Extended-wear contact lenses have been on the market for approximately four to five years. As the use of extended-wear contact lenses becomes more prevalent, nurses are more likely to encounter aging clients who are using them. Nurses need to be aware of techniques such as insertion and removal, care and cleaning, and problem solving because the wearer may not have me manual dexterity necessary to handle the contact lenses. The extended- wear contact lens is likely to be the method of management for the aphakic client to achieve optimal visual function. When me nurse caring for the aphakic client is willing to be involved in the care of the extended- wear lens, the client may have an option that otherwise is not available to him/her. Reaching optimal visual function allows clients to enjoy life more fully and take advantage of the visual opportunities that surround tiiem, such as books, letters, crafts and hobbies.
These lenses can be used by many people who require spectacle lenses for correction of myopia and hyperopia. The goal of die extended-wear contact lens is to provide comfort, good vision, and most importantly, an adequate supply of oxygen to the cornea.1 Whether an individual user will be successful or not depends on tlie reaction of the eye and die cornea's need for oxygen. The need for oxygen is variable and therefore; me individual must be carefully monitored to determine wearing ability (See Figure).
Extended-wear contact lenses are especially useful for the individual who has had a lens removed surgically and who cannot or does not already have a lens implant. For these people, extended- wear contact lenses give good vision all day while eliminating cumbersome eyewear and daily-wear contact lenses mat require much dexterity.2 These lenses are also useful for the handicapped individual who lacks die manual dexterity necessary to handle other types of eyewear. Ultimately, the decision about who wears the extendedwear contact lens depends on that individual's reaction and eye tolerance to the contact.
Types of Lenses - There are currently eight manufacturers of extended-wear contact lenses approved by die Food and Drug Administration for cosmetic use.* For die aphakic, six manufacturers have been approved by the FDA for production of the extended-wear contact lens. Several others are in me process of obtaining FDA approval. The various types of extended- wear contact lenses have different water contents varying from 36% to 78%. Selection of die type of contact lens is determined by die ophthalmologist or optometrist, and more man one type may be tried to achieve optimal vision. High water content lenses are comfortable and provide good vision but are fragile and susceptible to dehydration and calcium deposits.3 Medium water content lenses also provide good vision and are comfortable and less fragile but are prone to protein deposits.3 Silicone lenses let nearly 90% of the oxygen on the lens surface reach the cornea and are thicker which makes them useful for aphakics.3
Care and Cleaning - The nurse caring for clients who wear extended- wear contact lenses needs to be aware of insertion and removal techniques. The most important aspect of insertion and removal is cleanliness. Hands should be washed and soap completely rinsed away. Extended- wear contact lenses are somewhat more fragile than conventional contact lenses because of the high water content. Prior to insertion, the contact lens should be rinsed with fresh storage solution. Always start with the right lens and right eye to avoid confusion. Place the contact lens on the tip of the index finger of the dominant hand. Instruct the client to look straight ahead and raise the upper lid with the other index finger. Have the client look down and, keeping both eyes open, place the lens on the sclera. Slowly take away your fingers and instruct the client to gently close his eye. The extendedwear contact lens should center itself or it can be moved to the center by gentle finger tip pressure over the eyelids. If the lens seems to stick to the eye, apply a few drops of lubricating solution and instruct the client to blink a few times. Follow the same procedure for the left eye.
Removal of the extended-wear contact lens begins with hand washing and drying using a lint-free towel. The storage container must be filled with fresh storage solution and be in proximity to the client. Before attempting to remove the contact lens, check to see mat it is centered on the client's cornea. If the lens is off-center, it should be recentered before attempting to remove it. Begin with the patient's right eye. Direct the client to look up and keep both eyes open. Using the middle finger of the dominant hand, gently pull down the lower lid. With the tip of the index finger of the same hand, touch the contact lens and slide it into the white of the eye. Then gently "pinch" the contact lens off the eye using the right index finger and thumb of the same hand. If the contact lens cannot be removed easily, apply a few drops of lubricating solution and have the client blink a few times. Then repeat the procedure when the contact lens is moving normally. Clients usually are instructed by their practitioners how often the extendedwear contact lens needs to be removed and cleaned. To minimize the chance of errors, mis can be marked ahead on the clients' calendar and kept where it is visible for everyone involved in the care of the contact lenses.
