Contact Lens Exam
Contact Lens Services
Contact lens services are only provided during or after a comprehensive eye examination. If you require contact lens services, please notify the staff at the time you make your appointment. These services are not part of a routine eye exam and there are additional fees associated depending on the complexity of your contact lenses and corneal health.
Our office can fit any lens type for any condition including:
Normal, spherical lenses (non color, non sleep-in)
Toric lenses for astigmatism
Multifocal and Toric Multifocal lenses
Rigid Gas Permeable (RGP)
Toric, Bitoric, and Multifocal RGP
Hybrid soft/rigid lenses
Reverse Geometry Lenses or "Ortho-K"
Vicki Rosenbloom, R.O.
Vicki has retired as of Dec 31, 2021 :(
Before doing so she has confered her vast knowledge of contact lenses to our new technician, Jenn.
We wish Vicki all the best and will miss her dearly!
How is a CL exam different than a normal eye exam?
Conlact lenses are FDA-regulated medical devices and as such, require a precription to be dispensed legally. A comprehensive eye exam does not include the specialized services and procedures required to measure the eyes, inspect specific parts of the eye related to CL wear, or the fitting process required to ensure a properly fit contact lens. Even a previously-fit contact lens wearer's eyes and vision must be evaluated and deemed healthy enough to continue wearing the same lenses before a prescription can be written. Our office does not cut corners and we ensure every patient has the optimal fit for the best comfort and vision related to your specific hobbies, occupation, and lifestyle.
Contact lens services include the following from different providers during your visit:
Your eye doctor will provide the following services during your time in the examination room:
- Inspection of current lenses to measure visual acuity, over-refraction, lens movement, centration, and rotation.
- With lenses removed, we will 'stain' the cornea and ocular structures with a yellow dye to look for evidence of contact lens-associated problems such as a poor fit, abrasions, keratitis, giant papillary conjunctivitis, etc.
- Inspection of cornea to look for medical conditions from either an improperly fit contact lens or from an abusive wearer such as corneal neovascularization, sub-epithelial infiltrates, ulcers, etc.
- Only healthy eyes free from infection, major defects and other conditions will be recommended to continue to the contact lens technician.
CONTACT LENS TECHNICIAN
Your contact lens technician will provide the following services that will include:
- Extensive history to ascertain what type of lens will be the best for your personal occupation, hobbies, and lifestyle
- Current replacement schedule
- Daily wearing schedule
- If you sleep in your contacts (even accidentally)
- If you want colored lenses
- Daily cleaning regimen
- Dry eye questionnaire
- Educate you on the latest in contact lens technology
After this process, she will find a suitable starting contact lens for you to try that will work for your prescription, hobbies, and lifestyle. She will then inspect the lenses on your eyes for:
- Proper fitting characteristics to include hydration, centration, rotation, and movement.
- Proper education on what to do (and what not to do!)
- How to avoid major problems such as infections, corneal ulcers, GPC, etc.
- Educate you on the proper replacement schedule, if you can safely sleep in the lenses, and how long.
- Insertion and removal lessons (if required)
- Follow up care as needed
A contact lens prescription is issued only after the patient has completed all of the steps involved to ensure a proper and healthy contact lens fitting.
Contact Lens Complications
It is important for the average contact lens patient to understand the risks involved with wearing contacts. As FDA-regulated medical devices, contact lenses must be properly fit to your eye shape as well as be worn according to the proper cleaning and replacement schedule.
Most of what you see in this section can be mitigated or outright avoided by following the directions given to you by your doctor and contact lens technician!
Giant Papillary Conjunctivitis is a condition where the inside area of your upper lids become bumpy. This is not due to the contat lens itself, but to the build up of debris such as proteins, lipids, etc on the lens surface. Once we see this, daily contact lenses are recommended in order to have a clean lens every day. This is what we look for when we "flip your lids".
How to avoid: throw lenses away at recommended time period or consider dailies.
Superficial Punctate Keratitis are tiny areas of epithelial cell damage (denoted by the green patchy spots on bottom of cornea in image below) typically caused by either your solution, an old lens, an improperly fitting lens, a foreign body, lens frcture, or improperly worn lens. These heal very quickly, but can lead to infections as they are essentially tiny open wounds. We can limit this with proper lens replacement, proper lens care, using daily contacts, treating dry eye, and not sleeping in the lenses. This is what we look for when we put the yellow stain in the eyes.
How to avoid: keep eyes hydrated, use preservative-free solution, or consider dailies.
Corneal ulcers are open sores in the outer layer of the cornea. They are usually caused by infections of bacteria, but can also be viral, fungal, or Acanthamoeba in origin. They are denoted by a red, watery, and painful eye. Sometimes you will see white spot on the cornea as well.
How to avoid: follow all directions for healthy lens wear, do not sleep in your lenses, remove them as soon as you feel any discomfort and consult your eye doctor, and consider dailies.
