Puzio Eye Care Associates

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1 Puzio Eye Care Associates DENNIS HARWICH 38, Route 134 Route 137 & Route 39, Suite 119B P.O. Box 1412 P.O. Box 1661 South Dennis MA East Harwich, MA Voice: Voice: Fax: Fax: PREPARATION FOR CONTACT LENS WEAR Contact lenses allow for more natural visual function, an unobstructed field of view, freedom from your eyeglasses, and the obvious cosmetic and social benefits associated with maintaining a natural appearance. The special privilege of wearing contact lenses requires some additional responsibility on your part. Contact lenses are a medical device that must be specially fit to your eyes. Follow all of my care instructions, do not overwear your lenses, it is imperative that you replace them according to the recommended schedule, and pay close attention to any out-of-the-ordinary symptoms of discomfort or eye irritation. Always handle your lenses with clean hands and fingernails. To ensure your success and comfort with contact lenses, periodic follow-up progress exams are required. Contact lenses require a medical prescription, and at minimum, according to federal law, require a yearly examination to renew ocular suitability and accuracy. PLACEMENT OF A SOFT LENS ON THE EYE It is essential that you practice good hygiene when handling your lenses. Always wash your hands thoroughly with mild soap, rinse them to remove all soap residue, and dry. Make an attempt to keep your hands lint free, if possible. Remove a lens from the right side of your lens storage case. Optional; Rinse your lens with multipurpose solution, or if instructed, a special rinsing solution. Shake the lens gently to remove excess solution. Place the lens on your finger, and check to see if the lens is reversed. Insertion Technique #1: Always take time to dry or blot excess moisture from your fingertip to prevent the lens from sticking to your finger rather than your eye upon insertion. Place the lens on the tip of your index finger. Now that you have your lens positioned properly, using your middle finger on each hand, hold open your upper and lower eyelids. It is very important to have your eyelids as wide open as possible with both hands. Slowly move the lens toward the eye while looking directly into the mirror. Place the lens on the center of the eye as you look straight or straight into the mirror. Once the lens is on the eye make sure you do not let go of your eyelids, and move your eyes in all four direction as this will allow the lens to settle. Once the lens is on the eye release the eyelids slowly. Close your eyes slowly and blink normally. If you are having initial difficulty it is important to make certain that you don t hit your eyelashes on the way in to avoid having the lens turn inside out on your finger. Don t be discouraged. Practice makes perfect! Insertion Technique #2: Follow all of the instructions in #1, except it may be more helpful for some to place the lens on the eye as you look straight at the lens as it comes towards the eye. The curvature of the lens matches the center of the eye pore perfectly, and the lens will have less chance to wrinkle upon first blink when it is placed centrally. Comfort Tip: After insertion, if your lens is more uncomfortable than expected, it is common for debris (mucous, dust, makeup, etc.) to become trapped under the lens. Simply slide your lens with your index finger onto the outer white portion of your eye, look towards your nose, and then slide the lens back to the center. This process will generally void debris from under the lens, thus avoiding removal, rinsing, and reinsertion.

2 SOFT LENS REVERSAL TECHNIQUE Since a soft contact lens is so flexible, it is necessary to inspect a contact lens prior to insertion to see if it is inverted or inside out. An inverted lens will remain less comfortable and provide less than optimum visual function. Inspection: Before insertion, always inspect a lens on the end of your finger. An inverted lens will not harm your eye, however, the lens must be removed and reversed. There are a few methods used to determine the correct form of a soft contact lens. You must master a technique that works best for you. Fold or Taco Method: Shake excess solution from the lens. Place the lens on the tip of a dry finger. With Your other hand, fold the contact lens between your thumb and your index finger. Observe how the edge of the lens bends. If the lens is inside out, the edge of the lens will flare out and resist the fold. The edge of a lens turned correctly will fold together, like a taco, and will not flare out. If you have difficulty, let the lens dry on your finger for seconds before folding the lens. Edge or Bowl Method: Place the contact lens on your finger with the edges facing up. A correctly curved lens should appear concave. The edges of a lens should be turned upward, like a bowl. If the edge, or lip of the lens, appears to be slightly flared out, invert the lens and check it once again to be certain the lens is correct. Wetting Solution Method: Place the contact lens in the palm of your hand, on the the hand's central fold, or what some call, the life-line. Fill the center of the lens with only 2 drops of wetting solution. With a correctly turned lens, the edges of the lens will curl inward. If the lens is inside out, the lens will hold its shape. Shake Case Method: If all methods above prove difficult, some patients report that shaking the lens case vigorously automatically allows the lenses in the case to conform to their correct shape. Fail-Safe Method: If a patient removes their lenses and rinses them in the position they were removed from the eye, and continues to track their conformity while placing them in the case, again the same way they came out of the eye, when they are removed from the case the next morning, they should be in the correct position. REMOVAL OF A SOFT CONTACT LENS Wash your hands carefully, and rinse. When drying your hands, try to avoid dust or lint. It is good practice to get in a habit of removing your right lens first. It may be more comforting to visualize that when your fingers reach for the lens, they will not be touching your eye, but rather, they will be touching the lens. Stare at a point slightly above. Pull down your lower lid slightly, but not fully, with your other hand. Some may desire sliding the lens downward using a finger, and then reaching in far enough to gently pinch the lens between your thumb and index finger. Experienced lens wearers generally use the middle finger on one hand to pull the lower lid downward as they gently pick the lens off their eye with their index finger and thumb of the same hand. After removal, the lens should be rinsed, and stored for disinfection, as instructed. MULTI-PURPOSE SOLUTION SYSTEMS A multipurpose solution may be the only solution you require to safely and conveniently rinse, clean, and disinfect your soft contact lenses. Because harmful microorganisms are everywhere in our environment, and can live on a contact lens and in the lens storage case, disinfection of your lenses is an essential part of soft lens care. Disinfection kills bacteria and fungi, and when used properly, helps prevent infection. The following directions for care of your lenses must be performed each time you remove them to provide proper lens cleaning and disinfection.

