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Using Contact Lens Care to Treat Vision Impairment in Adult & Pediatric Patients: A Key
Component of Vision Rehabilitation
Lori L. Grover, OD, FAAO
Assistant Professor of Ophthalmology
Wilmer Eye Institute
The Johns Hopkins University School of Medicine
Lions Vision Research & Rehabilitation Center
Department of Health, Policy and Management
The Johns Hopkins Bloomberg School of Public Health
[email protected]
Learning Objectives
• Provide insights into contact lens considerations for patients of all ages with vision impairment
• Highlight commonly encountered populations & review clinical pearls
• Gain knowledge to make vision impairment contact lens care part of practice
• Discuss related stakeholder and practice management issues
I.
Introduction
“Optometrists, through their clinical education, training, experience, and broad geographic distribution,
have the means to provide effective primary eye and vision care services, including contact lens
prescription and fitting, vision rehabilitation, and disease management to children and adults …”
A. Evaluate patients who wear, or who desire to wear, CLs
B. Maintain and improve the care of patients wearing CLs
C. Manage complications encountered during contact lens wear
D. Inform and educate other health care practitioners & lay public about CL care
E. Assist in the professional care of patients wearing CLs
II. Vision Impairment (VI) and Vision Rehabilitation (VR)
A. Definition of Vision Rehabilitation
B. Examination of the Patient with Vision Impairment
C. Maximizing Visual Function in VR
1.
Accurate diagnosis of VI status
2.
Quantify remaining visual abilities
3.
Monitor stability or progression of disease/ocular health & changes in visual abilities
4.
Determine optimal refractive status & correct refractive error
7.
Evaluate effects of ophthalmic lenses, prism, or occlusion on visual function
8.
Prescribe magnification, other available optical treatment
III. The Patient and the Team
1.
Family and Stakeholders
2.
The Pediatric Population
3.
Evidence for CL Care & Its Value
A.
Benefits
B.
Safety
C.
Patient Management
4.
Patient Candidacy
5.
Common Clinical Rationale
A.
Refractive error
B.
Prosthetic needs
C.
Keratoconus
IV.
V.
VI.
VII.
D.
Corneal ectasia
E.
Strabismus
F.
Amblyopia
G.
Congenital disorders
H.
Trauma
I.
Myopia management
J.
Aphakia
K.
Lens subluxation (Marfans)
L.
Corneal irregularity (trauma, disease, surgery)
M.
Bandage requirement
N.
Occlusion treatment
O.
Treatment of accommodative ET, CE
P.
Ocular asymmetry
Q.
Iris transillumination
Available Treatment Options
1.
Hydrogels (SCL options)
2.
Rigids (RGP options)
3.
Hybrids and Silicones
4.
“Special” Applications
5.
Optional design features
6.
Multifocals (simultaneous vision)
7.
Monovision
8.
Therapeutics
Functional Issues
1.
Neurological conditions
2.
Illumination and glare control
3.
Maximized visual field
4.
Eliminate spectacle lens correction
5.
Vision Rehabilitation Treatment Compatibility
1.
Bioptic telescopic systems
2.
Reading telescopic systems
3.
Therapeutic filter spectacles
4.
Microscopic and bifocal systems
Pearls & Pitfalls
1.
Overwear
2.
Comorbid Conditions
3.
Solution Issues
Conditions/Case Presentation
1.
Keratoconus
2.
Corneal Ectasia
3.
Post-Surgical Vision Impairment
4.
Irregular Corneal Surfaces
5.
Achromatopsia
– Photophobia
– pendular nystagmus
– usually normal fundi (macular atrophy may occasionally be present)
– Occurs in complete (typical) and incomplete (atypical) forms
6.
Iris Defects
VIII.
IX.
X.
7.
Strabismus
8.
Prosthetic Cosmesis
9.
Special Applications
Clinical and Laboratory Resources
Practice Management Pearls
1.
Patient Education
2.
Stakeholder Training
3.
Scheduling
4.
EMR and Diagnostics
Conclusion