CONTACT

LENSES
Dr. Anupama Janardhanan

Dr. Reji Thomas

OUTLINE
 INTRODUCTION
 HISTORY
 CLASSIFICATION OF CONTACT LENSES
 METHODS OF MANUFACTURING
 TEAR FILM AND CONTACT LENS INTERACTIONS
 OPTICS OF CONTACT LENS
 GENERAL INDICATIONS AND CONTRAINDICATIONS
 BASELINE EVALUATION AND PRE REQUISITES
 CHARACTERSTICS OF DIFFERENT TYPES OF CONTACT LENSES
 SPECIAL CONDITIONS
 COMPLICATIONS
INTRODUCTION

CONTACT LENS

An Artificial device whose front surface substitutes the anterior surface

of cornea.
a thin, curved lens placed on the film of tears that covers the surface
of your eye.
HISTORY

 “Leonardo de Vinci” (1508 AD)

Neutralizing the cornea by substituting it

with a new refracting surface.

Transparent Methymethacrylate (MMA)

1938
“Obring & Muller”
Plastic Contact lens “Kevin Tuchy”
1948

 PMMA (Polymethyl methacrylate) 1946

Rigid contact lens
 CLASSIFICATION OF CONTACT LENSES

Scl
●
A Rigi
●

N Dail
● M Low
● W
d
era AT
y O
l N Non
Gas A wea
DE
(0-
40% ER
Se r
A Per
●
)
mi- mea
T Ext
●
OF Med
●
C
end
Scl T ble
Rigi ed
W ium O
U
●

(40-
era
O d Wea EA 55%
NT
l Gas
r
Per
R R ) EN
Cor
●
M mea
Dis
●

pos
High
●

T
ne (>5
AN IDEAL CONTACT LENS…….

Optical Properties

Biocompatibility Moulding
Tolerance
Stability
Sterility

Gas Permeability
Surface
Chemistry
 METHODS OF MANUFACTURING

LATHE
SPIN CASTING MOULDING
CUTTING
 LATHE CUTTING

A Lathe is used to carve the anterior and posterior surface.

Hard Lens: polished with

posterior surface = convex wax lens
anterior surface = concave wax lens

Soft Lens polished with ALUMINIUM OXIDE lubricated

with distilled paraffin.

Peripheral and intermediate curves and edges are modified.

Contact lens is then verified against the parameters

 SPIN CASTING

Process of centrifugal casting of Hydrogel lenses wherein polymerization

occurs simultaneously.
A monomer, cross linking agent and initiator are placed in a concave mould ,
rotating at a predetermined rate around its own axis.
Polymerization and shaping occur during its spinning.
 Outer surface of the lens is spheric and
inner suface is aspheric
MOULDING

Lens material is heated or cured to

produce a mobile phase and it is placed in
a mould to obtain desired contact lens
form.
TEAR FILM AND CONTACT LENS INTERACTION

Protects, nourishes and lubricates the cornea.

POSITIONING OF LENS AND TEAR FILM:

Pre corneal tear film with it properties

of surface tension and viscosity
functions as reversible sheeting
and glue to hold contact lens
to the cornea.
OPTICAL RELATION

Back of tear lens(post lens tear film) fills in the

irregularities of cornea..

Refractive index of tears is 1.337 and cornea 1.376

Difference being 0.04
Thus in an astigmatism up to 5 D, contact lens
leaves a residual astigmatism of 0.50 D.

CONTACT LENS AND CORNEAL NUTRITION

• evaporation of tears interfere with hypertonicity
of tears.
• Physical barrier for O2 entry
• Traps wastes and hinders waste disposal
LENS EDGE FLARE

Prism shaped meniscus is formed at the lens edge

when tear film surrounds the contact lens. If this edge cross over
pupillary area there occurs formation for a second out of focus image on
retina- EDGE FLARE or GHOST IMAGE..
OPTICS OF CONTACT LENS
The general principle of correction of refractive errors with contact
lenses is substituting a new refractive surface (contact lens) for the
old surface (cornea).
The new surface is uniform, with a different index of refraction and
anterior radius curvature. This substitutes for the cornea which may
be irregular.

A) NEUTRALIZATION OF CORNEA
Refractive
Cornea index -- 1.376 +48.83 D
Tear Film (Fluid Lens) 1.336 +5.19 D

Thus, the whole refraction by cornea is totally abolished or a small

balance persists. Refractive error additional to it corrected by Lenses
CORRECTION OF AMETROPIA

Rays of light passing through four media of different refractive

indices Air 1.00
Contact Lens(eg. PMMA) 1.49
Tears 1.33
Cornea 1.37

Most significant refraction occurs at AIR-LENS interface.

