CL Presentation.pptx... Define contact lens:

CONTACT LENS
MOHAMMAD SALAH UDDIN
M OPTOM; MPH
FACULTY & CONSULTANT
OPTOMETRIST
usalah22@yahoo.com
Mohammad Salah Uddin
M Optom; MPH

Contact lenses are the
smallest, least visible, the
finest of all devices for
correcting refractive errors of
the eye. Prescribing and
fitting contact lenses have
become an integral part of
today’s comprehensive
Optometry practice.
M Optom; MPH

Are you a contact lens
practitioner or a business
person?
M Optom; MPH

Me……??????
• I am a practitioner…
• I chose a health care field rather
than a business field…
M Optom; MPH

To be a successful contact lens
practitioner you must be a successful
business person.
Prepare Yourself
M Optom; MPH

ASK YOURSELF THESE
QUESTIONS:
• What are you doing to further your Professional
knowledge?
• Do you give your business ideas high priority?
• What do you need to do, to better understand the
Contact Lens aspects?
• What are your goals after today’s learnings?
• If you were hiring a contact lens practitioner, would
you hire someone like yourself ?
• Do you know how to READ PP ?
M Optom; MPH

Be a Self Starter !!!!
• Spend extra time outside the Clinics
• Get out in the business world
• Visit Successful Practioners/Colleagues
• Attend Seminars/Symposiums
• Do extra Reading
• YESS……Do it NOW!
M Optom; MPH

WHY FIT CONTACT
LENSES?
Is there any Hope?
M Optom; MPH

World Contact Lens Market
Current estimates show some 87 million contact
lens wearers worldwide, a number that is
increasing each year. These wearers are
distributed as follows:
North America 35 million
Europe 18 million
Asia 22 million
South America 8 million
Africa 3 million
Australia 0.35-0.5 million Mohammad Salah Uddin
M Optom; MPH

• Presbyopic Population
• Disposable Lenses
• New Technology
World Contact Lens Markets
Future Growth Areas
M Optom; MPH

POTENTIAL GROWTH
AREAS
• Siloxane hydrogels:
– Spherical
– Toric
– Bifocals/PALs
• Cosmetic coloured/tinted lenses
• SCLs:
– Torics
– Bifocals
• RGP Contact Lens
- Ortho-k Lenses Mohammad Salah Uddin
M Optom; MPH

CONTACT LENS MARKET BY
GENDER –
- 66% FEMALE
- 34% MALE
M Optom; MPH

Categorization: By Age
The contact lens market can also be
categorized by:
• Age (approximately):
− 15% are less than 17 years old
− 25% are 18-25 years old
− 39% are 26-39 years old
− 21% are more than 40 years old
M Optom; MPH

Spectacle Dispensing 49%
Exam/Professional Fees 27%
Contact Lenses 19%
Other Services 5%
SOURCES OF INCOME
GENERATED
(USA: Optometry)
M Optom; MPH

ASSIGN A VALUE TO YOUR TIME
As a new practitioner, you need a simple
equation to calculate what your time is
worth…
• By the minute
• By the hour
• By the day
M Optom; MPH

Advantages of contact lenses
1. Fewer magnification effects
2. Decreased peripheral and chromatic
abberations
3. Increase in the size of visual fields
4. Marked decrease in aniseikonia in monocular
aphakia and Anisometropia.
5. Good Cosmetic appearance.
6. Permits better correction for refractive errors
that occur with keratoconus and irregular
astigmatism. Mohammad Salah Uddin
M Optom; MPH

Indications
a) Optical: Myopia, Hypermetropia, Astigmatism,
Presbyopia, Aphakia, PostKeratoplasty, Keratoconus .
b) Orthoptic uses: Aniesokonia, Anisometropia,
Amblyopia (Occlusion).
c) Special Uses: Albinism, Aniridia, Nystagmus
with Refractive error, coloboma, symblepharon.
M Optom; MPH

d) Therapeutic uses: Bullous Keratopathy,
corneal ulcers, Glaucoma therapy (for Drug
Delivery)
e) Prosthetic uses: Pthisical eye, corneal
opacity, leukoma , corneal scars.
f) Surgical Uses: Corneal protection at surgery
Indications
M Optom; MPH

ALSO CAN BE USED
AS:
􀂋A bandage lens
􀂋To cover a corneal defect or bleb
􀂋Occlusion therapy in children with
Amblyopia or adults with diplopia
􀂋A custom tint to match the iris color to the
other eye
M Optom; MPH

Deciding on the Best Lenses
WORK UP –IF Currently Wearing Lenses
􀂋What type
􀂋What solution
􀂋Wearing schedule
􀂋Any problems
􀂋The fit
M Optom; MPH

