I know that there is flourescein available for soft and RGP lenses.....how often do you use flourescein when pre-evaluation of soft lenses? Tell me what you are using it for if you do use when doing slit lamp evaluation prior to soft lens fitting or seeing a patient for the first time....Thanks
Last edited by mullo; 09-14-2005 at 08:13 AM.
Never, the stuff for soft lenses (Floursoft) is expensive, messy and goes out of date fast.
it is not used in 'fitting' soft contact lenses.
please dont tell me there are opticians learning anecdotally.
I don't either....was taught not to with soft lenses...even though there is a compatible (non soft lens staining fluorescein available). What benefits are there to staining for a first time evaluation of a patient....besides TBUT....but that can be done fairly accurately without.
I have encountered a few fitters that are using on everyone (they do not fit RGP's either) to check eye health during a biomicroscopic exam prior to soft lens fitting??
Sure, you could use fluorescein for soft lenses. It will just permanently turn them yellow. . .
Don't ask what you can do. DO what you can do. -My Paternal Grandpa
Don't have any experience with Fluoresoft (comes in single unite dose vials), but all we use now is Fluora-Safe (comes in a bottle). It's a large molecule fluorescein that doesn't get into the matrix of a soft lens.
The point is not to use the stuff for fluorescein evaluation of a soft contact lens (since you don't need fluorescein to evaluate such a fit).
The reason why we use it is so we can do Goldmann tonometry on everyone without worrying about staining their lenses. It costs about the same as your basic Fluress and other similar products, and works very well. I also think the drop is much nicer than a lot of the crappy generic versions of Fluress, doesn't seem to get washed out of the eye quite as quickly.
I think we get it for about $7 to $9/bottle (depending on how many bottles we buy) from Pelion Surgical.
I am fully aware of how to fit and assess fit of a soft lens. My question was about pre-fit assessment.....before you place a soft lens on the eye. Do you use fluorescein to check eye health or for pathology?
Here is another brand of fluorescein that is safe for using but not staining soft lenses.
SOFT GLO
For staining the eye when fitting both soft and hard contact lenses. Each sterile strip is impregnated with .5mg of fluorexon disodium.
Mullo: I don't think Floursoft (Holles Labs) stains the cornea, or if so not well enough for tissure evauation. Just shows a pattern of tears beneath the lens.
they may be checking for dryness issues, including conjunctival staining
If you're doing this for the purpose of staining, I don't get it.
Most corneal SPK, abrasions, infiltrates, etc can be observed without fluorescein. And most conjunctival issues will have signs of obvious injection or chemosis that really don't require the use of fluorescein.
Any of you folks ever use rose bengal to check for dry eyes, necrotic tissue, etc?And no I don't know if it stains soft contact lenses or not.
I do know that you need to rinse the eye well after using or the patient may call back after hours complaining about how much thier eyes burn.
Chip
I once worked for an OMD that thought it was a wonderful diagnostic tool.
I don't do it....I wanted to know if you guys did....because I do "not" understand the use for it when fitting soft lenses. Besides being anal and wasting time.
Originally Posted by snowmonster
If you guys don't know whether or not to use flourescein during a contact lens fit, you should not be fitting contact lenses. That's just basic knowledge to use flourescein before a contact lens fit so you can evaluate the tear film and corneal integrity. Corneal SPK will be overlooked often without using flourescein.
It is good form to use NaFl to better evaluate the corneal and conjuntival integrity BEFORE taking the time and effort to fit first time SCLs. Does it happen all the time? No, of course not. Can you live without it? Sure. You may miss an underlying condition, but you can pick it up on followup. You may waste some time and effort and lens selection specificity, though.
I do think, however, that in the follow up care of a CL patient (1 week, 1 yr., etc.) that it is critical. We need to know if the lens is negatively affecting the eye.
While not a mandatory adjunctive test, Lissamine Green replaces Rose Bengal quite nicely and can give a more complete clinical picture than fluorescein alone. While fluorescein is absorbed into cytoplasm, meaning the cell has to have a ruptured cell membrane, i.e. be dead, before it stains, Lissamine Green (like Rose B) stains "devitalized" (dying) cells as well. What's more, NaFl is not rendered all that fluorescent by the cobalt blue filter alone, which is what most of us use. LG gives a high contrast dark green on white view of the lesion, which is especially nice on the conj., since Nafl seems to pool a lot on the conj. and be more difficult to visualize.
I use LG when I'm stumped, actually. It has helped elucidate the cause of mysterious symptoms on more than a few occasions. It's not a routine stain, though.
Why not have 2 appointments. Do the pre-asessment on one day, and then the fitting on a second day. Sounds like a pain in the backside? Well the days of the compliant patient are gone.. wrong, if you communicate well, and explain why you want to see them twice, you will end up with a loyal patient, who understands that you are a responsible practitioner. By asking the patient to come in a few times on the initial fit, you soon weed out the patients who are unlikly to respond to a routine 6/12 / 12/12 check up.
For existing contact lens wearers we do the appointment backwards! We assess the contact lenses in situ, and then remove them, and procede with the routine eye examination and refraction... that drives the message home about also wearing spectacles, and in some cases with a contact lens patient.. actually owning spectacles!
As a footnote, we use fluorescein impregnated strips, which we drip a drop of saline over. Some bacteria thrive in fluorescein, which is why we definatally do not have bottles of fluorescein anymore, this absoloutly decreases the chance of cross infection between eyes or patients
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