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Contact Lens I Part 2 > Contact Lens 1-2: Presbyopic SCL Fitting > Flashcards

Contact Lens 1-2: Presbyopic SCL Fitting Flashcards

1
Q

What is the largest untapped segment of the CL market?

a. Why?

A

Presbyopia

a. Steady increase in peeps over 60. 8% in 1950; 11% in 2009; and expected to hit 22% in 2050

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2
Q

3 Options for Presbyopes

A
  1. Distance SCL w/Reading Glasses
  2. Monovision SCL
  3. Multifocal SCL
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3
Q

Distance SCL w/Reading Glasses

  1. Number of Focal points?
  2. Best for what type of wearers?
  3. Con?
  4. Pro?
  5. What options are there?
  6. Pt stay Binocular or Monocular?
A
  1. 2
  2. Bifocal wearers or those w/o Significant Intermediate Needs
  3. Doesn’t get rid of the need for Glasses
  4. Easy Fit
  5. Toric Options
  6. Pt stays Binocular
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4
Q

Monovision SCL

  1. What is it?
  2. Visual System can alternate what?
A
  1. Correction of 1 eye for DISTANCE and the other for NEAR

2. Central Suppression as needed

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5
Q

How does monovision work?

  1. Which eye is fit for Distance?
  2. Which is fit for near?
  3. How does it work?
A
  1. Dominant Eye usually
  2. Non-Dominant (Distance Rx + Near Add)
  3. a. Interocular Blur Suppression
    b. Pt Learns which eye to use for which task (“brain”)
    c. Suppresses Dominant Eye when reading
    d. Suppresses Non-Dominant Eye when viewing at distance
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6
Q

Acuity In Monovision

  1. What happens to it?
  2. What is lost?
A
  1. about 1 letter loss in Binocular DVA per DIOPTER of ADD POWER
  2. Loss in Stereoacuity DIrectly Proportional w/Increasing Add Power
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7
Q

Drawback to Monovision

  1. 3 drawbacks?
  2. Success rate?
A
  1. a. Stereopsis reduced
    b. Contrast loss and difficulty suppressing bright images against a dark background
    c. Glare
  2. varies from 67-86%
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8
Q

Approach to Monovision

  1. 2 ways to determine Dominant eye?
    a. When determining Dominance, what needs to be done?
A
  1. Triangle Test and Swinging Plus Test

a. Pt HAS to be FULLY corrected for Distance

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9
Q

Triangle Test

  1. How is it done?
A
  1. Hold hands at arm’s length; form triangle w/thumbs at the bottom; Center 20/30-20/40 letter at distance; Close 1 eye then the other; and the eye that can STILL SEE THE TARGET when the other is closed is the DOMINANT EYE!
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10
Q

Swinging Plus Test

  1. How is it done?
  2. How do you tell which eye is MORE DOMINANT?
A
  1. Use 20/30 to 20/40 letter at distance then Swing +2.00 DS trial lens back and forth from right to left eye
  2. Eye that’s MOST BLURRED from the +2.00 DS loose lens being in front of it is the DOMINANT EYE
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11
Q

What other ways are there to determine Ocular dominance?

A
  1. Eye you put up to a camera
  2. Eye you Shoot with
  3. If you have unequal BCVA, the eye w/better BCVA is the dominant.
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12
Q

Near Eye Selection

  1. % of cases where near eye is the Non-dominant Eye?
  2. Start w/which eye as the NEAR EYE?
  3. When do we consider switching?
A
  1. 95%
  2. Non-dominant
  3. when adaptation is difficult
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13
Q

Adaptation to Monovision

  1. How long does Full adaptation usually take?
  2. May take as long as…?
  3. Difficulties may include what 3 things?
A
  1. 2-3 wks (counsel on activities that should be initially avoided)
  2. 4-6 wks
  3. Blur, Eyestrain, Headaches
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14
Q

Over-Refraction in Monovision SCL

  1. 2 things that you can use…?
A
  1. Trial Lenses or Flippers
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15
Q

Over-Refraction in Monovision

  1. Check vision how?
    a. What do we expect to see reduced?
  2. How do we over-refract?
A
  1. At DISTANCE and NEAR Monocularly AND Binocularly
    a. reduced Monocular DVA in non-Dominant Eye and reduced Monocular NVA in Dominant Eye
  2. In Free space and Over-refract MONOCULARLY (Present Lenses to DOMINANT EYE for Distance…and Non-Dominant eye for NEAR)
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16
Q

Verifying Whether a Change Needs to be Made

  1. Depends on Patient’s what?
    a. Incorporating what?
    b. ANY CHANGES TO BE MADE SHOULD BE VERIFIED at what?
A
  1. visual needs (Prioritization)
    a. a +0.50 over-refraction into the Non-dominant eye’s SCL Rx
    b. at BOTH DISTANCE and NEAR
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17
Q

To Determine a Patient’s Effective Add

  1. Effective Add: What is it?
  2. Over-refract which eye?
A
  1. The amt of reading add that the patient is getting in their lenses
  2. the NON-DOMINANT eye MONOCULARLY at DISTANCE!

