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.
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.
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.
- 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
- 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.
Replace your contact lenses at the recommended interval
Clean your contact lens case daily and replace your case every month
Do not sleep or nap in your contact lenses unless supervised and planned.
Water contains microbes that can cause serious eye infection. Your lenses should not come into contact with water: avoid swimming
and showering while wearing them
Bacteria are present on surfaces all around us.
• Only two thirds of people in the general population practice any sort of hand hygiene.
• Up to 50% of contact lens wearers are not compliant with hand washing procedures.
• Poor hand hygiene is a risk factor of developing microbial keratitis and corneal inflammatory events in contact lens wearers.
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.
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.
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
Contact lens induced abrasions on the eye, can aid the amoeba to attach when the eye comes into contact with water.
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
By 1970 a soft contact lens of a water containing plastic called hydrogel was introduced and by 1978 so were RGP Rigid gas permeable lenses that provide sharper vision than soft lenses, which can fluctuate in shape and clarity if they start to dry out.
1981 saw FDA approval of new soft lenses for extended (overnight) wear and by 1986 overnight wear of RGP
1987 saw the introduction of disposable soft and by 1987 RGP contacts were available in next-generation fluorosilicone acrylate
CooperVision clariti 1 day was the first family of silicone hydrogel daily disposables in 1999.
The silicone hydrogel lenses enabled up to five times more oxygen to reach the cornea than regular hydrogel lenses. Popular brands of silicone hydrogel lenses include Acuvue Oasys (Vistakon), Air Optix Aqua (Alcon), Biofinity (CooperVision) and PureVision2 (Bausch + Lomb) that can be worn for extended wear or as monthly contact lenses in suitable eyes as monthy disposables.
The science behind incorporating silicone was based on increasing oxygen transmissibility
By 2002 Overnight orthokeratology (corneal reshaping) was approved by the FDA
The Hypergel material released in 2013 is one material used in trying to achieve improvement in lenses that can make the eyes feel dry, itchy and uncomfortable and can even cause vision problems.
Ideally desire All-day comfort , UV protection and resistance to protein deposits ie a lens that mimics the natural eye
Safe contact lens wear involves being compliant with professional oversight for eye health and vision care.
Contact lens fitting is actually prescribing as the lens material interacts with the ocular surfaces.
Corneal reshaping ( Orthokeratology) can be induced for different results. The quality of contact lenses lenses can vary depending upon how they are produced.
Contact lens deposits and defects can effect eye safety,red eye and infection risk. There are many designs and material options.
Contact lens prescribing involves creating a valid contact lens prescription, whether new or modifying a previous prescription.
A valid contact lens prescription involves services with corresponding fees that are distinct to a general eye examination.
A contact lens prescription encompasses parameters including material, base curve, diameter, and power design and water content.
Grading scales exist for the eye responses to the provocative test of contact lens wear as many individual reactions can occur.
The latest advanced wearable lens technologies are ocular devices for vision providing comfort,safety and convenience.
