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Download getting back to the basics - Heart of America Contact Lens Society
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GETTING BACK TO THE BASICS By: Diane F. Drake, FCLSA Outline Introduction • • • • • • • Types of practices How to avoid litigation Terminology Patient Histories Evaluations Instruction Record Keeping Types of Contact Lens Practices • • • Specialty Discount Multi-service Dispensary Types of Contact Lens Patients • • • • Genders Ages Different backgrounds Special needs patients What Type of Practice? • • • Specialty Discount Multi-service How to Avoid Possible Litigation and Concerns • • • We are not attorneys – – What is malpractice? What are our responsibilities Product knowledge – – Study Attend seminars Patient knowledge – – Find out the patient’s needs Work with the patients Anatomy & Physiology Terminology Ocular Structures • • • • • Eyelids Tear Film Cornea Limbus Conjunctiva Eyelids • Important in health of eye – – – – Help to keep eye moist Help to distribute tears, oxygen and nutrients Protects the eye from light and injury Lids are elastic • Lose elasticity with age Tissues of Eyelids • • • • • • • Epithelial layer of the skin Underlying skin layers Layer of striped muscle Sub muscular tissue Fibrous layer Layer of smooth muscle Conjunctiva Eyelids • • • Termed palpebral aperture – – While opened Not always same size Contain Meibomian glands Contain Sebaceous glands Function of Eyelid • • • Mechanical defense Optics Corneal nutrition & gas exchange Conjunctiva • • Thin mucous membrane, running continuous from lid to corneal limbus – – Palpebral - lids Bulbar Contains goblet cells – Produce mucins • • • • • Glands of Krause Glands of Wolfring Inflammation – – – Conjunctivitis Caused by bacteria or virus Symptoms • Pain • Photophobia • Impaired vision • Discharge Blood Supply – Becomes injected when conjunctiva is inflamed Innervation – Very sensitive Lacrimal Apparatus - Tear Production • Lacrimal glands – – • • • Newborns have minimal output of reflex tears Lacrimal Apparatus - Tear Production Accessory glands – – – Provides basic tear secretion • Steady state Wolfring Krause Normal tears contain various antibacterial and immune substances to clean and protect eyes – – – Lysozymes Immunoglobulin Depressed in patients with tear deficiency • Patients frequently suffer from blepharitis Lacrimal Apparatus Tear drainage – – • Provides reflex tear secretion • Irritation • Coughing • Sneezing • Taste or smell – Through lacrimal punctua Into canaliculi • Tear canals Into nose via lacrimal duct Kinetics of the tears – Forms thin film over both cornea and conjunctiva – • • Creates tear meniscus • Prism • Lake Tears move upward and downward with each blink – – Spreads tears over entire eye and conjunctiva Moves from temporal to nasal Tear Film – Three Layers • Lipid • Aqueous • Mucin Tear Layer • • • Outer Layer - Oily – Lipid • Produced by meibomian glands • Prevents evaporation Middle Layer - Aqueous – – Volume • Provides oxygen • Provides nutrients Produced by lacrimal glands Inner Layer - Mucous – – – Produced by goblet cells Attaches tears to cornea Decreases surface tension Importance of Tear Layer to Corneal Health • • • Interruption of three layers could result in dry eye Could make difficult or impossible to wear contact lenses Could affect corneal health – Both contact lens wearers and non-contact lens wearers How to do Patient Histories • • • • What to include – Name – Address – Telephone numbers • Home • Work • Beepers - Pagers Age – Birthday Sex Social Security number • • • • • • Visual requirements – – Lifestyle • Hobbies • Work • Other Part time wear Visual Requirements – – – Near Intermediate Distant Ocular History - Patient – – – – – – Visual Medications Allergies Diseases Injuries Surgeries Ocular History - Relatives – – – – – – Visual Medications Allergies Diseases Injuries Surgeries Medical History - Patient – – – – – – – Heart Diabetes Thyroid Blood pressure Pregnancy Cancer Any other disease - Headaches Medical History - Relatives Heart – – – – – Diabetes Blood pressure Thyroid Cancer Any other disease - Headaches How to do a Personal Assessment • What to include • – – – – – Hair Eyes Skin Nails General appearances Other things to include – – – – – – – – – General Hygiene Abnormalities of eyes, skin or nails Tautness of lids Size and position of eyes Three sided white Aperture size Lid deformities or diseases Blink rate Tear break up time (BUT) How to Perform a Visual Assessment • • • • • • • • • • Corrected and uncorrected V/A Slit lamp evaluation Tear BUT K readings Refraction IOP Any abnormalities - Must be recorded Patient’s blood pressure and pulse rate for future use, if necessary Visual Field Refer patient back to doctor Types of Contact Lens Modalities • • • • • • • • Spherical Torics Soft Rigid Single Vision Bifocal Monovision Others - Bandage etc. How to Instruct the Patient • Teach insertion and removal – – Watch the patient Give personal attention and instructions • • Teach cleaning and care of lenses – – Handling lenses Solutions Instruct follow-up routine – – Wearing schedule Follow-up schedule for progress checks Trouble shooting • • • • Instructing the Patient Solutions Follow-up routine Documentation Contraindications of Contact Lens Wear INCLUDING BUT NOT LIMITED TO: • • • • • • • • • • • • • Poor personal hygiene Uniocularity Immunosuppressed patients Abnormal lid function Previous ocular infections or some ocular surgery Use of certain topical medications Occupational Hazards Significant allergies Significant dry eye (unless used as bandage lens) Chronic ocular infections – Severe blepharitis, etc. Corneal neovascularization Diabetes mellitus Sometimes pregnancy Don’t Let Patients Self Prescribe • • • Patients are consumers – Consumers are patients Explain that you fit what is best for each patient Solutions are selected for the individual needs of the patient Record Keeping • Patient files – – – Instruction sign off sheets Wearing schedule Care system used – – Lot numbers recorded Return visits scheduled Documentation • • If it’s not recorded, it wasn’t done Dates, times and signature of person who performed task FDA • • Duty to Warn Documentation and signatures Conclusion • • • • Get started Evaluate Educate Document Thank You Questions?
