Ординатура / Офтальмология / Английские материалы / Contact Lenses in Ophthalmic Practice_Mannis, Zadnik. Coral-Ghanem, Kara-Jose_2003
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230 C. Coral-Ghanem and M.D. Bailey
Figure 21.6. Examination of lens integrity by viewing the lens in profile placed on the fingertip.
Figure 21.7. A: Correct configuration of the lens. B: Incorrect appearance of the an ‘‘inside-out’’ lens.
positioned. If the border splays outward, however, the lens is inside out (Figure 21.8B).
Step 4
Place the contact lens in the eye (Figure 21.9A and B)
1.Always handle the lens, right or left, with the corresponding hand to avoid switching the lens.
2.Position the lens on the tip of the right index finger, for example, and be sure that it is dry, to facilitate transfer of the contact lens to the eye.
21. Maintenance and Handling of Contact Lenses 231
Figure 21.8. A: Correct configuration. B: Incorrect configuration with outward splaying of the border.
3.Place the middle finger of the same hand near the inferior palpebral margin, pulling the lid down inferiorly.
4.Use the fingers of the other hand to lift the superior lid.
5.Place the contact lens directly on the eye, using the index finger.
6.Look down and slowly remove the right hand, freeing the lower lid.
7.Look straight ahead and remove the left hand, freeing the upper lid.
8.Blink gently.
The same steps should be repeated for the contact lens in the left eye.
232 C. Coral-Ghanem and M.D. Bailey
Figure 21.9. Placement of a hydrophilic contact lens in the A: Right eye. B: Left eye.
Step 5
Check vision alternately in each eye to be sure that the contact lens is in place. If vision is blurred or discomfort is felt, check to see if the contact lens is off-center, dirty, in the wrong eye, torn, or damaged. If, after placement in the eye, vision is still blurred or the eye is uncomfortable, a new lens should be tried, or the old lens should be set aside and the wearer should contact his/her eye care practitioner.
21. Maintenance and Handling of Contact Lenses 233
Removal Method
1.Wash, rinse, and dry hands.
2.Use wetting drops 5 to 10 minutes prior to removal to ensure that neither the eye nor the contact lens is dry. A moistened contact lens remains loose and is more easily removed from the eye. This avoids ocular irritation and tearing of the contact lens during removal from the eye.
3.Begin removing the first lens by looking at a distant target.
4.Be sure that the lens is in the eye.
5.Look up without lifting the head. Pull the inferior lid down with the middle finger. Place the tip of the index finger on the inferior border of the contact lens, and slide it off of the cornea and over to the white of the eye.
6.Gently grasp the contact lens between the index finger and thumb and remove it (Figure 21.10).
39.What is the basic care routine for daily wear hydrophilic lenses?
1.Daily cleaning with surfactant.
2.Daily enzymatic cleaning (solution) or weekly (tablet).
3.Daily disinfecting with chemical solutions or 3% hydrogen peroxide.
4.Individuals with a good tear film may substitute multiuse solution for specific solutions. It may be necessary to augment regular maintenance with surfactant and enzymatic cleaners.
Figure 21.10. Removal technique of a soft contact lens.
234C. Coral-Ghanem and M.D. Bailey
40.What is the basic care routine for cosmetic hydrophilic lenses?
1.Daily cleaning with surfactant solution.
2.Daily enzymatic cleaning (solution) or weekly cleaning (tablet).
3.Daily chemical disinfecting.
4.Cleaning with abrasive solutions is not recommended.
5.Thermal disinfection is not recommended.
41.What is the basic care routine for extended wear hydrophilic lenses?
1.The lens should be removed at least once a week and, if possible, more frequently as the lens gets older.
2.Use surfactant solution and enzymatic cleaner.
3.Disinfect with specific solutions or 3% hydrogen peroxide.
4.High water-content lenses should not undergo thermal disinfection.
42.What is the basic care routine for hydrophilic lenses used only occasionally?
1.Cleaning with surfactant or multiuse solutions.
2.Chemical solution for disinfection and storage.
3.Change of the storage solution every time the contact lens is used.
Lenses should not be stored in saline.
43.What is the basic routine for care of disposable lenses?
1.Cleaning and disinfection with multiuse solution or 3% hydrogen peroxide.
2.Enzymatic cleaning can be dispensed with in lenses that are discarded at least every 3 months in wearers who do not have giant papillary conjunctivitis.
44.What is the basic care routine for hybrid contact lenses?
1.Instill lubricant in the contact lens prior to removing it from the eye.
2.Clean the lens with surfactant solution, rubbing gently for 20 seconds.
3.Avoid everting the contact lens.
