soft contact lens fitting
Post on 16-Aug-2015
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Soft contact lens fitting
Md. Nooruz ZamanM.Optom, (FIACLE), (PhD)
Factors which affects lens fit Modulus of elasticity Manufacturing method Water content Keratometric readings Lid tonus Tear film
Fitting steps History Initial eye examination-SLE Refraction, 4:1 Keratometry HVID Other tests like tear film, sensitivity,PAH
etc Selection of trial lens
The parametrs of lens is selected on following BC Power Diameter Types of lens
Steps for calculations K in mm Add 1mm to mean k Power- 1. transpose to minus cyl 2. Sph. equivalent 3. VDC for more than 4 D Diameter- HVID+2mm (13 to 14.5mm)
Evaluation of Fit Patients comfort response- Fairly comfortable – probably good fit- Uncomfortable - predicts loose
fit(excess movement)- Very comfortable – May be steep or
tight (immobile)
Corneal coverage
Slit lamp, diffuse illumination, - eye in primary position, lens should
show full corneal coverage about 1 to 2mm beyond limbus
- Full coverage (1 -2mm) – Ideal- Greater than 2 mm – lens too large- Corneal exposure – lens too small
Lens centration Equally centered in all distance beyond
limbus in all directions. Centered in all position – ideal Decentered with corneal exposure in
any position of gaze- steep or loose, dia may be small.
Movement Patient asked to look straight in primary
gaze and asked to blink normally. Movement is estimated in diffuse light
and moderate to high magnification with blink.
0.2 – 0.4 mm ---- ideal
Push up test Patients looks straight and examiner pushes
the lens up vertically through the pressure of lid
40-60% IDEAL Easy displacement- smooth recovery – ideal
fit Resistence to displacement – may not
recenter – tight fit Easy displacement- Erratic recovery – Loose
fit
Lens Lag Patient asked to loo up and lens move
down slightly –Lag 1 to 1.5 mm - Ideal
Edge Alignment Edge of the lens is observed with
reference to the conjunctiva. If the edge is sliding smoothly and
aligning with conjunctiva is the ideal. If indent on cornea- tight or steep If it stands off - loose
Other responses Vision before and After blink- - If ideal vision will remain same and clear- If vision clears with blink – steep- If vision gets blur with blink- flat fit Keratometry and retinoscopy with the lens
on the eye can also be performed. Clarity of mires is observed
If clears with blink-steep If blurs- flat
Alter the lens if ideal fit is not achieved Fitting can be changed on- BC- Dia- Thickness
- Rule of thumb- 0.3mm change in the base curve = 0.5 mm change in Diameter
Over refraction Refraction over trial lens Algebraically add power Note- aditional power needed should be
less than 4D If cyl required –fit toric
Final Order BC Power Diameter Water content Tint Material Manufacturer
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