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Contact lenses year 3 > Instruction and care regime > Flashcards

Instruction and care regime Flashcards

1
Q

give 8 examples of non-compliant behaviour with contact lenses

A
  • 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
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2
Q

which type of non-compliant behaviour can increase the risk of MK

A

sleeping in contact lenses

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3
Q

list 6 consequences of non-compliance

A
  • Lens/case contamination
  • Increase in lens deposits
  • Decreased comfort
  • Vision affected
  • Lens wear ‘drop out’
  • Serious complications
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4
Q

in how many % does contamination of lens case occur

A

30-85%

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5
Q

which 4 microbes can contaminate a lens case and what do they form on the case

A
  • 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
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6
Q

what can the contamination of a lens case from microbes cause

A

serious complications e.g. microbial keratitis

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7
Q

what may a case material react with and what can this cause as a consequence

A

may react with preservative and reduce solution efficacy

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8
Q

how quick can a biofilm form on a plastic case

A

as quick as 2 hours

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9
Q

what is a lens case material made up of and what instruction should be followed due to this

A
  • made up of a polymer and stoic acid to soften the case

- so must use case that comes with the CL solution

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10
Q

list 6 possible reasons for non-compliance

A
  • Busy lives
  • Complex care systems
  • Poor understanding
  • Poor patient education
  • Not suffered any adverse effects
  • Cost
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11
Q

what should you do if a patient resorts to non-compliance due to a complex care system

A

change to dailies

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12
Q

what should you do if a patient resorts to non-compliance due to poor patient education

A

give a leaflet

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13
Q

what can occur if a patient who has not suffered any adverse effects from non-compliance

A

reinforcement bad behaviour

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14
Q

what 3 things can you do in order to detect non-compliance

A
  • effective questioning
  • observe the patient
  • look at the CL order records
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15
Q

how can you perform effective questioning in order to detect non-compliance

A

by asking open questions and do not prompt

e.g. how do you clean your contact lenses?

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16
Q

what can you do when you observe a patient in order to detect non-compliance

A

Watch lens removal and note behaviours
do they was hands?
clean the lenses properly?

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17
Q

what sort of information from CL order records gives clues to non-compliance

A

Lack of correlation order history and frequency of wear

px may buy lenses online etc

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18
Q

which 2 types of patients may be non-compliant

A
  • online purchases

- age

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19
Q

how can people who purchase their contact lenses online be non-compliant

A
  • 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
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20
Q

how is age a factor of non-compliance and which age group has the highest non-compliance rate

A
  • Adults less compliant than children

- Complications by non-compliance highest in 18-25 year olds

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21
Q

list 8 things that can help with dealing with non-compliance

A
  • 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?
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22
Q

list 6 things you can advise a patient about lens insertion

A
  • 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
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23
Q

list 5 ways you can check a contact lens is the correct way around

A
  • 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?
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24
Q

what three points should you remember when teaching a patient on lens insertion

A
  • give clear instructions: say how it will feel
  • reassure the patient: no pain, lens can’t get lost behind the eye
  • be confident
25
Q

what three things should you have in your surroundings when teaching the patient to do their own lens insertion

A
  • 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
26
Q

list the 6 steps for a patient to follow when teaching SOFT lens insertion

A
  • 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
27
Q

list the 2 steps for a patient to follow when teaching SOFT lens removal

A
  • Eyelids held same way as insertion

- Sliding onto inferior or temporal sclera and pinching out

28
Q

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

A

because there is a risk of scratching the cornea

29
Q

list the 4 steps for a patient to follow when teaching RGP lens insertion

A
  • 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

30
Q

give an example of a technique that can be used for removal or RGP lenses

A

Two fingers, one from each hand, top and bottom lids, pushing towards each other

31
Q

how is a RGP lens supposed to be centred

A

Patient must remove lens and reinsert

Cannot ‘slide’ lens if decanted - risks corneal damage

32
Q

how is a soft lens supposed to be centred

A

Soft lenses usually reposition themselves

If lens decentred or folded over, instruct patient to look in opposite direction to where lens is and remove