There are two basic principles of correcting refractive error :

Types

AFOCAL POWERED
AFOCAL LENS
• Ant & post curvatures of CL is same as cornea
• No optical power
• Surface irregularities of cornea are taken care of
POWERED LENS

Correction of ametropia is with the difference in curvature of anterior

and posterior surfaces of lens.

Role of Tear Lens (FLUID LENS)

A) Thickness B) Surface Curvatures

Thickness not much important since its < 1.0 mm

To remember relation in converging power is such that
For every 1.0 mm --- 0.12 D

Surface curvature of Soft Contact lens conform to corneal curvature,

hence have plano power.
Surface curvature.. Applicable only to rigid gas permeable lens
varies with the base curve of the lens as below:

Plano Power Tear Lens: Base Curve = Corneal Curvature

Plus Power Tear Lens : Base Curve of CL steeper than Corneal

curvature

Minus Power Tear Lens : Base Curve of CL flatter than Corneal

curvature
 For every 0.05 mm --- 0.25 D

For the steeper CL power – Subtract Tear lens Power equivalent

{ S.A.M- STEEPER ADD MINUS }

For the flatter CL power – Add Tear lens Power equivalent

COMBINED LENS

• Curvature of both surfaces contribute

• Both glass lens & fluid lens give dioptric power.
POWER AND MAGNIFICATION BY CONTACT LENS

The distance at which correcting lens is placed in relation to vertex

plane determines the power and size of retinal image.
The power and position of the correcting lens must be such that the focal point of the
lens is conjugate to the focal point of the eye.

Spectacle is placed at 13 mm in front of vertex plane, CL is placed at

Vertex plane(Plane which passes through the anterior centre most
of point of cornea)
Back Vertex Distance: distance between the eye and the back
vertex of a spectacle lens.
Any lens power more than +/- 5 D, position in front of eye materially
affects the optical correction of refractive error.

Contact Lens power can be derived in two ways using following pre
requisites:
a) Spectacle Power
b) Individualistic Back Vertex Distance
POWER OF CONTACT LENS
METHOD -1

Contact Lens Power= DL DL = Ds .

Spectacle Power= Ds 1– (VD s)
Back Vertex Distance = V

Example: Aphakic Pt. requiring +10.0 D at BVD 15 mm (0.015 mt).

What power should the contact lens be?

DL = 10 . DL = 10 . = 10 .
+11.70
1- (0.015 x 10) 1- 0.15 0.85
METHOD -2

Contact Lens Power= DL

Change in power due to vertex distance = Δ
Back Vertex Distance = V

Δ=( Ds)² V DL = Δ + Ds

Example: An aphakic spectacle correction of +10.00 diopters at 15

mm in from the eye. What power should the contact lens be?

Δ = 10² x 0.015 Δ = 100 X 0.015 Δ = +1.50 D

The power of the required contact lens corrected for vertex distance is

DL = +10.00 +1.50= +11.50 D

CLINICAL INDICATIONS AND CONTRA-INDICATIONS
INDICATIONS
●
Anisometropia
●
Unilateral Aphakia
OPTICAL ●
High Myopia
●
Keratoconus
●
Irregular Astigmatism

●
Corneal diseases; Non healing Corneal Ulcers, Bullous keratopathy, filamentary keratitis, and
recurrent corneal erosion
Diseases of Iris: Aniridia, Coloboma, Albinism
THERAPEUTIC
●

●
Glaucoma
●
Ambylopia
●
Post Keratoplasty and microcorneal perforation

●
Prevention of Symblepharon formation
PREVENTIVE ●
Prevention of Exposure Keratitis
●
Prevention of Corneal irritation in Trichiasis
 ●
Electroretinography
●
E/o of Fundus in Irregular astigmatism
DIAGNOSTIC ●
Fundus Photography
●
Goldmann’s 3-mirror examination

●
Goniotomy
OPERATIVE ●
Vitrectomy
●
Endocular Photocoagulation

●
Unsightly Corneal scars
COSMETIC ●
Cosmetic Scleral Lenses in Phthisi bulbi

●
Sports Men
OCCUPATIONAL ●
Pilots
●
Actors
 ADVANTAGES OF CONTACT LENSES OVER SPECTACLES

