red eye

Question 1

things that cause a CL associated red eye

Answer 1

CHADS

• compliance
• hypoxia
• allergies
• dry eyes
• solution sensitivity

Question 2

what CL should be ordered for this patient?
Ks
-OD: 47.00/45.50 @ 090
-OS: 47.00/45.50 @ 090
SUBJ
-OD:-6.50 -2.00 x 090 20/20
-OS:-6.50 -2.00 x 090 20/20

Answer 2

-6.00 -1.75 x 090

make sure to do a power cross and use the vertex equation in both meridians and then figure out the Rx
vertex=(P/1-dP)

Question 3

after the SCLs are placed on the eye, you note the right CL rotes 10 degrees clockwise and the left lens rotes 10 degrees counterclockwise, resulting in BCVA 20/25 each eye. What new CL axis should be ordered in each eye to improve the patient's BCVA?
Ks
-OD: 47.00/45.50 @ 090
-OS: 47.00/45.50 @ 090
SUBJ
-OD:-6.50 -2.00 x 090 20/20
-OS:-6.50 -2.00 x 090 20/20

Answer 3

OD axis 100
OS axis 080

LARS from dr perspective
clockwise=left
counterclockwise=right

LARS only works if the lens consistently rotates to the same spot each time.

Question 4

which of the following available BCs is most appropriate  to use for the initial CL fitting for this patient?
Ks
-OD: 47.00/45.50 @ 090
-OS: 47.00/45.50 @ 090
SUBJ
-OD:-6.50 -2.00 x 090 20/20
-OS:-6.50 -2.00 x 090 20/20
CL RX
-OD: -6.00 -1.75 x 090
-OS:-6.00 -1.75 x 090

8.3, 8.6, 9.0, or none of these?

Answer 4

8.3

this patient has a fairly steep K that are best fit with a smaller (steeper) BC (measured in mm). remember that as the radius of curvature increases, the cornea becomes flatter and the K values become lower.

Question 5

Bercher Twist test

Answer 5

rotate the cyl in the phoropter. if the patient cannot tolerate less than 5 degrees of rotation, he likely will not be successful in a soft toric CL

Question 6

DK

Answer 6

refers to oxygen permeability of a CL material. a higher DK results in greater oxygen permeability. A higher DK is healthier for the eye because it allows more oxygen to be transmitted to the cornea

Question 7

DK/t

Answer 7

transmissibility. a thicker lens results in a decrease in oxygen transmissibility

Question 8

hydrogel and DK

Answer 8

DK increases as water content increases

Question 9

siHy and DK

Answer 9

as water content increases, DK decreases

siHY CLs have Dk values that are greater than traditional hydrogels (>60)

Question 10

PMMA and Dk

Answer 10

they have 0 oxygen permeability and are no longer RXed

Question 11

loose lens

Answer 11

flat BC
smaller diameter
decreased sag

Question 12

tight CL problems

Answer 12

central bubbles
mucin balls
poor comfort on insertion but improved comfort after wearing, improved vision immediately after a blink, and perilimbal injection after many hours of wear

Question 13

loose CL problems

Answer 13

may show increased drop fo the CL inferiorly on upgrade (>2mm), poor comfort (esp with a blink), and blurred vision immediately after a blink that improves between blinks

Question 14

SM and hyperopes and aphakes

Answer 14

corrected with + lenses. SM increases as vertex distance increases for a + lens. Mag will be decreased in Cl compared to specs

Question 15

myopes and SM

Answer 15

corrected with - lenses. SM decreases as vertex distance increases for a mins lens. therefore, in myopes, mag will be increased in CL compared to specs

Question 16

myopes + CL

Answer 16

more convergence and accommodation

Question 17

myopes and glasses

Answer 17

gives BI, decreased convergence and accommodation

Question 18

hyperopes and CL

Answer 18

less convergence and accommodation

Question 19

solution sensitivity

Answer 19

toxic

• follicles
• infiltrates
• diffuse SPK
• redness
• most common causes: thimerosal and chlorhexidine

Question 20

saline solution

Answer 20

it is ok for wetting CL, but it does not clean or disinfect

Question 21

tap water and CL

Answer 21

never use due to acanthamoeba

Question 22

management for solution sensitivity

Answer 22

• switch to a different MPS as they may be less sensitive to other preservatives
• hydrogen peroxide solutions such as clear care neutralize to saline after 6 hours; therefore no chemicals are present when the CL is inserted on the eye
• dailies worn only for one day before being thrown away, thus eliminating the need for CL solution

Question 23

GP BC

Answer 23

the curvature of the back surface of the optical zone of the CL. Recall that steepening the BC will results in a steeper CL fit and flattening the BC will results in a flatter CL fit. for every 0.5mm change in BC,the power of the CL should be adjusted by 0.25D to account for the change in the steepness of the fit.

