CL Aftercare

Pre-Advice

• Come in wearing lenses
• Daily wear px come in PM so effects of daily lens wear can be seen, extended wear AM so effects of overnight wear can be seen
• Bring in solutions/case

Initial Discussion

• RFV, any problems? comfort & vision ok?
• Recent lens wearing history - max wearing time, how many days/week, how many hours in today?
• Probs handling lenses? Solution/care system ok?
• Any other eye problems?

Vision w/CLs

• Snellen/logMAR acuity monoc/binoc
• Ret w/trial frame, assess quality of reflex (this may indicate lens lifting off central or peripheral cornea
• Duochrome useful

Assessment of Fit (Soft)

• Comfort
• Vision
• Corneal Coverage
• Centration
• Movement on blink
• Lag on upgaze
• Push-up
• K Mires
• Any conj compression/buckling of lens edge

Assessment of Fit (RGP)

• White light - lens position wrt lids, primary & tertiary gaze, lens centration
• Blue light - flu patterns

Also look for

• lens/eye interactions eg lens edge near 3&9 o'clock staining
• Blinking pattern
• Head position (may indicate loose lens)
• Eye movements
• Palp Ap size - can reduce w/RGP, increase w/soft lens

Keratometry over lens

• Can assess fit, front surface wettability

Inspect Lenses

• Knick/tears
• Edge or body defects
• Deposits - protein, mucus, calcium, Fungi, Jelly Bumps, Rust Rings
• Do wettability/TBUT

Lenses Out

Get px to do it if poss. This allows you to see how they do it, whether they wash hands etc. If it's the first aftercare you should ask them to clean the lenses too to see how they're doing it. Correct any errors. Generally assess compliance.

Slit Lamp

White Light

• Perioc skin, eyebrows, upper and lower lids and lashes
• Bulbar conj
• Tear film
• Cornea
• Inf/sup palp conj

Blue w/Flu

• Corneal/conj staining
• TBUT
• Evert eyelids and examine papillae formation on tarsus

Also examine lenses off eye for damage/deposits. Do any necessary supplementary tests. Rose Bengal, ophthalmoscopy if not done for a while etc

Taking Action

• Same lenses w/different params - shift in Rx/alteration of fit
• New lenses of same general type - higher Dk/t
• New lens type - hydrogel to Si-H to improve physiology, RGP to soft to improve comfort
• Change lens wear modality - extended wear to daily wear
• Change replacement freq - monthly to daily?

Taking Action: Care Systems

• Completely change regimen - multipurpose to hydrogen peroxide
• Change version - 2 step to 1 step
• Alter protocol - add extra saline rinse?
• Change to avoid particular preservative
• Eliminate need for solutions - dailies

Final discussion with patient

• Reassurance concerning symptoms - eyes often feel dry at end of day
• Explain why lenses are being changed - more myopic
• Explain why solns being changed - different preservative to avoid red eyes
• Answer any other questions raised - px has heard about extended wear
• Recommended date of next visit - 6 mths?