CRITERIA TO USE FOR SELECTION OF CLIENTS*
Following removal, the contact lenses must be cleaned and disinfected. The lenses are cleansed by applying sterile cleaning solution to the lens and holding the lens in the palm, gently rub me surface of the lens with the forefinger of me dominant hand. The two methods of disinfection are thermal or chemical. The physician recommends which type is to be used. It is important not to switch from one method to the otiier. Chemical disinfection involves placing the lenses in the storage case and filling the case with disinfectant solution. The lenses must be completely immersed and stored for a minimum number of hours, (such as four hours), depending on the disinfecting solution. Thorough rinsing with sterile rinsing solution is absolutely necessary prior to lens insertion.
Thermal disinfection involves placing the lenses in the storage container and filling the case with a special boiling and soaking solution. The case is then placed into a thermal disinfection unit. Specific instructions come with the unit and should be followed carefully each time. When the thermal disinfection process is complete, the lens may be removed from the unit and placed on the client's eyes. Be certain that the lenses have cooled completely prior to placing them on the client's eyes. The extended-wear contact lenses should be stored in their proper container with the correct solution filled to the top each time the lenses are placed in the case.
Problem Detection and Solution - Adverse eye reactions and problems occur more frequently and with greater severity in the extended-wear contact lens client as opposed to daily wear contact lens clients. The percentage of long-term complications of extendedwear contact lenses are not known because they have been in existence a short time.3 Because the elderly aphakic client may not be aware of developing problems, the nurse caring for mese clients must be especially sensitive to the development of complications. It is also important to make sure the aphake regularly washes his eyelids. Often, when an aphake develops a red eye, it is from crusty matter built up around the eyelashes.4 Clients should have their eyelids sponged by a special method that involves closing only the eye that is being sponged. The other eye should be opened and aimed down at a 45-degree angle.4 Closing both eyes can lead to displacement of the contact lens.
A suggestion for problem detection involves a simple procedure when the client wakes up in the morning (if a problem is suspected at that time). The nurse should have the client look straight ahead into the mirror and then up. The nurse then should touch the lens to make sure it moves easily.5 If it doesn't move easily, notify the doctor. Other symptoms mat the nurse can look for include poor vision, itching, redness, or dryness. If any of these symptoms occur, the eye-care practitioner should be notified immediately. Situations that alter me clients' ability to wear the lenses include viral infections (herpes) and allergies. Clients using antihistamines may dry the conjunctiva and reduce me tear flow, thus allowing displacement of the contact lens.5
Temporary blurring of vision on awakening is not uncommon; however should mis blurring persist, the practitioner should be notified immediately. The aphake should have 24-hour-a-day, seven-day- a- week emergency service by his doctor and the. nurse needs to be aware of where to go or whom to call for emergency care.
Environment plays a big part in the success of the extended-wear contact lenses. The lenses last from five weeks to two months in a heavily polluted area and men must be replaced wim new lenses. In the suburban/rural areas, lenses last approximately four months.5 Lenses in more polluted areas also require more frequent cleaning. Cleaning schedule and individual wearing ability are also factors.
If the elderly client has difficulty with dryness of the conjunctiva and reduced tear flow, a liquid tear solution can be administered. The specific type of liquid tear solution is usually determined by the doctor who prescribed the extended- wear lenses for the client. Excessively dry eyes may be a contraindication for extended-wear contact lenses and die individual may not be able to use them.
Extended-wear contact lens use is probably here to stay and the nurse needs to be sure that die client receives extended care as well. If the specific instructions given by me individual's doctor are followed and suggested techniques are used, die result should be comfort, good corneal oxygen supply and finally, good vision.
- 1. Kroll J: Extended wear - extended care, Contacto 1982; 26(3):28-30.
- 2. Cohen M: Aphakic care comes of age. Review of Optometry 1983; 120(2):57.
- 3 . Andrasko G : How to spot extended- wear problems, Review of Optometry 1982; 119 (4):58-60.
- 4. Fontana F: Extended wear: Roundtable discussion, Review of Optometry. 1982; 119(10):37-48.
- 5. Poster M: Extended wear: Roundtable discussion, Review of Optometry 1982; 119 (10):37-48.
- *As of the writing of this text, latter portion of 1983.
- The author wishes to acknowledge the assistance of Dr. Lyle Hall, OD.
CRITERIA TO USE FOR SELECTION OF CLIENTS*