revision and contact lens routine Flashcards
what are the 2 main contact lens routines
- new fit
- aftercare
list the 3 main stages that a new fit consists of
- baseline measurements
- teaching insertion and removal (done after the fitting appt)
- lenses given for a trial period
list the 4 main attributes that can be linked to a aftercare
- px in an existing wearer
- routine check or unscheduled visit e.g. a problem
- you may detect a problem in an asymptomatic patient
- might need a refit
list 6 reasons for conducting an aftercare
- assess the ocular reaction to a lens
- answer patient queries/questions
- address any compliance issues
- safety - reduce risk of infection
- ensure optimum comfort and optical performance
- minimise drop outs
why will you assess the ocular reaction to a lens during an aftercare
as it may not happen straight away, but a few months after
list the 11 steps of a new fit from beginning to end
- check initial details
- history and symptoms
- anterior eye slit lamp and lid eversion
- preliminary measurements
- select and insert lens
- va, overrefraction, balance
- lens fit
- post lens removal and slit lamp check
- advice and recommendations
- book teach
- trial lens specification
list the 8 steps of an aftercare from beginning to end
- check initial details
- history and symptoms
- va, overrefraction, balance
- lens fit
- remove lens, insert NaFl
- anterior eye slit lamp and lid eversion
- advice and recommendation
- final specification
what 3 points needs to be checked when checking initial details
- valid spectacle prescription
- during aftercare you also need to know the contact lens prescription as well as spectacle prescription
- check the recall dates
why do you need a valid spectacle prescription before carrying out a new fit or aftercare on a px
because you can guess what power lens to put in and you also know that the posterior eye has been checked
during a new fit, what will you ask for their reason for visit
- their sensible motivation for wear…cosmetic, sport, special occasion?
- the patients expectations e.g. FT wear or occasional wear
during an aftercare, what will you ask for their reason for visit
- isit routine or unscheduled visit
- determine if there are any problems
- follow up any advice from their previous visit (so need to know if any advice was given before)
when measuring dist va and near va during a new fit, what 3 points do you have to consider
- to check it with the specs on
- do they have any amblyopia
- do they have any presbyopia
when measuring dist va and near va during an aftercare, what 4 points do you have to consider
- vision must be good with contact lenses
- vision must be good with specs
- how is their visual stability with the contact lenses throughout the day
- the onset of presbyopia
what two things can cause visual stability problems with contact lenses
- fluctuation: px has to blink to make the lens clear = fitting problem
- is the lens the correct way around?
what 2 points do you have to consider during a new fit, when asking a px about their current ocular health
- check for any symptoms: if so, treat the pre-existing symptom before doing the fit
- contraindications to lens wear
what 4 points do you have to consider during an aftercare when asking current ocular health
- any new problems?
- comfort: any issues when wearing CLs?
- Qus about lenses: age of lens/case, cleaning of lens/case, solution (px may have switched to another brand)
- wear times: days, hours, max, average, today
what 4 main symptoms are considered as an ocular emergency
- light sensitivity
- discharge
- pain
- vision suddenly blurry/loss
but ask questions first
which part of the anterior eye is considered most important
the cornea
what 5 points will you ask a px about their symptoms during history and symptoms
- when
- onset
- triggers: what causes the symptoms/associations
- severity
- how
list 5 times a px can have symptoms when asking ‘when’ they suffer from these symptoms
- on insertion: e.g. hands not clean
- during wear
- end of wear
- after removal: can be probs with eye itself
- beginning of month/end of month: e.g. deposits, lens not clean
what do you need to consider/ask when asking about the onset of a px’s symptoms
- how recent: days? weeks?
- longstanding - check previous records. Has there been a change in symptoms?
what questions would you ask a px about when asking about the severity of their symptoms
- ask px to grade on a scale of 1-10
- how long does the symptoms last for
what 2 things do you have to consider when asking about previous ocular history during both a new fit and an aftercare
- have they ever suffered from any eye conditions?
- establish if there is anything which might limit the px’s wear, lens type, or require more frequent monitoring?
what three things do you need to know during previous ocular history during a new fit
- reason for ceasing wear
- previous lens details
- previous problems
what two things do you need to know during previous ocular history during an aftercare
- check previous records and confirm
- anything new which has occurred since the previous visit
give two reasons why you will ask about any allergies or general health during a new fit or aftercare
- contraindications to wear
- increased risk to ocular infection/ocular discomfort: e.g. diabetic px takes longer to heal
what lifestyle questionnaires would you ask a px during a new fit
does the patient intend to smoke, use VDU and how much, drive, hobbies and occupation whilst wearing their lenses
what lifestyle questionnaires would you ask a px during an aftercare
is the px wearing lenses when, smoking, using VDU, driving, during hobbies and their occupation
what do you do when observing the anterior eye using the slit lamp with white light
- lid eversion
- use grading scale and state the scale used
- record baseline data for medico-legal requirements
- enhance visibility of blood vessels using red free filter (green)
what do you do when observing the anterior eye using the slit lamp with blue light
- check with flourescein sodium and cobalt blue filter
- measure TBUT
which filter can you use to enhance flourescein visibility
wratten 12 filter (yellow)
list the 4 things you must record when checking staining
- location (central is worse)
- extent
- depth (using optic section)
- type (confluent, punctate)
list 4 preliminary measurements that must be taken on all patients, new and existing and why
- HVID
- IP
- pupils
- keratometry
incase the existing px has developed a problem, previous measurements may have changed
how must you mature pupils on a px and what must you comment on about them
in dim lighting and room lighting
- comment on: size, shape and reactions
how must you measure visual acuity on a contact lens px
perform an over refraction:
- check mono VA’s
- push the plus - give minus if improves acuity
- sph/cyl correction if required
- +1.00DS blur test/duochrome
binocular balance
what 2 things do you check with a binocular balance on a pre-presbyope
accommodation and near VA
what 2 things do you check with a binocular balance on a presbyope
near VA and near add (required to achieve N5 at px working distance)
list the advice and recommendations required after a new fit
- explain: if eyes are suitable/unsuitable for contact lens wear
- action plan: book teach appointment/address OH issues
- recall: state weeks
list the advice and recommendations required after an aftercare
- explain: ocular health ok? lens wear ok? address any symptoms or signs
- action plan: either continue with wear or treat signs and symptoms
- recall
- give specifications if appropriate
what must you do if a px reports symptoms such as flashes and floaters
conduct a posterior eye exam
