Visit 4 :
1.1.3 Identifies and responds appropriately to patients’ fears, anxieties and concerns about
their visual welfare.
TCD RP, px with symptoms/ symptomatic cataract.
Establishes and maintains a good professional and clinical relationship with the patient to
inspire trust and confidence. Recognises emotion in patients.
Explores patient concerns and provides reassurance where appropriate, using explanations
that are relevant to that patient.
1.2.2 Communicates with patients who have poor or non-verbal communication skills, or
those who are confused, reticent or who may mislead.
RA: px with communication difficulty or who is confused and might be misled.
Makes effective use of body language to support explanation.
Demonstrates awareness of own body language. Uses appropriate supportive material.
1.2.5 Communicates effectively with any other appropriate person involved in the care of
the patient.
RA: where communication with a parent or guardian has taken place
2.2.5. Interprets and responds to existing records.
PR: Where clinical management decision has been based on previous records
Makes a decision based on their own and previous findings.
Modifies their actions appropriately as a response to relevant history or previous records.
Identifies and responds to the significance of:
• refractive change/ocular status
• clinical findings, for example, reduced VA
• previous form of optical correction.
Additional guidance
The previous record should be made available by the trainee.
4.1.7 Manages non- tolerance cases.
PR: where intolerance to spectacles has been investigated.
Identifies problems.
Undertakes appropriate investigation and takes appropriate action.
Explains to patient what course of action will be taken and obtains patient’s agreement.
Arranges follow-up if necessary.
5.3.3. Understands the techniques used in the fitting of complex contact lenses and advises
patients requiring complex correction.
CS
Knows the methods for the CL correction of aphakia, high ametropia, keratoconus, post-
surgical and post-refractive surgery including:
• the types of lenses available
, • their fitting characteristics, fitting technique and any patient advice required when fitting
these lenses.
Aphakia: No crystalline lens, can be due to congenital abnormality or cataract removal. Use
a high plus contact lens (soft or hard) with UV filter. If elderly consider handling
Albino: coloured CLs can reduce light sensitivity.
Therapeutic CL: Bandage CL post LASEK
Keratoconus: generally fitted with an RGP lens
Refractive surgery: type of surgery, wound position, corneal shape, reason for fitting,
residual refractive error.
Scleral lenses:
-mainly used where conventional soft CLs don’t work. Irregular astigmatism caused by:
keratoconus, post corneal trauma, post keratoplasy, post refractive surgery
- full scleral (18-24mm), mini scleral (15-18mm), corneoscleral (13-15mm)
Reverse geometry RGP:
Cornea is normally steeper centrally and flatter peripherally, reverse geometry is the
opposite so works for keratoconus.
Lenses for iris trauma:
Inability to change pupil size, so a cosmetic soft CL would work, creates new pupil from the
CL. Also works in aniridia. Cosmetic soft CLs have low dk/t so poor optical performance
3 point touch:
Keratoconus. Most common is rose K, very small optic zone so that it only fits on the cone.
Distributes the weight of the lens between the cone apex and the mid periphery of the
cornea. Cone is usually inferior.
Piggy back/hybrid lens:
Used to correct things like keratoconus. RGP with a soft lens skirt. Prpvides the best optical
quality from the RGP and the soft skirt provides increased comfort.
Mini-scleral lenses:
Designed to vault the cornea (no contact with cornea)
Because not contacting cornea, can fit irregular cornea, protect the surface and
minimise scarring.
Fitted based on sag/depth, rather than curvature.
Should clear the entire cornea and limbus, touch of lens should be on the sclera.
Fitted from a fitting set, initially calculated from topography and OCT
Insertion: lens filled with saline solution, looking down holding both lids and place
lens on eye.
3 zones: central clearance, limbal clearance and scleral landing
Central clearance zone- check if iris and pupil visible (this means adequate clearance)
Limbal clearance zone- look to see if NaFl bleeds out from centre to conjunctiva.
Needed for corneal health
Scleral landing- need to be smooth and not impinging any vessels.
Scissor technique for removal.