(I.e. if patient takes a -1.00 DS over their non-dominant eye MONOCULARLY to get from 20/40 to 20/20 at distance, their effective add is a +1.00 w/their current SCL)

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18
Q

Should Pilots wear Monovision CLs?

A
  1. NO! It’s PROHIBITED by the FAA
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19
Q

Depth Perception with Monovision

  1. Decrease in Stereopsis: By how much?
  2. Decrease in Stereo increases with what?
  3. % of monovision patients that report problems with night driving?
  4. Who is a Liability to fit in Monovision?
A
  1. b/w 37-150 seconds of arc
  2. with Increasing Add Power
  3. 80%
  4. Anyone w/Critical Depth Perception Requirements
20
Q

What 3 things need to be done and Documented in regards to Monovision SCL Wearers?

A
  1. Educate pt on Adaptation Period to Monovision
  2. Educate on Loss of Contract Sensitivity, decrease in Depth Perception and increase in glare at night
  3. Prescribe a Pair of Glasses to wear over the CL for driving when finalizing the CLRx
21
Q

Multifocal/Bifocal SCL

  1. Most are of what design?
    a. What does this mean?
    b. They can be 1 of 2 things?
  2. There’s also an ALTERNATING VISION (TRANSLATING) design: what is it?
A
  1. SIMULTANEOUS VISION Design
    a. there’s a focused image and an out-of-focus image on the retina at one time.
    b. Center distance or Center Near
  2. Only a Focused image on the Retina at one time.
22
Q

Multifocal SCL

  1. 4 Types
A
  1. Concentric
  2. Aspheric
  3. Combo Concentric/Aspheric
  4. Diffractive (None on the market today)
23
Q

Aspheric Designs

  1. How are they centered?
A
  1. Can be DISTANCE or NEAR Centered; depends on brand…some use 1 over the other, and some use both
24
Q

Aspheric Designs that use BOTH Distance and Near Lenses

  1. What are they?
A
  1. Proclear Multifocal

2. Biofinity Multifocal

25
Q

Near-Centered Aspheric Designs only

  1. What are the 2?
A
  1. Air Optix Aqua Multifocal

2. Purevision 2 Multifocal

26
Q

Biofinity Multifocal Fitting Guide

  1. Add Power
    a. +1
    b. +1.50
    c. +2.00
    d. +2.50
A
  1. Dominant/Non-Dominant Eye
    a. D/D
    b. D/D
    c. D/N
    d. D/N
27
Q

Air Optix Multifocal Fitting Guide

  1. Select Initial Lenses
    a. Then determine what things?

b. Choose Add based on what?

A
  1. a. Vertex-corrected, Least minus/most plus, spherical equivalent distance Rx
    b. Lo, MED, HI based on chart: over BOTH EYES

Lo: Up to +1.25

MED: 1.50 to 2.00

HIGH: 2.25 to 2.50

28
Q

Concentric/Aspheric Design

  1. What is it?
  2. What company makes it?
A
  1. Hybrid of the 2 designs

2. Acuvue Oasys for Presbyopia

29
Q

Simultaneous Vision Design

  • Regardless of whether they’re concentric, aspheric or combination concentric/aspheric can be the following:
    1. Center Distance (3)
    2. Center Near (4)
A
  1. a. Acuvue Oasys fro Presbyopia (Vistakon)
    b. Biofinity Multifocal D Lens (Coopervision)
    c. Proclear Multifocal D Lens (Coopervision)
  2. a. Air Optic Multifocal (Ciba/Alcon)
    b. Purevision 2 Multifocal (Bausch + Lomb)
    c. Proclear Multifocal N Lens (Coopervision)
    d. Biofinity Multifocal N Lens (Coopervision)
30
Q

Challenging Multifocal SCL Patients

  1. Pupils smaller than what?
  2. What other 2?
A
  1. smaller than 3 mm

2. Emmetropes and Peeps who don’t want to Compromise any of their distance vision

31
Q

What about Astigmatism?

