Contact Lens Case Study Analysis

involvement Lens Case Study Analysis see genus Lens systemeesContact electron genus Lensees be a suitable substitute for correcting vision in a number of scenarios. There are hundreds of different contact lens types out there in todays market with the bod growing extensively every year. With the advancement of research and technology, manufactures are forever attempting to better their own product lines to suit a variety of of necessity a person may postulate, whilst alike attempting to 1-up their competitors.The patient of we are attempting to fulfill with lenses has never feeble them before so as far as options go, we are open to explore different lens types and materials amounting to 100s of different combinations. She is a nurse who works long shifts in a hospital and desires full judgment of conviction CL have of up to 12 hours a day, 7 days a week. To do this, we must assess each aspect of the test and provide and cater lens plectrum to match intended wear met re and to too correct her vision for both distance and near.The ethical drug drug that we flip been presented with is a high myopic prescription so we pick out to level for the change in distance as the contact lens volition sit on the cornea and non 12mm away. The compensated contact lens prescription equates toSoft lenses come in many forms and for this patient, a silicone hydrogel (SiH) lens material would be the one to choose payable to its high oxygen transmission (Dk/T) levels, oftentimes higher than hydrogel, like the SiH AirOptix Aqua, Dk 138, 33% urine, 8.6 trading floor curve, 14.mm diameter, (AIR OPTIX greenish blue Contact Lens, no date) lens vs. the Frequency 55, Dk 21, 55% water, (Frequency 55 aspheric Cooper wad UK, no date) hydrogel lens. The Dk/T should be at a level where large oxygen is passing through and through to the cornea, avoiding hypoxic conditions and preventing neovascularisation and oedema of the cornea which can lead to stable corneal d amage.SiH lenses save are not as comfortable as regular hydrogel materials due to the rubbery nature of the lens, and also the lenses hold less(prenominal) moisture compared to regular hydrogel. Silicone is not a wettable material so corneal hydration is an anaesthetise. (Sweeney, 2004, pp. 3 3). Manufacturers combat this by incorporating technology into the lens such(prenominal)(prenominal) as AquaGen found in Clarity 1 day toric Dk 57, peeing 56%, 8.6mm base curve, 14.3mm diameter (SAUFLON, no date) .This allows the lens to stay hydrous and plus overall comfort wear-time, something extremely important for this nurse.Soft lenses winding-sheet over the cornea and range between 13.8mm-14.5mm coats in rule to cater for the patients measurements. A well run intoted well-fixed lens impart contain that the lens has corneal coverage in all directions of gaze. The lens should have movement of at to the lowest degree 1/4mm when blinking, not more be origin of the multivariate vision it will pose, or less as it will cause discomfort and should also allow adequate exchange of tears rotter the lens to allow debris removal (Gasson and Morris, 2010, pp. 227-227).Rigid gas leaky (RGP) lenses are a great deal more complex to fit than soft lenses They are tailor made to the patients prescription and measurements such as horizontal iris diameter (HVID) and pupil size. RGPs are smaller than soft lenses and smaller in diameter than the cornea itself, with diameters ranging from 8mm to 11mm. RGPs float on the tear occupy and can create a lens made out of tears.(Gasson and Morris, 2010, pp. 137 139)Practitioners make to oblige this tear lens into account as it can annul the command for toric lenses or require prescription ad skillfulments through over-refraction (Gasson and Morris, 2010, pp. 137 139). RGPs offer master copy clarity than their softer counterparts and are much more durable and longer lasting, except are mostly overlooked in modern times ( outside of therapeutics) due to the patients impatience of aligning to the initial uncomfortable fitting. RGPs are also easier to lose as they can pop out of the eye much easier and are more difficult to completely cleanse, something important for this nurse considering her works environment.Assessing her slit-lamp examination results such as her tear break up time (TBUT) and tear optical optical prism, I would be looking at a lens that plentiful hydration to the cornea. This is because her TBUT of less than 10 seconds at 7 seconds and her tear prism of 0.2 mm indicate that she suffers from dry eyeball (Dry lookmedical, no date). Having dry eyes and not addressing the issue will result in significantly decreased wear time due to great increase in discomfort. senior high water content lenses whilst more comfortable than most new(prenominal) lenses at first, deteriorate in comfort as the day progresses due to vapor (Efron, 2012, pp. 87 87). These lenses then proceed to draw wat er from the next usable source being the tear film through osmosis will cause