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    Special Contact Lenses

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    black00swan
    The document discusses various types of specialty contact lenses, including those used for diagnosis and surgery, protection, therapy, research, color deficiency, and sports. It describes lenses that aid in procedures like gonioscopy, fundus examination, and laser surgery. Therapeutic soft contact lenses are discussed for uses like bandaging damaged corneas. Bifocal contact lens designs include simultaneous vision, translating, monovision, multi-zone, and non-refractive types. Focus progressive bifocals provide clear vision at both distance and near through over-refraction.

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    Special Contact Lenses

    Uploaded by

    black00swan
    78 views6 pages
    The document discusses various types of specialty contact lenses, including those used for diagnosis and surgery, protection, therapy, research, color deficiency, and sports. It describes lenses that aid in procedures like gonioscopy, fundus examination, and laser surgery. Therapeutic soft contact lenses are discussed for uses like bandaging damaged corneas. Bifocal contact lens designs include simultaneous vision, translating, monovision, multi-zone, and non-refractive types. Focus progressive bifocals provide clear vision at both distance and near through over-refraction.

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    9. Special Contact Lenses

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    9. Special Contact Lenses

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    The document discusses various types of specialty contact lenses, including those used for diagnosis and surgery, protection, therapy, research, color deficiency, and sports. It describes lenses that aid in procedures like gonioscopy, fundus examination, and laser surgery. Therapeutic soft contact lenses are discussed for uses like bandaging damaged corneas. Bifocal contact lens designs include simultaneous vision, translating, monovision, multi-zone, and non-refractive types. Focus progressive bifocals provide clear vision at both distance and near through over-refraction.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    78 views6 pages

    Special Contact Lenses

    Uploaded by

    black00swan
    The document discusses various types of specialty contact lenses, including those used for diagnosis and surgery, protection, therapy, research, color deficiency, and sports. It describes lenses that aid in procedures like gonioscopy, fundus examination, and laser surgery. Therapeutic soft contact lenses are discussed for uses like bandaging damaged corneas. Bifocal contact lens designs include simultaneous vision, translating, monovision, multi-zone, and non-refractive types. Focus progressive bifocals provide clear vision at both distance and near through over-refraction.

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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.

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