  1. Most designs Can’t be used for patients with more than what?
  2. Only 1 Toric Multifocal SCL on the Market: What is it?
  3. Custom ones?
A
  1. with > 1.00 DC
  2. Proclear Multifocal Toric (Coopervision)
  3. Custom Toric Multifocal SCL Available
32
Q

Multifocal/Bifocal SCL

  1. Most are SIMULTANEOUS VISION design: What 3 things?
  2. There are also what designs?
A
  1. Aspheric, Concentric, and Combo Concentric/Aspheric

2. Alternating Vision (Translating) Designs

33
Q

What’s the Alternating Vision Design?

What is it?

A

Distance at top half of CL and Near at bottom half. (Only 1 Translating SCL on the Market)

*Primary Gaze uses DISTANCE and DOWN GAZE uses Near

34
Q

Translating CLs

  1. Good for what kind of patients?
  2. Who shouldn’t use them?
    a. Which LID has the MOST EFFECT on TRANSLATION?
A
  1. w/Lower Lid position below the Limbus and/or Loose lids are not good candidates
  2. Loose lids don’t allow a lens to translate
    a. UPPER LID; Lower lid accounts for 1mm of the total translation
35
Q

Multifocal SCL: 2 groups

A
  1. Simultaneous Vision
    a. Aspheric (Center distance or Center Near)
    b. Concentric (Center Distance or Center Near)
    c. Diffractive
  2. Alternating Vision/Translating
36
Q

Fitting Multifocal SCL

  1. How is it done?
A
  1. Choose Lenses according to manufacturer’s fitting guide;
  2. Place diagnostic Lenses on Patient’s Eyes
  3. Let the Lenses Settle
  4. Check Vision/Over-Refraction
  5. Check Fit
37
Q

Simultaneous Multifocal SCL Vision

  1. Check vision how?
A
  1. At Distance and Near Monocularly and Binocularly
    * May have reduced mono distance vision in eye w/HIGHER ADD POWER or Center-Near Design and in Near Vision in eye with LOWER ADD POWER or Center-Distance Design
38
Q

Over-Refracting in Multifocal SCL

  1. Over-Refract how?
  2. Some designs call for Over-Refraction how?
  3. Any changes to be made should be verified how?
A
  1. in FREE SPACE!!
  2. BI-OCULARLY at distance and near Separately (Bi-ocularly –> Both eyes are open but loose lenses or flippers are presented over one eye only)
  3. Both at DISTANCE and NEAR
39
Q

Refracting Bi-Ocularly

  1. How is it done?
A
  1. Both Eyes Open; Loose Lens or Flipper over ONE EYE ONLY!!
40
Q

Verifying whether a Change needs to be made

  1. Assess what?
  2. Most important vision is what?
A
  1. Patient’s Visual Priorities
  2. is OU VISION
    (e. g. Incorporating a -0.50 over-refraction into the dominant eye’s SCL Rx to improve distance)
41
Q

Trouble Shooting

  1. Poor Distance Vision
    a. Check for what?
  2. Poor Near Vision
    a. Do what?
A
  1. a. Check for Underminusing at distance (esp in DOMINANT EYE)

b. Reduce Add in Dominant Eye
c. Uncorrected Cyl??

  1. a. Push PLUS at distance (esp. in non-dominant eye)
    b. Increase the add in the non-dominant eye
    c. Uncorrected Cyl?
42
Q
  • Language…Use what terms?

2. Avoid what terms?

A
  1. Balance and Prioritizing

2. Compromise or Sacrifice

43
Q

Creative Combinations

  1. Modified Monovision
  2. What else?
A
  1. Single vision SCL in dominant Eye and Multifocal SCL in non-dominant eye; Fitting monovision by correcting dominant eye for distance and the non-dominant eye for intermediate
  2. a. Fitting a different brand of multifocal SCL in each eye
    b. Only wearing a lens in 1 eye (Multifocal or single vision)
    c. Distance SCL w/Intermediate Glasses
    d. Distance SCL w/”Computer PAL”
44
Q

Presbyopic Correction Success? (3)

A
  1. Cosmesis is an issue
  2. Spectacles are bothersome
  3. Visual demands are not very critical
45
Q
  1. Monovision: Pros/Cons
A
  1. Decreased Stereo
    a. Not for every occupation
    b. Always Prescribe Overglasses for Driving
46
Q
  1. Multifocal: Pros/Cons
A
  1. Better stereo but depends on lens design
    a. Flexible patient
    b. Determine Patient’s primary visual demand
47
Q

Distance SCL w/Overglasses: Pros/Cons

A
  1. No intermediate with NVO
  2. Taking glasses on and off
  3. For patients w/critical visual demands and no cosmetic concern

Contact Lens I Part 2 (5 decks)

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