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CL > Final > Flashcards

Final Flashcards

1
Q

Top 3 considerations with SCL

A

wet ability, mechanical, o2 perm

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2
Q

Polymer in CL

A

Bind H20 or oxygen permeability.

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3
Q

How to make CL

A

Hema background, polymerize, add water.

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4
Q

Ways to make SCL

A

Lathe cutting, spin casting, cast molding.

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5
Q

SCL Advantages

A

comfort, large size, easy to fit, decreased flare/glare, decreased spectacle blur, eye color change.

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6
Q

SCL Disadvantages

A

cost, doesn’t mask astigmatism, VA, Optics, more risks, hard to verify, increased risk, life expectancy.

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7
Q

When to prescribe SCL

A

spherical, low astigmatism, sports, part time, good tear film, previous GP failure, extreme refractive errors, anisometropia.

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8
Q

CI with SCL

A

compromised eye: surgery, oc dz, systemic dz, poor hygiene, atopic disease, vascularization. High astigmatism or irregular.

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9
Q

Extended wear

A

6 days

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10
Q

DW

A

Only during the day

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11
Q

FW

A

Flexible wear. Sometimes DW and sometimes EW

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12
Q

Low CL H20

A

20-40

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13
Q

Medium CL H20

A

41-60

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14
Q

High CL H20

A

Greater than 60

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15
Q

How is water content determined

A

by weight

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16
Q

High water content dehydrates ______

A

More quickly.

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17
Q

Low water content

A

Has more structural integrity. Stiffer.

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18
Q

High water content lens ____ quicker and _____ sooner

A

dehydrates; equilibrates.

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19
Q

Hydrophilic monomers

A

HEMA, GMA, VA, MA

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20
Q

Non-ionic hydrophilic

A

HEMA, GMA, VA. Interaction without a formal charge

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21
Q

Ionic hydrophilic

A

MA. Needs a formal charge.

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22
Q

Hydrophobic monomers

A

Mechanical strength. Silicone.

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23
Q

Cross Linking agents

A

mechanical strength and thermal stability.

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24
Q

Silicone Hydrogel

A

Good oxygen permeability, also referred to as SCL, similar diameters.

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25
Q

DK for overnight wear

A

Needs to be 125 to sonly 4% occurs. 4% is swelling that occurs in closed eye.

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26
Q

What are the only lenses that meet the ability for NW

A

Silicone hydrogel

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27
Q

How to optimize oxygen transmission

A

Silicone, H20, decreased thickness.

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28
Q

DK vs H20

A

Increasing DK results in decreased H20. DK does not like water.

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29
Q

Biofinity

A

An outlier. Somehow has high water and high DK.

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30
Q

Silicone hydrogel

A

High DK and low H20

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31
Q

Conventional hydrogel

A

Low DK and high H20

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32
Q

Limbal hypermia and lenses

A

Less hyperemia with silicone hydrogel.

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33
Q

SCL Optics

A

Tear lens does not go under the tear. Don’t need to take it into account. Refractive index changes with hydration and temperature.

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34
Q

Aspheric CL

A

Controls spherical aberrations. Get power at center but may change as leaves center. Doesn’t compensate though. All peripheral rays center in the same place.

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35
Q

Spherical CL

A

Power is constant. Central and peripheral rays are not focused at a single point.

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36
Q

FDA Ionic division

A

Ionic if >0.2% ionic material

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37
Q

FDA water content division

A

Low >50. High

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38
Q

FDA Group 1

A

Low water and non-ionic

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39
Q

FDA Group 2

A

High water content and non ionic

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40
Q

FDA group 3

A

Low water content ionic

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41
Q

FDA group 4

A

High water content and ionic.

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42
Q

Time for a group 5

A

Silicone hydrogels are unique and some think they should have their own group

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43
Q

Unique silicone hydrogel

A

Low protein deposits, high lipid deposits, surface wet ability varies, unique solution interactions.

