92313 Prescription of optical and physical characteristics of and fitting of contact lens, with medical supervision of adaptation; corneoscleral lens

Name of the Procedure:

Prescription of optical and physical characteristics of and fitting of contact lens, with medical supervision of adaptation; corneoscleral lens

Summary

This procedure involves the prescription and fitting of corneoscleral contact lenses under medical supervision. Corneoscleral lenses are specially designed contact lenses that cover both the cornea and the sclera (the white part of the eye) to improve vision and comfort for patients with certain eye conditions.

Purpose

The procedure aims to improve vision and provide comfort for people with irregular corneas, severe dry eyes, or conditions like keratoconus. The expected outcome is enhanced visual acuity and increased eye comfort.

Indications

• Irregular corneal conditions such as keratoconus or post-cornea transplant
• Severe dry eye syndrome
• Patients who cannot achieve satisfactory vision with standard contact lenses or glasses
• Any other corneal conditions that benefit from a larger lens surface

Preparation

• No specific fasting or medication adjustments are typically required.
• A comprehensive eye exam and corneal topography to map the surface of the eye.
• Patients should bring any current contact lenses or glasses to the appointment.

Procedure Description

1. Eye Examination: An eye care professional will conduct a thorough eye exam to understand the patient's vision needs.
2. Corneal Mapping: Detailed corneal topography is performed to measure the eye's surface.
3. Lens Prescription: The eye care professional prescribes the corneoscleral lens based on the measurements and the patient's vision requirements.
4. Lens Fitting: The corneoscleral lenses are fitted onto the eyes, ensuring a proper fit and comfort.

5. Supervised Adaptation: The patient wears the lenses under medical supervision to monitor adaptation and address any discomfort or issues.

   Tools used include slit lamps, corneal topographers, and fitting sets for corneoscleral lenses.

Duration

The initial fitting session typically lasts about 1 to 2 hours. Follow-up sessions might be shorter.

Setting

The procedure is performed in an outpatient clinic or an optometry office.

Personnel

• Optometrist or ophthalmologist
• Ophthalmic technician or assistant may also assist

Risks and Complications

• Mild discomfort or irritation during the adaptation period
• Risk of infection if lenses are not properly cleaned
• Possible allergic reactions to lens materials
• Management involves proper hygiene, adjusting the lens fit, or switching lens materials if necessary

Benefits

• Improved visual acuity and comfort
• Enhanced quality of life due to better vision
• Immediate improvement in vision once properly fitted, but full adaptation may take a few days to weeks.

Recovery

• Patients might experience mild discomfort initially, which usually resolves.
• Follow proper lens care as instructed.
• Schedule follow-up appointments to ensure proper fit and eye health.
• Avoid touching or rubbing eyes excessively.

Alternatives

• Standard soft or rigid gas permeable contact lenses
• Eyeglasses
• Surgical options like corneal cross-linking for keratoconus
• Each alternative has its own benefits and limitations. Standard lenses might not offer the same level of comfort and vision improvement, while surgical options carry different risks and recovery times.

Patient Experience

• During the procedure, patients may feel brief discomfort during the fitting process.
• Adaptation period may involve mild irritation, sensitivity to light, or a feeling of something in the eye.
• Pain management involves the use of lubricating eye drops and proper lens hygiene practices.