contact lens primer
Follow Through on Follow-up Care
BY TIMOTHY B. EDRINGTON, OD, MS,
FAAO, & JOSEPH T. BARR, OD, MS, FAAO
How frequently should you examine contact lens patients? There is no simple answer. It depends on the patient's contact lens history, lens type, general and ocular health, refractive error, wearing and lens replacement schedules, etc. There are general guidelines that could be debated, but the frequency of follow-up care should be prescribed by the practitioner after weighing all of the variables. Most practitioners feel that after adaptation, the majority of contact lens patients should be re-examined every six to 12 months.
Main Issues to Consider
Contact lens history. If the patient is new to contact lenses, not presenting with corneal disease and not requiring a complicated fit, follow-up visits at one and three weeks post-dispensing should be sufficient. Evaluate lens fit and corneal health, and judge patient satisfaction regarding lens comfort and vision. Determine compliance to lens wearing time and lens care procedures. Examine extended wear contact lens patients the day after first sleeping in lenses. Patient education should be a part of every patient visit.
Lens type. Spherical and toric rigid and soft lenses prescribed for daily wear require only one to two visits after initial dispensing. More complex lens designs such as bifocals and special corneal conditions like keratoconus generally require more visits after initial dispensing in order to fine-tune the fit and vision.
Wearing schedule. Patients prescribed flexible or extended wear contact lenses for cosmetic use should be examined at three and six months after initial adaptation and every six to 12 months thereafter.
General and ocular health. Your patient's general or ocular health, independent of contact lens wear, may dictate more frequent visits. If your patient is diabetic or has a corneal dystrophy, he may require more frequent follow-up. Patient education illustrating signs and symptoms for these patients to monitor should be thoroughly communicated.
Refractive error. Highly myopic patients (including post-refractive surgery patients who were myopic prior to surgery) should have their eyes dilated annually. Patients wearing high minus contact lenses should be routinely examined on a six-to-12-month basis to assess corneal health, specifically to monitor limbal vascularization changes. Every six to 12 months, assess patients wearing high plus contact lenses to rule out signs of corneal edema such as central striae or microcysts. Examine toric soft contact lens patients for adverse physiological changes due to the thicker lens profile.
Lens replacement schedules. Examine annually part-time wearers or patients disposing lenses on a daily basis.
What to Assess
Assess patient satisfaction, corneal physiology and patient compliance at each contact lens follow-up visit. Evaluate satisfaction by determining patient happiness with lens comfort and vision. Assess corneal physiology by a thorough slit lamp examination. Judge patient compliance by wearing time habits, care system familiarity and the number of replacement lenses the patient has remaining. Another indication of compliance is whether the patient shows up for the follow-up visit.
Minimize Patient Loss
Educate your patients on the importance of regular eyecare as the road to long-term success. Explain the purpose of the testing and interpretations that you perform and how this testing may reveal early signs of preventable conditions.
Dr. Edrington is a professor and chief of contact lens services at the Southern California College of Optometry. E-mail him at firstname.lastname@example.org.
Dr. Barr is editor of Contact Lens Spectrum and assistant dean of Clinical Affairs at The Ohio State University College of Optometry.