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44
Q

Silicone hydrogel protein deposits

A

Low. Less uptake than hydrogel. Concentration near the surface. More denatured. Presents as GPC.

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45
Q

Silicone hydrogel lipid deposits

A

more attraction. Sometimes require surfactants.

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46
Q

Modulus

A

High=stiffer and longer wear time. Pro: easier handling and removal. Con: comfort and moves on eye

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47
Q

Modulus of silicone hydrogels

A

LOW

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48
Q

Who determines replacement schedule?

A

ODs

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49
Q

Does replacement schedule =wear time

A

NO

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50
Q

Disposable

A

Remove and discard. Right after taken from eye throw away.

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51
Q

Quarterly replacement

A

Speciality CL

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52
Q

Typical SCL parameter

A

13.8-14 mm. 38-60%. .06-.2 mm. Sphere +6-12. Cylinder: 0 to -2.25

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53
Q

SCL fitting

A

Measure patients HVID and pick one 2 mm larger. Obtain central Ks. Select a BC. Evaluate

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54
Q

Time for equilibrations

A

5-10 minutes

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55
Q

Ideal SCL fit

A

1 mm from limbus, .25-.5mm with blink, .5-1.25mm with blink on up gaze.

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56
Q

Push up test

A

Push up and then see force required and how long to decenter.

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57
Q

Normal BC Radius

A

The normal BC will fit many different corneas.

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58
Q

Flat CL

A

May be uncomfortable due to excessive movement. May have fluting.

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59
Q

Which lens move the most

A

very flexible lenses as they confirm to the eye.

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60
Q

How to fix a CL that is too flat

A

Steepen the base curve or increase the overall lens diameter.

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61
Q

Steeping the BC ____ the fit

A

tightens.

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62
Q

Steep Soft lens fit.

A

Will not move with blink, may be initially comfortable but become tired later. Difficult to dislodge.

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63
Q

How to fix a steep CL

A

Decrease lens diameter, decrease BC.

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64
Q

Labeled vs. actually BC

A

Different brands will label different. A 8.4 BC is flatter than an 8.7 cooper vision.

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65
Q

Lid with SCL

A

can decenter lens. Often overlooked

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66
Q

Tear exchange with RGP

A

20% per blink

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67
Q

Tear exchange with SCL

A

1% per blink

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68
Q

Importance of tear exchange

A

oxygen, nutrients, debris, eliminate waste

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69
Q

IF patient tearing with lens suspect

A

FB beneath lens, lens inside out, solution sensitivity, Lens damage.

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70
Q

Thin lens and water evaporation

A

A thin lens will take water from TF.

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71
Q

Corneal radius and sagital height

A

greater radius=deeper.

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72
Q

Corneal diameter and sagital height

A

Greater diameter=greater sagittal height.

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73
Q

A steep cornea often goes with what?

A

A small cornea

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74
Q

Effective K

A

Used to assist in the selection of BC radius. Incorporated central corneal radius and corneal diameter.

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75
Q

How to calculate effective K

A

For every .2 mm mean K smaller than 11.8 mm subtract 1 D. For every .2 mm mean K greater than 11.8 add 1 D.

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76
Q

Selecting a SCL

A

Find Mean K. Calculate Effective K. Take diameter of eye. Add from the BC chart.

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77
Q

When was the first hydrogel lens approved?

A

1971

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78
Q

Next way to disinfect lenses?

A

Use heat disinfectant but since with non sterile saline. Also tired salt tablets and distilled water.

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79
Q

When was the first chemical disinfectant for SCL invented

A

1977.

80
Q

Solution sensitivity

A

Thimerosal and/or chlorhexidine

81
Q

Heat disinfectants

A

Very effective. However can denature tear secretion on the lens and affect the lens. Could do a 90s microwave.

82
Q

Modern SCL

A

Affective against many organisms. Compatible with ocular tissue, lens polymers. Continue to work under many condition. Less than 1 hour for disinfection. Easy to use and cheap.

83
Q

MPS

A

Cleans, rinses, disinfects.

