Contact Lenses Bega,Tathra, Tura, Bombala, Narooma, Merimbula, Eden
See Both Ways - with spectacles without spectacles
Peter D’Arcy Optometrist member Contact lens Society of Australia in Bega can fit, assess and monitor all types of contact lenses for suitable patients to supplement spectacles used in the standard eye correction.
SCL wearers-daily disposable contact lenses,monthly disposables and extended wear lenses are often trialled instead of or before refractive surgery options are undertaken. Even multifocal conatct lenses are available.
RGP (rigid gas permeable) lenses for kerataconus and ortho K myopia control.
Post graft CL fitting and advice on laser surgery/refractive surgery options.
Latest materials and designs including silicone hydrogel lenses are now available,and are more oxygen-permeable and wettable including daily and monthly types.
Wearing contact lenses even daily disposable wear lenses means eye care becomes more important.Studies have shown that wearers who do not follow recommended replacement schedules have more complications and self-reported discomfort than contact lens wearers who follow the replacement recommendations and after care visits. The risk of inflammation and infection increases with the frequency of overnight wear,especially in non peroxide disinfecting regimes.
An eye care professional often encounters eye health issues from unsuitable contact lens solutions or regimes being employed.
Lens specifications can vary widely including water content and contact lens intolerance can include giant papillary conjunctivitis (GPC).
Latest materials consist of a silicone layer in between thin layers of soft hydrated polymers allowing for greater oxygen transmission and greater wearing time,especially important for extended wear contacts.
Benefits
However this non removal prior to sleeping increases the risk of getting a serious type of corneal infection called microbial keratitis especially if the wrong gas permeable material is used on a susceptible eye. The eyes are examined whilst wearing contactsdrop in shooting pr for pgd assessment and also when you remove your lenses.
Regardless of the type of worn, rubbing and rinsing the lenses is vital in maintaining contact lens and eye health preceded by washing and drying of hands notably the middle and index fingers.
Daily disposable lenses reduced the risk of infection by 12^ times compared to reusable soft lenses: Saline is incapable of disinfecting lenses because it contains no disinfection agent.
Some people report they have been doing this without problems but in the same way some people have smoked 20 cigarettes a day and live to be 100, but that doesn’t mean smoking is safe.
^R.L. Chalmers, L. Keay, J. McNally, J. Kern, Multicenter case-control study of the role of lens materials and care products on the development of corneal infiltrates, Optom Vis Sci (89) (2012) 316-25.
- Offer a full field of view eg freedom from glasses,sports use without fogging.
- There is a lens to suit almost everybody, young and old,even multifocal contact lenses
- Ideal for sports with wider peripheral vision.
- Affordable and convenient.
- Certain brands and designs can be worn for up to 29 consecutive nights,depending upon your suitabilty. There are also many customised lenses available if you have particular needs or an unusual prescription.
- Irregular cornea reshaping is possible.
BIOFINITY lenses may be prescribed for daily wear and extended wear for up to 6 nights/ 7 days of continuous day and night wear USFDA but it is subject to patient suitability.
Not all patients can achieve the maximum wear time. It is recommended that the contact lens wearer be evaluated on a daily wear schedule. If successful, then a gradual introduction of extended wear can be followed as determined by your personal responses and your eye doctor.
Once removed, it is recommended that the lens remain out of the eye for a period of rest overnight or longer and discarded in accordance with the prescribed wearing schedule. We can advise the appropriate wearing time for your specific circumstances.
Major brand lenses
All lenses have their purpose and different modality. Dailies are supplied than monthlies.
A fresh pair of daily contacts for daily wear are known as daily disposable contacts. Monthly disposable contacts are discarded after 30 days of wear and require more contact lens care eg surfactant cleaning with your index finger.
Recent studies demonstrated that daily disposable lenses decrease the risk of CIEs (corneal infiltrative events ) more than 12‐fold compared to reusable lenses or extended wear (EW) types.
