Week 12 - Aftercare

Question 1

What are factors that can affect recall intervals for contact lenses?

Answer 1

• Corneal pathology
• Corneal physiology
• Application of the lenses
• Compliance
• Acute problems

Question 2

What is additional questions are asked during History and Symptoms during an AfterCare?

Answer 2

• Confirm type of lenses
• How often?
• What time do you put your lenses in? And take them out?
• Age of current pair and hours in today
• Do you sleep in your lenses? Swim in your lenses?
• Cleaning regime (look at the lens case, ask how old it is)
• Comfort
• Any redness/pain/itching/dryness. If yes -> LOFTSEA

• DV/Near/VDU vision
• Back up glasses?

Question 3

What normal questions are asked during aftercare history and symptoms?

Answer 3

• General health - keep this relevant!
• Medications
• Allergies
• Occupation/Hobbies
• Driving
• Smoke

Question 4

What is checked with the lenses in during an aftercare?

Answer 4

• VA
• Over refraction
• Over keratometry
• Lens surface assessment
• Fitting assessment
• Lens-eye interactions

Question 5

how is VA, Over refraction and Over keratometry checked?

Answer 5

• VA - monocular and binocular (think when you are checking monovision)
• Over-refraction
- Spherical if VA good
- Sphero-cyl if necessary to improve VA
- Remember the impact the fit of the lens can have on VA and the Rx

• Over-keratometry
- With the B&L keratometry

Question 6

What is looked for during the lens surface assessment?

Answer 6

• Deposits
• Surface or edge defects
• Wetting of the lens (esp RGP!)
• Tear film interactions

Question 7

How is the fitting assessment done?

Answer 7

This is the same as when you fit the lenses initially
• You want to see the lens at its worst
• But you should be assessing the fit at certain times for different lenses
• I.e. first thing in the morning for EW, towards the end of the day for
DW (and just before the lens will be thrown away)

Question 8

What is looked for during Lens-Eye interactions?

Answer 8

Looking for any adverse interaction between the lens and the ocular
- E.g. 3 and 9 o’clock staining from an RGP
- Or indentation (particularly from soft lens)

Question 9

What inspection techniques are done when having the lenses out - during after care?

Answer 9

• Keratometry/topography
• Refraction
• Slit-lamp biomicoscopy
• Lens inspection
• Other applicable tests

Question 10

What is done during Keratometry/topography and Refraction with lenses out?

Answer 10

Keratometry/topography:
• If you suspect corneal shape changes
• Compare to baseline values
• 3 common changes:
1. Oblate shape (flattening central cornea, EW SiHy)
2. Inferior steepening (low Dk RGP, hydrogel lenses)
3. Impression arcs (RGP induced, usually inferior).
• Can take up to 6 months to resolve

Refraction
• To check for changes induced by corneal warpage.
• Use the ret reflex to look for corneal distortion

Question 11

What is checked for during the Slit-Lamp Biomicroscopy?

Answer 11

• Which grading scale have you used? Why is this important?
• Lid margin/lashes - clean and healthy? Ant bleph? MGD? Excessive make up?
• Bulbar conjunctiva - grade any hyperaemia. Any pterygium? Pinguecula?
• Palpebral conjunctiva - assess inferior and superior. Grade redness and roughness.
• Cornea - grade staining. Must comment on depth of staining (optical section). Draw!
• Limbus - grade redness. Measure neovascularisation. Add this to your drawing
• Tear Film - TBUT, debris (make up) in the tear film?

Question 12

How is the lens inspected?

Answer 12

• Can be held up in front of slit lamp with rubber tipped tweezers
• Looking for any damage to the lens

Question 13

What are some other additional tests that can be done?

Answer 13

• Pachymetry if corneal oedema is suspected (works well if you have baseline or are monitoring over time)
• Corneal endothelial analysis with a specular microscope if suspected polymegathism or pleomorphism (rarely used in standard practice)
• Any symptoms that require further investigation, do not ignore symptoms because it is booked in as a CL appointment.

Question 14

What are the 3 categories in problem solving for CL work?

Answer 14

1. Redness
2. Discomfort
3. Poor vision

Question 15

What thought pattern should be followed with Eye Redness during aftercare?

Answer 15

• Lens causing problem?
• Conjunctival hyperaemia or a deeper structure?
• Conjunctival redness with a quiet limbus and no pain = conjunctival problem
• Conjunctival redness with an injected limbus and pain = corneal problem
• Then go through possible differential diagnosis
• But remember, do not just think about CL complications.

Question 16

What thought pattern should be followed with discomfort during aftercare?

Answer 16

• Bilateral or unilateral?
- Bilateral suggests toxic
- Unilateral suggests problem with that lens

• Still there when lenses removed?
- Suggests ocular problem, gone with lenses out suggests lens problem

• Do ocular lubricants provide relief?
- If yes then consider mechanical or abrasive source

Question 17

What are some possible causes of discomfort?

Answer 17

• Poor fitting
• Damage to lens
• Foreign body on or under lens
• End of day dryness
• Older lenses
• Deposits on lens surface
• Toric lenses can be less comfy due to stabilisation methods
• Pathology - see complications lecture

Question 18

What information is needed if poor vision is found during aftercare??

Answer 18

• Severity
• Consistency
• Onset
• Distance or near
• Description

Question 19

What thought pattern should be followed with Poor vision during aftercare?

Answer 19

• Vision better after removing lenses? Lens problem.
• Sustained vision loss after removing lenses? Ocular problem
• Bilateral? Toxic reaction, allergy, refractive, systemic
• Worse after blink? Lens movement, flat fit.
• Improved after blink? Tight fit

Question 20

What are possible causes of poor vision??

Answer 20

Refractive causes:
• Lens missing
• Change in Rx
• Incorrect lenses (either from supplier or by Px)
• Thick lens causing corneal warpage
• Uncorrected astigmatism
• Mislocation of toric lens
• Monovision lenses in the wrong eyes

OR Ocular pathology!