Soft Contact Lens Troubleshooting
Nacor Exam Questions and Answers9
Pt. Has worn soft lenses for 15 years
He has come in on an unscheduled basis as he notices reduced vision OS and a mild burning
sensation. After CL removal, he notices that vision still seems reduced with spectacles.
VA is reduced to 20/80 OS, no improvement with over-refraction or pinhole. The biomicroscope
reveals a central coalesced area of staining. What is wrong with this patient? - ANSWERS-
Abrasion or ulcer
New wearer comes for an unscheduled follow-up visit. They wear hydrogel monthly lenses. She
comes in without the lenses on and complains of discomfort immediately upon insertion. What
is the solution - ANSWERS-Edge Tear/damage Inspect the lens with or without slit lamp
Care regimen: ReNu Fresh
Wearing time 8-10 hrs.
VA OU 20/20
Patient complains of dry eyes and increased lens intolerance. She received her lenses in April
and it is now November. She finds the symptoms to be worse at work. Possible solution? -
ANSWERS-Preservative sensitivity
Pregnancy
Any new medications or systemic issues?
What is her environment like? It's fall and the heat may have been turned on. She may need a
vent deflector or a humidifier
Patient is a new CL wearer. She wears the lenses for awhile, but can't increase time above about
8 hrs.
, Possible solution? - ANSWERS-If fitting in a lens material known to be good for dry eyes and
using hydrogen peroxide disinfection or daily disposable wear doesn't help, consider dry eye
therapy- Steroids, fish oil, lid scrubs and massage, lubricants and then refit
What are two common reasons that patients have decreased vision with cls? - ANSWERS-They
switched the lenses or the lens is inverted
Rx OD -2.25-0.75X180
OS -2.50-0.50 X180
K's OD 42.00/42.75 @90
OS 42.00/42.50 @90
TBUT 9 seconds OU
CL's OU -2.50/8.7/AV Oasys
VA OD 20/25-3 OS 20/20-2
She comes for follow-up complaining of reduced vision with the contact lenses only. What
should you do? - ANSWERS-Can try toric lens in the right eye with aspheric in the left
What could possible problems be if the patient is complaining of decreased VA with both cls and
specs? - ANSWERS-1. Ocular condition
2. Edema
3. Abrasion
4. Myopic Creep
5. Incorrect Rx
6. Mucous from GPC
7. Irregular Astigmatism
What is the main cause of a pt reporting a burning sensation? - ANSWERS-Solution sensitivity
Others can be dry eye, lens contamination, cigarette smoke
Nacor Exam Questions and Answers9
Pt. Has worn soft lenses for 15 years
He has come in on an unscheduled basis as he notices reduced vision OS and a mild burning
sensation. After CL removal, he notices that vision still seems reduced with spectacles.
VA is reduced to 20/80 OS, no improvement with over-refraction or pinhole. The biomicroscope
reveals a central coalesced area of staining. What is wrong with this patient? - ANSWERS-
Abrasion or ulcer
New wearer comes for an unscheduled follow-up visit. They wear hydrogel monthly lenses. She
comes in without the lenses on and complains of discomfort immediately upon insertion. What
is the solution - ANSWERS-Edge Tear/damage Inspect the lens with or without slit lamp
Care regimen: ReNu Fresh
Wearing time 8-10 hrs.
VA OU 20/20
Patient complains of dry eyes and increased lens intolerance. She received her lenses in April
and it is now November. She finds the symptoms to be worse at work. Possible solution? -
ANSWERS-Preservative sensitivity
Pregnancy
Any new medications or systemic issues?
What is her environment like? It's fall and the heat may have been turned on. She may need a
vent deflector or a humidifier
Patient is a new CL wearer. She wears the lenses for awhile, but can't increase time above about
8 hrs.
, Possible solution? - ANSWERS-If fitting in a lens material known to be good for dry eyes and
using hydrogen peroxide disinfection or daily disposable wear doesn't help, consider dry eye
therapy- Steroids, fish oil, lid scrubs and massage, lubricants and then refit
What are two common reasons that patients have decreased vision with cls? - ANSWERS-They
switched the lenses or the lens is inverted
Rx OD -2.25-0.75X180
OS -2.50-0.50 X180
K's OD 42.00/42.75 @90
OS 42.00/42.50 @90
TBUT 9 seconds OU
CL's OU -2.50/8.7/AV Oasys
VA OD 20/25-3 OS 20/20-2
She comes for follow-up complaining of reduced vision with the contact lenses only. What
should you do? - ANSWERS-Can try toric lens in the right eye with aspheric in the left
What could possible problems be if the patient is complaining of decreased VA with both cls and
specs? - ANSWERS-1. Ocular condition
2. Edema
3. Abrasion
4. Myopic Creep
5. Incorrect Rx
6. Mucous from GPC
7. Irregular Astigmatism
What is the main cause of a pt reporting a burning sensation? - ANSWERS-Solution sensitivity
Others can be dry eye, lens contamination, cigarette smoke
