Contact Lens Aftercare The Missed Opportunity Written by Gurraj - - PowerPoint PPT Presentation

Contact Lens Aftercare The Missed Opportunity

Written by Gurraj Jabbal and Neil Retallic

• Understands the importance of record keeping in contact lens wear and understands the

minimum data set that should be recorded in contact lens wearers.

• Understands methodologies for a proactive approach to communicating which will elicit a full

history from patients and allow recommendations to be made authoritatively in a way which will be understood by all patients.

• Understands the causes of contact lens discomfort and common pathologies seen at aftercare,

how to identify the probable cause and how to manage the various causes using the right combination of lens material, lens design, wearing modality and care products.

Learning objectives

Written by Neil Retallic & Gurraj Jubel

Ca Case 1a e 1a - Am Amar arjit jit

Case 1a - Amarjit

• 1. What are the positives in the way this history was conducted?
• 2. How would you have improved on our approach?
• 3. What other questions would you ask?
• 4. How is Amarjit getting on with his lenses?
• 5. How long does Amarjit wear his contact lenses?
• 6. Does he have any problems handling the lenses?
• 7. Is he compliant with his solution and care regimen?

Discussion Points

¹Wolffsohn J et al. History and symptom taking in contact lens fitting and aftercare. Contact Lens & Anterior Eye; 2015;38: 258–265

What Qu t Ques estions tions do do U UK Pra racti ctitioner tioners s typi ypicall ally y ask k dur urin ing g af after ercar are e vi visit its?

¹Wolffsohn J et al. History and symptom taking in contact lens fitting and aftercare. Contact Lens & Anterior Eye; 2015;38: 258–265

What Qu t Ques estions tions do do U UK Pra racti ctitioner tioners s typi ypicall ally y ask k dur urin ing g af after ercar are e vi visit its?

Compliance approach during CL consultation?

Lens cleaning Lens case cleaning Hand washing

Response (%)

20 40 60 80 100 No Describe Demonstrate

Case 1b - Amarjit

Case 1b - Amarjit

1. What are the positives in this summary? 2. Did the summary cover everything we need to? How could it have been done better? 3. What would you have done differently? 4. Is it OK to recall him for aftercare in 2-years? 5. Is his prescription correct? 6. What might have caused the staining? 7. Are you happy with the way he handles his contact lenses?

Discussion Points

Contact lens recall frequency

¹Ewbank A. Understanding the CL consumer: Part 1 – Buying habits and customer loyalty. Optician 2013; 245: 38–41.

Frequency of CL wearers presenting for ACs (Ewbank)¹

Contact lens recall frequency

Contact lens recall frequency

²Efron, N and Morgan, PB. 2017. Rethinking contact lens aftercare. Clinical and Experimental Optometry. 100. Pp. 411-431.

.

Contact lens recall frequency

Contact lens recall frequency

²Efron, N and Morgan, PB. 2017. Rethinking contact lens aftercare. Clinical and Experimental Optometry. 100. Pp. 411-431.

.

Decision matrix for AC frequency (Efron and Morgan)²

Contact lens recall frequency

Case 1c - Amarjit

Case 1c - Amarjit

Discussion Points

• 1. What are the positives from today’s history and symptoms?
• 2. Why did Amarjit drop out of contact lenses?
• 3. What would you say to bring Amarjit back into contact lens wear?
• 4. Could we have predicted or even prevented him dropping out last

year?

• 5. What triggers can you look for in a history and symptoms that

might indicate someone is at risk of dropping out of lens wear?

• 6. What tools do you have in practice to help choose new contact

lenses?

Reasons for contact lens drop out

Main drop-out reasons

Application and removal Discomfort Months after fitting

• Drop out with in 3 months:

➢42% handling issues (A&R) ➢13% discomfort through out day

Reason for contact lens drop out?

Reasons for contact lens drop out

Main drop-out reasons

Application and removal Discomfort Months after fitting

• Drop out after 3 months:

➢45% comfort / dryness / red eye / watering / infection ➢16% cost, too expensive

Is perceived value for money linked to comfort and performance?

Reason for contact lens drop out?

Trying something new?

When the participants were asked questions regarding the contact lenses they had trialled…

Highlights

• Lapsed wearers were not

given the option to try a different lens.

• However, many claim they

would have liked the

• ption to do so.

However almost 50% would have been interested to trial an alternative. Only 13%

• f lapsed

wearers were

• ffered an

alternative lens type.

Try something new……

Case 2 - Tosh

Case 2 - Tosh

Case 2 - Tosh

Discussion Points

• 1. What is good about this patient record card?
• 2. What other questions would you ask Tosh about his lenses?
• 3. Were any opportunities missed in this consultation?
• 4. Why would you upgrade Tosh’s lenses?
• 5. What lenses would you recommend for Tosh and how would you explain

the benefits?

• 6. Is Tosh at risk of dropping out of contact lens wear?

Long term hydrogel wearer Refitted with SiH lenses

Fonn D, Dumbleton K, Jalbert I and Sivak A. Benefits of Silcone Hydrogel Lenses. Contact Lens Spectrum February 2006 – Special Issue. Images taken by K. Dumbleton. Published in Manual of Contact Lens Prescribing and Fitting, 3rd Edition. Hom and Bruce. Chapter 20. Authors Lyndon Jones and Kathy Dumbleton

What time do you commonly carry out aftercares? What time do Pxs remove their CLs?