The risk of developing a CIE may be higher with silicone hydrogel materials as they may bind more micro‐organisms than hydrogel lenses, but the events that occur are less severe
CLARE (contact lens induced acute red eye) has been reported with EW RGP lenses, silicone elastomer lenses, and with the over wear of daily soft lenses, a history of extended wear with hydrogel lenses is most typical, as is a uniocular presentation.
EW research studies report yearly incidence rate between 4% to 30 % depending on lens type, lens care regimen, and lens replacement frequency.
Bausch and Lomb Popularity
- Biotrue daily
- Pure vision 2
- Ultra monthly
- Pure vision
- Soft lens
Coopervision Proclear has the FDA approval for dry eye.
Proview Elite and the Proview Perform are considered the best for handing. The Proveiw Elite has a blue tint and the Proview Perform has not.
all equally popular but differ in water content
- Proclear 1day is 60%
- Proclear monthly is 62%
- ProView Elite has 54% water content
- ProView Daily has 60% water content
- ProView Perform has 56% water content.
Johnson & Johnson Vision Acuvue Popularity
- 2 weekly Acuvue Oasys (also now available with Transitions Light Intelligent adaptive technology.)
- 1 Day Moist
- Oasys 1 day best lens for dry eye and handling and first choice often if compatible with material
Alcon Dailies Total 1 Smart Tears technology allows further release of phosphatidylcholine (PC) which exists in our tears naturally. Its role is to bind the lipid layer to the aqueous layer which allow for a smooth protective lipid layer.
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Popular materials.
- Boston XO
- Harmony Plus
- Boston EO
- Boston ES
- Fluoroperm 30
- Fluorperm 60
Coloured lenses
- Two week option of daily wear overnight disinfecting
- Freshlook Colourblends can provide a noticeable change on lighter coloured eyes.
- Freshlook colours can be used for darker eyes.
- Freshlook Dimensions have blended colours.
The corneal health and regularity needs to be determined in assessing the optical correction possible.
Keratoconus - Cone shaped cornea- contact lens fitting.
Keratoconus lens wearers be they be in Bega ,Tathra, Tura, Bombala, Narooma, Merimbula or Eden need to ensure their lens fitting and tolerance is safe and comfortable.
Kerataconus (usually bilateral) is a progressive thinning of the cornea and is the most common corneal dystrophy. It can cause double or blurred vision, nearsightedness, astigmatism, and increased sensitivity to light.
You may need specially fitted custom,soft,rgp, (rigid gas permeable) ,scleral or piggyyback forms to correct the distortion of the cornea and provide better vision rather than glasses if the disease progresses.
Corneal collagen cross linking ideally in the mid teens can be considered to strengthen the cornea.
Using an application of riboflavin (Vitamin B2) eye drops during exposure to ultraviolet (UVA) light, the exposed deeper layers of the cornea develops bonds between its fibres,followed by a bandage contact lens to aid repair.
The cause of keratoconus is unknown,likely to be an inherited condition. Some studies have connected keratoconus with allergies such as asthma ,eczema and excessive rubbing.
KBA design 10.2mm, Epicon 13.5mm or Katt 16.5mm can vault much of this irregularity.
We can advise on the material and design based on the optics,health and shape of your eyes and frequency of replacement.
In advanced cases corneal grafts can be done often ideally between 20 – 45 years of age which then are fitted sometimes with contact lenses.
Different materials vary in how much oxygen can pass through to the eye, and how moist your lenses stay throughout the day .
Corneal topography images and maps the surface curvature regularity as does anterior OCT scanning for a variety of eye conditions.
In most cases, the cornea stabilizes after a few years without causing severe vision problems.
A small number of people with keratoconus may develop severe corneal scarring or become unable to tolerate a contact lens. For these people, the corneal transplant may become necessary
Contact lens fitting requires continued after care.
CONTACT LENS WEAR AND COVOID-19
There’s currently no evidence to suggest an increased risk of being infected with SARS-CoV-2, the novel coronavirus that causes the disease known as COVID-19, through contact lens (CL) wear. Contact lens wear is safe and can be maintained by healthy individuals.