Eyeglasses Contact Lenses

The distance between your eye and

Worn right on the eye, for more
the lens sometimes creates
natural normal field of vision.
distortion.
Nulls all aberrations: Spherical,
Spherical, Chormatic and Prismatic
Chromatic and prismatic
aberrations occur
; sports and in driving
Irregular Corneal astigmatism not
Can be fully corrected.
fully corrected
Diplopia can occur in high Binocular vision can be retained in
Anisometropia Anisometropia (unilateral aphakia)
 ADVANTAGES OF CONTACT LENSES OVER SPECTACLES

Eyeglasses Contact Lenses

Awareness of frame and lens edge,

no annoying obstructions or
as well as reflections off the
reflections in view.
backside of the lens.
Uncomfortable weight on your face No weight and resulting discomfort.
and ears. Periodic need for No frame constantly slipping down
tightening or other adjustment. your nose.
Glasses fog up with changes in
Don't fog up.
temperature.
Eyeglasses are annoying to wear in Contact lenses won't collect
rain or snow. precipitation and blur your vision.
Glasses are an unnatural, Contacts don't detract from your
distracting barrier between your natural appearance; they let people
eyes and the world. see your eyes.
CONTRA INDICATIONS
• Mental Incompetence or irresponsibility and poor motivation
• Diseases of lacrimal apparatus; chronic dacrocystitis
• Diseases of Eyelids; Styes, blepharitis
• Conjunctivitis
• Episcleritis and Scleritis
• Iridocyclitis
• Occupational Hazards: smoke, dust, etc. Seventh nerve Palsy
• Inability to use hands; crippling arthritis
• Poor personal hygiene
• Allergic Patients
• Dry Eyes
BASELINE EVALUATION AND PRE REQUISITES
A) EXTERNAL EXAMINATION
- The external examination done with a slit lamp.
- CL is contraindicated if there is any active pathology of the eye or
above mentioned contraindications
- The Patient tear quality and quantity should be tested,

 Tear quality→ Tear breakup time (TBUT)

 Tear quantity→ Schirmer’s test
The corneal diameter is required for specification of the Contact lens
diameter. Because the corneal diameter is assumed to be equal the
diameter of the iris. (HVID)

The actual measurement is made with a P.D. ruler. The pupil diameter can
be approximated by using the iris as reference scale.
- The Palpebral Aperture Height is important factor in determining
corneal contact lens dimension.

- Three reading of keratometer measurement for the patient is obtained for maximum
accuracy, and then the median value of the three is recorded.
PRE-REQUISITE MEASUREMENTS
1) Selection of lens diameter
- Obtain patient's horizontal visible iris diameter (HVID) measurement

CL diameter = HVID + (1 to 3mm, average = 2mm)

- Increase or decrease lens diameter in 0.50 mm step if necessary during evaluation process.
- Lens must completely cover cornea.

- Most soft CLs are available from diameter of 13.50mm to 15mm

2) Selection of Base curve (BC)

- The flattest K minus 3.00 diopter

BC = flattest K - 3.00 D

- Convert the diameter value to millimeters using a converting table.

- Or in BC in 0.30 mm steps if necessary.

- Clinical experience shows that majority of patient can be fitted with an

average or median BC. This is usually is the 8.50 - 9.00 mm range.

- SCL are usually fitted flatter than the flattest K

As a guide and an alternative method of BC selection. The following table can be used:

-
Soft CL Base Curve K-reading
Flat ( >9.00mm) Less < 41.00D

Medium (8.00-.00mm) Between 41.00– 45.00 D

Steep (< 8.00mm) Larger > 45.00D

3) Selection of lens power

- Refraction prescription must be converted to minus cylinder form:

1- If cylinder in refraction is less or equal ≤ 0.50D,

“ power = spherical component”

2 - If cylinder in refraction is 0.75 D to 1.00D,

“the contact lens power = spherical equivalent (spherical
component + 1/2 Dcyl)”

3- If overall spherical component is greater than ± 4.00D,

“compensate for vertex distance using either method 1 or 2”
Method 1

Fc = Fs / 1- d Fs

Where
Fc = power of CL,
Fs = power of spectacle lens (D)
d = distance between spectacle lens
CL in meter

Refraction :
-5.00 +1.00 x 90 (plus Dcyl form)
-4.00 -1.00 x 180 (minus Dcyl form)

vertex distance = 13mm 13 / 1000 = 0.013m

Fc = -4.5 / 1- (0.013 x 4.5)

