insertion ask px to look at different points in room, this will eliminate any air bubbles and prevent the lens from falling out
- Slowly release lids once air bubbles have disappeared
list the 2 steps for a patient to follow when teaching SOFT lens removal
- Eyelids held same way as insertion
- Sliding onto inferior or temporal sclera and pinching out
why must the patient be advised against pinching their lens off the cornea and encouraged more to pinch it off the sclera with SOFT lenses
because there is a risk of scratching the cornea
list the 4 steps for a patient to follow when teaching RGP lens insertion
- Ask px to look up
- Hold LE upper eyelid from under the lashes with left index finger
- Use right hand for holding lower lid and for lens insertion
- Keep both eyes open -prevents Bell’s phenomenon
the lens goes straight onto the cornea with RGPs
give an example of a technique that can be used for removal or RGP lenses
Two fingers, one from each hand, top and bottom lids, pushing towards each other
how is a RGP lens supposed to be centred
Patient must remove lens and reinsert
Cannot ‘slide’ lens if decanted - risks corneal damage
how is a soft lens supposed to be centred
Soft lenses usually reposition themselves
If lens decentred or folded over, instruct patient to look in opposite direction to where lens is and remove
what must you ensure and advise a patient on lens insertions and removal before allowing them to take the lenses away
- Patient must be proficient before leaving practice
- Can arrange a further teach appointment if required
- Give advice on adaptation
after how long do you usually see a patient after their contact lens teach/trial period
Usual to see patient 1 week after initial fitting/teach
what is the advised wear time for a patient who is trying a high water content soft lens
- Initially 4 hours
- Build up by two hours per day
- Maximum of 12 hours before next after-care visit
what is the advised wear time for a patient who is trying a low water content soft lens
- Initially 3 hours
- Build up by one hour per day
- Maximum of 12 hours before next after-care visit
what is the advised wear time for a patient who is trying hard lenses
- Initially two hours
- Build up by two hours per day
- Maximum of 8 hours before next after-care visit
- Do not have to achieve maximum each day
- Can break into two wearing periods
what 4 steps does the care regime of a contact lens consist of
- sterilisation
- disinfection
- cleaning and rinsing
- rub and rinse
what 2 products are used for the care regime of soft/silicon hydrogel lenses
- multipurpose solutions
- hydrogen peroxide
what is the advantage of multi purpose solutions and how long is the minimum time the lenses must be stored in them for soft/silicon hydrogel lenses
- Simple and convenient
- Cleaning, disinfecting, storing
- clean, rub, rinse, store (for min 4-6 hrs)
what must you do before inserting soft/silicone hydrogel lenses that are stored in hydrogen peroxide and what are the advantages of hydrogen peroxide
- metallic disc in case or tablet to neutralise the disinfectant before wear
- No adverse reaction to preservatives (mps have preservatives)
- Gold standard?
what 4 products are used for the care regime of RGP lenses
- cleaner
- conditioner
- saline to rinse
- protein removing (enzyme) tablets
what are the 2 properties of cleaner used in the care regime of RGP lenses
- Remove lipids and mucus
- Can enhance the disinfecting action of soaking solution
what are the steps of a contact lens case regime
- Clean lens case with solution
- Wipe with a clean tissue and air dry
- Place case and lids face down on a tissue
list 6 things you will advise a patient NOT to do with their contact lens and case
x Do not lick lenses! x Sleeping in contact lenses x Do not share lenses with anyone else x Avoid tap water x Do not reuse dailies x Do not exceed life of lens x Do not use solutions/lenses past expiry x Do not reuse or top up solution
what 4 things will you advise your patient to do with their contact lens and case
- Insert same lens first to avoid mixing up lenses
- Keep eyes closed when using hairspray etc
- Replace lens case at least monthly
- Make sure you have an up to date pair of specs
what are the 5 pieces of advise you will give to a patient regarding water
- Do not swim with lenses
- Do not shower in lenses
- Dry your hands before handling the lenses
- Keep case away from sink
- Never ever store lenses in water
what are 3 risk factors/causes of acanthamoeba keratitis
- Exposure to contaminated water and soil
- Poor hygiene
- Reusing/topping up CL solutions
list he 4 signs of acanthamoeba keratitis
- Vision affected
- Hypopyon
- Secondary glaucoma
- Characteristic corneal ring infiltrate
list the 4 symptoms of acanthamoeba keratitis
- Pain
- Light sensitivity (photophobia)
- Red eye
- FB sensation
list the 4 questions a patient should ask themselves in the case of an emergency and what signs/symptoms correlates with their questions, what should be done if the answer is no to all these questions
- Do my eyes look good? i.e. is there redness, discharge
- Do my eyes feel good? i.e. any FB sensation, irritation, discomfort
- Do I see well? Is VA affected
- Do I feel well? E.g. do they have the flu? Other infection?
if answer is no, then lenses should be removed
if the patient feels they have an emergency case related to their contact lenses, who are they advised to contact
- Contact practice in office hours
- Contact eye casualty out of office hours
Add this advice to answerphone message
Collection frequently delegated to ______ _________ staff, but ultimately responsibility of ____________
Collection frequently delegated to non clinical staff, but ultimately responsibility of practitioner
what are the 6 points related to delegation at the time of collecting lenses
- Standard of care - must be met
- Ensure competence - are staff trained?
- Responsibility - yours!
- Preserve confidentiality
- Provide adequate information
- non clinical staff should not be expected to interpret clinical signs
list everything (9 things) that must be included in a contact lens specification as stated by the GOC rules 1989 section 25(5) of the act
The specification provided under section 25(5) of the Act must include the following particulars:
(a) the name and address of the individual;
(b) if the individual has not attained the age of sixteen on the day the specification is issued, his date of birth;
(c) the name and registration number of the person signing the specification;
(d) the address from which the person signing the specification practises;
(e) the name of the practice on whose premises the fitting was done;
(f) the date the fitting was completed;
(g) sufficient details of any lens fitted to enable a person who fits or supplies a contact lens to replicate the lens;
(h) the date the specification expires; and
(i) such information of a clinical nature as the person fitting the lens considers to be necessary in the particular case
what does the AOP advise must be done when supplying contact lenses to a patient
- Ask the patient to sign a consent form indicating patient understands advice and instructions about the wearing and care of the lenses
- Record on patient’s record
what does the college of optometrists state that must be done when supplying contact lenses to a patient (8 points)
- Provide a written specification of each powered (or plano) contact lens when you have completed the fitting
- Include expiry/recall date
- Use professional judgment
- to determine expiry
- Must not supply patients with lenses after specification has expired
- Can buy contact lenses from any supplier
- Sale must be by, or under the supervision or general direction of a
–registered optometrist
–dispensing optician
–doctor - Supplier of contact lenses may ask you to verify patient’s specification
–need the patient’s consent to give any information to supplier
as stated by the college of optometrists, when can you not supply contact lenses to a patient
after the specification has expired
as stated by the college of optometrists, which three types of people must the sale of contact lenses be done by or under the supervision of
- registered optometrist
- dispensing optician
- doctor