84
Q

Modes of Cl disinfection

A
  1. Rub, rinse, soak 2. Rinse soak 3. immersion only
85
Q

Recalled lens care products

A

Gave fungal keratitis and acanthamoeba.

86
Q

What makes up the TF

A

mucous, aqueous, inorganic, organics, proteins, lipid lay.

87
Q

What is SCL drops out due to

A

51% discomfort (41% dryness) 13% vision problems (reading 6%, General vision 7%)

88
Q

Silicone Hydrogel and TF

A

High oxygen transmission, dehydrate slower then HEMA, SH have less protein and more lipid. May have reduced wet ability due to silicone.

89
Q

POLYQUAD/ALDOX

A

Less corneal staining

90
Q

Best cleaning for silicone hydrogel

A

Hydrogen peroxide

91
Q

Disinfection times with hydrogen peroxide

A

Platinum disc (longer) vs. catalase.

92
Q

Clear Care cleaning

A

3% peroxide for 10 minutes. Platinum disc neutralization replace the disc every 90 cycles or 3 months. Cleaning from short 5 s rinse.

93
Q

what cleaning regime had the greatest dryness.

A

Clear care.

94
Q

When are blink rates decreased

A

When doing cognitive tasks.

95
Q

What cleaning system had a higher blink rate

A

clear care. The more frequent blink rate=dryness.

96
Q

Oxysept peroxide system

A

3% peroxide for 20 min catalase enzyme neutralization in 2 hours. For all Heme and SH lenses. no preservative. Use a catalase tablet.

97
Q

Saffron one step

A

FDA approved. Only one step.

98
Q

Purilens System

A

UV Generating lamp, subsonic agent, preservative free saline. Use 265 nm.

99
Q

Private label SCL care products

A

Older generation FDA approved MPS lens care products.

100
Q

Enzymatic cleaners

A

Use to get rid of protein. ultrazyme with H202 and enzyme with h202.

101
Q

Rinsing salines

A

Rinses and hydrates. Does NOT disinfect.

102
Q

Antimicrobial lens case

A

Forms an electrochemical coil or battery formed with saline. Release antimicrobial silver ions.

103
Q

how often to replace lens case

A

Every 3 months.

104
Q

How much do CL wearers make up of a practice

A

49%

105
Q

Cl drop out and growth

A

New=29%. Drop out=16%

106
Q

Meibomian Gland Dysfunction

A

Obstruction causes keratinization of office, increased meibum viscosity, long term atrophy. Gland structures change with age.

107
Q

Meiobomian gland dysfunction and CL

A

High MG atrophy in CL wearers. Correlates with duration of lens wear. Upper lid affected more. No difference with lens material.

108
Q

MG Early stage

A

No symptoms

109
Q

MG moderate stage

A

minimal to moderate discomfort, vascularization of lid margin, plugging, meibum is thicker

110
Q

MG severe

A

Ocular discomfort, irregular and vascularized lid margin, meibum in thick.

111
Q

Tx for MG

A

warm compress, hygiene, AT/ointment qPM, Omega3, fish oil, flax seed oil, doxycycline, azithrocycline, lipiflow. (more studies to prove Cl causes)

112
Q

Lid wiper epitheliopathy

A

Proposes that inadequate lubrication creates friction and inflammation of the upper lid. Upper and lower. Stain with NaFL and Rose Bengal. Occurs 5-6 hours after Cl wear.

113
Q

conditions associated with lid wiper epitheliopathy

A

Associated with dry eye disease. Exposure keratopathy, decreased mucin production, incomplete blinking, dry eye.

114
Q

Tx for lid wiper epitheliopathy

A

AT

115
Q

Dry eye disease stats and types

A

40% Of US has dry eye. Can be evaporative (lipid) or aqueous (aqueous)

116
Q

CL and TF

A

CL splits the CL into two different section. Pre lens and pre cornea. Pre lens TF evaporates quicker.