4.Disinfect with 3% hydrogen peroxide or chemical solution, avoiding chlorhexidine.
Enzyme cleaner is recommended for wearers who have a tendency to
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deposit formation. Hybrid contact lenses should not be disinfected thermally.
45.How does one proceed when a contact lens is dislocated in the eye?
A contact lens may dislocate over the conjunctiva during insertion or wear. To re-center it, the following method should be used:
1.Look in the direction of the dislocated contact lens. Blink gently. The contact lens should move automatically in the direction of the center of the eye, returning to the correct position.
2.Close the lids and massage the contact lens gently through the closed lid.
3.Push the dislocated lens over the cornea with the eye closed, placing slight pressure with the finger on the border of the superior or inferior lid.
46.What are the recommended intervals for use and exchange of different types of conventional contact lenses?
Contact lens type |
Wearing time |
Period of exchange |
|
|
|
PMMA |
10 hours |
Years |
Daily wear RGP |
15 hours or all |
18 to 24 months |
|
waking hours |
|
Extended wear RGP |
Continuously up to |
12 months |
|
7 days |
|
Daily wear hydrophilic |
12 hours or all waking |
12–18 months |
|
hours |
|
Extended wear |
Continuously up to |
Up to 12 months |
hydrophilic |
7 days |
|
|
|
|
47.What is the recommended period for the use and exchange of disposable and planned replacement contact lenses?
1.Daily disposable: One day of use followed by disposal.
2.Weekly disposable: Up to 7 days of continuous wear with disposal, or removal each night with disposal after 2 weeks. Examples include Acuvue 1 and 2 (Vistakon J&J); Focus Week (CIBA Vision); Hydron Biomedics 55 (Ocular Sciences); Precision UV (Wesley Jessen); SofLens 66 (Bausch & Lomb); etc.
3.Monthly disposable: Silicone hydrogel contact lenses generally can be used during sleep for up to 30 days. These lenses must be discarded after 30 days. It is recommended that they be removed once
236 C. Coral-Ghanem and M.D. Bailey
weekly for cleaning and disinfection. Examples include Night & Day (CIBA Vision); Purevision (Bausch & Lomb).
4.Programmed exchange: Daily wear lenses are discarded monthly. Examples include Surevue and Vistavue (Vistakon J&J); FreshLook tinted lenses (Wesley Jessen); Focus Toric and Focus Progressives (CIBA Vision).
Some wearers may require more frequent exchange of contact lenses if deposits form, if the lens breaks or tears, or if other problems with lens maintenance occur.
48.What is the appropriate wearing time immediately after fitting of a contact lens?
Daily Wear Contact Lenses
1.One should initiate wear beginning with 6 hours a day, increasing by 2 hours a day.
2.An alternative approach is to initiate wear at 4 hours a day, adding 2 hours every 2 days until one reaches 10 hours a day. If, during the gradual adaptation to a rigid contact lens, the process is interrupted, it should be reinitiated until a maximum of 10 to 12 hours is reached.
Occasional Use Contact Lenses
Individuals who use a contact lens for weekend events or for sports should not wear the lens for more than 8 hours at a time.
Extended Wear Contact Lenses
There are two possible approaches:
1.In the first week, the lens can be worn all day, with removal at bedtime. If there is no irritation or blurring of vision, the patient can begin wearing the lenses continuously. However the eye care practitioner should reevaluate the patient after the first week.
2.The lenses can be left in for the first 24 hours with a follow-up examination with the eye care practitioner the next day. The period of extended wear can then be determined by the ophthalmologist or optometrist.
The general rule is that all extended wear lenses should be removed at least once a week for cleaning and disinfection.
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49.What are the most frequent symptoms during the fitting and adaptation to a rigid gas permeable lens?
Normal Symptoms
●Sensation of a wet eye and the intermittent blurring of vision with increased tearing.
●Lid irritation that can cause excessive or incomplete blinking. The incomplete blink (an unconscious reaction to diminish the discomfort caused by the edge of the lens on the lid) should be corrected with the fitting.
●Difficulty with upgaze.
●Light sensitivity.
Abnormal Symptoms
●Sudden burning or pain. Acute pain may be caused by particulate matter under the contact lens.
●Constant halo around lights.
●Ocular irritation and progressive redness.
●Difficulty with contact lens removal with adherence of the contact lens to the eye.
●Blurred vision with glasses for more than 1 hour after removal of the contact lens.
50.How can practitioners avoid contamination of contact lenses in the office?
1.Wash hands before every manipulation of the contact lens.
2.Wash hands after contact with the patient’s eyes.
