1. Understanding the Contact Lens & Workshop Jill J. Luebbert, CPOT, ABOC 1

2. Contact Lens

3. Mona Lisa Contact Lens

4. Timeline of the Contact Lens
Leonardo da Vinci illustrates the concept of contact lenses

5. Timeline of the Contact Lens
British astronomer Sir John Herschel conceptualizes a practical lens design
First contact lens manufactured from glass, and fit to cover the entire eye

6. Timeline of the Contact Lens
Contact lenses first made from plastic
Plastic contact lenses designed to cover only the eye's cornea

7. Modern Day Contact Lens Timeline
Introduction of soft contact lenses
Introduction of gas permeable contact lenses

8. Modern Day Contact Lens Timeline
FDA approval of new soft contact lenses for extended (overnight) wear
Overnight wear of GP contact lenses becomes available

9. Timeline 1987 - Introduction of disposable soft contact lenses
GP contacts available in next-generation fluorosilicone acrylate materials

10. 1995 – One day disposable contact lenses are introduced

11. It is estimated that 125 million people used contact lenses worldwide
In the United States, there are to 38 million people in contact lenses

12. Types of Contact Lens
Hard
Soft

13. Hard Contact Lens Materials 1940’s, 50’s, 60’s 1970’s
Polymethylmethacrylate (PMMA)
1970’s
Rigid Gas-permeable (RGP)
Silicone Acrylate
Fluoro- Silicone Acrylate
Fluorine known for its nonstick properties in Teflon
Enhanced surface wettability
Silicon adds higher oxygen permeability

14. Permeable The ability to allow oxygen to pass through it
Referred to Dk
DK/t (t = thickness)

15. Base Curve The back central region of the lens
Important in determining the final lens power
Fit to the flatter K reading

16. Optical Zone The central area of the lens
Corrects the patient’s vision
Must be larger than the patient’s pupil

17. Intermediate and Peripheral Curves
Designed to flatten the overall lens in increments
Enables tear fluid exchange
Not used for correction patient’s refractive error

18. Overall Lens Diameter

19. Specialty RGP’s Multifocal designs Annular/Simultaneous Vision
Segmented
Truncated

20. Gas Permeable Contact Lens
Removal
Placement
Recentering

21. Care and Handling of RGP’s
Clean Hands
Use Hard Contact Lens Solutions

22. Soft Contact Lens Materials 1970’s Soft Hydrogel (water-absorbing)
Silicon Hydrogels

23. Manufacturing Techniques
Spin Cast
Hydrogel plastic is spun
The faster it is spun, the steeper the base curve
Lathe Cut
Cut in dry form, then hydrated
Dimensions change as it is hydrated
Cast-Molding
Material is injected into a mold with anterior and posterior curved surfaces
Preferred method of disposable contact lenses

24. FDA Classifications Group 1 Group 2 Group 3 Group 4
Less than 50% water content; nonionic
Group 2
More than 50% water content; nonionic
Group 3
Less than 50% water content; ionic
Group 4
More than 50% water content; ionic

25. Modalities
Daily wear
Flexible wear
Extended wear

26. Soft Contact Lens Designs
Single Vision
Toric
Prism Ballast
Truncations
Alteration of edge design
Multifocal
Monovision
Simultaneous

27. Contact Lens Suitability Analysis
Not every patient is a candidate for contact lenses
How do you determine who can wear contacts?
Is it all science?

28. Contact Lens Suitability
Patient Age
Refractive Prescription
Fingernail and finger tip analysis

29. Contact Lens Suitability
Patient Lifestyle

30. Contact Lens Suitability
A complete case history is important
General Health
Allergies
Ocular Health
Dry Eye Syndrome
Motivation

31. Contact Lens Suitability
Responsible
To care for the contact lens as instructed
To be able to afford the contact lenses
What is the patient’s expectation?

32. Evaluation Occupation Hobbies
Are they exposed to chemicals or other hazards?
Hobbies
Swimming
Computer

33. Contact Lens Suitability
Lids
Tension
Separation
Normal fissure is 9 – 10 mm
Pupils
Normal reading is 10.5 to 12.5 mm
Blink Rate
Average person blinks 10 – 15 times per minute
Complete Blinker???

34. Contact Lens Suitability
Corneal Sensitivity
Sterile wet cotton wisp
Tear Production
Schirmer Tear Test
Phenol Red Thread Test
Tear Coverage
Slit Lamp w/ blue cobalt and fluorescein
Uniform tears for 10 – 15 seconds after normal blink
Corneal Curvature

35. “Is this going to hurt?”

36. “I’ve seen my friends to this a million times.”

37. Relax

38. Hygiene
Clean hands!!!!
Any and Every time you touch the lens!!!!!

39. Let them hold a contact lens
What does it feel like?
What does it look like?
Is it inside out?
How easy does it tear?
How should it be on my finger?