HISTORY
􀂋Past lenses
􀂋What did & didn’t work
􀂋Patient’s work & hobbies
􀂋Medications, allergies & medical problems
􀂋What they know or want
Deciding on the Best Lenses
M Optom; MPH

Contact Lens Fitting
Thorough Eye Exam To Include:
– Check lids/lashes-invert lids
– Check corneas
– Check cornea diameter
– Refract-anytime there is a patient that is not
refractable to 20/20 without a corresponding
history, do topography
M Optom; MPH

Contact Lens Fitting
– Check K’s
– Accouont for vertex correction if Rx is above
or + 4.00 D
– Overall hygiene of patient
– Health and eye history
– Access TBUT (tear break-up time)
M Optom; MPH

Types
Modern system classifies contact lens
into three major types such as –
(i) Soft
(ii) Semi soft and
(iii) Hard contact lens
M Optom; MPH

"Hard" Contact Lenses -
Advantages:
– Great for correcting astigmatism and irregular
astigmatism
– Provides a smooth stable refractive area for
the cornea
– The material is durable and reproducible
– It is fairly resistant to coating with tear film
products and can be polished to lessen
surface scratches and deposits
M Optom; MPH

Disadvantages
– Does not allow transmission of oxygen
– Can induce an anoxic environment
– Long-term wear can cause Problems in
cornea
"Hard" Contact Lenses -
M Optom; MPH

"Soft" Contact Lenses -
Advantages:
– Available in larger diameters
– Can be slept in up to 7 days
– Can be worn off and on without
readapting every time
– Comes in multipacks with a variety of
replacement times
M Optom; MPH

– Affordable price and healthier modality
– Comes in a variety of colors to enhance
or change the color of patients eye
– Can also be used when the patient has
a defect of the cornea or pupil due to
injury or congenital defect.
Advantages:
M Optom; MPH

Disadvantages:
– The vision is sometimes not quite as
sharp as with a gas permeable lens
– Can dry considerably at times and not
as much at others
– Can absorb other fluids, some of which
can be toxic to the cornea
M Optom; MPH

– More prone to deposits from the tear film
– More build up on the lenses
– Need to be replaced more frequently
than hard or gas perm (With the
introduction of frequent replacements
and disposable this is now easier and
cheaper for patients to do.)
Disadvantages:
M Optom; MPH

Soft contact lenses are indicated …….
􀂋Previous success with soft lenses
􀂋Either a spherical or mild astigmatism
􀂋History of discomfort with gas perm lenses
􀂋When patient wants or needs a tinted lens
􀂋Work environment that in dusty
􀂋When used as a bandage lens to allow the
epithelium to heal in cases of surgery or injury
M Optom; MPH

3 Basic Soft Lens Types
Conventional - Patient gets one pair, usually lasts about
9 months. (If the patient looses or tears one, the patient
is out of lenses until a replacement is received.)
Frequent replacement - These lenses are replaced
anywhere from biweekly to quarterly.
Disposable - These lenses are worn one day and
disposed of at the end of the day. (No solutions needed)
M Optom; MPH

Fitting The Patient
Transpose the Rx if necessary. Using spherical
equivalent if possible.
Account for vertex correction for anything above
+4.00 D. To vertex divide the sphere into 1000.
Add the vertex number if the Rx is a minus and
subtract the vertex number if the Rx is a plus.
Then divide this number into 1000. This is your
sphere power.
M Optom; MPH

Soft Contact Fitting
􀂋Select lens based on previous information.
􀂋Choose a base curve about 4 Diopters flatter than
flattest K
􀂋Once you have selected the Rx and base curve,
the specific lens you try is personal preference
􀂋Place lens on eye and allow to settle
􀂋Check vision and over refract if necessary
􀂋Watch or have teach insertion and removal
􀂋Give solutions specific for that type of lenses
M Optom; MPH

Soft Contact Instructions
• Discuss problems in changing solutions,
use of store brands.
• Discuss with patients the implications of
over wearing lenses.
• Caution patients especially teens of
dangers associated with contact lens
misuse.
• NO Hot Tubs/Swimming Pools.
M Optom; MPH

Follow Up Follow-
• Have the patient wear the lens for a week
• At return visit (wearing lenses) ask specific
questions about comfort and vision
• Check vision and movement of lens (check
movement of a soft lens by placing your index
finger on the lower lid and applying gentle
pressure in and up)
• Evaluate Fluorescein Pattern
• Ask about any problems with insertion & removal
• Have patient demonstrate
• Remove lens Mohammad Salah Uddin
M Optom; MPH

TORIC SOFT LENS
A toric lens is one in which either or both of the
optical surfaces have the effect of a cylindrical lens,
usually in combination with the effect of a spherical
lens
Corrects astigmatism
Lens is specially weighted to conform to irregular
cornea
More expensive than spherical
Some are available in disposable Mohammad Salah Uddin
M Optom; MPH