3 Preliminary Procedure: First, always wash and rinse your hands. Remove a contact lens, right lens first. Despite a "no-rub" product claim, it is best to rinse a lens or swirl the lens in multi-purpose solution in the palm of your hand for a few seconds to remove foreign debris and tear residues. Rubbing is not required. Disinfection: Place fresh multi-purpose solution in the well of the lens storage case. Use fresh solution each time your lenses are stored overnight. After overnight disinfection, rinse your lenses thoroughly with fresh multi-purpose solution. For very sensitive eyes, sterile saline may be used for lens insertion however saline may not be used as a substitute for disinfection during storage. If your lenses are not worn within a 24-hour period, repeat the disinfection cycle. It is recommended to stay with the multipurpose solution recommended by this office. Contact my office for alternative recommendations if you find you are sensitive to this form of disinfection. SAUFLON or CLEAR CARE - HYDROGEN PEROXIDE DISINFECTION SYSTEM Hydrogen peroxide disinfection systems are the most beneficial lens care products providing optimum comfort and safety. Because harmful microorganisms are everywhere in our environment, and can live on a contact lens and in the lens storage case, disinfection of your lenses is an essential part of soft lens care. Disinfection kills bacteria and fungi, and when used properly, helps prevent infections. The following directions for care of your lenses must be performed each time your remove them to provide proper lens cleaning and disinfection. Preliminary Procedure: Always wash and rinse your hands. Remove a contact lens, right lens first. Rinse each lens individually with Sauflon solution and place each lens into the appropriately marked domed lens holder. Do not overfill the lens holder chamber. Caution: If Sauflon solution makes contact with the outside of your lens holder system you may experience a burning sensation when the case is handled in the morning for lens insertion. To insure comfort, rinse the outside of you case with water before storing your lenses overnight. Disinfection / Neutralization: To disinfect fill the lens holder cup to the fill line with Sauflon solution. Close the top and allow lenses to remain in the Sauflon case for a minimum of 6 hours or overnight. The base of the lens holder contains a special catalytic disc that neutralizes the hydrogen peroxide solution. If your lenses are not worn for over seven days repeat the disinfection/neutralization procedure. DO NOT PUT SAUFLON SOLUTION DIRECTLY IN YOU EYE OR RINSE LENSES WITH IT PRIOR TO INSERTION. After a minimum of 6 hours insert your lenses with the neutralized solution in your case. This solution is saline and lubricants and is preservative free. Hydrogen peroxide solutions require this disinfection/neutralization cycle before it is comfortable for use in the eye. If this were to ever happen rinse your eye with water until burning subsides. Lens Insertion: At the end of the disinfection cycle, generally in the morning, remove a lens for insertion. Your lenses are ready for insertion using the neutralized solution in the lens holder case. Again, do not rinse your lenses with fresh Sauflon solution directly out of the bottle. If necessary, you can rinse your lenses with saline or a multi-purpose solution for insertion. Always discard your old lens holder case between purchases of new bottles of Sauflon solution. Each purchase will provide a new lens holder case containing a fresh catalytic disc. Contact my office for alternative recommendations if you find you are sensitive to this form of disinfection. LUBRICATING SOFT CONTACT LENSES Soft lenses are made of water and a "water loving" plastic polymer, however, while the lenses, the water that evaporates is replaced by your own tears. Like the rest of your body, your lenses and your eyes may become dehydrated from time to time. It is normal to require lubrication occasionally but not all the time. Lubricating solutions may be used as needed, up to several times a day, while you are wearing your lenses. To use, simply place one or two drops of lubricating solution in your eyes as you wear your lenses. Call my office to schedule a progress exam if you must use excessive lubricating solution or you cannot maintain satisfactory wearing comfort.