Benefits of High DK/t:

A Closer Look at Oxygen Requirements

• Traditional criteria for no central corneal swelling1,2
• Open eye: 24 units 10-9(cm/s) (mlO2/ml X mmHg)
• Centre and periphery of lens need to be considered3

1. Holden BA, McNally JJ, Mertz GW, Swarbrick HA. Topographical corneal oedema. Acta Ophthalmol 1985;63:684–691. 2. Holden BA, Mertz GW, McNally JJ. Corneal swelling response to contact lenses worn under extended wear conditions. Invest Ophthalmol Vis Sci 1983;24:218–226. 3. Morgan et al. Central and peripheral oxygen transmissibility thresholds to avoid corneal swelling during open eye soft contact lens wear. Applied Biomaterials. 2010;92:361- 5.

Central and Peripheral Dk/t requirements

Figures reproduced from Morgan et al. Central and peripheral oxygen transmissibility thresholds to avoid corneal swelling during open eye soft contact lens

• wear. Applied Biomaterials. 2010;92:361-5.

19.8 32.6

33Dk/t in periphery to avoid corneal swelling

• “no conventional hydrogel soft lenses meet both the

central and peripheral thresholds”

• “only the silicone hydrogel lenses offer the required

level of Dk/t of 32.6 units”

33 dk/t

Nichols JJ, et al. The TFOS International Workshop on Contact Lens Discomfort. Invest Ophthalmol Vis Sci.2013;54;11:1-203

Lenses uncomfortable Wear lenses for shorter periods Wear lenses for less days Sporadic wear with lapses Stop CL wear

Progression of contact lens discomfort

Case 5 - Jayne

Case 5 - Jayne

Case 5 - Jayne

• 1. Why did Jayne drop out of contact lenses?
• 2. Were any opportunities missed in this consultation?
• 3. Are there any contra-indications to lens wear?
• 4. How would you explain that she might now be suitable for

contact lenses again?

• 5. What lenses would you recommend for Jayne and how would

you explain the benefits?

Discussion Points

Contact lens use by age

Ackerman CL Spectrum March 2010

• After 40 years of age, the onset of

prebyopia brings abut a marked rise in the use of specs

• However, at the same time the

use of contact lenses drops significantly

UK presbyopic contact lens Wearers

Monovision 21% Multifocal 45% Single vision 34%

Morgan, P. et al. International Contact Lens Prescribing 2011 and 2014. CL Spectrum.

Monovision 17% Multifocal 23% Single vision 60%

2011 2014

N new strategies to ↑ engagement, motivation, satisfaction & to identify changing needs R R recognise Px needs, expectations, symptoms & risk factors E E evaluation of vision, CL fit, CL & ocular surface

T T trial new CLs, care systems &/or products

E E ensure handling & correct compliance is discussed N normalise their CL wear routine & replacement frequency T T treat & manage co-exisiting ocular surface disease/allergy I improve environment/lifestyle demands & prescribe tear supplements O obtain agreement on future compliance & review frequency

Retallic N -BCLA Contact Lens Discomfort presentation-Part of BCLA Dry Eye and Contact Lens Retention Certificate; 2017. Adapted from: Veys J and Sulley A. Pay attention to retention; Optician Magazine.2016;June edition;26-30 Aberdeen K and Rogers B. How to retain and gain from contact lens technology. Optometry Today Magazine.2015;March edition:44-49

Retention Strategies for existing wearers

• Malope, O. Visionstryt’s Practical Guide for Optometric Staff. 2017
• General Optical Council, Love Your Lenses, Land the Message
• Communication Skills. Making effective recommendations. CooperVision 2019.
• Efron, N and Morgan, PB. 2017. Rethinking contact lens aftercare. Clinical and Experimental Optometry. 100. p. 411-431)
• CooperVision. 2016. Contact Lens Category Retention White Paper. Available online:

https://coopervision.co.uk/sites/coopervision.co.uk/files/xsm2550-retention-whitepaper.pdf

• Young G et al. A multi-centre study of lapsed contact lens wearers. Ophthal & Physiol Opt, 2002 22: 516-527
• Sulley A, Young G, Lorenz KO & Hunt C. Clinical evaluation of fitting toric soft contact lenses to current non-users. Ophthalmic Physiol Opt

2013, 33, 94–103. doi: 10.1111/opo.12028

• Are your fitting habits meeting patient expectations? CooperVision survey of 100 ECPs, March 2018
• Morgan et al. Central and peripheral oxygen transmissibility thresholds to avoid corneal swelling during open eye soft contact lens wear.

Applied Biomaterials. 2010;92:361-5

• Dumbleton K, et al. Redness, dryness and comfort following refitting long term low Dk hydrogel lens wearers with silicone hydrogels. Optom

Vis Sci. 2004;81:31.

• Gellatly KW, Brennan NA, Efron N. Visual decrement with deposit accumulation of HEMA contact lenses. Am J Optom Physiol Opt. 1988

Dec;65(12) 937-941.

• Lyndon Jones, Noel A. Brennan, José González-Méijome, John Lally, Carole Maldonado-Codina, Tannin A. Schmidt, Lakshman Subbaraman,

Graeme Young, Jason J. Nichols; The TFOS International Workshop on Contact Lens Discomfort: Report of the Contact Lens Materials, Design, and Care Subcommittee. Invest. Ophthalmol. Vis. Sci. 2013;54(11):TFOS37-TFOS70.

• Young G et al. A multi-centre study of lapsed contact lens wearers. Ophthal & Physiol Opt, 2002 22: 516-527
• Chalmers RL, Keay L, McNally J et al. Multicenter case-control study of the role of lens materials and care products on the development of

corneal infiltrates. Optom Vis Sci 2012; 89:316–325

• Nichols JJ, Willcox MDP, Bron AJ et al. The TFOS International Workshop On Contact Lens Discomfort: Executive Summary. Invest

Ophthalmol Vis Sci 2013;54:TFOS7–TFOS13.

• Wolffsohn J et al. History and symptom taking in contact lens fitting and aftercare. Contact Lens & Anterior Eye; 2015;38: 258–265

References

Thank you