CLM - Extended Wear - PAP Week 1 Flashcards
By what percentage does the cornea swell overnight with eyelid closure?
~4%
By what percentage does corneal oxygen concentration decrease to with eyelid closure?
Decreases to 4%
What is the minimum concentration for oxygen for no reduction in physiological function?
~10%
What happens to lens temperature, tear pH, and tear osmolarity with lid closure (overnight)?
Temperature increases (~2C)
Tear pH decreases
Tear osmolarity decreases
What is the minimum Dk/t set by the Holden-Mertz Criteria for daily and overnight contact lens wear?
Daily - 24
Overnight - 87
What revision to the Holden-Mertz Criteria is being considered, and to prevent what?
Critical Dk/t should be revised to at least 125 to prevent stromal anoxia
Is corneal swelling uniform? Explain.
No it isnt
Peripheral > central
Are adapted contact lens wearers more resistant to swelling than non-contact lens wearers or vice versa?
Adapted contact lens wearers are more resistant
List 6 possible indications for extended wear contact lenses.
Convenience
Aphakes
Anisometropic infants
Therapeutic
Occupation
Pre-refractive surgery
List four therapeutic uses for extended wear contact lenses.
Bullous keratopathy
Dry eye disease
Post-corneal surgery
Recurrent erosions
List 8 lifestyle considerations for extended wear contact lenses.
History of CL non-compliance
Smoking
Regular swimming
Chronic blepharitis or MGD
Severe dry eye disease
History of previous corneal inflammatory events
Delayed wound healing
Immunocomprised
Are hydrogel soft contact lenses physiologically acceptable for extended wear? Explain?
No, they do not meet the Holden-Mertz Criteria
What ocular effect is evident after a few hours of wearing hydrogel soft contact lenses?
Limbal hyperaemia
What is the major factor for limbal hyperaemia? What is tis directly related to?
Hypoxia, directly related to lens oxygen transmissibility
List 6 ocular pathologies that can occur as a result of hydrogel soft contact lenses.
Limbal hyperaemia
Epithelial microcysts
Stromal oedema
Stromal neovascularisation
Endothelial blebs
Endothelial polymegathism
What size are epithelial microcysts and what are they composed of?
4-30μm
Composed of necrotic cells/debris
What technique can be used to see epithelial microcysts on a slit-lamp?
Characteristic reversed illumination with retroillumination
After how long do epithelial microcysts occur (for extended wear in hydrogel) and after what condition specifically?
Typically occurs after >2 months of hypoxia
Where do epithelial microcysts originate and how do they move?
Originate deep in the epithelium and migrate anteriorly
Is stromal oedema with extended wear hydrogel lenses acute or chronic? Is it reversible? What is the occurence of striae and folds (percentage)?
Striae >5%
Folds >10%
Acute and reversible
Define stromal neovascularisation. In what proportion of patients using hydrogel extended wear lenses will this occur?
Formation and extension of new capillaries into the previously avascular corneal stroma
Occurs in ~67% of patients using extended wear hydrogel lenses
Does the vascular response in stromal neovascularisation regress over time after fitting to a higher Dk/t lens or is it completely irreversible?
Does eventually regress after 1 month somewhat
What are endothelial blebs and are they a short or long term response to extended wear hydrogel lenses?
Oedematous cells (blebs) creating dark spots on the endothelial mosaic
Short term response to contact lens wear
Do endothelial blebs persist for long after lens removal?
Disappears within 10 minites of lens removal
What is the aetiology of endothelial blebs?
Altered stromal pH
What is endothelial polymegathism? Is it permanent or reversible? What does it occur in response to?
Increased variability in the size of corneal endothelial cells
It is a permanent change
It occurs in response to chronic hypoxia