5.2.2 Manages the aftercare of patients wearing rigid gas permeable contact lenses.

HISTORY AND SYMPTOMS

RGP A/C

General symptoms

• Discomfort, dryness, or irritation while wearing the lenses?

• Notice any redness, itching, burning or watering?

• Experienced blurred vision, ghosting, glare, halos?

• Do the lenses meet your needs?

• How is the comfort, rated out of 10?

HISTORY AND SYMPTOMS

RGP A/C

Care and compliance

• Hygiene?

• Insertion and removal routine?

• Case cleaning compliance?

• Tap water contact?

HISTORY AND SYMPTOMS

RGP A/C

Wearing habits

• Average wear time? Maximum wear time? Wear time today?

• How many days per week do you wear them?

• How often are you replacing your lenses? (Reusable)

Record lens details:

RGP A/C

• Name of brand

• Name of lens

• Modality (monthly/daily)

• Base curve

• Diameter

• Prescription

Assessing an RGP fit

• Centration

• Movement on blink

• Movement on eye motion

• Fluorescein pattern

• Comfort

Assessing an RGP fit

Centration

• Is the lens centred on the cornea?

  • (Or is it decentered superiorly/inferiorly/temporally)

• Upper lid position relative to lens edge

• Lens riding with upper lid or sitting between lids?

  • (Lid-attachment vs intrapalpebral fit)

Assessing an RGP fit

Movement on blink

Should have smooth repositioning, no excessive lag

Assessing an RGP fit

Movement on eye motion

Stability and return to the centre

No limbal crossing

Assessing an RGP fit

Fluorescein Pattern

• Central fit

• Mid-peripheral fit

• Edge lift

Fluorescein must be applied to superior conjunctiva whilst patient looks down

Maximises length of time stain stays in eye

Assessing an RGP fit

Comfort

• 0-10 scale

• Early vs late wear comfort

• Awareness of lies edge under lids?

RGP A/C

Lid attachment fit

• The lens is designed to ride under the upper lid, so the lid helps hold it in place.

• Lens sits slightly superior

• Minimal vertical movement

N.B. not possible if upper lids sits above limbus

RGP A/C

Intrapalpebral fit

• Lens is designed to fit within the palpebral aperture, without significant lid interaction.

• Lens centres on cornea, not held by lid

• Freely moves 1-2mm with blink

RGP A/C

Optimal fit

Slight central clearance

Mid-peripheral alignment

Appropriate edge clearance

Toric cornea, spherical RGP

Fill in the table:

RGP A/C

OVER-REFRACTION

Trial frame

(Wider field of view; allow you to observe more realistic binocular interactions)

• Occlude left eye

• Perform spherical refinement

  • Present plus / minus

  • Find maximum plus that gives best comfortable acuity

• Binocular balance

  • Remove occluder and check with both eyes open if the lenses added before make a difference to VA

RGP A/C

Common aftercare complications

• Mechanical

• Hypoxia-related

• Inflammatory complications

• Infection

Common aftercare complications

RGP A/C

Mechanical

• Corneal abrasion / epithelial staining

  • Usually from lens edge trauma or trapped debris under the lens

• 3 and 9 o’clock staining

  • Due to poor blink, poor edge clearance, or excessive dry eye at the horizontal meridian

• Superior arcuate staining

  • From a steep upper lens edge or tight superior fit

• Corneal warpage

  • Steep lens or lens worn excessively can temporarily distort corneal curvature

Common aftercare complications

RGP A/C

Hypoxia-related

• Corneal oedema

  • Stromal haze, striae, microcysts cause blur and discomfort

• Endothelial changes

Common aftercare complications

RGP A/C

Inflammatory complications

• CLPC (Contact Lens Papillary Conjunctivitis )

  • From mechanical irritation of the upper lid

  • More common with dirty lenses or deposits

• Limbal redness

  • Often from poor edge alignment or excessive movement

• Peripheral corneal infiltrates

  • Typically sterile, but must be monitored

Common aftercare complications

RGP A/C

Infection

• Microbial keratitis

  • Rare in RGP wearers

  • Usually due to poor hygiene, overnight wear or contaminated cases

Name this :

RGP A/C complication

3 and 9 staining

Name this :

RGP A/C complication

Superior arcuate staining