Silicone Hydrogels - The UK Experience

Brian Tompkins - BSc (Hons) FCoptom
Brian is an experienced independent practitioner in his Victorian house-practice in Northampton, UK. His practice was a finalist in the 1999 Optician, Eyecare Practice of the Year Awards. His main interests include contact lenses, children's reading and learning difficulties.

He is proactive in fitting all types of contact lenses and is keen on imaging and video capture for enhanced patient education. He was given the accolade as ''The Best Clinical Photographer in the World Today'' by Prof Nathan Efron at the BCLA 2001 Conference.

Recently appointed Clinical Consultant to Cibavision, his work in contact lenses has included clinical trials with Eurolens Research and Visioncare Research Ltd. He is also an advisory panel member for Monoptica and a number of international contact lens companies.

Brian runs lectures and workshops for practitioners on silicone hydrogel extended wear contact lenses, contact lens problem solving and multifocal contact lenses, all based on real life experience in the consulting room, illustrated using high quality images and video.

Case 1:

CR is a 42 year male solicitor who had worn RGP contact lenses for 20 years. He reported no medical problems or allergies and no previous surgery. CR presented for the first time to the practice complaining of reduced wearing time and contact lens intolerance. He was finding it particularly difficult to manage a full working day in front of a VDU screen in an office environment.

Figure 1: Bulbar and limbal conjunctival injection with previous RGP in situ.

Slit Lamp examination showed marked 3 & 9 o'clock staining at an 11.00 a.m. appointment, graded as at least 2.50 on the Efron scale(ES), with a similar grade of conjunctival injection within the palpebral aperture (Figure 1).

High magnification examination of the corneal area adjacent to the limbus showed neovascularisation and engorged vessels associated with the exposed and compromised cornea (Figure 2). CR was also found to have a grade 1.5 meibomian gland dysfunction for which he started immediate treatment with "Lid Care" and heat and massage.

CR was initially trial fitted with a pair of Focus N&D 8.40 -8.00DS (slightly over corrected). He was instructed in handling and lens care (Focus Plus) and after settling and refraction was dispensed with -7.50 R&L. This gave a slightly under corrected LE which he enjoyed for monovision for his office work. Initial wearing schedule was advised at 1 week of DW and then review.

Figure 2: High magnification of neovascularisation and limbal hyperemia with previous RGP in situ. Arrow indicates reference vessel.

Best CL Rx was then found to be:

R -7.25 6/5
L -7.50 6/6-2, Over Rx -0.50 6/5 Ready Readers of +1.00 gave N5 which were dispensed from stock and the patient was instructed to return at 9.15am after his 1st overnight.

The 1st overnight follow-up showed no problems. Conjunctival injection was down to approximately 1.00 ES, but symptoms of intermittent blurring led me to advise artificial tears as examination showed some lipid contamination. He was also instructed to continue with EW until the next appointment , but to remove the lenses to rub and rinse if they felt smeary.

At the end of the first month the neovascularisation had reduced to ghost vessels and the conjunctival injection was also significantly reduced (Figure 3). The lipid problem remained and he is now on a pattern of flexible wear to suit his schedule. He continues with "Lid Care" and artificial tears as needed. The wearing time is now generally all waking hours with occasional EW as required.

Figure 3: High magnification of ghost vessels and reduced limbal hyperemia following 1 month of EW with Focus N&D lenses. Arrow indicates reference vessel from Figure 2.

All images taken with Eyecapture.