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2017 HCHB_digital

Eyes: Contact Lenses

Eyes: Contact Lenses Contact lenses are an alternative to wearing glasses for poor eyesight, although some are worn for cosmetic reasons (eg, to change colour of the eyes). There are two general categories of contact lenses: soft and rigid gas permeable (RGP) lenses. Hard contact lenses are now obsolete. Disposable and extended-wear lenses are types of soft contact lens. These are the most common, as they are usually better tolerated; however, RGP lenses offer advantages for people with certain eye conditions. Disposable and extended-wear (soft) lenses Disposable and extended-wear lenses are made from soft, flexible materials that allow oxygen to pass through to the cornea. They are quick to get used to wearing, so can be used occasionally (ie, just for sport). They have a high water content, are more stable on the eye during exercise, and are easy to remove. They are less likely to trap dust and eyelashes than RGP lenses, although they can be easily torn if not cared for properly. Various types are available. Vision-correcting disposable lenses These are worn for a set period of time (eg, daily, two-weekly, monthly) then thrown away. Daily disposable lenses remove the need for cleaning, while weekly or monthly lenses require nightly care so should be removed each night. Vision-correcting leave-in (extended-wear) lenses These are designed to be worn continuously, day and night, for up to 30 days and then thrown away. They are made from silicone hydrogel, which allows more oxygen to reach the cornea than standard soft lenses. This means the eye can breathe, even while you sleep. “Cosmetic” lenses Soft lenses are also available that enhance the colour of the eyes or add special effects (such as designs) to them. The middle of the lens is left clear so the person can still see; however, vision may be affected if the lens slips from its correct position. Customers wanting advice about cosmetic lenses should always check with an optometrist before using them, as some people have eye conditions that make them unsuitable. People who wear cosmetic lenses are prone to the same infections as visioncorrecting lens wearers, so lenses must be cleaned and disposed of as instructed. Cosmetic lenses should never be shared. Rigid gas permeable (RGP) lenses RGP lenses are made of durable plastic that has a high permeability to oxygen. They are smaller in diameter than the cornea (8–10mm). The good oxygen transmission maintains corneal health and the risk of corneal infections and allergic reactions is lower than with soft lenses. RGP lenses also provide better vision, durability, and deposit resistance than soft contact lenses. They usually take longer to get used to initially (soft lenses are instantly comfortable) which is the main reason they are not as popular as soft contacts. RGP lenses may be better suited to people with astigmatism (although soft toric lenses are available) or those with presbyopia since bifocal and multifocal types are available. Patients with keratoconus (a cone-shaped cornea that causes severe visual disturbances) may require a RGP lens to achieve reasonable vision, as may people requiring contact lenses after refractive surgery. Although RGP lenses are more expensive initially than soft lenses, they can last for years so can work out cheaper in the long run. An ophthalmologist may be able to apply for a government subsidy to help with the costs of contact lens wear in certain TREATMENT OPTIONS Category Examples Comments Disinfecting/cleaning products For soft lenses only, eg, Bausch & Lomb ReNu Fresh, BioTrue, MeniCare Soft, Opti- Free PureMoist, Oxysept RGP lenses only, eg, Total Care 1 Solution, Boston Advance Conditioning Solution, Lobob Optimum, MeniCare Plus Cleaning products include multi-purpose solution, daily cleaner, hydrogen peroxide solution, cleaning/ disinfecting devices. Immediately after removing lenses each day, clean them with a cleaning solution to remove eye-produced build-up such as protein, cosmetics and other debris. Place lens in the palm of the hand, put two or three drops of the cleaner on it and rub well for 20 to 30 seconds. Note some cleaners are ‘no rub’ cleaners. Leave for as long as recommended. Saline solutions Protein removal tablets Suitable for both soft and RGP lenses eg, Lens Plus Saline RGP lenses only eg, Menicon Progent Soft lenses eg, AMO Ultrazyme Protein Remover Tabs Useful for rinsing lenses or dissolving protein tablets. Rinse lens for recommended time to remove cleaner and loosened debris. Removes excess protein deposits from lenses that are worn for longer periods of time. If used with correct cleaning products some lenses do not require separate protein removal. Lubricants, artificial tears, wetting agents Suitable for all types of lenses, eg, Complete Blink-N-Clean, Blink Contacts, Refresh Contacts, Vistil Eye Drops Lubricants can help improve dry eye in contact lens wearers although referral to an optometrist is recommended as dry eye in contact lens wearers can sometimes be resolved by changing the lens type or improving gland function around the eye. Page 68 HEALTHCARE HANDBOOK 2017-2018 Common Disorders