117
Q

Dry eye disease TX

A

CL change, Warm compress, punctual plugs, AT, steroids, cyclosporine, Doxycycline, Omega 3 fish oil.

118
Q

Mucin balls

A

Small particles of lipid, protein, and mucin. Tear film collapses and lid interacts with epithelium and rolls these. Will be indention in cornea following lens removal. Cause no discomfort, VA decrease, or health concerns.

119
Q

CL and mucin balls

A

70% have mucin balls with silicone hydrogels. Not related to age, gender, run. Higher with steep cornea, EW, and no use of rewetting drops.

120
Q

Limbal epithelial hypertrophy

A

No symptoms. Seen in some long term wear HEMA wearers. Possible precursor to corneal neovascularization.

121
Q

How to view gimbal epithelial hypertrophy

A

NaFL (Cannot be viewed with white light only)

122
Q

TX for LEH

A

It will resolve after stop wearing CL for 3-5 days. Decrease wear time. Suspect a steep fitting lens.

123
Q

CL papillary conjunctivitis Signs and symptoms

A

See blepharitis and papillae. Same as GPC. Mucus discharge in the nasal cornea of eye when wakening, itching with lens removal, decrease wear time.

124
Q

Stage 1 CLPC

A

Preclinical. Tarsal conj. is normally with only a slight velvet appearance. Some mucus discharge in the AM and itching upon lens removal

125
Q

Stage 2 CLPC

A

Early clinical. Increase in size and elevation of papillae. Mild itching while wearing lens. Increased lens awareness and decrease WT.

126
Q

Stage 3 CLPC

A

Moderate. Increase in papillae. Increased itching and discharge. Great decrease in wear time.

127
Q

Stage 4 CLPC

A

Papillae often 1 mm or larger. Severely coated lenses and decentered. Severe itching. Almost total lens intolerance.

128
Q

What causes GPC

A

Antigen on CL so body starts immune response. Can get from prosthetic eye as well.

129
Q

CLPC Tx

A

Rule out mechanical GPC. Manage Cl deposits. Change to preservative free. AT. Mast cell stabilizer, topical steroids, consider GPs. Surface coat SiHy with plasma coating to make more hydrophilic.

130
Q

Surfactants

A

Improve cleaning

131
Q

Preservatives

A

increase disinfection efficacy

132
Q

Viscosity

A

Buffer the ocular tissue from preservative disinfectants.

133
Q

Hydra-PEG

A

Allows more water to bind CL. Some CL already have this.

134
Q

what causes Contact lens acute red eye

A

Appears as a response to endotoxins from gram neg bacteria on cl.

135
Q

CLARE signs/symptoms

A

Modesto to severe bulbar hyperemia that is circumferential or sectoral. Peripheral to mid peripheral diffuse or focal infiltrations. None to mild VA reduction. Uncommon to be bilateral, A/C run, epithelial involvement.

136
Q

CLARE Tx

A

D/C cl wear, lubricants and cycloplege. Steroids with severe symptoms or infiltration. Recurrence possible.

137
Q

Superior Limbus keratoconjuctivitis

A

Strong association with lens care products that have thimerosal preservative (not used today).

138
Q

SLK signs/symptoms

A

Increased lens awareness, burning, itching, light sensitivity, vision loss (when there is extensive pants), injection in superior bulbar conj, infiltrates, panes, cornea and conj staining, haze (v shapes towards pupil), sub-epithelial opacities, superior gimbal edema, hypertrophy, staining, and injection. Pseudo-Dendrites.

139
Q

If you see a contact lens red eye and it is symmetrical is is CLARE or SLK?

A

SLK! Bilateral with symmetry but variable onset.

140
Q

TX for SLK

A

discontinue SCL. Stop thimerosal exposure. New Cl (GP has no additional benefits). Scraping affected epithelium.

141
Q

Prognosis for SLK

A

3 weeks-9 months. Papillary changes take longer.

142
Q

Theodores SLK

A

SLK without CL wear. Over 40, F, linked to thyroid disease.

