University of Missouri-St. Louis
School of Optometry
Optometry 553 Lab
Contact Lens I
Soft Contact Lens Care and Education
Introduction
The purpose of this lab is to acquaint the clinician with the proper exam procedures and care systems for soft contact lenses. It is important to become familiar with insertion, removal and care, enabling the clinician to properly educate the patient. If you are unfamiliar with rigid lenses, soft lenses or both, it will be necessary for you to spend extra time learning about the different solutions, how to properly care for the lenses and to perfect insertion and removal to be able to adequately instruct the patient.
Examination
The fitting of soft contact lenses will be covered in a future lab.
Dispensing Exam: When dispensing lenses to a patient, the top portion of the progress form (lenses on section) needs to be completed. When dispensing lenses to a previous wearer who is simply receiving a replacement, no patient education is required. When dispensing a first-time wearer or changing the type of lenses, you will need to first evaluate the lenses and then educate the patient on care, insertion and removal.
The following is the suggested order of a dispensing exam in order to use the time provided efficiently:
1. Always insert the lenses yourself and perform the evaluation before educating the patient.
2. Allow the lenses 10-15 minutes to adapt. During this adaptation time, you can begin to explain the care system, properties of the lens, insertion and removal.
3. Evaluate the lens performance by the following tests:
Visual acuity
Best sphere over-refraction
Over-keratometry and appearance of mires (Soft CL)
(Fluorescein pattern - Rigid CL)
Position and movement of lens
Other pertinent information
At this point, allow the preceptor to check the lenses!
4. Teach insertion and removal at the desk. The successful insertion and removal of the lenses a maximum of two times per eye, usually makes the patient feel comfortable enough to take the lenses home. Some patients require a second visit. Remember to give them encouragement.
5. Fill out the education forms and provide a wearing schedule to the patient. (Example - 4 hours the first day, 4 hours the second day, 6,6,8,8 hours until the next exam)
6. The preceptor will decide when the patient’s progress visits are but a typical example is:
1 week after dispensing
2 weeks
1 month
3 months
6 months
Every 6 months thereafter
Progress Exam: This may change dependent upon the preceptor preference but basically follow the progress form.
1. Make sure you record name, date, care system, lens type, time worn and maximum wearing time.
2. Take a brief history and record any complaints.
3. Evaluate lenses on as with the dispensing visit.
At this point, allow the preceptor to check the lenses. Lenses do not look the same on reinsertion as they do after at least 4 hours of wear.
4. Evaluate the eyes with lenses off. Remember to rinse fluorescein out or
have patient wear glasses if using fluorescein to check staining.*
5. Check keratometry and refraction.
*Note: Never use fluorescein with a soft lens on. There is only one type of fluorescein that can be used with soft lenses - high molecular weight fluorescein. You may find this very difficult to use as it does not show up as clearly as the fluorescein in the strips or in Fluress. If you need to check IOP, staining or TBUT and wish to use the fluorescein strip or Fluress, you must rinse the eyes thoroughly before re-insertion of the soft lenses. A better alternative is to have the patient wear their glasses for approximately 3 hours before re-insertion of the lens.
Purging: Used to remove potentially harmful substances from the matrix of a soft lens, such as fluorescein or preservatives. The two methods are:
1. Swirl Clean-2 cycles of 10 minutes each in distilled water. 2 cycles
of 10 minutes in Saline.
2. 3 cycles of 8 hours in distilled water, then put the lenses in saline.
If it is fluorescein in the lens, you can also bleach with a hydrogen peroxide system.