Prepare For Day 1 Review

It is normal for patients to be delighted with the day one results. For over  90% of patients the lenses they have will be the final specification they need. Because it takes 10-14 days to for the cornea to fully correct on day 1  the full power will not be corrected, and the effect wears off quite quickly. On day one it is not uncommon for a -4.00 myope to be-1.00 or -2.00 when you see them for review, and they will still be delighted! From a clinical perspective the day 1 appointment is not going to give us much valuable information, but its great to get the feedback from the patient. And to offer any support or answer questions.

The typical routine for the day 1 review is-
Welcome the patients, ask them how their vision is, ask them how they managed lens handling.

Check visions and refraction.
Check binocular VA
Do a spherical only refraction and each eye and acuity.
If acuity is poor do a sphero-cyl refraction and acuity.
Don’t worry if this is only a partial correction, that is expected. Young eyes seem to correct much quicker than even teenagers which are quicker than adults. The stable correction will be revealed at the next appointment at 2 weeks.

Take topography and review subtractive map.
Like the VA this will likely show a vague partial power treatment zone than we would expect for the power. What to look for is that the treatment zone is forming in the bullseye position.

Check corneas.
If lenses have been removed by the patient when they woke up there will usually be minimal staining. There can be corneal staining from tear film debris. This type of staining becomes less common by week 2. These are highlighted by green outlines. Staining that would cause concern which would be accompanied by discomfort after removal is lens abrasion on the corneal apex., highlighted in red.

If you instruct the patient to keep lenses in until the appointment the tear film debris usually will leave some stain after lens removal. This also usually disrupts the VA as the lens sits in a different position in the open eye. So two treatment zones are formed, causing a reduced VA. Topography and lens design being so accurate it is rare to get abrasive stain. For this reason it is normal to get patients to remove the lenses on waking. Abrasive stain and the stromal flare is still visible hours after lens removal.

Answer any questions the patient has or offer any lens handling coaching. Encourage the patient for the improving vision they will experience over the next two weeks.

It is important not to have the next appointment before 2 weeks. The correction will not be fully achieved until that point, no no lens adjustments can be made. It also it gives the patient time to get into a routine.

Patients will typically wake up getting their full correction by day 2 or day 3. Their vision will fade as the day goes on, but by day 4 or 5 most will find it lasting until the evening. If their vision fades they can put on their glasses, reassure them although they might feel a bit strong they won’t do them any harm. Advise NO soft day lens wear if they wore them previously. These massage the epithelium undoing the night lens effect, slowing the time until final correction is achieved.

✅ TASKS TO DO

• Welcome the patient and ask them how their visionis and how it was just after they removed the lenses.
• Check BVS refraction and VA, and sphero-cyl if VA reduced with BVS correction.
• Check topography to see treatment zone starting to form and slit lamp examine cornea.
• Set up next review appointment and encourage patient they have started out well on their night lens journey.