Spring 2017

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CLSA EyeWitness Spring 2017 19 terpretation of the fluorescein pattern when using a handheld burton lamp or LED cobalt flashlight. Once the appro- priate fit has been determined, the lens is remade incorporating a material that provides an ultraviolet filter. A relatively flat fitting lens on the eye allows one the ability to determine the approximate corneal shape and curvature. If the diagnostic lens being evaluated vaults the anterior corneal surface, the inter- pretation and extrapolation of corneal curvature is difficult if not impossible. As in any GP fitting, the goal is to equally distribute lens mass and provide periph- eral fulcrums to maintain stability and a central position. This central position of the lens is especially important in higher powers to minimize spherical aberra- tions. Larger lens diameters tend to pro- vide more stability and less decentration of the optics over the visual axis. A gener- al rule to follow with small children and GP lenses is that a tight lens will tend to dislodge from the eye and a loose fitting lens will tend to displace off the cornea onto to bulbar conjunctiva. SOFT LENS FITTING Determining appropriate movement of a soft lens on a small child, the "spring back" test may be helpful. With the soft lens on the eye, digitally displace the lens off center. If the lens immediately "springs back" into place on the cornea, the lens may be fit too tightly on the oc- ular surface. If the lens stays off center while manually closing the lids to mimic a blink, the lens may be fitted too loosely on the ocular surface. In addition, ret- inoscopy over the soft lens to determine if the reflex maintains clarity during the blink is a finding seen with a well-fitting lens. If the reflex is clearer with a blink, the fit may be too steep. If the reflex is worse with a blink, the fit may be too flat. The reflex seen with a well-fitted soft lens will maintain the same clarity before, during and after a blink. The retinoscope is not only used to determine the final lens power with any type of lens but also an important instrument to guide you to the best cornea lens relationship. Pediat- ric fitters of contact lenses should be pro- ficient with a retinoscope. If the child is Buddy Russell, FCLSA, COMT, FSLS, is currently the Director of Contact Lens Services at Thomas Eye Group in Atlanta, GA and the Chief Clinical Specialist for X-Cel Specialty Contacts. He serves on the CLSA Board of Directors and EyeWitness editorial team, is the National Contact Lens coordinator for the Infant Aphakia Treatment Study; peer reviewer for Cornea, Eye and Contact Lens Science and Research publications; and is a national/ international lecturer and writer. older and cooperative enough to use the slit lamp, the fitting techniques will be similar to evaluating an adult. APPLICATION AND REMOVAL OF CONTACT LENSES AND SMALL CHILDREN The application of any contact lens to the eye of a small child by the eye care professional or caregiver is initially a daunting task. Through practice and good technique, this necessary skill can be mastered. The small fissure and tight lids do not often allow one to apply a lens the same as to an adult patient. The contact lens can be applied to small eyes by gently sliding the leading edge under the upper lid and then massaged into the correct position if necessary. With practice, this technique is quick and effective. The removal of a soft lens is the same cloth and allowed to air dry. In addition, the storage case should be scalded once a week and replaced monthly. Lens care systems should include an approved cleaner and lens disinfectant. Approved oxidative care systems for both GP and soft lens modalities should be consid- ered to maximize microbial efficacy and avoid hypersensitivities. Despite lens materials maximizing oxygen delivery, overnight wear of any contact lens carries a greater chance of microbial keratitis. The use of these approved materials should be consid- ered but primarily prescribed as a daily wear modality. In addition, the care- giver who only applies and removes the contact lens once a week is less skilled than the caregiver who applies and re- moves the lens on a daily basis. CONCLUSION I realize that there are those who could care less about seeing children in an eye clinic. However, in my experience there is no area in eye care that I find more ful- filling and satisfying. To have the oppor- tunity to help a child develop, restore or retain vision is a special privilege that each of us has, once you overcome the fear and that chill down your spine. EW in a small child as an adult. Simply pinch- ing the lens with the thumb and ring finger will release a soft lens from the eye. The re- moval of a GP lens from a young patient can be aided with a DMV™ suction cup. However, one must be able to hold the eye open wide enough to apply the tool to the anterior lens surface. Scissoring a GP lens off of the eye can be achieved by simply sliding the lid under the lens edge in order to dislodge. Either of these two techniques is equally effective. CONTACT LENS HYGIENE AND SAFETY Contact lens wear is not a sterile event. Proper hand washing is essential. The daily care of the lens storage case is achieved by removing the storage solu- tion and drying the case with a lint free References on file at the CLSA office

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