Practical Flashcards
When looking at Kertaometry readings in Diopters what indicates steeper?
Higher the number, the steeper the curve
When looking at Kertaometry readings in mm of Radius what indicates steeper?
The lower the number, the steeper the curve
When using the keratometer, what happens if you cannot see the - signs?
This means that the eyes are not wide enough.
When using the keratometer, what happens if you cannot see the + signs?
This means that the occluder is in the way
When using the keratometer, what happens if there are irregular mires?
This means the eyes are dry, too wet or they have an irregular cornea
What is the average power of the cornea?
+43.00 D (or 7.85 mm)
What is the average power range of the cornea?
42.00 to 45.00 D
or
8.04 to 7.50 mm
What is a nomogram?
The manufacturer’s guide of how to fit THEIR lenses
What happens when you change the diameter of a SCL?
You change the fit because for every 0.5 step change in the diameter, you must compensate 0.3 mm BC
14.0 diam with 8.6 mm BC
fits the same as
14.5 diam with 8.9 mm BC
Anytime you make the lens smaller you are also flattening the fit
Define LARS
Lars is a fitting technique to compensate for the lens rotation on a toric soft or GP lens. It is based on the fitter’s point of view while looking at the eye in the slit lamp.
Every hour of the clock is 30º rotation
If the lens rotates L add 30º to the axis for every “hour”.
If the lens rotates R subtract 30º from the axis for every hour
Once refit, the lens will still rotate, but the patient will be seeing the correct prescription as you have compensated
Define SAM/FAP
A fitting technique used to compensate for the power created by the tear film under a GP lens
SAM - When fitting a GP lens steeper than the cornea, a plus tear film lens is created → Steeper Add Minus
FAP - When fitting a GP lens flatter than the cornea, a minus lens is created → Flatter Add Plus
Why are front Toric Lenses the worst option?
- Cause fluctuating vision
- Lots of Lens movement ∴ patient discomfort
As much as possible you should avoid these fits (ideally use bi/back toric or aspheric lens
How do you decide if you are going to use a bi/back toric?
if Tcyl is 1.5 then use a BACK TORIC
Why can you drop the residual cyl in a toric GP lens?
It is accounted for in the CL power
When using a back aspheric lens design, why would you choose the Steeper K?
This lens would have less movement ∴ more comfortable
When using a back aspheric lens design, why would you choose the Flatter K?
This lens would have better edge lift ∴ more tear exchange
What is Flexure?
A lens design used to try to avoid using a Front Toric Lens design
How does Flexure work?
A minimum centre thickness typically keeps the lens from bending with every blink which keeps the lens power consistent
Flexure takes advantage of this principle by reducing the centre thickness. You put a sphere lens on the eye and use each blink to bend the lens and induce the proper amount of cylinder
Why is Flexure not a popular design?
Now you can order a back aspheric!
What are the two fitting philosophies for GP lenses according to Robert Mandell?
Interpalpebral and Upper Lid Attachment
What is the main use of a slit lamp?
To look at the eye to check basic health and to check if the eye is healthy enough to wear contact lenses
What are the two categories of Illumination?
Direct focal (in click stop) Indirect focal (out of click stop)
Define Direct Focal Illumination. What is an example?
Both the light source and the oculars are focused on the same point of interest
Example: Parallel Piped
Define Indirect Focal Illumination
The light source ant eh oculars are NOT focused on the same point of interest
Example: Direct and Indirect Retro
In terms of using the slit lamp, define magnification
The magnification number read on the oculars
In terms of using the slit lamp, define focus
The point that the OCULARS are focused on
In terms of using the slit lamp, define light
The intensity of the light source
In terms of using the slit lamp, define slit width
How wide the beam of light is
In terms of using the slit lamp, define slit direction
Where the light source is directed
In terms of using the slit lamp, define angle
The angle between the light source and oculars
In terms of using the slit lamp, define click stop
Asking if this illumination direct focal or indirect focal
What is the relationship between light and magnification
Low light - use low mag.
Medium light - use medium mag.
High light - use high mag.
What is the purpose of a Diffuse Illumination?
A general overview of the health of the eye/cornea. Checking if there is anything that blatantly shows this person cannot wear contact lenses.
For a Diffuse illumination, what is the:
- Magnification
- Focus
- Light
- Slit width and direction
- Angle
- Click stop?
- Low (6-10x)
- Cornea
- Low
- Wide Open on the cornea
- 45-60º
- Direct Focal
Name 5 things can you detect using a Diffuse Illumination
- Outer Adnexa
- Pinguecula/Pterygium
- Arcus
- Entropion/Ectropion
- Chalazion
- Hordeolum
- Ptosis
What is the purpose of a Parallel Piped Illumination?
To see the cornea /pathological condition in more detail. You can see the anterior and posterior at the same time. This is a good starting point for the other illuminations
For a Parallel Piped illumination, what is the:
- Magnification
- Focus
- Light
- Slit width and direction
- Angle
- Click stop?
- Start low then work up to Medium (10-16x)
- Cornea
- Medium
- 2-4 mm on the cornea
- 45-60º
- Direct Focal
Name 5 things can you detect using a Parallel Piped Illumination
- CL Fit/Scribe Marks)
- TBUT
- Meibomian Orifices (raised or plugged)
- Scars/Ulcers
- Desiccation
- Abrasions
- Keratitis
What is the purpose of an Optic Section Illumination?
To view the corneal layers in detail/cross-section.
This is very similar to the parallel piped, but your beam is narrower because you are looking WITHIN the cornea and you will see 3 layers
For an Optic Section illumination, what is the:
- Magnification
- Focus
- Light
- Slit width and direction
- Angle
- Click stop?
- Medium (16x)
- Cornea
- Medium to High
- 02-1.0 mm on the cornea
- 45-60º
- Direct (in click)