Rigid Lens Care and Patient Education
•Common use in ophthalmic solutions and PMMA solutions
•Quaternary ammonium compound
•Effective against bacteria, fungi
•High concentrations (greater than 0.0004% = SPK, desiccation, conjunctivitis). Meyerson study: 11 S/A patients with BAK-induced SPK initiating within 2 months, were switched to non-BAK preserved regimens and showed no reactions in 4 months
•Exps. Wet n’Soak, Sereine
•Mercurial Compound (high sensitivity rate)
•Slow-Acting
•Being phased out
•Exps. Barnes-Hind, Soaclens
•Bacteriocidal, quick-acting
•Problematic with soft lens solutions but used in several RGP solutions due to low binding capacity
•Exps. Barnes-Hind, Boston Conditioning
•Recently FDA-approved – was originally considered as a solvent
•Benefits include low molecular weight, bipolar and soluble in water
•Very little uptake on S/A and F-S/A lenses
•Hydrogel preservative recently introduced with the Boston system
•Low sensitivity rate
•Greater effectivity against Serratia Marcescans
•Enhance surface wettability
•Maintain hydrated state
•Disinfection
•Mechanical buffer
•Polyvinyl Alcohol – beneficial properties include:
•Methyl Cellulose Derivatives
•Viscosity
•Material Specificity – Boston Conditioning Solution with cationic cellulose molecules
•Preservative Interaction
Store hydrated due to:
•Disinfection
•BCR stability
•Enhance wettability
•Minimize surface scratches
•Wettability problems have been noted as number 1 concern by practitioners
•It is essential for a uniform tear mucin coating to be adherent to lens surface. There is an electrostatic attraction between silicone and lysozyme.
•Muco-protein haze
•Muco-protein film
•Lipids
•Minor scratches
•Power changes
•20 yr. PMMA refit into Fluoroperm 92 (March, 1987) with Opticlean.
BCR – 8.10, Rx = -2.25 O.U.
CT = .19mm (OD); .18mm (OS)
•January, 1990 pt presented asymptomatic for refit (first visit since 11/20/87. She had since switched to the Boston system.
•CL’s verified as:
OD: Rx = -3.75; CT = .14mm
OS: Rx = -4.75; CT = .14mm
•Minus results from circular motion during forceful cleaning
•Primarily lens center
•Patients must be educated to:
•3 cleaners (Boston, Opticlean II, Resolve), 2 cleaning methods (palm, digital), 2 lens powers (-3.00, -8.00), 2 time periods (10 sec, 20 sec).
•Boston caused greatest changes
•Grohe study (1984) showed deposit-prone S/A wearers benefited by soaking in LOBOB
•DeStat 3 (Sherman) – Disinfecting/cleaning
•Effective in protein removal
•2 Hour Soak 1x/week as needed
•In-office cleaning of very adherent/thick deposits
•Includes:
•HydraMat
•Minimize rough handling/warpage
•Use of abrasive initially; add enzyme if film/haze results
•Deep-welled
•Leakproof
•L vs. R
•Ridges/Holes
•Pre-Soaking
•Conditioning Solution
•Laboratory Cleaner
•Polish???
•Wettability improves with tear film interaction
•Carefully in Palm of Hand (not between fingers) to minimize warpage
Material Dk # Total #Replaced
Optacryl 60 18 40 1
Optacryl K 32 30 6
Paraperm EW 56 40 14
Optacryl Z 84 36 13
•clean upon removal (not A.M.)
•10 seconds minimum
•Ease of surface scratches
•Handle over soft surface
•Contain preservatives, oils and solvents – discomfort/injection
•Applied after CL’s
•Don’t use "lash builders"
•Bacteria is a problem
•No eyeliner to inner lid margin
•Use recommended products
•Use water-based mascara (hypoallergenic/sensitive eyes) – discard after 3 months
•No lanolin-based or commercial soft soaps
•Use AO Soap, Optisoap or most bar soaps
•10-14 days – varies but can evaluate via initial reaction
•if d/c, they will need to build up wearing time
•wear 4 hours (minimum) prior to visits
Normal
AbnormalMild Discomfort Pain
Mild Injection Severe
Mild Tearing Excessive
Difficulty with
Superior gaze
Days One/Two: 4 Hours
Three/Four: 6 Hours
Five/Six: 8 Hours
Seven/Eight: 10 Hours
Nine/Ten: 12 Hours
Eleven/Twelve: 14 Hours
•One week (after dispensing)
•One month (after Visit One)
•Three Months (after Visit Two)
•Six Months (after Visit Three)
•Every 6 Months
•Insertion, removal and recentration
•Proper cleaning
•Care system
•Adaptation/Wearing schedule
•Normal/Abnormal symptoms/signs
•Instruction booklets should be simple, concise and legible
•Anadem Publishing (1-800-633-0055)
•Don’t expect patients to read instructions
•Reinforces written and verbal messages; can be loaned to patient as well
•Generic video on insertion, removal, cleaning and care is available from CLMA/RGPLI Video Library (1-800-343-5367)
•Reinforce solution use, case cleanliness and compliance
•Wilson study: contamination of care samples decreased from over 50% to 6% when instructions were reinforced
•agreement in duplicate (see attached)
•Anadem Publishing
•Tap water
Patient has the following pre-fitting information:
Otherwise a good candidate and high motivated for RGP’s