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SPECIAL CONTACT LENSES

1. Lenses to aid diagnosis and surgery


Haag streits
Eliminate bright reflex when doing specular reflection
Eisner CL
Gonioscopy
Different types and designs
Fundus
High negative powered CL
Observation of fundus of high myope during ophthalmoscopy
Reduces mag and enlarges field
Lenses for laser
CL with special properties for laser transmission and safety used
surgery
Iridectomy
Trabeculectory
Capsulotomy
Vitrectomy
2. Protective lenses
- Lead lined haptic shell: covers eye during radiation treatment
3. Therapeutic + special SCL
Bandage lens
Bullous keratopathy ulceration
Helps healing
Prevents lid rubbing damaged cornea
Medical
Soft lenses soaked in drug until saturated
applicators
Collagen lenses
Sufficiently translucent for hazy vision
Applying water soluble and non-water soluble drugs
Klein applicator + Anderson applicator
Haptic lenses
Drugs pumped beneath lens through special holes
4. Research
a. Electrodes
b. EM
c. Stabilized retinal images
d. Tear measurements
e. Das exchange
5. X-chrom lenses
- Red CL; peak transmission 595nm; one eye
- Overcome RG deficienciese/monochromats
- Both eyes open > different perception of hues > alter saturation and brightness
- Wearer relates appearance to particular colour name
- DDV: can induce Pulfrich phenomenon
6. Sport:
Cold weather
Swimming
Scuba diving

ADV: No misting of specs


DDV: cleaning solutions freeze
Hypotonia
Dirty water
In water = 42D hyperope
Special CL/lenses under mask
DDV: bubbles under RGP

X-chrome lenses
Discuss the therapeutic uses of soft contact lenses
PEDIATRIC CL
Indications

Contraindication
DDV

Criteria for
proper lens fit

Optometry
exam

Lens type

Evaluating fit
Success

Insertion

(therapeutic)
1. Aphakia
2. High myopia
3. Irregular astigmatism
4. Anisometropia
Mmoderate refractive states
Frequent exams and lens changes because of fit and power
Excess financial implications
Physiological risks do not outweigh benefits
1. Optimal refractive compensation
2. Good fit:
- Centration
- Movement
- Alignment
3. Adequate tolerance
4. Adequate physiological response
- Px might need to wear for rest of his life
- No clear idea of how young cornea functions with lenses
Refractive power
- Retinoscopy = usual method
BC
- Keratometry if px cooperates
- Series of trial lenses (anaesthesia may be required) done in
theatre for cataract removal
Silicone:
- Very good ito Oxygen
- Limited powers
Hydrogels
- Aphakia, myopia, hyperopia
- Infants under few months = steep BC (7-8mm)
- Over 2 years = adult type lens
Rigid lens:
- Fitted acc to normal principles
Slitlamp might be out of question
Direct observation may be only method
Possible to dispense 9-10 lenses per eye per year
Most children quickly tolerate lenses and care
Usually 2-4 weeks adequate for parent/child to become familiar with
procedure
Restrain child
Put on floor, hold head with elbows, use hands to hold everything elses
down
Fit lenses in under top lid lift lid and form pocket

BIFOCALS
Number of changes in
Lids become

less elastic

Changes in VA

Pupils smaller
Crystalline lens
loses
transparency

presbyopic eye that can affect fit of CL:


Affects lens movement
Lid margins fall away from globe slightly
Meibomian gland dysfunction
- Drying
- Lacrimal glands may produce more viscous tears
VA reduces after 5th decade
Worse in poor light (lens and media hazy)
Use CSF
Problems when fitting annular/aspheric simultaneous lenses
Pupil area needs to be covered by both far and near zones
Reduces amount of light passing through
Changes in retina > decline in ability to see in low illumination

Changes that occur in a presbyopic eye


Lids become less elastic
Changes in VA
Pupils become smaller
Lens loses transparency
Changes in retina low illumination problem
Bifocal design based on five different categories:
1. Simultaneous vision bifcals
2. Translating bifocals
3. Monovision
4. Multi-zone bifocals
5. Non-refractive bifocals:
a. Pinhole
b. Spherical aberration correcting lenses
c. Diffraction bifocals
Simultaneous vision
Definition
Light enters eye from both distance and near section simultaneously
Vision
Distance
- clear image formed at retina of distance view
- blurred image from near superimposed at same time
Near > opposite
ADV
Patient doesnt have to hold head/material at specific position
DDV
Vision isnt perfectly clear at both distance and near
Patient has to be happy with compromised vision
Driving in bright sunlight > near section is in centre of lens
Pupil size change > ratio of light entering eye from two sections of lens
changes
Translating bifocals
Theory
Patients view translates from distance to near and back just as view
changes when wearing bifocal specsd
Properties
Prism ballast/truncation used to orientate correctly
Mechanism
Achieving correct amount of movement difficult
Lens must move up when px looks down to read so pupil views through