Question 24

SAM FAP

Answer 24

if the BC is steepened, add minus power, if the BC is flattened, add plus power to the CL

Question 25

GP OAD

Answer 25

the uncurled distance of the CL from edge to edge. the OAD is selected to minimize flare (most commonly occurs when the edge of the CL is close to the edge of the pupil), to avoid the bottom lid, facilitate lid attachment, and max comfort ( a larger OAD is more comfortable), the average OAD is 9.4-9.6mm and is adjusted in 0.4mm steps

Question 26

GP OZD

Answer 26

the usable area of optics in the CL (avg 7.6-8.2). Increasing the OZD increases the sag, resulting in a steeper fit. th maintain the same physical alignment between the GP and the cornea, the BC should be flattened. conversely, decreasing the OZD decreases the sag depth and flattens the fit of the CL; the BC should be steepened to maintain the same physical alignment

Question 27

for every 0.4mm change in OZD, the base curve should be adjusted by

Answer 27

0.25D

Question 28

GP peripheral curves

Answer 28

allow alignment between the edge of the CL and the peripheral cornea. CP CL may have one (bicurve) or two (tricurve), or three (tetra curve) peripheral curves in addition to the BC

Question 29

3 main functions of the perisperhal curves in GP

Answer 29

- prevent the edge of the CL from bearing on the cornea when the Cl moves on the eye - promote tear exchange under the CL to maintain adequate corneal metabolism - support tear meniscus at the edge if the CL, which promotes lens centration

Question 30

edge thickness and GP

Answer 30

ideal edge thickness will promote lid attachment and is similar to the edge thickness of a -3.00D GP CL - GP lenses that are more plus than -1.50D have a "plus shape" and will often drop inferiorly due to inadequate lid attachment. Plano/minus carrier lenticular can be added to thicken the CL edge and promote lid attachment - CL that are more minus than -5.00D have excess edge thickness, causing the lens to ride higher due to excessive lid attachment. a plus lenticular or CN beveling can be added to decrease the edge thickness and promote normal lid attachment

Question 31

edge lift and GP

Answer 31

the distance between the peripheral edge of the CL and the cornea. can be adjusted by changing the peripheral curve radii in 1mm steps. remember that steepening the peripheral curve radius and or reducing the width of the peripheral curve will decreased edge lift

Question 32

center thickness and GP

Answer 32

influences oxygen transmissibility of the CL, flexure, and the center of gravity of the CL. the CT can be changed 0.03mm steps

Question 33

thinner CT

Answer 33

has greater oxygen transmissibility, better centration, and more flexure (esp with 1.50D or more corneal astigmatism)

Question 34

thicker CT

Answer 34

less oxygen transmissibility, less flexure, and tends to drop inferiorly on the eye

Question 35

Dk and thickness

Answer 35

higher Dk values require a thicker CT in order to minimize flexure

Question 36

center of gravity and GP

Answer 36

the center of the weight of a GP CL; it is influenced by the CL power, diameter, center thickness, and base curve. The more posterior the center of gravity, the better the centration of the CL

Question 37

what causes a more anterior center of gravity for a GP lens

Answer 37

thicker CT smaller OAD "plus" shape flatter BC drops inferiorly on the eye

Question 38

BC selection for SCL

Answer 38

in general, SCL are typically fit with a BC that is 4D flatter than on K - average K (41-45): fit the median BC or the flatter BC - for a steeper K (>45), fit the steeper BC - for a flatter K (<41), fir the flatter BC

Question 39

power of SCL

Answer 39

determined by the spec refraction at the corneal place and the over-refraction. Remember that the tear lens power is always Plano for a SCL, and thus does not influence the final power

Question 40

diameter of SCL

Answer 40

measures the horizontal visible iris diameter (HVID) and add 3mm to ensure 1.5mm extension of the SCL edge beyond the limbus for 360 degrees

Question 41

material of SCL

Answer 41

consider wear schedule and the patient needs when selecting material. daily wear CL can have a lower Dk compared to extended wear or continuous wear CL. Also consider deposits and patient complains of dry eye