The College of Optometrists

Hey,

What questions do we need to ask the px in the H&S for a CL fit? And how do we decide what lens to go for..hard/soft, daily/planned replacement/EW, etc??

Sorry if this has been mentioned in another post..havent had time to browse through them all.

Thanks

Hi amahmood

-most of this will be in contact lens books such as Effron. Also there is much detail in contact lens fitting guides that B and L and Ciba and J and J do.

The sort of questions needed Are to answer the question "what are the risks if they wear contact lenses".

The lenses are the answer to " which lenses minimise risk and fullfill what the patient wants or needs"

In order of safety: Daily disposables, 2 Weekly Silicons such as J & J Oasys, Acuvue Advance Silicon monthly disposables such as Airoptix and extended lenses worn on a daily basis Then Monthly gel lenses Then Silicon Extended wear.

In a different catagory are hard lenses and lenses for medical purposes.

Questions You need to know about previous wear and for how long (risk increases with years wear)

Any history of poor health and long term medicine taking. (you are searching for things that would increase risk of infections, reduced immune system, such as diabetes)

Any family history of ocular problems such as glaucoma

You want to check their maturity and ability to stay compliant, and simple ability to handle lenses.

You need to find out if their job would spoil any contact lens wear.

Their age would be important as to optical needs of presbyopia and dry eye.

As the discussion goes along - you can build pu an idea of what lens would be good to start.

Often it is that they could start with any lens. But it is good practice to fit the safest available.

With new wear I often suggest they start with daily disposables and see how they go along. I avoil gel lenses completely if I can, prefering to fit silicons.

If they have an increased risk of problems (which are neov, infections and inflamations, thickened eyelids and loss of bulbar whiteness) - perhaps due to dry eye or some systemic problem - then perhaps they can wear a daily lens on an occasional basis.

If they previously wear gel lenses 7/7 15/24 = I put them into silicon monthly and advise 1/7 rest per week. Most people will listen to reason and those that don't - I limit their wear to daily lenses.

Don't forget : you can't be wronged by doing what is right

- but you can be wronged - by doing what is wrong (so never allow people to wear their daily lens twice, or a 2 weekly lens for 3 weeks, etc)

In this way, I try to tailor their wear and lens to what is feasable. You really can't predict how they will do - you need to get them to experiment with different modes of wear until they feel happy and safe.

Having said that - anyone can get an acute problem with contact lenses - an infection usually happens out of the blue - so people need to be warned what to do.

-steve

Whats the difference between a gel and silicon lens? :-S

He means Hydrogel vs SiH