Patient Suitability and Lens Types

Patient Suitability

Learning Outcomes

  • Outline the main elements involved in assessing patient suitability for contact lenses (CLs).
  • Describe in detail the factors that need to be discussed with patients prior to fitting contact lenses.
  • Discuss indications and contraindications for CL wear.
  • List the relative advantages and disadvantages of soft and gas permeable contact lenses.

The Story So Far

  • Approximately 4.5 million existing CL wearers in the UK.
  • Common issues include perceived discomfort and fear of putting CL in the eye.
  • Patients are often willing to try CLs based on practitioner advice.
  • Advancements in new materials have improved ocular physiology.
  • Wide range of wearing and replacement modalities are available.
  • Large range of lenses and designs are available.
  • Simple care regimes are now widely used.

Assessing Suitability

  • Assessment involves:
    • Patient Discussion
    • Patient Examination

Patient Discussion

Expectations & Visual Requirements
  • Patient Expectations:
    • What are the patient's expectations from contact lenses?
    • When does the patient intend to wear contact lenses?
    • Where will the patient be wearing the contact lenses?
  • Previous CL Wear:
    • Current or discontinued lens wear?
    • Lens types and wear modality used previously.
    • Reason for discontinuation, if applicable.
  • Visual Requirements & Status:
    • Nature of spectacle prescription (Rx).
    • Consideration of amblyopia.
Ocular & General Health
  • Ocular Health:
    • Previous or recurrent infection/inflammation.
    • History of anterior eye surgery.
    • History of ocular trauma.
  • General Health:
    • Atopic history (allergies).
    • Rheumatoid arthritis.
    • Thyroid eye disease.
    • Autoimmune disease.
    • Diabetes.
Medication
  • Prescribed medications:
    • Antihistamines.
    • Diuretics.
    • Tranquilizers.
    • Antidepressants.
    • Oral contraceptives.
    • Glaucoma medications.
  • Non-prescribed medications:
    • Ocular lubricants.
    • Dry eye drops.
Occupational & Recreational Needs
  • Occupational Issues:
    • Consider indications versus contraindications based on the patient's occupation.
  • Recreational, Social & Sporting Needs.
  • Patient Education:
    • Inform patients about the lens types available.
    • Explain different wearing modalities.
    • Discuss the replacement schedule for lenses.
Other Factors
  • Motivation:
    • Consider the patient's personality (introverted vs. extroverted).
  • Age:
    • Consider suitability for children.
    • Address presbyopia in older patients.
    • Assess manual dexterity.
  • Patient Compliance:
    • Hygiene practices.
    • Adherence to aftercare instructions.
  • Financial Considerations.
Closing
  • Use the gathered information to discuss the best options for the patient's needs.
  • Discuss advantages and disadvantages of different options.
  • Provide a recommendation.
  • Involve the patient in the decision-making process.

Indications & Contraindications

  • Refractive/Optical
  • Occupational
  • Cosmetic
  • Medical
  • Psychological
  • Other
Refractive / Optical Indications
  • (No specific indications listed in the transcript, typically myopia, hyperopia, astigmatism are indications.)
Refractive / Optical Contraindications
  • Low refractive errors:
    • Example: +1.00/−0.50x90+1.00/-0.50 x 90 or −0.25/−0.50x180-0.25/-0.50 x 180
  • Correction for near vision only.
  • Requirement for prism correction horizontally or vertically.
Occupational Indications
  • (No specific indications listed in the transcript.)
Occupational Contraindications
  • Legal constraints:
    • Pilots not permitted to use monovision, multifocal, or cosmetic CLs.
    • Coloured and photochromic CLs not permitted for train drivers.
    • RAF (Royal Air Force) do not permit CLs which alter colour perception.
Cosmetic Indications
  • (No specific indications listed in the transcript, typically desire to change eye color or enhance appearance are indications.)
Cosmetic Contraindications
  • Spectacles may provide better correction of large-angle squint.
  • Spectacles may hide facial/ocular disfigurement.
Medical Indications
  • (No specific indications listed in the transcript, medical necessity after trauma, or surgery are indications.)
Medical Contraindications
  • Active infection or pathology.
  • Recurrent corneal erosions.
  • Severe catarrhal or sinus problems.
  • Allergies.
  • Diabetes (fragile epithelium).
  • Anatomical features (e.g. misshapen lid).
Psychological Indications
  • Where the patient cannot accept the concept of wearing spectacles.
Psychological Contraindications
  • Cannot tolerate any level of discomfort.
  • Unable to cope with insertion and removal (fear factor).
  • Total perfectionist!
Other Indications
  • Recreational uses:
    • Contact sports like rugby, football, yachting, and skiing.
  • Inability to wear spectacles:
    • Skin allergy.
    • Sinus problems.
Other Contraindications
  • Environmental factors:
    • Dust/Fumes.
    • Dry atmosphere (central heating, air conditioning, airplanes).
    • Altitude (low EOP).

Assessing Suitability Summary

Patient Discussion
  • Expectations & Visual Requirements
  • Ocular History & General Health
  • Visual, Occupational & Recreational Needs
  • Indications & Contraindications
Patient Examination
  • Full Eye Examination
  • Slit Lamp Examination
  • Corneal Topography Assessment
  • Tear Film Assessment

Lens Types & Patient Suitability

Advantages of Soft Lenses

  • Good initial comfort
  • Ease of adaptation
  • Long wearing times (WTs) possible
  • Suitable for intermittent wear
  • Suitable for sports
  • Low risk of loss
  • Convenience
  • Maintenance of corneal sensitivity
  • Flare not a problem
  • Low incidence of photophobia or lacrimation
  • Absence of spectacle blur

Disadvantages of Soft Lenses

  • Corneal astigmatism uncorrected with spherical lenses
  • Lens dehydration
  • Lens damage
  • Limited lifespan
  • Deposit formation
  • Disinfection more complicated
  • Solution allergies
  • Modification impossible
  • Neovascularization
  • CLAPC (Contact Lens-Induced Acute Red Eye)
  • Expensive

Patients Suitable for Soft Lenses

  • Most patients
  • Full-time (FT) or part-time (PT) wear
  • Large or decentered pupils
  • Sporting requirements
  • Rapid adaptation necessary
  • Spherical Rx with astigmatic Ks (corneal readings)
  • Poor GP lens centration
  • GPs unsatisfactory – lids/cornea too sensitive
  • Evidence of 3 & 9 o’clock staining

Advantages of GP Lenses

  • Excellent VA (visual acuity)
  • Correct corneal astigmatism
  • Large range of designs
  • Ease of maintenance
  • Low incidence of solution allergy
  • Reduced deposit formation
  • High O2 permeable materials available
  • Low complication rate
  • Easy to check
  • Modifications possible

Disadvantages of GP Lenses

  • Initial discomfort
  • Precise fitting required
  • Regulations regarding single use diagnostics
  • Foreign bodies
  • Risk of loss and/or breakage
  • Flare
  • 3 & 9 o’clock staining
  • Lens adhesion
  • Lens greasing with some patients

Patients Suitable for GP Lenses

  • Significant corneal astigmatism > 2.00D
  • Corneal irregularity
  • Dry eyes
  • Prolonged VDU (Visual Display Unit) use
  • Atopic history
  • Vascularization present or imminent
  • Unlikely to adhere to soft lens care regime
  • Unable to handle soft lenses
  • Px (patient) wishing to avoid ongoing costs of disposable lenses