3.Disinfect trial lenses. The quickest way is to use 3% hydrogen peroxide when one wants to test a contact lens in another patient. The most practical is to change the chemical solution every time a lens is manipulated.
4.Rinse with multiuse solutions or saline.
5.Discard preserved saline solutions after 2 weeks.
6.Discard saline solutions without preservatives at the end of each day.
7.Avoid tap water, filter water, or mineral water for rinsing of lenses.
8.Vigorously clean and follow programmed exchange of the contact lens cases.
9.Monitor the expiration date on the contact lens solution labels.
10.Impress upon all staff the need for the prevention of contamination.
238C. Coral-Ghanem and M.D. Bailey
51.How should hydrophilic contact lenses be stored in the office?
1.Change the disinfectant solution every time the contact lens is used as a trial lens.
2.Change the solution in all open containers every 15 days.
3.Perform periodic laboratory culture of the contact lens stock.
4.Monitor the expiration date on the contact lens labels.
52.How should rigid gas permeable lenses be stored in the office?
Rigid gas permeable contact lenses should be maintained clean and dry, in a clean, dry case. Alternatively, RGP contact lenses can be maintained in solution. However, there does not appear to be any significant difference with regard to the rate of contamination in these two forms of storage. Dehydration of the contact lens may have a slight effect on the contact lens parameters and the wettability of the lens surface.
53.How can incompatibility reactions among solutions be avoided?
The manufacturers have tested the compatibility of their products with ocular tissues and the most commonly employed materials in contact lenses, but it is not possible to test cross-compatibility among all of the solutions and existing materials. For this reason, it is important to closely follow the instructions of each manufacturer. Systemic medications excreted into the tear film and, more commonly, any medication that is placed on the eye topically may interact with the contact lens. Examples of incompatibilities between contact lens materials and solutions are as follows:
●Thimerosal, when heated, may cloud the contact lens or the case.
●Hydrocare solution may cause mild keratitis when used with contact lenses made of silicone elastomeres.
●Rigid gas permeable lenses undergo a polymeric alteration when in contact with alcohol, acetone, perfumes, or gasoline.
●Hydrophilic contact lenses stored in surfactant solution may turn opaque or discolored.
●Chemical disinfection, when used in combination with thermal treatment of contact lenses, may discolor or alter the polymer.
●High-water-content hydrophilic lenses may become opaque, discolored, or wrinkled when submitted to thermal disinfection.
●Thermal disinfection with saline solution that has been previously used may turn the lens gray.
In addition to issues of compatibility between contact lens solutions and materials, there are examples of incompatibility between solutions; e.g., solutions such as chlorhexidine should not be used with enzymatic
21. Maintenance and Handling of Contact Lenses 239
cleaners that contain papaine. To avoid incompatibilities, it is best not to mix solutions manufactured by different companies; to give instructions to patients about contact lens care in writing; to ask at every visit which methods and what products the patient is using; and to let the patient know about the possibility of incompatibilities of the contact lens with specific solutions.
54.Can one swim while wearing contact lenses?
The primary reason to avoid swimming while wearing contact lenses is the risk of bacterial infection, as the water is generally contaminated. Aside from this risk, one should consider that swimmers, divers, skiers, and surfers require good distance vision to avoid accidents and to maximize performance.
In lakes and oceans, there may be contamination from chemical products and sewage, particularly after heavy rains. Nonetheless, studies have demonstrated that the presence of chemical products and microbes in contact lenses used by swimmers is not significant. In pool water, Staphylococcus, Streptococcus, Pseudomonas aeruginosa, and Acanthamoeba may proliferate. The latter two cause severe corneal ulceration when associated with contact lens use. To minimize contamination, large quantities of chlorine are added to pools periodically. The chlorine, besides altering the color of the contact lens, may adhere to the polymer and produce significant ocular irritation. The risks of ocular infection must be explained in detail to the patient. Nonetheless, it is the responsibility of the contact lens wearer to weigh the risks of using contact lenses under these conditions.
55.What are the recommendations for the individual who wants to swim with contact lenses?
In the pool:
1.Use protective goggles.
2.Clean and disinfect the contact lens carefully after swimming, or consider wearing daily disposable lenses during swimming that can just be discarded after swimming.
3.Wait 20 minutes after swimming before removing the contact lens. This permits reequilibration of the contact lens with the tears, making the lens looser and preventing any damage to the corneal epithelium during removal.
4.Use wetting drops prior to removing the contact lens to loosen the contact lens and to help eliminate any chemical or microbial contaminants.
5.Have two pairs of contact lenses, with one pair for use during swimming, that can be set aside, cleaned, and disinfected while the other pair is worn.