1. PRELIMINARY EVALUATION
    1. Current Status

      2. 20,000,000 CL wearers in U.S.

      4-5,000,000 New Wearers each year

      4-5,000,000 D/C every year

    2. History

Reasons for Contact Lenses
    1. Cosmetic
    2. Inconvenience of glasses
    3. Sports and recreation
    4. Occupation – yes to performing arts, athletes, no (or borderline) to those around sprays, chemicals, dirt, flight attendants/pilots, VDTs???)

Medical History
    1. Allergies
    2. Sinusitis
    3. Dryness of mouth, eyes, or mucous membranes
    4. Convulsions/epilepsy
    5. Fainting spells
    6. Diabetic
    7. Pregnant
    8. Psychiatric Treatment
    9. Thyroid imbalance

Medications
    1. Diuretic
    2. Dilantin
    3. Tranquilizers
    4. Antihistamines
    5. Birth control pills

 

 

Do You Plan to Stay in Area for 6 months (minimum)???

Contact Lens History

What is the Patient Wearing? Satisfaction? Symptoms?

Reason(s) for Changing

Beware of Shopper
    1. Refractive Information
    1. Keratometry
    2. Refraction
    3. Calculated Residual Astigmatism (CRA)

CRA = refractive cyl – keratometric cyl

If refraction = -2.00 – 1.00 x 180 and

Keratometry = 42.00 @ 180; 42.25 @ 090

CRA = -1.00 – (-)0.25 = -0.75 x 180
    1. Slit Lamp Evaluation
    1. Conjunctiva
    2. Lids – grade palpebral conjunctiva

      3. 0 = satin

      1 = several papillae per mm

      2 = papillae 0.5 – 1.0mm in size

      3 = Giant Papillary Conjunctivitis (GPC), lens intolerance, discharge, with fluorescein, large papillae are observer near margin

    3. Cornea

      4. •limbal vasculature

      •staining

      •opacities

      •endothelium

    4. What if the patient has???
    1. blepharitis
    2. coalesced corneal staining
    3. neovascularization
    4. pinquecula
    5. pterygium
    6. entropion
    7. ectropion
    8. corneal scar
    1. Binocular Vision Status
    1. the prepresbyopic myope may experience accommodation problems when being fitted into contact lenses
    2. If base-in and base-out prism necessary, contact lenses may be contraindicated
    3. A spectacle corrected myope has base-in prism when fixating at near and must not converge more for a given distance. A spectacle corrected hyperope has base-out prism when fixating at near. A contact lens corrected hyperope does not have base-out prism when fixating at near and must converge less for a given distance.
    1. Anatomical Measurements
    1. Corneal Diameter = horizontal visible iris diameter
    2. Pupil Diameter (dim and normal illumination)

      3. Small < 5mm

      Medium 5-7mm

      Large >7mm

    3. Palpebral Aperture Height – straightahead gaze
    1. Lid Tension/Blink Rate
    1. Lid Tension – determined via lid eversion
    2. Blink Rate – 10-15/minute normal
    1. Tear Film Evaluation
    1. Tear B.U.T.
    2. Schirmer (1 minute)
    1. Evaluation of Motivation
    1. Satisfaction with spectacles (i.e., "shopper???")
    2. My parents made me do it
    3. Limited wearing time
    4. Concerned about fees, comfort, possible complications, etc.
    5. Determined during consultation
    1. Consultation
    1. Benefits of CL’s versus spectacles
    1. increased magnification of retinal image
    2. free from obstruction of spectacle frame
    3. slight increase in light transmission
    4. fewer optical aberrations – most significant as the patient views through the optical center of the lens at all times

2. Benefits – RGPs Benefits – Hydrogels

Vision Initial Comfort

Ocular Health Ability to Inventory

Good Surface Wettability No Foreign Body Sensation

High Oxygen Transmission Variable Wear/Disposable

Correction of Astigmatism Athletes

East of Care/Good Compliance Residual Cyl with Rigid

Long-term Comfort Change Eye Color

Reduce Myopia Progression

•Stone (PMMA)

•Perrigin (Houston)

3. Comfort – important factor; don’t tell patient they will always experience excellent comfort. Even after adaptation, they cold occasionally experience dryness, FB sensation and redness

Discomfort is the number ONE reason for discontinuation of contact lens wear

4. Fees

5. Wearing Time/Expectations

6. Myths:

"The contact lens will get behind my eye"

"The contact lens will break on my eye"

"I can’t be fit as I have astigmatism"

"Contact lenses damage the eye"

"You must be 16 to wear lenses aren’t you"

"Contact lenses HURT"

Eye Protection:

•Rengstorff and Black – 125 cases where eyes were protected

•Wear with Protective Eyewear
    1. Suitability
    1. Good Candidates:
    1. Aphakia
    2. High Myopia
    3. Hyperopia
    4. Refractive Anisometropia
    5. Keratoconus
    6. Motivated
    7. Good ocular/systemic health, binocular status
    1. Poor Candidates:
    1. Unmotivated
    2. Dry Eye
    3. Moderate Allergies/Antihistamine use
    4. Giant Papillary Conjunctivitis, Coalesced Staining, Active Infection, etc.
    5. Dirty
    6. Pregnant
    7. Binocular Vision problem

3. What about the –0.50D myope???