Section 5: Follow Up

Question 1

Daily silicone Hydrogel wearers should be checked with in the first _____ of lens insertion and why?

Answer 1

2-4 hours to see if any solution interactions.

Question 2

Step 1: Take History:

My Only Cosy Home I S my B E D

Answer 2

Review medications, anything new?
Question if any redness, tearing, photobhobia or discharge is present
How long wearing / day, what time put in/ out
How do they feel when first put in
How do they feel after taken out
What solution- How cleaning
Are you using Lubrication drops

Question 3

Step 2: With lenses in take VA’s

Answer 3

Distance and near Monocular and Distance and near binocular.
(lights on, contacts in)
Want 20/25 Distance J2 (20/32) Near

Question 4

Step 3: Over Refraction

Answer 4

If VA’s not as good as they should be try +/- 0.25-0.50

Question 5

Step 4: Over Keartometry

Answer 5

While lenses are worn by seeing how clear mires are before and after blink.
Tight- Blurred before blink, clear after
Loose- Clear first, blur after blink, then clear.

Question 6

Step 5: External Exam

Answer 6

Do general survey without slit lamp for redness, blink habits, inflammation..

Question 7

Step 6: Slit lamp with lenses in

Answer 7

Examine surface of lens for quality, deposits, tear film, and edge defects
Evaluate fit/ movement
Possible interactions between lens and eye (indentation, staining)
Check tear break up time ( 5 sec of more clean/ mild. Less than 5 sec replace lenses more frequently)

Question 8

Step 7: Lens removal

Answer 8

Have patient remove contact lenses and clean them in front of you and observe their habits. (or have them describe if they don’t have glasses with them)

Question 9

Step 8: VAs without lenses in

Answer 9

Record Distance and near, monocular and binocular with lights on, contacts out

Question 10

Step 9: Keratometry without lenses

Answer 10

Check against previous Ks (changes greater than +/- 1.00D are significant, investigate fit)

Question 11

Step 10: Slit lamp without Lenses

Answer 11

Instill Fx
Upper lid eversion
General anterior-seg exam (lids, adnexa, conjunctiva, cornea, tear film, anterior chamber, iris and lens)

Question 12

Step 11: Discuss changes

Answer 12

Reinforce good practices, resolve problems if necessary

Question 13

Step 12: Rebook next follow up

Answer 13

Instruct patient to wear lenses into next appointment and bring case and solutions with them.

Question 14

My Only Cosy Home Is My B E D

Answer 14

Modality
Old (how old is this pair)
Cleaning (how do you clean them)
Hours worn
Insertion and Removal
Solution used (same or changed)
Medication (new?)
Brand
Eye drops
Dry Eye