4 YOUR CONTACT LENS WEARING SCHEDULE (Daily Wear) Your personalized wearing schedule is based on the your lens type, compatibility of your eye tissues, lens materials, and your work and recreational habits. Since this is your first experience, or you have not worn contacts for a period of time, I advise that you gradually build up wearing time in the first few days of wear. Generally, an eight hour first day is achievable comfortably for most patients. Subsequently, add approximately 2-3 hours each day until a desirable wearing time is maintained. Please don't exceed this recommended schedule, and do not wear your contact lenses if your eyes are uncomfortable. Contact my office, if you cannot achieve a satisfactory wearing schedule. GOOD HABITS OF SOFT CONTACT LENS WEAR - Always wash your hands thoroughly. - Always work the same lens first to avoid switched lenses. - Always check to see if your lens is inside out before insertion. - Always use contact lens care solutions that my office has recommended. - Always follow recommended care procedures, as directed. - Always attend recommended contact lens progress examinations. - Always have a current pair of prescription glasses available for use. - Always keep your lens storage container clean. - Always remove your contacts if your eyes are excessively red, or irritated. - Always call my office if you have questions or concerns. BAD HABITS OF SOFT CONTACT LENS WEAR - Never over-wear your contact lenses and never wear beyond their discard date. - Never wear contacts if your eyes are excessively red, or irritated. - Never wear contacts if your vision becomes blurry. - Never handle your lenses with dirty hands. - Never use saliva, or water, to wet or clean your lenses. - Never handle your contacts with long or dirty fingernails. - Never use commercial eye drops that claim to make eyes less red. - Never go more than one year between eye examinations. - Never use anyone else's contact lens solutions. - Never wear your contact lenses if you have a serious cold or the flu. - Never hesitate to call our office if you need our assistance. TROUBLESHOOTING SOFT CONTACT LENSES If you experience problems wearing contact lenses, look through the following list of problem / solution antidotes for a possible remedy to the issue. A lens flattens on your finger prior to insertion: The lens or your finger may be too wet. If your finger is too wet, the lens will stick to your finger instead of your eye. Shake the lens once or twice before inserting the lens. A lens flattens on your finger during insertion: The lens is hitting your eyelashes or eyelid. You must open your eye wider and/or take better aim. Flattening of the lens can also occur if you press on your eye too hard while inserting your lens. After insertion, a centered lens still causes discomfort: Possibly dust, mucus or make-up is under the lens. Gently touch the lens with your index finger and slide it slowly away from the center of your eye onto the white portion of your eye and then back again onto the center. If the lens is still uncomfortable, remove, clean, rinse and reinsert your lens.

5 A lens was left out of solution and it has dried out: Lenses are not necessarily destroyed if they accidentally dry out and become hard. To rehydrate or re-soften a dry lens, carefully place it in fresh multipurpose solution to hydrate, and disinfect, as recommended before wearing. Before insertion, check your lens for defects. After insertion, your lens burns or stings your eye: Your lens should be removed and rinsed thoroughly to remove any residue or debris. This can also be caused by improper solutions. If your eye continues to burn, do not wear your lenses and call my office for recommendations. You have long fingernails: Sorry, you must have short fingernails to handle your contact lenses comfortably and safely. After some time of wear, your lenses are uncomfortable: Remove, rinse and reinsert your lenses. Apply a lubricating comfort drop if needed. If you cannot maintain a satisfactory wearing schedule, contact my office for further recommendations. Your eyes are typically red and excessively irritated: Do not wear your contacts if you suspect eye infection. Make sure you are rinsing your lenses thoroughly and following all disinfection procedures properly. Do not wear your lenses if this symptom remains. Contact my office for further recommendations. You experience blurry vision or sensitivity to light: Continued blurry vision or light sensitivity may indicate a problem caused by a dirty lens, a damaged lens, and lenses in the wrong eye, eye abrasions, eye infections, or prescription changes. Always feel comfortable in contacting my office if you experience extraordinary problems or concerns. This eye care report is provided as an advanced level of service. If you have any questions after reading this report, or if ocular, or visual symptoms persist, please contact my office immediately. Thank you for allowing us to participate in your care. Respectfully, Drs. Frank and Matthew Puzio

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