Understanding the Contact Lens & Workshop Jill J. Luebbert, CPOT, ABOC 1

Contact Lens

Mona Lisa Contact Lens

Timeline of the Contact Lens 1508 - Leonardo da Vinci illustrates the concept of contact lenses

Timeline of the Contact Lens 1823 - British astronomer Sir John Herschel conceptualizes a practical lens design 1887 - First contact lens manufactured from glass, and fit to cover the entire eye

Timeline of the Contact Lens 1939 - Contact lenses first made from plastic 1948 - Plastic contact lenses designed to cover only the eye's cornea

Modern Day Contact Lens Timeline 1971 - Introduction of soft contact lenses 1978 - Introduction of gas permeable contact lenses

Modern Day Contact Lens Timeline 1981 - FDA approval of new soft contact lenses for extended (overnight) wear 1986 - Overnight wear of GP contact lenses becomes available

Timeline 1987 - Introduction of disposable soft contact lenses 1987 - GP contacts available in next-generation fluorosilicone acrylate materials

1995 – One day disposable contact lenses are introduced

It is estimated that 125 million people used contact lenses worldwide In the United States, there are 28 to 38 million people in contact lenses

Types of Contact Lens Hard Soft

Hard Contact Lens Materials 1940’s, 50’s, 60’s 1970’s Polymethylmethacrylate (PMMA) 1970’s Rigid Gas-permeable (RGP) Silicone Acrylate Fluoro- Silicone Acrylate Fluorine known for its nonstick properties in Teflon Enhanced surface wettability Silicon adds higher oxygen permeability

Permeable The ability to allow oxygen to pass through it Referred to Dk DK/t (t = thickness)

Base Curve The back central region of the lens Important in determining the final lens power Fit to the flatter K reading

Optical Zone The central area of the lens Corrects the patient’s vision Must be larger than the patient’s pupil

Intermediate and Peripheral Curves Designed to flatten the overall lens in increments Enables tear fluid exchange Not used for correction patient’s refractive error

Overall Lens Diameter

Specialty RGP’s Multifocal designs Annular/Simultaneous Vision Segmented Truncated

Gas Permeable Contact Lens Removal Placement Recentering

Care and Handling of RGP’s Clean Hands Use Hard Contact Lens Solutions

Soft Contact Lens Materials 1970’s Soft Hydrogel (water-absorbing) Silicon Hydrogels

Manufacturing Techniques Spin Cast Hydrogel plastic is spun The faster it is spun, the steeper the base curve Lathe Cut Cut in dry form, then hydrated Dimensions change as it is hydrated Cast-Molding Material is injected into a mold with anterior and posterior curved surfaces Preferred method of disposable contact lenses

FDA Classifications Group 1 Group 2 Group 3 Group 4 Less than 50% water content; nonionic Group 2 More than 50% water content; nonionic Group 3 Less than 50% water content; ionic Group 4 More than 50% water content; ionic

Modalities Daily wear Flexible wear Extended wear

Soft Contact Lens Designs Single Vision Toric Prism Ballast Truncations Alteration of edge design Multifocal Monovision Simultaneous

Contact Lens Suitability Analysis Not every patient is a candidate for contact lenses How do you determine who can wear contacts? Is it all science?

Contact Lens Suitability Patient Age Refractive Prescription Fingernail and finger tip analysis

Contact Lens Suitability Patient Lifestyle

Contact Lens Suitability A complete case history is important General Health Allergies Ocular Health Dry Eye Syndrome Motivation

Contact Lens Suitability Responsible To care for the contact lens as instructed To be able to afford the contact lenses What is the patient’s expectation?

Evaluation Occupation Hobbies Are they exposed to chemicals or other hazards? Hobbies Swimming Computer

Contact Lens Suitability Lids Tension Separation Normal fissure is 9 – 10 mm Pupils Normal reading is 10.5 to 12.5 mm Blink Rate Average person blinks 10 – 15 times per minute Complete Blinker???

Contact Lens Suitability Corneal Sensitivity Sterile wet cotton wisp Tear Production Schirmer Tear Test Phenol Red Thread Test Tear Coverage Slit Lamp w/ blue cobalt and fluorescein Uniform tears for 10 – 15 seconds after normal blink Corneal Curvature

“Is this going to hurt?”

“I’ve seen my friends to this a million times.”

Relax

Hygiene Clean hands!!!! Any and Every time you touch the lens!!!!!

Let them hold a contact lens What does it feel like? What does it look like? Is it inside out? How easy does it tear? How should it be on my finger?