However correct hand-washing and strict hygiene practices for CL wearers in order to decrease the risk of eye infections is still very much essential. Contact Lens Wear is a safe activity with low rates of infections or other serious complications, but poor compliance with safe practices can icrease risk.
Contact lenses, solutions and eye drops (where applicable) should be used, worn and replaced as prescribed. Storage case hygiene and care practices should be followed for reusable lenses.
Where possible, Daily Disposable Contact Lenses are advised as they improve compliance and reduce risks of complications in lens wear.
It is advised not to wear contact lenses if a wearer is unwell. This applies in particular to any signs or symptoms of colds and flu, respiratory tract infections, red sore eyes, discharge. Contact lens wear does not appear to increase the risk of developing COVID-19, compared to spectacle lens wearers, or those with normal vision who do not need any corrective devices. To date there is no known research suggesting any such link or risk.
• It should also be noted that contact lenses provided by leading manufactures are manufactured in sterile conditions and the lenses are safe to wear. The majority of contact lenses provided on the market are in a state ready for wear. Customised lenses should be disinfected before use.
• Contact Lenses obtained from dubious sources, including counterfeit lenses and those offered through unlicensed
premises and providers should be avoided as these may not be sterile or safe to wear.
• Always seek professional advice and consult with your eye care provider.
• Avoid touching your eyes, face, nose and lips as far as possible and avoid eye rubbing.
• There are a few basic messages we can apply to contact lenses. Your eyes should ‘Look Good’, ‘See Good’ and ‘Feel Good’.
- Proper Handwashing: A Cornerstone of Safe Contact Lens Wear
- Thoroughly WASH HANDS before;
- Handling Contact Lenses and CL cases.
Applying contact lenses, even for brand new lenses direct from the pack. The aim is to prevent spreading any nasty pathogens (bugs, bacteria, fungi, viruses etc) from hands or fingers to the lens and therefore the eye.
• The same applies to removing contact lenses from the eye. - The US-based Centers for Disease Control and Prevention has issued COVID-19 guidance stating that eyes should not be touched with unwashed hands.
CONTACT LENS COMPLICATIONS are graded by severity and location
| • Conjunctival redness • Limbal redness • Corneal neovascularisation • Epithelial microcysts • Corneal oedema • Corneal staining • Conjunctival staining • Papillary conjunctivitis | • Blepharitis • Meibomian Gland Dysfunction • Superior Limbic Keratoconjunctivitis • Corneal infiltrates • Corneal ulcer • Endothelial polymegathism • Endothelial blebs • Corneal distortion |
Standardised grading scales are used for recording and monitoring clinical changes to ocular tissues.
The conditions under which lenses are purchased, stored and transported should be better regulated as should controls over on line sellers with risks of counterfeit lenses or repackaged.
Never change your lens-care system without oversight as preservative reactions are common and require examination.
As well as the risk of cosmetic contact lenses being worn unsupervised some other cosmetic eye procedures have their risks also eg
Eyelash extensions: If synthetic material fragments from the fake eyelashes corneal abrasions can occur as well as requiring removal
Cosmetic laser procedures: If goggles or shields to protect the eyes are faulty laser light can be detrimental to eye health.
Episcleral tattooing: Dye is injected beneath the conjunctiva to change the white of the eye to a colour of choice. Risks of headaches, light sensitivity, infection, haemorrhages, can result.
INSERTION AND REMOVAL DAILY SOFT CONTACT LENSES
One’s ring or middle finger of your dominant hand is used to insert lens centrally . Removal is by looking up and pulling down your lower eyelid with your middle finger. Using your index finger, slide the lens down to the white of your eye pinching the lens between your fingers to remove it.
Storage is in fresh disinfecting solution in freshly cleaned case depending upon wearing modality.
How to use Hydrogen Peroxide correctly
Hydrogen peroxide placed directly into the eyes or on your contact lenses can cause stinging, burning, and temporary corneal damage. When using hydrogen peroxide you must follow the disinfecting process with a neutralizer. The neutralizer turns the peroxide into water and oxygen, making it safe to put your lenses back into your eyes.
