How to Manage Poor Initial Comfort?
Rule-Outs
Poor edge quality or defect, inferior decentration, patient sensitive to touching eye (as demonstrated via drop instillation, lid eversion, tonometry), or lid inflammation.
Management
- Presentation of GP lenses: “There will be some initial lens awareness due to the upper lid feeling the lens edge on the blink. It will go away as your lid adapts to the lens.”
- Topical anesthetic application immediately before lens insertion.
- Once contact lenses are applied, simply have the patient sitting in the chair looking at his or her knees (but keeping eyes open). This eliminates significant lens movement until the patient begins to adjust and reflex tearing abates.
- Edge polish (if indicated).
- Inferior decentration: Please see Spherical Lenses FAQ 5.
Useful References
GP Lens Institute
- Optimizing GP Initial Comfort (narrated PowerPoint)
- GP Lens Case Grand Rounds Troubleshooting Guide Case 2
Publications
- Jedlicka J., Malooley M., and Reeder R. Semi-Scleral Applications for Healthy Eyes.
- Davis R., Eiden S.B. Hybrid Contact Lens Management.
- Laurent J. Using Large-Diameter GP Lenses to Improve Comfort.
- Quinn T. How to Explain GP Lens Benefits.
- Bennett E.S. A Closer Look at Lens Comfort.
Acknowledgements
GP Lens Institute Advisory Committee members: Bruce Anderson OD, Marlane Brown OD, Carmen Castellano OD, Walter Choate OD, S. Barry Eiden OD, John Laurent OD, PhD, Derek Louie, OD, MS, Joe Shovlin OD, Frank Weinstock MD, Bruce Williams OD.