CONTINUING OTC EDUCATION conditions. Because they can last for years, RGP lenses require scrupulous cleaning and disinfecting to keep the wearer safe from eye infections. Initial assessment All customers with contact lenses should be refered to a pharmacist as they are prone to more serious eye conditions. Contact-lens wearing customers whose eyes are red, uncomfortable, painful, sensitive to light or who have abnormal vision should see a doctor or optometrist immediately. It is especially important that pharmacy staff do not sell a lens cleaning or rewetting product if they are not 100% sure that it is compatible with the customer's lens type. Laser eye surgery Photo-refractive keratectomy (PRK) and laser in situ keratomileusis (LASIK) are two laser eye surgery techniques that are commonly used for correcting shortsightedness (myopia), long-sightedness (hyperopia), astigmatism and presbyopia. PRK is more suitable for treating mild degrees of myopia. A layer of cells covering the cornea is removed then a laser is used to alter the shape of the front of the cornea. LASIK uses a highly specialised laser underneath a corneal flap to reshape the cornea, and provides improved results for people with greater degrees of myopia, hyperopia and astigmatism. Orthokeratology Orthokeratology (also called Corneal Refractive Therapy) is a non-surgical, noninvasive and reversible process of using a specially designed contact lens to reshape the cornea during sleep, allowing lens-free clear vision throughout the next day. Research has shown that orthokeratology can slow down and even stop the progression of short-sightedness in children and teenagers. Effects are usually noticed after the first night, and lenses are worn nightly initially, reducing to two or three nights a week to maintain the effect long term. Orthokeratology is available throughout New Zealand. »» Dry lenses may be rehydrated with saline, rewetting solution, or lubricant drops before reinsertion. Soft lenses become brittle if they dry out. »» Do not exceed the recommended wearing time of your lenses. »» Never share contact lenses. • If contact lenses make eyes drier than normal, lubricant eye drops are available that are compatable with contact lenses. »» Consider using preservative-free products long term. • Insert lenses before applying make-up and remove them before removing make-up. »» Cream or gel eye shadows are less likely than powders to fall into the eye. »» Avoid mascara with lash-building fibres. • Do not use lens-care products or eye products (especially make-up) past their expiry date. • If you lose or drop a lens: »» For a RGP lens, use a vacuum cleaner with pantyhose over the inlet to catch the lens »» For a soft lens, turn out the light and shine a torch around the room (the light will reflect off the lens). Eye products and contact lenses • Remove contact lenses before using eye drops or ointments, except when using lens-wetting agents or when directed by the optometrist to keep the lenses in. • Soft lenses in particular may become stained when exposed to chemicals in diagnostic eye drops, some medicated eye drops and some medicines taken by mouth that are then secreted in tears (eg, rifampicin, sulfasalazine). Advice for customers • See an optometrist for an eye check regularly (at least every 12 months). • Always wash, rinse and dry hands before handling lenses. • Do not use tap water or saliva on contact lenses. »» A naturally occurring amoeba found in water can cause an infection that can be difficult to treat and has the potential to lead to blindness. »» Dirty storage cases, incorrect cleaning of lenses and using tap water or saliva on lenses or lens cases are common sources of infection. »» Use an unused toothbrush to clean the lens case every week before rinsing with lens cleaner. Replace the case every month. »» Never touch lens solution bottle tips to any surface as they may become contaminated. Now you can complete your ENHANCE modules on your phone or tablet www.pharmacytoday.co.nz Page 69

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