- Neutralization can be either a one-step or two-step process. The one-step process neutralizes your lenses during the disinfecting stage, while the two-step process neutralizes your lenses after the disinfecting stage.
- Some storage cases have a neutralizer built-in, making it a simple one-step process. With other cases, a neutralizing tablet that comes with the hydrogen peroxide solution must be added. This is the two-step process.
An invisible layer called a biofilm can grow in the case and its presence can make contact lens disinfecting solution less effective at killing germs
Specific lubricating eyedrops or artificial tears that are preservative free can help wetting of specific lens materials and we can recommend the ideal wearing replacement schedule to avoid the potential contact lens blindness at worst or suboptimal performance and safety.
Saline cannot be used as a disinfecting agent.
See Center for Disease Control & Prevention https://www.cdc.gov/contactlenses/index.html
https://www.cdc.gov/contactlenses/germs-infections.html
https://www.cdc.gov/contactlenses/care-systems.html
For reusable contact lenses, disinfecting Solution will reduce the amount of germs on the lens after each wear, so as to prevent an infection from occurring. For contact lens disinfecting solutions to be effective, they have been tested and must pass the government FDA/TGA requirements to reduce germs but also be safe on the eye. Disinfecting solutions also remove build-up (proteins & lipids) on the contact lens to provide optimal comfort through the wearing schedule of the lens.
Saline does not pass this requirement; it does not contain any ingredients that will reduce the germs that are on the contact lens. It also does not contain any ingredients that will remove the proteins and lipids that stick to contact lenses during the day.
Bausch & Lomb regimes
Soft
In terms of the regimen for soft lenses, it’s a one step process for cleaning, disinfecting and conditioning.
B+L solutions for soft lenses :
- Renu Fresh
- Biotrue
- Renu Sensitive
- EasySept (hydrogen peroxide)
RGP regimes
One Step Cleaner – Boston Simplus – cleans, disinfects, conditions and cushions RGP contact lenses and removes protein daily.
- Two Step Cleaner
Step one – Boston Advance Cleaner removes debris and deposits from RGP lenses, leaving lenses clean and clear. It is visibly tinted for improved rinsing.
Step two – Boston Advance Conditioner contains a dual disinfecting system that delivers excellent protection against harmful microorganisms.
For Additional Cleaning Boston One Step Liquid Enzymatic Cleaner removes protein deposits weekly from RGP lenses.
Lubricated contact lenses Boston Rewetting Drops, rewet, recondition and lubricate RGP lenses to relieve minor irritation and discomfort during contact lens wear.
Acanthamoeba keratitis
Worst cases which can lead to a corneal graft
Vast majority are wearers of soft lenses who ignore the risks of rinsing their lenses in tap water or wear them in the shower.
In rare cases, the parasite has been known to enter the spinal cord (via the optical nerve) which can lead to death.
Red and sore eyes can quickly escalate into corneal ulcers and by using clinical grading scales under microscopic evaluation during your eye examination safe lens wear can be achieved and maintained.
Diving with contact lenses or glasses
Cressi and Tusa with your contact lens or spectacle lens correction.
Scuba divers enjoying the beautiful nearby sapphire coast from Narooma to Merimbula and Eden ideally need to wear prescription dive masks.
The health of your eyes can be comprimised so supervision is advisable.
Often trials of a free contact lens in the form of a daily disposable can engender a false sense of security which is why follow up appointments can troubleshoot for potential problems.
Baush and Lomb TerraCycle recycling used contact lenses and blister packs
Too many contact lens wearers are not opting for proper disposal so not being biodegradable can find their way into fish, birds or other animals.
Such recycling means after proper disposal , they can be shredded, washed and melted down into sustainable raw material that can be used as an alternative to newly manufactured materials.
All brands and blister packs can be sent to via us to TerraCycle an innovative recycling company for this purpose.
Contact lens fitting and history