GP Contact Lenses
Advantages
– Allows oxygen to pass through it making it
better for the cornea
– Different materials have been developed to
make the lens more resistant to tear film deposits
– Improve the wettability of the lens
– Can be cut in larger diameters than the hard
lenses improving comfort, adaptation and
stability
M Optom; MPH

Disadvantages
– The material is more fragile & may have
to be replaced more frequently
– Deposition of the lens can occur
GP Contact Lenses
M Optom; MPH

GP Contact Lenses are indicated…..
• Previous Gas Perm wearer
• Moderate to high corneal astigmatism
• Corneal irregularity (from scars, transplants, previous corneal
surgery) and keratoconus.
• History of overwearsyndrome with PMMA or soft contact lenses
• Unsuccessful attempts with soft contact lenses due to
decreased visual acuity, neovascularization, problems with
solutions, and hypoxia
• History of GPC (Giant Papillary Conjunctivitis)
• Certain occupational environments-fumes etc.
• History of severe allergies
M Optom; MPH

GP Lens Fitting
• Some fit on flat K, some .50 flatter or .50 D
steeper.
• Easiest is to go .50 D flatter on spherical .
• On K if they have up to .75 cyl and .50 steeper if
they have up to 2.00 cyl .
• Usually a diameter of 9.5 is average.
• The steeper the cornea the smaller the
diameter.
M Optom; MPH

To determine the diameter needed,
measure the HVID
• If the HVID is: Small <11.0mm use a 8.5 lens
diameter Med. 11.0-11.9mm use a 9.0 lens
diameter Large >12.0 mm use a 9.5 diameter
• This is a general rule and will work with most
patients.
• Another rule to keep in mind is when you have a
patient with a very steep cornea >46D go with a
Small diameter and in case of flat cornea <42D
Works best with a large diameter. Mohammad Salah Uddin
M Optom; MPH

Some Key Points…
• Check patient’s lids position.
• An ideal fit for a GP Lens would be slight
pooling centrally with peripheral clearance.
• The lens should center well, slight decentration
is acceptable.
• Observe fluorescein pattern.
• Watch for 3 & 9 O O’clock staining.
• Watch horizontal movement
M Optom; MPH

SAM FAP Rule
If you are fitting Steeper than K add the
same amount of Minus to the Rx, if you
are fitting Flatter add the same amount
of Plus to the Rx.
M Optom; MPH

Tips to the patient
Have them demonstrate on insertion & removal
Have patient start the first day with two three
hours wear and add one hour each day
following. Up to 12 14 hours in most cases.
M Optom; MPH

Follow Up -
- See the patient in at least after one
week, wearing the lenses
- Check the vision, ask if any problems
with comfort, handling or vision
- Confirm that patient is comfortable with
insertion and removal and solutions
- Check the fit with the slit lamp
- Instill fluorescein to evaluate the fit Mohammad Salah Uddin
M Optom; MPH

FULLY KERATOCONIC DESIGNED LENSES
??
Rose k family of lens
Scleral and Mini scleral lens
M Optom; MPH

ROSE K
Unique keratoconus lens design with complex
computer-generated peripheral curves based
on data collected by Dr Paul Rose of
Hamilton, New Zealand.
Standard diameter: 8.7 mm
• BOZD decreases and axial edge lift
increases as base curve steepens
M Optom; MPH

ROSE K1 VS ROSE K2
ROSE K2
ROSE K1 Multiple back curves
Aspheric back surface
M Optom; MPH

• Every individual Rose K2 lens has its own
aspheric
value on the front and back, computer
designed to minimize spherical aberration
M Optom; MPH

ROSE K2 FAMILY OF LENSES
Rose K2 Xl
Indications: Keratoconus
, Pellucid Marginal
Degeneration, Post Graft,
Corneal Rings, Post-
LASIK ectasia and dry
eye
Rose K2
•Indications: Oval
Keratoconus, Nipple
Keratoconus & early
Pellucid Marginal
Degeneration
M Optom; MPH

Rose K2 NC
Indications: Moderate &
Steep Nipple Cones
Rose K2 IC
•Indications: Pellucid
Marginal Degeneration,
Keratoglobus, Oval
Keratoconus, LASIK-
induced Ectasia and
Post Graft
M Optom; MPH

Rose K2 PG
Indications: For patients who have
undergone penetrating keratoplasty, Oval
Keratoconus, Nipple Keratoconus and
Lasik
M Optom; MPH

SCLERAL AND MINI-SCLERAL LENS
M Optom; MPH

Advantages Mini Scleral Contact Lens
Better comfort,
Less mechanical trauma to the cornea,
Better vision.
M Optom; MPH

M Optom; MPH

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