discomfort for this nurse as she does suffer from dry eyes, reducing wear time considerably. Her TBUT and tear prism will influence the lens preference as she does intend full time lens wear, such as a SiH lens like the Acuvue Oasys toric lens Dk 147, Water 38%, 8.4mm base curve, 14.3mm diameter, (JJvisioncare, no date) or a RGP lens.The astigmia present in her prescription will necessitate toric lenses which allow practitioners to correct astigmatism. Most popular toric lenses accessible on the market such as the Biofinity toric lens corrects astigmatism plainly up to a maximum of -2.25DC and the axis is only correctable to the near 10 meaning that contact lens practitioners must sometimes agree the vision slightly when the prescription is unavailable in exact supply and axis specifications such as this nurse (Ruben and editor., 1978, pp. 212 213), where an axis of 180 would need to be given for b oth lenses.An noble-minded lens for this nurse such as the Clarity 1day toric employs prism ballast which places 1-1.5 of base tidy sum prism at the base of the lens for stability. Stability of the lens reduces lens rotary motion and ensures toric lenses stay on axis. This does increase lens thickness and causes a reduction of Dk/T at the base of the lens, increasing find of hypoxia at the partition (Efron, 2012, pp. 221 221). Acuvue Oasys toric lenses employ peri ballast aka urge ond stabilisation designs which have 4 stability zones. This design is claimed to provide more rapid settling on the cornea deep down 1 minute, and achieve correct orientation within 5 of the judge position in 90% of cases (Gasson and Morris, 2010, pp. 266 266)Prism Peri ballast designs (Methods of Stabilisation Optometry by Catherine Care, no date)RGP lenses would be a serious candidate due to her corneal astigmatism (K) developments gained from the keratometer. Her measurements gained were RE emailprotected emailprotectedLE emailprotected emailprotectedEvery 0.05 of difference between the 2 readings gained by each eye corresponds to 0.25DC, so comparing her corneal astigmatism to prescription, we can deduce that the difference equates to -0.75DC in her right eye and -1.25DC in her left eye. This means that when the lens is fitted on the flattest K, the difference between the K readings will create a negative powered tear lens that will correct the astigmatism completely in both eyes for his nurse, negating the need for toric lenses (Gasson and Morris, 2010, pp. 137 139).Multifocal contact lenses are an slight way to correct prevision and exist both in soft and hard lens designs. synchronous designs such as concentric ring multifocals (MF) are fairly normal such as the Oasys for presbyopia lens, Dk 147, Water 38%, 8.4mm base curve, 14.3mm diameter, (JJvisioncare, no date) which provides both distance and near vision in one lens. They do this based on pupil size and often are fail up between centre distance (CD) lenses for the dominant eye in most cases and centre near (CN) lenses for the some other eye. Depending on the level of illumination, a certain working distance will be favoured over the other as the concentric rings are positioned at intervals which the pupil size will coincide with. This MF design does increase the amount of flash experienced by the patient due to the rings and can also decrease contrast sensitivity due to superimposed retinal physical body sizes if CD and CN are given (Gasson and Morris, 2010, pp. 277 282). I would not recommend a MF soft lens for this patient as it will not correct her astigmatism.Daily MF toric lenses do not currently exist, however monthly soft MF toric lenses do exist with one lens type being the Proclear multifocal, a hydrogel lens with low Dk and high water content Dk 42, 62% water content, (Coopervision, no date) something definitely less than rarefied for our patients desired wear memorial. Bifocal RGP lenses exist providing excellent distance and near vision and use the lenses movement on the cornea. The lens moves up as the eye rotates down, bringing the segment into the pupils path and allowing the patient to read. As the eye rotates back up, the lens moves down and the segment moves out of the pupils path and distance vision is restored.(Gasson and Morris, 2010, pp. 277 282)RGP bifocals such as the Boston Multivison lens would be an excellent choice for this patient if she were to adapt to them due to correcting astigmatism through the tear lens, allowing her to see distance and reading in one package and allowing plenty of oxygen to pass through the lens.Another successful form of CL correction for presbyopia is monovision (MV), in which one eye is optimally corrected for distance acuity and the other is corrected for near vision (Weissman, 2006, pp. 20 20). MV does not via media lens fitting options and is a highly versatile option and is the least c omplicated method of dealing with. The distance prescription would be languid in the dominant eye and the reading prescription would be worn in the non-dominant