In the second in a series of articles summarising the key findings of the BCLA CLEAR publications, a major review of the published evidence relating to all aspects of contact lens practice, Pauline Bradford offered an overview of the BCLA CLEAR section relating to contact lens complications (see Optician 06.05.22). This article now acts as the source material for a new interactive CPD exercise where you are to discuss two different cases. In each case, the patient is a contact lens wearer presenting with some degree of discomfort.

Consider the details of each case and then address the questions relating to each in your discussions. The source material article can be found in the CPD area of opticianonline.net.

Cases for discussion

Case study 1

A 34-year-old male patient presents for an unscheduled aftercare complaining of a sore right eye for the last few days. He has been unable to wear his lens but the eye still feels like it is getting worse without lens wear too. He is photophobic and has some noticeable oedema of the right eyelid. The left eye is asymptomatic.

Slit lamp examination reveals a 2mm circular lesion 3.5mm away from the limbus with fuzzy edges which stains with fluorescein (figure 1). He also has grade 2 MGD.

His lenses are monthly replacement and he is unsure exactly how old they are or how old the case is. He admits he only sometimes rubs and rinses and thinks he may have slept for a few hours in them at the weekend.

Questions to consider in your discussions:

  • What is likely to be the cause of his discomfort?
  • What is the most appropriate initial course of action?
  • What might be the safest and most appropriate management plan?

Case study 2

A 25-year-old woman presents for a routine aftercare appointment on her monthly disposable SiHy lenses, reporting occasional grittiness over the last few weeks in the left eye. It has not stopped her wearing the lenses.

She is a smoker and has a long-standing history of blepharitis, and generally adheres to contact lens related compliance well.

Slit lamp examination reveals a 1mm circular lesion. It is located 1mm in from the limbus between 4-5 o’clock with clearly defined edges and some fluorescein staining.

Questions to consider in your discussions:

  • What is this lesion likely to be?
  • What might be an appropriate in a management plan?  
  • The most likely prognosis would be what?

Interactive CPD Instructions

In order to be able to log one provider-led interactive CPD point to your MyCPD account, this is what you need to do:

  • Make sure you have read the article ‘BCLA CLEAR – 2 Contact lens complications’ by Pauline Radford.
  • Arrange a time to undertake a discussion on the subject with a similarly qualified registrant; another optometrist or dispensing optician.
  • Read the case scenario and questions (above) and use them as the basis for the discussion with your colleague. Note, the discussion needs to address each of the questions outlined above and must be for longer than 10 minutes.
  • When finished, you then need to send an email to ‘opticiancpd @markallengroup.com’ as follows;
    • Subject box should state ‘CLEAR Interactive 2’
    • Please state your name and GOC number
    • Please state the name and GOC number of the person you discussed the matter with
    • Please confirm you had read the source material
    • Please include a summary of your discussion, explaining your views and thoughts on each of the three discussion questions
  • Each submission will be read individually and, where needed, feedback will be given directly. Where the submission meets a required standard, you will receive an email confirming this which you can then use as evidence of completion allowing you to log one distance learning interactive CPD point.
  • A summary of the responses and discussions will appear in a future issue of Optician with comment from the authors. 
  • Neil Retallic is President of the BCLA. 
  • Pauline Bradford is a lecturer and contact lens optician.