Fc = -4.5 / 1- 0.0585
Fc= -4.5 / 0.9415 = - 4.249 ≈ -4.25D
Method 2

Add 1/2 of cyl to sphere

Example

Refraction :
-5.00 + 1.00 x 90 (plus Dcyl form)
-4.00 - 1.00 x 180 (minus Dcyl form)

contact lens power = - 4 - 0.50 = - 4.50D

This is greater than ± 4.00D, so compensate for vertex distance

e.g. 13mm (by calculation or using table)

CHARACTERSTICS OF DIFFERENT TYPES OF CONTACT
LENSES
CONTACT LENS SPECIFICATIONS

I. Diameter
1. Overall diameter/ Total diameter/ Chord Diameter (OD):
Linear measurement of greatest distance across physical
boundaries of lens.
PMMA Lens: 7.5 - 8.8 mm
RGP Lens: 9.0 – 9.8 mm
Soft Contact Lens: 13 – 15 mm

2. Optic zone diameter (OZ) :

Dimension of the central optic zone of lens which is
meant to focus rays n retina.
II. Curves
1. Base curve (BC)/ Central posterior curve (CPC):
Curve on the back surface of lens to fit the front surface of cornea.
Ranges 7.0 to 8.5 mm in 0.05 mm increments

2. Peripheral curves:

Curves which are present concentric to base

curve and include intermediate posterior curve
and peripheral posterior curve. When multiple;
Eg. Tricurve or Bicurve
 3. Central anterior curve (CAC) / Front curve (FC)
Curve on the anterior surface of the optical zone of lens.
Its curvature determines the power of contact lens

4. Peripheral anterior curve (PAC):

Slope on the periphery of anterior surface which goes up to the edge.
Intermediate anterior curve (IAC) : It is fabricated only in High
Plus or High minus lenses. It lies between the central anterior curve and
Peripheral anterior curve

III. Blend :
Smooth area of transition of radius of curvature between curves Central anterior
curve
Light: Transition between the post curves distinctly visible
Medium: Transition between the post curves just visible
Heavy: Transition between the post curves not visible

Peripheral
anterior curve
Edge
Polished and blended union of the Peripheral Posterior Curve
& Peripheral anterior Curve of the lens.
Sharp: Dig into corneal tissue
Thick: Irritate lids
EDGE LIFT (Z-Factor): Extent to which most peripheral
curve differs from that of base curve radius is a measure of edge lift

Power
• Central anterior curve determines the power of the lens
• Measured in terms of posterior vertex power in diopters
Thickness
• Measured in the geometric center of the lens
• Varies depending upon the posterior vertex power of the lens

Tint
• Color of the lens
 RIGID CONTACT LENS

 WORK UP History

General ocular examination

Refraction

Keratometry

Trial Lens fitting

 SELECTING LENS FROM TRIAL SET

DIAMETER
9 mm with +/- 0.5 mm increment depending corneal diameter and
palpebral aperture.
BASE CURVE RADIUS
derived from keratometric reading. Astigmatism a base curve steeper
than K is chosen:

i. 0.5 - 1.0 D then 0.25 D steeper BC than K

Eg: K reading of 44 D/ 45 D, then BC chosen is 44.25 D
ii. 1.0 – 2.0 D then 0.50 D steeper BC than K
Eg: K reading of 44 D/ 46 D, then BC chosen is 44.50 D
iii. >2.0 D then 1/3rd Toricity to be added to K
Eg: K reading of 44 D/ 47 D, then BC chosen is

44 + 47- 44 = 45 D
POWER OF TRIAL LENS

Spectacle refraction should be

determined in minus cylinder form
and then corrected for the power at
the refracted vertex distance to a
vertex distance of zero
 EVALUATION OF THE TRIAL LENS FIT
Selected trial lens is inserted into the eye and after an adaptation period
(usually 15-30 minutes), evaluated
1. POSITION OF LENS
Ideally optic zone must cover entire pupillary area adequately in all
directions of gaze. Following Lens positions can be seen:
HIGH RIDING

Upper edge of the lens crosses the upper limbus while

looking straight
 HIGH RIDING
COMMON CAUSES AND THEIR CORRECTION:
Upper edge of the lens crosses the upper limbus while looking straight
Small lens/
Reduce Make the
prism
diameter edge thin ballast
Position of lower Lid; higher  pushing the lens up
Prism
Smaller Edge
thin/carrier ballast/
Upper Lid may be tight lens lenticular lens large lens

