CONTACT LENS & FLUROSCIEN

[Sara]

Being a second year student,I am coming on contact lens fitting assignments.
My question is to assess contact lens fit on a patient do we instill fluroscein first on eye and than place contact lens on patient or we place contact lens first on patients's eye and then instill fluroscein solution on top of that.
Second question is do we need to take K readings for patient who need soft contact lens.
Please can someoneteach the student.
Sara

[chip anderson]

Yes you still instill flouresiene, lens on first. I prefer to put moistened flouristrip on sclera above iris although most teach it now to put it in the pool of tears inferiorly. Do not use with soft contacts as it absorbs, unless you use the type for soft contacts, which is seldom needed.

Yes you need to take K readings. Believe it or not it is possible to misfit soft contact lenses one size does not fit all. Another very good reason for K readings, is one of your best criteria for how a lens is effecting the eye, is: Do the K readings change with wear? You'll never know if you don't take them before fitting. Lastly, never trust K readings done by anyone else.

[Diane]

Sara,

I will agree with Chip on his answers to your specific questions. Here's just one more little piece of information. I like to evaluate the eye with the lens in place prior to instilling fluroscein into the eye, on either rigid or soft lenses. Then I evaluate with the fluroscein and then I remove the lenses and evaluate the eye.

Won't give you too much information here too fast, but ask those questions.

Diane

[Optom]

Sara welcome to this friendly & wonderful board.
I will come to answer the specifics of your question later on since I want to encourage my fellow opticians to answer your question first,I note the turn out is poor.
For now please note:
1)You must take K readings on all your contact lens patients,be it soft or RGP.This is necessary for record purpose.
2)If you are using manual Keratometer,observe corneal surface smoothness,regularity of mires,principal meridians/axis and record it on patient file along with radius of curvature in both dioptres and millimeters.
3)Most contact lens material will absorb fluroscein dye if instilled on top of them thereby increasing risk of corneal infection if the lens is not thoroughly cleaned.Put fluroscein on eye prior to inserting contact lenses if possible.
Flurostrip is better to fluro solutions.
they are economical and contamination free.
If you prefer to use solutions,use single use disposable unims.Solutions can be easily contaminated when in opened bottles.
I put a drop of SALINE solution on fluro strip to wet it and apply on cornea near limbus.Ask pt to blink couple of times.
A piece of advise:
Do not use same fluro-strip on both eyes if you suspect infection in any one eye-use seperate strips for each eye.
See you soon with more info.

[This message has been edited by SHABBIR KAPASI (edited 03-02-2001).]

[chip anderson]

Why in the H--- would anyone put anesthetic on a floristrip? Anesthetic should never be used unnecessarily and never on an eye that is going to have a contact lens put back on it in the next hour or so. This used to be the first thing we were taught. Hate to see wimpy residents putting it in to teach a patient "pain free" insertion. It numbs and drys the cornea, making unaware abrasion a very real possibility. Flourciene is painless, doesn't need drugs unless you are going to do tononometry following. The the lens should be left out for an hour.

[This message has been edited by chip anderson (edited 02-17-2001).]

[Optom]

Chip,

Thank you very much for correction!
I confused it with applanation tonometry when we use anaesthetics.
Sorry Sara,you see I am getting old now,so please call me uncle.

Chip,thanks again!!

It should be SALINE to wet strip,though anaesthetics can be used intially for apprehensive first time RGP fitting patients.

[This message has been edited by SHABBIR KAPASI (edited 03-02-2001).]

[Sara]

Shabbir
You said "see you with more info"
I am still waiting for your more info on the subject.
Sara

[Optom]

Sorry Sara I overlooked this tread.
OK, for soft lenses you may use FLUORESOFT or FLUOREXON which does not penetrate soft lens material immediately because of its high molecular weight.Caution!this may not work with very high water content contact lenses and chances are discolouration can occur.
Always apply wet fluoro strip to eye,dry ones
can hurt.Moisten strip with saline solution.NEVER use tap water,acanthamoeba can be present and also note that pseudomonas aeruginosa has strong affinity for fluoroscein.Take little extra care,that's all.
I hope this has answered your question.If you have any further questions please post it today ,from tommorrow I will not be able to visit optiboard for a while.
(never ever call me uncle or brother)-Sara,take it lightly!
Shabbir

[chip anderson]

Shabbar: What makes you think things don't grow in saline? The salt sure doesn't inhibit anything. As to floursene purity, that's why the flouristrips came out instead of drops.

[Sara]

Shabbir,
Be back soon.We like your challenges and benefit from your knowledge.Thanks for infos.
Sara

[Maria]

Originally posted by chip anderson:
Shabbar: What makes you think things don't grow in saline?

As I understand it, saline starts growing mould afer 24 hours, and there's a thread somewhere about a friend of mine who stored his lenses in home-made saline, with lots of (negative) opinions about saline use. Saline is manky :)

[Sara]

We are not talking about home made saline for storing contact lenses,but sterile saline to wet fluoro strips prior to insertation in eye.
Coincidently ophthalmologist in our clinic use saline minims to wet strip.
Can someone tell me chemical components of saline.
Sara,
Optical student

[chip anderson]

Sara: Chemical components of saline: Water/table salt. I think in .09%. Yes sodium cloride type salt and H20 type water.

[Sara]

Uncle Chip,
I was talking to an Ophthalmologist in my dispensary on why he is using saline to wet fluorostrips.
He replied that saline is safer than tap water and near to natural tears composition of our eyes which also has antibacterial properties.If he uses sterile bottled saline solution he discards it 5 days after first opening.
I also asked him what happens to pupils when someone is sexually aroused.He replied in men pupil constricts but in females it dilates.He said when he was in medical college he used to look directly into girls eyes and if he finds her pupils dilated,he will know she is interested in him.
Check my aunty's pupil & let us all know!!

Your niece Sara

[chip anderson]

Sara: Open a sealed new soft lens in a bottle. Put the cap back on and re-seal. Do not remove or put anything else in the bottle. Check the bottle in 3 days, it will have fungus growing in it (That's what those black particles are). If the doctor, wants to do it his way, he should use preserved saline or autoclave the stuff every night.

Chip

[chip anderson]

Sara: One further note on flourcein. Years ago I seem to have read that the PH of flourestrips was adjusted to simulate tears (saline) when moistened with tap or distilled water. Don't know if this is still true or was then for that matter, but if so, this would make it a little salty when mixed with saline.

Chip