Physical Address

304 North Cardinal St.
Dorchester Center, MA 02124

Practice Management

Introduction Contact lens practice resides within a general eye care practice embracing the prescribing, fitting, dispensing and long-term management of contact lens-wearing patients. Thus practice management issues that have an impact on contact lens practice are first all those that have an impact on general eye care practice, and second, issues and elements specific to contact lens fitting, dispensing, ordering and patient interaction at each stage…

Compliance

Introduction Patients are often lying when they say they have regularly taken the prescribed medicine . Hippocrates, 400 bc The issue that Hippocrates was highlighting was that of compliance – an important field of medicine that has been the subject of medical research since the beginning of the 20th century. In the contact lens field, studies of compliance commenced only in the mid-1980s, with the first…

Complications

Introduction Just as contact lenses (CLs) have become easier to fit over the past century, our knowledge base of the ocular response to lens wear has expanded exponentially over the same period. Thus there has been a commensurate shift in emphasis in CL practice away from the technical skills of lens fitting (although these are certainly still required) and more towards the theoretical knowledge and clinical…

Aftercare

Introduction Follow-up examinations represent a fundamental aspect of healthcare, especially when managing ongoing or chronic conditions. In this context, contact lens wear can be considered a healthcare modality that requires ongoing management. The aftercare examination is therefore an important cornerstone of contact lens practice. Contact lenses are generally very well tolerated by the majority of patients; however, appropriate aftercare of the contact lens patient is essential…

Patient Education

Introduction The quality of instruction and advice given to a patient contributes to the success or failure of the new wearer ( ). Therefore, the importance of the dispensing visit should not be underestimated, and this chapter covers some of the key aspects of this activity. Objectives Proper and careful instruction of a patient at a dispensing visit will facilitate confident lens handling by the patient…

Preliminary Examination

Introduction The preliminary examination includes the taking of a full history and initial patient assessment (see Chapter 33 ), ocular measurements, refraction, slit-lamp biomicroscopy and additional tests. The examination enables the practitioner to advise patients on their suitability for contact lens wear and of appropriate lens choices for fitting. The information obtained from the preliminary examination is vital in the selection of the most suitable lens…

Diagnostic Instruments

Introduction The purpose of this chapter is to review a number of the clinical instruments that are of utility in the preliminary examination and ongoing care of contact lens patients. The emphasis will be on the design and principles of operation, with some comments on clinical use. Further details on the application of these instruments in contact lens practice can be found in Chapter 38 .…

History Taking

Introduction History and symptoms is critical to determining whether an individual is suitable for contact lens wear, to aid selection and to inform management. The aim is to comprehensively elicit relevant information in as concise a manner as possible, as time is limited in a clinical setting, but missing information can result in suboptimal clinical decisions. Clinical records have been found to underestimate actual care provided,…

Diabetes

Introduction Diabetes mellitus is one of the most common systemic diseases in the world and it occurs when the pancreas does not produce enough insulin or when the body cannot effectively use that insulin. Hyperglycaemia (elevation of blood glucose concentration) is a common effect of uncontrolled diabetes and over time this leads to damage to, and dysfunction and failure of many of the body’s organs including…

Myopia Control

Introduction Myopia is a commonly seen condition and is the most important cause of distance vision impairment. Data from many East Asian countries show a consistent rise in the prevalence of myopia from approximately 20–30% in the 1940s to 70% and above today ( ). Although the prevalence is not as high in many other countries, a similar trend to rising prevalence has been observed (…

Orthokeratology

Introduction Rather than using contact lenses to add a new refracting surface to the eye to correct ametropia, in orthokeratology (OK), specially designed rigid contact lenses are instead used to temporarily alter the shape and thereby refractive power of the anterior corneal surface. History of Orthokeratology was the first to describe how rigid lenses, then manufactured in polymethyl methacrylate, could be fitted steeper than corneal curvature…

Post-surgery

Introduction After corneal surgery, contact lenses may be indicated to provide improved optical correction or therapeutic ocular surface protection. Optical indications include the correction of irregular or high regular astigmatism, secondary aniseikonia and the correction of refractive error to eliminate spectacle correction ( ). For those with induced anisometropia, restoration of binocular vision may be achieved with contact lenses. When there is induced irregular astigmatism, contact…

Therapeutic Applications

Introduction The concept of a protective eye bandage originated in the first-century ad when Celsus reportedly applied honey-soaked linen to the site of a pterygium removal to prevent symblepharon development ( ). The therapeutic use of contact lenses goes beyond visual improvement in irregular and distorted corneas or correction of refractive errors. The term ‘therapeutic contact lens’ has become synonymous, for many, with a soft plano…