Practice First Use the mirror Have them wash their hands Practice without the contact lens “What do I do with my hands?” Scleral touch Both eyes

Time for the real thing Placement Removal

First responses Don’t expect to see perfectly immediately Nose is going to run

More instructions

Hygiene Clean Contact Lenses Use soft contact lens solution recommended by ECP

Soft Contact Lens Solutions Saline Hydrogen Peroxide Multi-Purpose Enzymatic Lubricants

Contact Lens Cases Care Clean Contact Lens Case Every three months

Contact Lens Replacement Replace the contact lenses as recommended by the doctor 1 day 1 week 2 weeks 1 month 3 months

Signed Agreement Review dispensing instructions Review anticipated Review wear schedule Have them sign this agreement Keep copy in chart

Recommend Sunwear Contact Lens wearers are more sensitive to sunlight and wind.

Schedule next evaluation visit “Your vision is now corrected with a piece of plastic ON your eye.”

Give them Starter samples of the recommended contact lens cleaning, rinsing, storage solutions Starter samples of recommended hand soaps Additional contact lenses if necessary Your business card

Thank them Thank them for trusting you for this service Ask them to recommend your office to their friends

Now are you ready? Workshop on dispensing

Soft Contact Lens Placement and Removal Instruction Workshop

Where to start? Emphasis on hygiene methods!!! Demonstrate On your own eye On the patient’s eye Evaluate patient for anxiety and/or overconfidence

Practice Proper lid separation Proper hand placement Handling of the contact lens

Site Preparation Use a well lighted area Use a mirror (magnifying mirror) Work over a cloth or paper towel at first

Contact Lens Placement Method #1 Remove right lens from storage container Inspect for foreign particles, tears, or other damage Lens should be moist, clear, clean and intact Grasp lens gentle on place it on index finger Verify that it is not inside out Taco method

Ready???? Take a breath Secure upper lid lashes against brow bone with opposite hand Secure lower lid lashes against cheekbone using middle finger Slowly bring contact lens toward the eye “looking through” the lens Gently place lens on center of cornea

Finishing up Slowly release lower lid Slowly release upper lid BLINK Is the contact lens on the eye??? Can you see better with this eye? Is the contact lens on your finger yet?

One down -- One to go Repeat with left lens Blink Can you see better with this eye? CONGRATULATIONS!!!! Discard the solution

Contact Lens Placement Method #2 Carefully remove contact lens from storage container Inspect lens for foreign particles or defects Is it right-side out or inside out??

Ready??? Place lens on middle finger of preferred hand Look up Place contact lens on lower white of the eye Remove trapped air by apply gentle pressure Look down to position the lens on eye Slowly release lower lid BLINK Now to the left eye

Removal Method #1 Wash and dry hands thoroughly Pull lower lid down with middle finger Gently pinch contact lens between thumb and middle finger WATCH FINGERNAILS!!!!! Remove contact lens from eye surface Put in solution Go to left eye

Removal Method #2 Wash and dry hands thoroughly Verify the contact lens is centered Pull lower lid down with middle finger Lightly touch bottom edge of contact with tip of your index finger Look up Slide contact down onto the white of the eye Gently pinch contact using your thumb and index finger

What if……. the contact lens decenters? the edges of contact lens stick together? the contact lens get dry while instructing? the contact lens falls?

Tips Using a penlight to guide the patient on placement of contact lens Magnification mirror for hyperopes Reassure the patient that there are no stupid questions regarding their contact lenses.

Care of the Contact Lens Clean hands and fingers first After removal, rub lens thoroughly with cleaning solution for 10 – 20 seconds (ABC’S, Happy Birthday Song, Yankee Doodle) NEVER, NEVER use tap water or saliva!!!! Clean both sides Rinse with rinsing solution Place in clean storage case Cover completely with disinfecting solution

Other issues to address Can I use eyedrops? What if my vision gets blurry? Can I shower with my contact lenses on? Can I swim with my contact lenses on? What about eye makeup and hairspray? Can I sleep with my contact lenses? What if my eyes get red when I’m wearing my contact lenses?

Other issues Do I still need my glasses? What about sunglasses? When do I need to see the doctor again? Can I have my prescription?

“Before you leave, we have… Additional contact lenses (if necessary) Starter size of recommended hand soap Start kit of recommended contact lens care products Copy of instructions for care of contact lens “Your next appointment is …….” Your business card

Incentives Offer discount on optical quality sunwear Offer discount on backup eyewear

THANK YOU! Always thank them for allowing you to provide them your services and products Ask for referrals

Enjoy Heart of America Experience Jill J Luebbert, CPOT, ABOC jill@jjlconsulting.com www.jjlconsulting.com Luebbert Consulting & Training