Contact lenses that have been fit by a professional and patients that follow the rules of proper lens care should not have many, if any, problems. However, if you sleep in your lenses, overwear them, keep them in when you have pain or redness, or generally abuse your contacts, you put yourself at risk. Eye infections are common if you do not properly wear your contacts as directed.
How to avoid: follow all directions for healthy lens wear, do not sleep in your lenses, avoid swimming or hot tubs while wearing lenses, remove them as soon as you feel any discomfort and consult your eye doctor, and consider dailies.
Contact lenses are essentially foreign bodies in the eye and your eye would prefer that they not be in there. When worn properly, your eyes can typcially handle the mild irritation caused by contacts; however, in some situations your eye may decide that it has had enough and needs a break. At this point, your eye begins to treat the eye like a threat. Your eye mobilizes its immune system to kick out the intruder. This is called infiltrative keratitis which is a noninfectious immune response to a dirty or overworn lens.
How to avoid: wear your lenses as prescribed, do not sleep in your lenses, throw your lenses away at recommended intervals, and/or consider dailies.
Neovascularization literally means "new vessles". These vessels for in response to a low-oxygen state in your cornea. The cornea (clear outer part of eye) in a healthy person is vessel-free. If we see neovascularization ("NEO" for short) then the cornea is not getting enough oxygen. This is either from the patient sleeping in unapproved contacts or overwearing them for longer than they should.
How to avoid: switch to newer, high-oxygen contacts, throw your lenses away at the recommended intervals, and do not sleep in your lenses.
Proper Lens Care
If you experience any symptoms of eye irritation or infection,
- remove your lenses immediately and do not put them back in your eyes.
- contact us right way.
- don't throw away your lenses. Store them in your case and take them to your eye care professional. He or she may want to use them to determine the cause of your symptoms.
- report serious eye problems associated with your lenses to the FDA’s MedWatch reporting program.
Symptoms of Eye Irritation or Infection
- excess tearing or other discharge
- unusual sensitivity to light
- itching, burning, or gritty feelings
- unusual redness
- blurred vision
The Golden Rule: your eyes should look good, feel good, see good. If even one of these is not the case, do not wear your contacts!
Wearing contact lenses puts you at risk of several serious conditions including eye infections and corneal ulcers. These conditions can develop very quickly and can be very serious. In rare cases, these conditions can cause blindness.
- WASH YOUR HANDS!
- Rub and rinse your contact lenses as directed by your eye care professional.
- Clean and disinfect your lenses properly according to the labeling instructions.
- Replace your lenses as directed by the manufacturer.
- Do not “top-off” the solutions in your case. Always discard all of the left over contact lens solution after each use. **Never reuse any lens solution.**
- Do not expose your contact lenses to any water: tap, bottled, distilled, lake or ocean water. Never use non-sterile water (distilled water, tap water or any homemade saline solution). Tap and distilled water have been associated with Acanthamoeba keratitis, a corneal infection that is resistant to treatment and cure.
- Remove your contact lenses before swimming. There is a risk of eye infection from bacteria in swimming pool water, hot tubs, lakes and the ocean
- Replace your contact lens storage case every 3 months or as directed by your eye care professional.
Fitting contact lenses is an art. There are no 2 eyes that are exactly alike and as such, every patients needs to be properly measured and contact lenses "fit" onto their eyes. Some eyes are flat, some are rounder, some are distorted, and some are oblong.
Our office uses the latest technology in order to ensure you have the most-comfortable and clearest contact lenses possible including:
- Corneal Topographer
- Slit Lamp
- Dry Eye Scanning
- OCT (Optical Coherence Tomography)
A corneal topographer maps to corneal surface which in turn reveals its geomtry. Topographies are essential to fitting rigid lenses as well as tracking many ocular diseases.
The slit lamp is large bonicoular microscope that has many options for light color and width (hence the "slit" in slit lamp). Using this device, the doctor looks for abnormalities of your eyes related to contact lens wear. The CL technician uses the slit lamp to observe in detail how the contact lens is moving, centering, rotating, and overall 'fitting' on your eyes.
Dry Eye Scanning
Our new Lumenis Antares machine can examin and quantify your dry eye. We can show you the dry areas as well as how fast your eyes dry out between blinks. This is the first step to begin treating dry eyes.
Optical Coherence TOmography is a fantastic tool we use primarily for glaucoma and retina; however, it can also give us detailed information about the fit of complex RGP lenses such as sclerals. In the image below you can see the contact lens that is vaulting over the cornea without touching it - just as it should be.
Meibography is the imaging of the meibomian glands. These are finger-like glands that keep your eyes moist. You have them in your eyelids; however, age and other causes (contact lens wear, chronic inflammation, poor diet, etc) can lead to the atrophy and eventual loss of these glands. Unfortunately, once they are gone, you cannot get them back. Our office provides IPL treatment for dry eye plus a Home Care Kit to help you preserve the glands that you have now.