A Guide to Clinical Contact Lens Management

Signs, Symptoms, Diagnosis and Management

Academy for Eyecare Excellence™
IN COOPERATION WITH
Centre for Contact Lens Research
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Contact Lens Wear Management Principles

In choosing the appropriate management strategy, it is necessary to differentiate those corneal changes which can be considered physiologically acceptable from those that are pathological. A pathological condition compromises the normal optical, mechanical and defense functions of the cornea, or would be likely to in the foreseeable future. For example, confluent corneal staining would require intervention, whereas low level corneal staining may be tolerated without any other relevant complication.

Replace Lens

Replace contact lens

A common management intervention is to replace the lenses with a new pair of the same lenses, This is particularly recommended if deposits or lens imperfections are suspected.

Cease Lens Wear

Cease contact lens wear immediately

For relevant conditions, common management intervention may involve ceasing lens wear until the condition resolves or improves.

Change Lens

Change lens
Consider SiHy lenses
Consider refit to daily disposable replacement lens
Consider refit to daily/weekly replacement lens
Consider refit to toric lens
Consider GP lenses

A common management intervention is to change to a different lens type.

Choices include:

  1. (1) SiHy lenses offer improved oxygen transmissibility over conventional hydrogel lenses
  2. (2) Disposable lenses – daily disposable (DD), 2 weekly and 1 monthly replacement lenses offer many advantages over conventional lenses in terms of reduction in deposits and improved wettability over time.
  3. (3) Specialty design lenses including toric and multifocal lenses, many of which are available in SiHy materials and various replacement modalities.
  4. (4) A change from soft lenses to GP lenses (e.g, for keratoconus).

Alter Care Regimen

Change lens

Current generation multipurpose solutions are very effective, have a very low toxicity, and are the care system of choice for many contact lens patients. The use of solutions may be avoided completely if daily disposable lenses are prescribed for the patient. Hydrogen peroxide systems may be used if there is a preservative sensitivity. A buildup of deposits may indicate the need for a change in lens material or increased replacement frequency.

Rewetting Drops

Consider rewetting drops

Rewetting drops (lubricants) can reduce dryness, flush away toxins within the tear film and are a common addition to strategies to manage contact lens complications.

Other Therapeutic Action

Consider therapeutic treatment

Occasionally, complications may arise that require over–the-counter medication, therapeutic prescription drugs, or referral for other treatment. Referral to another contact lens practitioner is also an option.

Wearing Time or Wearing Mode

Reduce lens wear time

Chronic complications of lens wear may require a reduction in DW or EW wearing time, either singly or in combination with some other management option(s). Often the patient will be unaware of the link between wearing time and such complications. Other possibilities are changing modality from EW to DW, or ceasing wear entirely.

Advice / Counseling

Counsel patient on lens care

Counseling of the patient occurs at every visit, however, care should be taken to ensure comprehension. Issues that may be discussed include: compliance with the care regimen possible interactions with medications, environmental influences, limitations with sports such as swimming, as well as any of the interventions described in this section. Advice should always be carefully recorded in the patient records.

Review

Review

A review appointment to ensure continuity of care should be discussed at every visit. Whether the appointment is to evaluate recovery from a complication of lens wear and timed to be later the same day or the next day, or if it is a routine 6 or 12 month appointment, the review is a vital part of contact lens patient management.

Alcon Vision Care is uniquely poised to serve every contact lens wearer by addressing the full life cycle of their needs.