eye, with the brain suppressing images from one eye depending on the working distance. The issue with MV however is that stereopsis is lost as binocular vision is not being utilised. This can be an issue for this nurse if she is required to deem out tasks that require accurate judgement of depth like administering an shooting to a patient or driving. If the concept is well explained initially, there is a much higher chance of acceptance of MV and seeing that she hasnt worn CLs before, she is very likely to adapt. (Gasson and Morris, 2010, pp. 277 282)The other alternative to this would be just to correct her distance prescription with contact lenses and to give her a dissolve pair of +1.75DS reading spectacles which although a viable effect, can be inconvenient for her and defeats the purpose of replacing glasses with full time CL wear.Some special advice for this patient would include managing her grade 1 blepharitis, which in its current state will not impact lens choice or length of wear if managed correctly. I would advise her to apply calorifacient compresses to her lids and recommend a gel like Blephagel in methodicalness to accelerate debris clearance. I would advise her against using baby shampoo which is a surfactant, as it will break lipids in her tear film and will further detriment her dry eyes. I would advise her to administer false tears into her eyes which are CL compatible in order to maintain extended comfort all day. I would advise her to soundly clean her lenses daily if choosing a non daily lens by corrasion and rinsing in preservative free multipurpose solution, or rather recommend peroxide solution and let the lenses fully be cleansed without the need to rub and rinse.My overall recommendation after all things considered would be to fit this patient with the soft bi-m onthly Acuvue Oasys toric lens with HydraClear technology to permanently lock a high volume of wetting agent inside the contact lens (JJvisioncare, no date). I would utilise monovision with distance dominance to correct for presbyopia, thoroughly explaining to her the mechanics of monovision and what to expect, as not to be overwhelmed by loss of stereopsis and to increase the overall likelihood of acceptance. Id also tell her to take precaution if driving. My reasoning for this is heavily based off her wearing schedule in tandem with her dry eyes and her working environment. In order to achieve the wear schedule that she desires, it is extremely important that the lens has a high Dk/T lens in order to prevent hypoxic conditions and a high wettability in order to maintain corneal hydration, minimising discomfort and and so allowing said wear schedule taking into account her dry eyes. She is a nurse so automatically this puts her at a higher risk of infection, hence a lens more freq uently replaced would be ideal to prevent deposit build up from affecting her too much and overall decrease the risk of infection. I would recommend her the peroxide solution to further clean the lenses and to decrease the risk of infection and to apply near tears for extra comfort.2199 wordsBibliographyAIR OPTIX AQUA Contact Lens(no date) unattached at http//www.airoptix.com/contact-lenses/aqua.shtml (Accessed 28 April 2015)CooperVision (no date)Proclear multifocal toric. in stock(predicate) at http//coopervision.com/practitioner/our-products/proclear-family/proclear-multifocal-toric (Accessed 25 April 2015)Efron, N. (2012) Contact lens complications. Third edn. Edinburgh Saunders (W.B.) CoFrequency 55 aspheric CooperVision UK(no date) lendable at http//coopervision.co.uk/contact-lenses/frequency-55-aspheric (Accessed 28 April 2015)Gasson, A. and Morris, J. (2010) The contact lens manual a virtual(a) guide to fitting. Edinburgh Elsevier Health SciencesJJvisioncare (no date)AC UVUE OASYS for ASTIGMATISM. Available at https//www.jnjvisioncare.co.uk/contact-lenses/all-acuvue-brand-contact-lenses/toric/acuvue-oasys-for-astigmatism (Accessed 25 April 2015)JJvisioncare (no date)ACUVUE OASYS for PRESBYOPIA Johnson and Johnson Vision Care. Available at https//www.jnjvisioncare.co.uk/contact-lenses/all-acuvue-brand-contact-lenses/multifocal/acuvue-oasys-for-presbyopia (Accessed 25 April 2015)MEDICAL, D. E. (no date) Diagnostic tests. Available at http//www.dryeyesmedical.com/ diagnosis/diagnostic-tests.html (Accessed 25 April 2015)Methods of Stabilisation Optometry by Catherine Care (no date) Available at http//optometry.catherinecaregroup.com/method-of-stabilisation/ (Accessed 29 April 2015)Ruben, M. and editor. (1978) Soft contact lenses clinical and applied technology. New York John WileySAUFLON (no date)Clariti 1day toric. Available at http//www.sauflon.co.uk/eye-care-professionals/products/clariti-1day-toric (Accessed 25 April 2015)Sweeney, D. F. (2004) Si licone hydrogels continuous-wear contact lenses. Oxford Butterworth-HeinemannWeissman, B. A. (2006) OPTOMETRIC CLINICAL PRACTICE guidepost CARE OF THE CONTACT LENS PATIENT. 2nd edn. St. Louis, MO American Optometric connectedness