The ABCs of Soft Lens A&R
BY MARY JAMESON, BHS, COA, NCLC, CPOT
After you select the base curve and power for a patient who wants contact lenses, the battle has just begun. It is challenging to apply soft contact lenses to patients' eyes, especially those patients who have not worn lenses before. When applying soft lenses during a contact lens fitting, make sure you apply and remove them quickly and comfortably for the patient. This helps build the the patient's confidence in your abilities as a contact lens technician.
MOST IMPORTANT: Always wash your hands before handling lenses!
First, take the lens out of the package or vial, making sure not to injure yourself in the process. If opening a contact lens vial, slide the flat end of a pair of contact lens tweezers under the top of the aluminum cap and push the tab up. Pull the tab directly back to tear off the cap. Place the flat end of the tweezers between the rubber stopper and the top of the vial and lift off the rubber stopper. This leaves the rubber stopper intact for replacement back into the top of the vial.
Opening a disposable lens bubble pack is easier now than before. You still need to be careful not to cut yourself on the aluminum foil top. Also, keep the bottom of the pack (the part with the lens in it) steady. It can easily tip, and the lens can spill out if you are not careful.
Place the lens on your index finger and hold it up to the light to inspect it for any damage, such as chips or edge tears. Make sure the lens is right side out by looking directly at its edge. If the edge flares out, like the rim of a saucer, then the lens is "inside out." Turn the lens over and check again. With thin lens designs, it may take a few seconds of close inspection to tell. When the edges resemble the sides of a bowl, the lens is ready for application.
Applying the lens
Ask the patient to look down. Place the lens on the index finger (or middle finger, if you prefer) of your right hand. Lift the patient's upper lid with the thumb or index finger of your left hand. While the patient is looking down, place the lens onto the upper sclera (conjunctiva) and slide it down over the cornea. I find this makes it less likely for air bubbles to get trapped under the lens. The patient is still looking down. Release the upper lid and ask the patient to close his eyes for a few seconds. Then ask him to open his eyes and look straight ahead.
Sometimes the patient will report discomfort or awareness upon soft lens application. Before you remove the lens, try moving it on the patient's eye, using his own tears to dislodge any debris under the lens.
Ask the patient to look down. Pull the upper lid gently. Have the patient look up toward the ceiling. Pull down on the lower lid. Slide the contact lens down off the cornea and onto the lower sclera (conjunctiva). Rotate the lens in a circular motion for two to three seconds. Slide the lens back onto the cornea. If the patient reports better comfort, let the lens settle. If the patient still reports lens discomfort, remove, rinse and re-inspect the lens before reapplying.
Ask the patient to look down. Pull up the upper lid. Ask the patient to look up toward the ceiling. Pull down the lower lid. Slide the lens down onto the lower sclera (conjunctiva) with your index or middle finger. Bring your thumb in to sweep the lens off the sclera without moving your other finger. If you release the lens, it will return to the cornea.
Ms. Jameson is laboratory supervisor for the Department of Clinical Sciences at the Pennsylvania College of Optometry and past chair of the AOA Paraoptometric Section.