143
Q

Superior Epithelial Arcuate Lesion Symptoms

A

Pt. relatively asymptomatic with maybe a slight FB sensation. usually found during routine Cl exam.

144
Q

SEAL Signs/Symptoms

A

Linear breaks seen in the superior cornea of SCL wearers. In most cases eroded down to BM. Usually unilateral. Lesion .5 mm wide and 2-5 mm in length. Little or no injection of the superior bulbar conj.

145
Q

What causes SEAL

A

Stiff, thick lens and high levels of dehydration

146
Q

SEAL treatment

A

D/CL Cl wear. Lubricants. Topical AB? long term change base curve. Change OAD. Change material.

147
Q

Inferior arcuate corneal staining

A

Coarse punctate epithelial disruption in the inferior cornea. Seen in patient with clean, well fitted wet lenses in DW or EW. May occur during lens removal. Does not depend on water content, lens thickness.

148
Q

Solution comfort

A

In longer term more comfort with hydrogen peroxide

149
Q

Dryness of MPS vs. hydrogen peroxide

A

Less dryness with hydrogen peroxide

150
Q

Fusarium infection

A

From Renu brand.

151
Q

Complete moisture plus infection

A

Acanthomoeba. infections.

152
Q

Rub vs. no rub

A

Rub is much better on cleaning lens.

153
Q

Opta-Free perservative

A

Aldox/polyquad

154
Q

Preservative associated transient hyperfluorescence

A

Staining is though to be binding of the Nail to preservatives on eat epithelium. Preservatives have different peaks of incidence of binding. Polyquad/aldox-30 minutes. PhMB-2 hours

155
Q

PATH Presentation

A

Noted after lens application. Diffuse corneal staining. Epithelium unaffected. Generally bilateral. Asymptomatic. Non-pathological. Resolution in 6-8 hours post lens removal.

156
Q

Micro cysts

A

Vision is asymptomatic but comfort is symptomatic. As you decrease wear time and DK you get more cysts.

157
Q

Micro cysts description

A

Small translucent or grey irregular shaped or ovoid inter epithelial cysts. Form near the BM and move toward anterior surface. Do not stain until they break through the surface. Reversed illumination tells you it is a micro cyst. Response to high levels of hypoxia.

158
Q

Micro cyst time course

A

Onset is slow usually after 2 months of lens wear. Number increase and decreases in cycles. Takes 3 months to clear.

159
Q

Micro cyst tx

A

decrease wear time. Change to higher Dk/T

160
Q

What things can be seen with reversed illumination

A

micro cyst and mucin balls. Micro cysts don’t stain with NaFL though. Mucin much bigger too. Mucin superior too.

161
Q

Limbal hyperemia

A

Increased in blood flow at the gimbal arcades resulting in dilation and distention of gimbal blood vessels. Can have dilation of blood vessels and some lipid leakage.

162
Q

Hypoxia theory for corneal vascularization

A

Tissue hypoxia resulting in an increased production of lactic acid which may result in venous draining. Chronic edema results in stroll softening or loss of physical barrier to vessel penetration. Hypoxia alone cannot do this

163
Q

Vasostimulation theory for corneal vascularization

A

Contact lens induced epithelial trauma results in a release of enzymes. Inflammatory cells migrate to this sit and release vasostimulating agents

164
Q

What is minimum DK for patient sleeping in lenses

A

125.

165
Q

What must you do with neovascularization

A

Document it. Location, depth, degree of penetration, severity

166
Q

Corneal vascularization tx

A

Discontinue lens wear, treat underlying pathology, minimize physiological insult.

167
Q

Other signs of hypoxia

A

Vertical striae, folds in descents.

168
Q

Epithelial vacuoles

A

10% nonsense wearer. Unknown etiology. Spherical fluid or gas filled vacuoles in the periphery. Generally asymptomatic and good prognosis as big turn over

169
Q

Epithelial bullae

A

Low prevalence in CL wearers. Indicates chronic epithelial edema. When it breaks through the surface the patient comes in with pain.