reading seg
Monovision
Definition
Success
ADV
DDV

Procedure

Not a bifocal
Most successful
60-65% success
Simple technique
Little increase in costs
Binocular vision degraded
Px must suppress central vision of each eye alternately
Night ddriving > difficult to ignore blurred images when all you have is
bright clear light and bright blurred one
Often pair of compensating specs needed/distance lens used to replace
near lens while driving
Dominant eye fitted with distance lens
Research: swopping system is just as successful
Add is as low as possible
Explain very carefully to px

Multizone bifocals
Pupil size
Problem overcome by designing lens with many distance and near zones
ADV
As pupil size varies, more or less portions of distance and near used
50/50 ratio between distance and near maintained
EG
Acuvue bifocal pupil intelligent lens design
Non-refractive BF
1. Pinhole BF
2. Spherical aberration BF
3. Diffraction BF
Diffraction bifocals
Holographic bifocal contact lens
Near image formed by diffraction
Distance image form by refraction
Advantages
pupil independence
equal image intensity
simultaneous vision (diffracted blur, refracted blur)
ease of fitting
success quickly known
Disadvantages
decrease illumination
decrease contrast
decentrated ghost images

Choice of bifocals
1. Pxs occupation
Good
Pilot/driver
distance
Concentric BF shouldnt be used
vision
Alternating BF better
Good near
Concentric with small distance portion
vision
Alternating with large seg
Good
Eye level/slightly below
intermediate
Musician
Add designed for intermediate
Concentric BF possibility
2. No one BF will satisfy everybody
3. Modern soft lens BF > make sure px understands limitations and accept compromise
Discuss bifocal contact lens designs. Include a description of focus progressive
bifocals
1. Simultaneous Vision
Light enters the eye from distance and near simultaneously
When viewing at distance, clear distance image formed at retina but at the same
time blurred near image is superimposed over it
Opposite occurs when viewing near
Advantages: patient does not have to hold head or material at a specific distance
Disadvantages:
i. Vision is not perfectly clear at distance or at near (compromised vision)
ii. As pupil sizes changes so does the ratio of light entering the eye from the 2
sections of the lens
iii. Driving in bright sunlight and near section in the centre of the lens
2. Translating bifocals
Theory: patients view translates from distance to near and back just as with
spectacles
Prism ballast to keep lenses orientated correctly
Truncation sometimes performed
Achieving correct amount of movement is difficult
Lens has to move up when the patient looks down to read so that the pupil views
through the reading segment
3. Monovision
Most successful technique
Advantages: simple, little increase in costs
Objection: Binocular vision degraded, the patient has to learn to suppress central
vision of each eye alternately
Usually dominant eye fitted with the distance lens
Add as low as possible
Common problem = night driving, often compensating spectacles needed or
distance lens to replace the near one
4. Multi-zone bifocal
Many distance and near zones
Advantages: pupil sizes varies, more or less portions of distance and near used, but
ratio between distance and near maintained
5. Non-refractive bifocals

Pinhole bifocals
Spherical aberration bifocals
Diffractive bifocals
Focus Progressives
Quick fitting guide
1. Sperocylindrical refraction, determine near add and select initial lens. Initial trail
lens power = spherical equivalent refraction + spectacle/2
2. Insert lenses, allow to settle, with both eyes viewing together, evaluate acuity and
subjective quality of vision at distance and near
3. While both eyes are viewing, over-refraction using hand held trail lenses. Endpoint =
lenses which give best balance between distance and near vision.
To improve near vision
With patient viewing binocularly
Determine amount of additional plus or less minus power for one or both eyes that
provides satisfactory near vision
With over refraction in place, recheck acuity and quality of binocular vision at distance
If distance vision is no longer in acceptable, decrease plus over refraction for one or both
eyes, rechecking near vision after each step.
To improve distance vision
With patient viewing binocularly
Determine amount of additional minus or less plus power for one or both eyes that
provides satisfactory distance vision
With over refraction in place, recheck acuity and quality of binocular vision at near
If near vision is no longer acceptable, decrease over refraction for one or both eye,
rechecking distance vision after each step.