33
Q

what must you ensure and advise a patient on lens insertions and removal before allowing them to take the lenses away

A
  • Patient must be proficient before leaving practice
  • Can arrange a further teach appointment if required
  • Give advice on adaptation
34
Q

after how long do you usually see a patient after their contact lens teach/trial period

A

Usual to see patient 1 week after initial fitting/teach

35
Q

what is the advised wear time for a patient who is trying a high water content soft lens

A
  • Initially 4 hours
  • Build up by two hours per day
  • Maximum of 12 hours before next after-care visit
36
Q

what is the advised wear time for a patient who is trying a low water content soft lens

A
  • Initially 3 hours
  • Build up by one hour per day
  • Maximum of 12 hours before next after-care visit
37
Q

what is the advised wear time for a patient who is trying hard lenses

A
  • 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
38
Q

what 4 steps does the care regime of a contact lens consist of

A
  • sterilisation
  • disinfection
  • cleaning and rinsing
  • rub and rinse
39
Q

what 2 products are used for the care regime of soft/silicon hydrogel lenses

A
  • multipurpose solutions

- hydrogen peroxide

40
Q

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

A
  • Simple and convenient
  • Cleaning, disinfecting, storing
  • clean, rub, rinse, store (for min 4-6 hrs)
41
Q

what must you do before inserting soft/silicone hydrogel lenses that are stored in hydrogen peroxide and what are the advantages of hydrogen peroxide

A
  • metallic disc in case or tablet to neutralise the disinfectant before wear
  • No adverse reaction to preservatives (mps have preservatives)
  • Gold standard?
42
Q

what 4 products are used for the care regime of RGP lenses

A
  • cleaner
  • conditioner
  • saline to rinse
  • protein removing (enzyme) tablets
43
Q

what are the 2 properties of cleaner used in the care regime of RGP lenses

A
  • Remove lipids and mucus

- Can enhance the disinfecting action of soaking solution

44
Q

what are the steps of a contact lens case regime

A
  • Clean lens case with solution
  • Wipe with a clean tissue and air dry
  • Place case and lids face down on a tissue
45
Q

list 6 things you will advise a patient NOT to do with their contact lens and case

A 
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
46
Q

what 4 things will you advise your patient to do with their contact lens and case

A
  • 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
47
Q

what are the 5 pieces of advise you will give to a patient regarding water

A
  • 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
48
Q

what are 3 risk factors/causes of acanthamoeba keratitis

A
  • Exposure to contaminated water and soil
  • Poor hygiene
  • Reusing/topping up CL solutions
49
Q

list he 4 signs of acanthamoeba keratitis

A
  • Vision affected
  • Hypopyon
  • Secondary glaucoma
  • Characteristic corneal ring infiltrate
50
Q

list the 4 symptoms of acanthamoeba keratitis

A
  • Pain
  • Light sensitivity (photophobia)
  • Red eye
  • FB sensation
51
Q

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

A
  • 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

52
Q

if the patient feels they have an emergency case related to their contact lenses, who are they advised to contact

A
  • Contact practice in office hours
  • Contact eye casualty out of office hours

Add this advice to answerphone message

53
Q

Collection frequently delegated to ______ _________ staff, but ultimately responsibility of ____________

A

Collection frequently delegated to non clinical staff, but ultimately responsibility of practitioner

54
Q

what are the 6 points related to delegation at the time of collecting lenses

A
  • 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
55
Q

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

A

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

56
Q

what does the AOP advise must be done when supplying contact lenses to a patient

A
  • 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
57
Q

what does the college of optometrists state that must be done when supplying contact lenses to a patient (8 points)

A
  • 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
58
Q

as stated by the college of optometrists, when can you not supply contact lenses to a patient

A

after the specification has expired

59
Q

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

A
  • registered optometrist
  • dispensing optician
  • doctor

Contact lenses year 3 (15 decks)

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