170
Q

Keratitis

A

Involves multiple layer of the cornea

171
Q

What is an infiltrate

A

A focus accumulation of cells or tissue in the anterior storm. PMN leukocytes. Can be sterile or infectious

172
Q

When will you see infiltrate with CL

A

with almost any chronic irritation to the cornea

173
Q

Infiltrative Keratitis signs/ symptoms

A

Inflammatory reaction of cornea. Mild to moderate irritation. Redness. Occasional discharge. Can be bilateral. Va may or may not be infected. No A/C or lid edema.

174
Q

Infiltrative keratitis causes

A

FB entrapment, mechanical trauma, bacterial toxins, MPS reaction.

175
Q

Risk forzctors for infiltrative ceratisis

A

CL wear

176
Q

Infiltrative keratitis Tx

A

D/C Cl wear temporarily. Steroids if moderate symptoms or VA decrease. Ocular lubricants. Rarely scars. Recurrence possible.

177
Q

Contant lens peripheral ulcer signs/symptoms

A

Peripheral location, Modert to severe discomfort, FB sensation, slight irritation, slight redness, tearing, infiltrate, no lid edema, unilateral, no a/c reaction.

178
Q

CLPU cause

A

inflammatory reaction to G+ exotoxins. Toxins release by S. Aureus on lens surface.

179
Q

Tx for CLPU

A

Anti-infective agent, cycloplegia, steroids after re-eptithelium, monitor

180
Q

Prognosis with CLPU

A

will always have bull’s eye scaring

181
Q

What is Microbial keratisis

A

Focal defect or excavation of the sub-epethial surface. Produced by sloughing of necrotic inflammatory tissue. Not the same as a corneal ulcer.

182
Q

What causes microbial keratitis

A

Bacteria, protozoan, fungal, viral. Must have an acute inflammatory infiltrate of the epithelium and stroma in the presence of infectious microorganism.

183
Q

Symptoms with microbial keratisi

A

can be severe to mild. May have pain, photophobia, tearing, blepharospasm, red eye, floaters, AM lid crusting, purulent discharge.

184
Q

Signs with microbial keratitis

A

Central or paracentral. Large, irregular focal. Satellite lesions. Anterior stromal to full thickness. Corneal edema. Full thickness epithelial loss. Anterior chamber reaction. Lid edema. Severe bulbar and gimbal redness. Unilateral. Hypopyon.

185
Q

MK and CL

A

More likely to get more severe if you sleep in them

186
Q

CL with least chance of MK

A

GP

187
Q

Peak in age of infiltration in cl

A

15-25 years

188
Q

Contact lens risk survery

A

15-25 year olds more likely to nap in lens, sleep in lenses, expose to water.

189
Q

Greatest risk for CL

A

Napping and showering in cl

190
Q

Water exposure with CL

A

Some rinse CL in water. M>F. We fear acanthamoaeba.

191
Q

Bacterial keratitis caues

A

Pseudomonas. Intact epithelium (corynebacterium diphtheria, listeria, haemophilus)

192
Q

Protozoa keratitis

A

Appear dendritic or patchy stromal infiltrate. Symptoms dispropriate to signs. Risk factors with CL wear.

193
Q

Fungal Keratisis

A

Large white infiltrate with fluffy or branching margins. Significant edema. High risk of loss of BCVA. NO STEROIDS!

194
Q

Viral keratitis

A

Simplex: Terminal end bulbs. Zoster: no terminal end bulbs on psudodendrites.

195
Q

Principals risk factor for MK

A

Overnight wear.

196
Q

Endothelial Bedewing

A

Endothelial deposits of unknown etiology in patient who are CL intolerant. Fine white precipitates or pigment dusting of cells. Idiopathic. 20% occur in noncl wearers

197
Q

Endothelial blebs

A

Black, no reflecting ares. Occurs in 100% CL wearers. Rapid onset of 10 minutes after application and resolution 2 minutes post removal. Adaption of the endothelium.

CL (3 decks)

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