1.1.3 Identifies and responds appropriately to patients’ fears, anxieties and concerns about
their visual welfare.
TCD RP, px with symptoms/ symptomatic cataract.
Establishes and maintains a good professional and clinical relationship with the patient to
inspire trust and confidence. Recognises emotion in patients.
Explores patient concerns and provides reassurance where appropriate, using explanations
that are relevant to that patient.
1.2.2 Communicates with patients who have poor or non-verbal communication skills, or
those who are confused, reticent or who may mislead.
RA: px with communication difficulty or who is confused and might be misled.
Makes effective use of body language to support explanation.
Demonstrates awareness of own body language. Uses appropriate supportive material.
1.2.5 Communicates effectively with any other appropriate person involved in the care of
the patient.
RA: where communication with a parent or guardian has taken place
2.2.5. Interprets and responds to existing records.
PR: Where clinical management decision has been based on previous records
Makes a decision based on their own and previous findings.
Modifies their actions appropriately as a response to relevant history or previous records.
Identifies and responds to the significance of:
• refractive change/ocular status
• clinical findings, for example, reduced VA
• previous form of optical correction.
Additional guidance
The previous record should be made available by the trainee.
4.1.7 Manages non- tolerance cases.
PR: where intolerance to spectacles has been investigated.
Identifies problems.
Undertakes appropriate investigation and takes appropriate action.
Explains to patient what course of action will be taken and obtains patient’s agreement.
Arranges follow-up if necessary.
5.3.3. Understands the techniques used in the fitting of complex contact lenses and advises
patients requiring complex correction.
CS
Knows the methods for the CL correction of aphakia, high ametropia, keratoconus, post-
surgical and post-refractive surgery including:
• the types of lenses available
, • their fitting characteristics, fitting technique and any patient advice required when fitting
these lenses.
Aphakia: No crystalline lens, can be due to congenital abnormality or cataract removal. Use
a high plus contact lens (soft or hard) with UV filter. If elderly consider handling
Albino: coloured CLs can reduce light sensitivity.
Therapeutic CL: Bandage CL post LASEK
Keratoconus: generally fitted with an RGP lens
Refractive surgery: type of surgery, wound position, corneal shape, reason for fitting,
residual refractive error.
Scleral lenses:
-mainly used where conventional soft CLs don’t work. Irregular astigmatism caused by:
keratoconus, post corneal trauma, post keratoplasy, post refractive surgery
- full scleral (18-24mm), mini scleral (15-18mm), corneoscleral (13-15mm)
Reverse geometry RGP:
Cornea is normally steeper centrally and flatter peripherally, reverse geometry is the
opposite so works for keratoconus.
Lenses for iris trauma:
Inability to change pupil size, so a cosmetic soft CL would work, creates new pupil from the
CL. Also works in aniridia. Cosmetic soft CLs have low dk/t so poor optical performance
3 point touch:
Keratoconus. Most common is rose K, very small optic zone so that it only fits on the cone.
Distributes the weight of the lens between the cone apex and the mid periphery of the
cornea. Cone is usually inferior.
Piggy back/hybrid lens:
Used to correct things like keratoconus. RGP with a soft lens skirt. Prpvides the best optical
quality from the RGP and the soft skirt provides increased comfort.
Mini-scleral lenses:
Designed to vault the cornea (no contact with cornea)
Because not contacting cornea, can fit irregular cornea, protect the surface and
minimise scarring.
Fitted based on sag/depth, rather than curvature.
Should clear the entire cornea and limbus, touch of lens should be on the sclera.
Fitted from a fitting set, initially calculated from topography and OCT
Insertion: lens filled with saline solution, looking down holding both lids and place
lens on eye.
3 zones: central clearance, limbal clearance and scleral landing
Central clearance zone- check if iris and pupil visible (this means adequate clearance)
Limbal clearance zone- look to see if NaFl bleeds out from centre to conjunctiva.
Needed for corneal health
Scleral landing- need to be smooth and not impinging any vessels.
Scissor technique for removal.