40. Practice First Use the mirror Have them wash their hands
Practice without the contact lens
“What do I do with my hands?”
Scleral touch
Both eyes

41. Time for the real thing
Placement
Removal

42. First responses Don’t expect to see perfectly immediately
Nose is going to run

43. More instructions

44. Hygiene Clean Contact Lenses
Use soft contact lens solution recommended by ECP

45. Soft Contact Lens Solutions
Saline
Hydrogen Peroxide
Multi-Purpose
Enzymatic
Lubricants

46. Contact Lens Cases Care
Clean Contact Lens Case
Every three months

47. Contact Lens Replacement
Replace the contact lenses as recommended by the doctor
1 day
1 week
2 weeks
1 month
3 months

48. Signed Agreement Review dispensing instructions Review anticipated
Review wear schedule
Have them sign this agreement
Keep copy in chart

49. Recommend Sunwear
Contact Lens wearers are more sensitive to sunlight and wind.

50. Schedule next evaluation visit
“Your vision is now corrected with a piece of plastic ON your eye.”

51. Give them
Starter samples of the recommended contact lens cleaning, rinsing, storage solutions
Starter samples of recommended hand soaps
Additional contact lenses if necessary
Your business card

52. Thank them Thank them for trusting you for this service
Ask them to recommend your office to their friends

53. Now are you ready?
Workshop on dispensing

54. Soft Contact Lens Placement and Removal Instruction Workshop

55. Where to start? Emphasis on hygiene methods!!! Demonstrate
On your own eye
On the patient’s eye
Evaluate patient for anxiety and/or overconfidence

56. Practice Proper lid separation Proper hand placement
Handling of the contact lens

57. Site Preparation Use a well lighted area
Use a mirror (magnifying mirror)
Work over a cloth or paper towel at first

58. Contact Lens Placement Method #1
Remove right lens from storage container
Inspect for foreign particles, tears, or other damage
Lens should be moist, clear, clean and intact
Grasp lens gentle on place it on index finger
Verify that it is not inside out
Taco method

59. Ready????
Take a breath
Secure upper lid lashes against brow bone with opposite hand
Secure lower lid lashes against cheekbone using middle finger
Slowly bring contact lens toward the eye “looking through” the lens
Gently place lens on center of cornea

60. Finishing up Slowly release lower lid Slowly release upper lid BLINK
Is the contact lens on the eye???
Can you see better with this eye?
Is the contact lens on your finger yet?

61. One down -- One to go Repeat with left lens Blink
Can you see better with this eye?
CONGRATULATIONS!!!!
Discard the solution

62. Contact Lens Placement Method #2
Carefully remove contact lens from storage container
Inspect lens for foreign particles or defects
Is it right-side out or inside out??

63. Ready??? Place lens on middle finger of preferred hand Look up
Place contact lens on lower white of the eye
Remove trapped air by apply gentle pressure
Look down to position the lens on eye
Slowly release lower lid
BLINK
Now to the left eye

64. Removal Method #1 Wash and dry hands thoroughly
Pull lower lid down with middle finger
Gently pinch contact lens between thumb and middle finger
WATCH FINGERNAILS!!!!!
Remove contact lens from eye surface
Put in solution
Go to left eye

65. Removal Method #2 Wash and dry hands thoroughly
Verify the contact lens is centered
Pull lower lid down with middle finger
Lightly touch bottom edge of contact with tip of your index finger
Look up
Slide contact down onto the white of the eye
Gently pinch contact using your thumb and index finger

66. What if……. the contact lens decenters?
the edges of contact lens stick together?
the contact lens get dry while instructing?
the contact lens falls?

67. Tips
Using a penlight to guide the patient on placement of contact lens
Magnification mirror for hyperopes
Reassure the patient that there are no stupid questions regarding their contact lenses.

68. Care of the Contact Lens
Clean hands and fingers first
After removal, rub lens thoroughly with cleaning solution for 10 – 20 seconds (ABC’S, Happy Birthday Song, Yankee Doodle)
NEVER, NEVER use tap water or saliva!!!!
Clean both sides
Rinse with rinsing solution
Place in clean storage case
Cover completely with disinfecting solution

69. Other issues to address
Can I use eyedrops?
What if my vision gets blurry?
Can I shower with my contact lenses on?
Can I swim with my contact lenses on?
What about eye makeup and hairspray?
Can I sleep with my contact lenses?
What if my eyes get red when I’m wearing my contact lenses?

70. Other issues Do I still need my glasses? What about sunglasses?
When do I need to see the doctor again?
Can I have my prescription?

71. “Before you leave, we have…
Additional contact lenses (if necessary)
Starter size of recommended hand soap
Start kit of recommended contact lens care products
Copy of instructions for care of contact lens
“Your next appointment is …….”
Your business card

72. Incentives Offer discount on optical quality sunwear
Offer discount on backup eyewear

73. THANK YOU!
Always thank them for allowing you to provide them your services and products
Ask for referrals

74. Enjoy Heart of America Experience
Jill J Luebbert, CPOT, ABOC
Luebbert Consulting & Training