NCLE - Patient Care / Follow-Up
Subjective, Objective, Assessment, Plan
What is the purpose of a subjective exam?
To discuss the patients vision, comfort, and wearing time in regards to their contact lenses. Record the following information about the patient:
- Changes in medication, overall heath, and eye health
- the care system they use at home
- previous lens parameters and materials
- the care systems that the patient has had problems with in the past
-Any issues with insertion or removal
What is the purpose of an objective exam?
To evaluate the fit on the patient and to see if the lenses have altered the patient's eyes. The evaluation should include appropriate gross observation of the eyes and adnexa
What tests does the objective exam include?
Visual Acuity test
Slit Lamp Exam with lenses in the eye (SITU)
Slit Lamp exam with lenses out of the eye
What do you look for when you do SITU?
to assess centration, movement, lens surface, lens and corneal relationshi
What do you look for when you do a Slit Lamp Exam with lenses out of the eye?
Giant Papillary Conjunctivitis
What do you do to Assess the situation?
Gather info found in the subjective and objective exams. This is used to come to a final decision on what action should be taken.
What do you do during the PLAN part of SOAP?
Use the assessment to formulate a care plan for the patient.
New soft lens wearers should be seen how often for followups?
One week, one month, three months, and six months form the time of their initial fit, then every 6 to 12 months.
FDA recommends that overnight wear soft hydrogel lenses be-
Removed and not worn overnight at least once a week for overnight cleaning and disinfection.
Follow up for extended wear lenses should be-
Day one (visit within 2 hours of waking up)
Three months, and every three months there after, if no problems are reported.
Follow up for Rigid gas permeable extended lens should be-
Morning after the first night of wear
6 months, then every 6 months after that`
What is the follow up for a therapeutic bandage lens?
24 hours, 72 hours, every week
Routine cosmetic daily wear patients should be seen:
at 3 month intervals for contact lens evaluation, once the patient has already gone through initial follow-up care sequence for new contact lens wearers
According to the FDA, when should disposable contact lenses that are removed nightly be discarded?
Patients that wear RGP lenses after penetrating keratoplasty may need more follow-up visits than patients with keratoconus because:
post-graft patients tend to be more difficult to fit with contact lenses and the graft/host junctions needs to be monitored closely for problems
When should daily wear lenses be discarded?
according to the manufacturer's specifications
In most cases, initial treatment for contact lens-associated papillary conjunctivitis (CLAPC) consists of:
improving contact lens hygiene, increasing the use of rigorous surfactant or enzyme cleaners, and replacing lenses more frequently.