How to provide patient training for contact lens insertion and maintenance.
In many optometric practices, the technician is responsible for teaching patients how to insert and remove contact lenses as well as proper lens care. Here is an overview of techniques to share with patients””particularly new ones.
CONTACT LENS CARE AND COMPLIANCE
Before discussing how to keep contact lenses clean, the technician should stress the importance of hygiene with the patient. When handling and cleaning the lenses, the work area should be clean and well lit with a mirror so the patient can see well.
Advise the patient to follow the specific contact lens cleaning and storage guidelines from your eyecare professional (ECP) and the recommended solution’s manufacturer. Soft contact lenses can be cleaned by placing the lens in a cupped hand, rinsing the lens thoroughly with disinfecting solution and gently rubbing the lens to remove dirt and deposits. The lens should then be rinsed and placed into a contact lens case filled with saline and allowed to soak overnight until ready for insertion.
After inserting the contact lens, the lens case should be rinsed with hot water, left open and allowed to air dry.
Contact lenses should be worn according to the ECP’s recommendations. Daily wear lenses should be removed at night and not worn during sleep. Disposable lenses should be replaced as recommended.
Before inserting contact lenses, patients should thoroughly wash their hands with warm water and soap that does not contain fragrance or oil, then dry them with a lint-free towel. Patients should not dry their hands using tissues because the fibers from the loose weave may be transferred to their fingers and possibly to the lens. When inserting the contact lens while in the bathroom, patients should be instructed to close the drain of the sink and place a colored towel in the bowl. This way, if the lens is dropped into the basin, it will be easy to find. After removing the lens from the contact lens solution, the lens should be placed into the palm, rinsed with saline and placed on the index finger of the dominant hand. The lens should then be inspected for tears and debris. If the lens has a tear then it should not be used.
HOW TO TELL IF THE LENS IS INSIDE OUT
A contact lens that is inserted into the eye inside out is not only uncomfortable, but moves around and can affect the vision. Here’s how to determine the correct orientation of a lens.
The taco test is performed by placing the contact lens between the thumb and forefinger and gently bending the lens edges toward each other. If the lens edges point inward, the lens is correct. If the lens edge splays outward, the lens is inside out.
Flare Out Test
To determine if the contact lens is correctly oriented using the flare out test, the lens is placed on the tip of the patient’s forefinger. Hold the lens in front of the eyes and look at the lens edge. If the lens points upward, like the rim of a bowl, the lens is correct. If the lens edge flares out, the lens is not correct and should be gently flipped over.
Many contact lens manufacturers mark the contact lens in order to determine orientation. The lens may be laser marked with numbers or letters. Place the lens on the tip of the finger and hold it close to the eyes. The laser marking is usually located near the edge of the lens. If the numbers or letters are backward, the lens is inside out.
CONTACT LENS INSERTION
After proper hand hygiene and contact lens maintenance, patients should place the lens on the fingertip of their dominant hand and:
“¢ Lift the upper lid of the right eye, using the forefinger of the non-dominant hand.
“¢ With the middle finger of the dominant hand, gently pull down on the lower lid.
“¢ While looking in a mirror, slowly bring the contact lens that is sitting on the forefinger of the dominant hand toward the eye.
“¢ Center the contact lens over the cornea, and gently place the lens onto the eye.
“¢ Without releasing the lids, instruct the patient to look up, down, left and right. Then slowly close the eyelid.
“¢ The lens will naturally center itself after blinking a few times.
“¢ Repeat the same procedure for the other eye.
Occasionally during the process of insertion, the eye may become dry or irritated from a bit of debris that inadvertently transfers into the eye. Artificial tears may be used to soothe the eye. However, if the irritation persists, the contact lens should be removed, rinsed and inspected for nicks or tears. If after re-insertion, the irritation persists, the lens should be removed, thrown away and a new lens should be used.
CONTACT LENS REMOVAL
The contact lens removal procedure is very similar to contact lens insertion. After washing and drying their hands with a lint-free towel, patients should look in the mirror of a well-lit room, and:
“¢ Look closely at the eye and locate the edge of the contact lens. The lens edge is seen around the outside border of the limbus.
“¢ Using the middle finger of the non-dominant hand, lift the upper lid.
“¢ With the middle finger of the dominant hand, gently pull down the lower lid.
“¢ With the eyes looking upward, gently stroke the lower edge of the lens down toward the lower lid. This will cause the lens to move off the cornea. The patient will note that the vision will become blurry as the lens is moved down to the lower cul-de-sac.
“¢ The lens will start to buckle as it makes contact with the lower lid.
“¢ While still holding the lens down toward the lower lid, use the thumb and index finger to pinch and remove the lens.
“¢ Repeat the same procedure for the other eye.
Janet Hunter, COMT, president of Eye Source, LLC, specializes in ophthalmic technician training.