Ординатура / Офтальмология / Английские материалы / Eye Essentials Rigid Gas-Permeable Lens Fitting_Franklin_2006
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ELSEVIER
BUTTERWORTH
HEINEMANN
© 2007, Elsevier Limited. All rights reserved. First published 2007
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ISBN-13:978-0-7506-8890-1
ISBN-10:0-7506-8890-4
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A catalogue record for this book is available from the British Library.
Library of Congress Cataloging in Publication Data
A catalog record for this book is available from the Library of Congress.
Note
Knowledge and best practice in this field are constantly changing.As new research and experience broaden our knowledge, changes in practice, treatment and drug therapy may become necessary or appropriate. Readers are advised to check the most current information provided (i) on procedures featured or (ii) by the manufacturer of each product to be administered, to verify the recommended dose or formula, the method and duration of administration, and contraindications. It is the responsibility of the practitioner, relying on their own experience and knowledge of the patient, to make diagnoses, to determine dosages and the best treatment for each individual patient, and to take all appropriate safety precautions. To the fullest extent of the law,neither the publisher nor the editors assumes any liabilityfor any injury andlor damage.
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Foreword
Eye Essentials is a series of books intended to cover the core skills required by the eye care practitioner in general and/or specialized practice. It consists of books covering a wide range of topics ranging from routine eye examination to assessment and management of low vision; assessment and investigative techniques to digital imaging; case reports and law to contact lenses.
Authors known for their interest and expertise in their particular subject have contributed books to this series. The reader will know many of them as they have published widely within their respective fields. Each author has addressed key topics in their subject using a practical rather than theoretical approach, hence each book has a particular relevance to everyday practice.
Each book in the series follows a similar format and has been designed to allow the reader to ascertain information easily and quickly. Each chapter has been produced in a user-friendly format, thus providing the reader with a rapid-reference book that is easy to use in the consulting room or in the practitioner's free time.
Optometry and dispensing optics are continually developing professions, with the emphasis in each being redefined as we learn more from research and as technology stamps its mark. The Eye Essentials series is particularly relevant to the practitioner's requirements and as such will appeal to students, graduates sitting
Foreword
professional examinations and qualified practitioners alike.
iiiWe hope you enjoy reading these books as much as we have enjoyed producing them.
Sandip Doshi
Bill Harvey
Introduction
It might seem a little eccentric to produce a book on rigid contact lenses when for the past 30 years their use has been in constant decline. When the authors entered contact lens practice in the mid-1970s, rigid lenses accounted for nearly all of the lenses fitted and soft lenses were the new kids on the block. At the time both the available soft lenses and their care systems were frankly not very good, but they have evolved to the point that most of the original advantages to RGP wear have been eclipsed. By 1991, RGPs accounted for 39% of lenses fitted in the UK and by the end of the 1990s leading figures in the contact lens world were predicting the virtual demise of rigid lens fitting by 2010. In 2001 only 7% of new fits were with rigid lenses, but they accounted for 21% of refits. However, the actual numbers of rigid lenses supplied does not seem to be declining, possibly due to the rise of planned replacement.
There are still considerable numbers of RGP wearers around, and anyone intending to practise as an optometrist should be aware of the basics of RGP fitting and aftercare. The UK General Optical Council (GOC) requires that those entering the profession should have both skills,and all training institutions for optometry retain RGP lenses on the syllabus. A number of factors have combined to make RGP lenses a difficult area for students and registered practitioners alike. The declining number of RGP patients is reflected in the experience available to undergraduate students in their clinics, and a significant
Introduction
number graduate with little or no practical experience of these
xlenses. The pre-registration year may offer little remedy, as some practices simply don't see many RGP patients. Many registered optometrists see few contact lens patients of any sort as, in large multiple practices, much of the contact lens work has been delegated to Dispensing Optician contact lens fitters.
This book is aimed at those entering the profession, as students, pre-registration optometrists or trainee contact lens opticians. Furthermore, those registered colleagues who are not in regular contact lens practice may find it of use as a refresher and update on current RGP practice, which has undergone an evolution of its own. It also aims to meet the requirements suggested in our new GOe entry level competencies to which all qualified practitioners are meant to adhere if maintaining their place on the GOe register. The authors have a combined experience of about 60 years of fitting RGP contact lenses (I suddenly feel old), and we have tried to concentrate on the practical aspects of selection, fitting and aftercare rather than obscure theory.
Dedication
To paraphrase the late, great Milligan: "After the last book, I swore I would never write another. This is it (or at least one of them)."
Acknowledgment
We are grateful to Chanel King and Heidi Harvey for assistance with photographs.
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Initial consultation
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Ocular health |
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General health |
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Visual factors |
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Psychological factors |
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Financial considerations |
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Soft or rigid? |
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Patient examination |
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General observation of the eye and adnexa |
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Assessment of the bulbar conjunctiva |
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The tear film |
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General examination of the cornea |
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Specific examination of the cornea |
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Blue light examination of the cornea |
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References |
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Initial consultation
2 Introduction
The initial consultation with a prospective contact lens wearer is an important dialogue between the practitioner and patient which has a number of goals:
1.To establish whether the patient is suitable for any type of contact lens correction.
2.To identify the optimal contact lens correction for the individual patient.
3.To establish reasonable expectations for the performance of the lenses and care system.
4.To educate the patient so that their use of the lenses will be safe and sensible.
5.To determine baseline information that can be used to monitor change that can influence future management decisions.
The majority of contact lens fitting is elective (i.e. non-therapeutic) and the patient will exert a degree of control over the lenses selected and their compliance with care systems. The principle
of informed choice is important here. The patient must be given enough information to make appropriate decisions (i.e. those the practitioner approves of). The days when the practitioner held a monopoly on information have long departed. Most patients who present for contact lens fitting will also possess a computer and internet access. Therefore information that is incorrect or out of date will be easily detected, with consequent loss of credibility for the practitioner. It is important that practitioners keep themselves well informed on current developments.
Should this patient be wearing contact lenses?
There are few absolute contraindications to contact lens wear these days, though there are many more issues that may limit it or make it more complicated for the patient or practitioner.