Both of the above

Large lens

High Minus Lens

Upward displacement of optic cup

 LOW RIDING
Lower edge touches the limbus
Plain Larg
Large/
Lenticular/ Stee
Carrier lens Steep Lens smal
Heavy Lens (single cut aphakic lens)
Plain Replace lens
lenticular/- with proper
Small diameter Lens carrier lens optic cup

Exophthalmic eyes

Upper Lid Push

Inferior Localised Optic Cup

 HORIZONTAL DECENTERING OF THE LENS

Nasally/ temporally

Causes: Corneal opacity, oblique or against the rule

astigmatism

Solution: Fitting steep and small lens

 2. BASE CURVE DETERMINATION
Determined by checking wether lens is flat, steep or ideal in relation
to cornea.

- High / low riding -Little or N o m ovem ent

-Fluorescein pattern: Black - Air bubbles u nder su rface
area over corneal apex and - Fluorescein pattern: Pooling
diffuse green pattern in of tear fluid in central position,
peripheral and intermediate bright green peripheral band&
zones broad black interm ediate area

FLAT STEEP

-Adequate move ment

- Fluorescein pa ttern: Apical

appearance, midperipheral
touch and peripheral clearance

IDEAL
3.FINALISATION OF OVERALL DIAMETER

A Large lens should have flat radius to produce the same effect as that of
a small lens with steep radius.
One millimeter change in diameter is equivalent to 0.01 mm change in
radius.
Lenses having same radii of curvature with two different diameters will
have different sagittal depths and vice versa.
 POST FITTING MANAGEMENT

PRESCRIPTION FOR RIGID LENSES

For eg.
Base curve radius- 7.5
Optic zone diameter 7.0
First Back Peripheral curve radius- 8.5
Second back peripheral radius- 9.0
Overall diameter of the lens- 9.5
Power of the lens- - 3.0

Prescription:
7.5: 7.00/ 8.30: 8.50/9.00: 9.5, power -3 DS
3. EVALUATION OF ORDERED LENS FIT

Lens Position
Ideal fit-well centred

Lens movements
Ideal fit- adequate movement is marked by 1-2 mm of smooth vertical/
lateral excursion on lateral or downward gaze

Flourescein Pattern
Most important test

Quality of vision
Vision should match the best corrected vision with glasses or should be
better and stable throughout the blink cycle and not vary due to lens
movement
 POST FIT FOLLOW UP

Regular follow up examination is most essential.

First visit- 24 hours
Second- after 72 hours
Third- after a week
Fourth after a month
Fifth after 3 months
Sixth visit after 6 months
Subsequent visits every year

History  Visual acuity  General Inspection  Biomicroscopic

examination
 SOFT (HYDROGEL)CONTACT LENS

 WORK UP History

General ocular examination

Refraction

Keratometry

Trial Lens fitting

 TRIAL LENS FITTING TECHNIQUE

Commonly available soft lens series in the local market.

Most of the manufacturers provide a maximum of three choices
base curve and overall diameter and the choice is to be made
by practitioner.
 SELECTING INITIAL TRIAL LENS

A trial lens with the following parameters must be selected

first:

1. Overall diameter

1.5 -2.0 mm larger than HVID, it can be greater if limbal sulcus is

pronounced.

2. Base Curve

Overall diameter -13 mm

A base curve 0.3 mm flatter than flattest K
For every 0.5 mm further increase in diameter a 0.3 mm increase in
High water content lens needs slight steeper fitting than low
water content lenses

For eg,
low water content lens
diameter =14 mm
base curve flatter by 1 mm than the flattest K-reading

high water content lens

of same diameter may need to be
flatter by 0.8 mm than flattest K
3. Power of the lens

 The spectacle refraction is corrected for vertex distance.

 The spherical equivalent of this gives the contact lens power.
If
 The spectacle cylindrical power is more than 1.5 D,
then toric soft lenses are required.
 EVALUATION OF TRIAL LENS FIT

20 mins- low water content lens

10 mins- high water content lens

so that the lens hydrates properly and fits in the eye

environment.

FLORESCEIN IS NEVER USED IN SOFT LENS FITTING

EVALUATION
 A) Evaluation of the base curve:

IDEAL FLAT/LOOSE FIT STEEP /TIGHT

FIT
Movement Would not move Moves rapidly Moves very little
more than 0.5-1.0 over the cornea or does not move
mm with upward or at all.
downward movement Presence of air
of the eyeball or with bubbles under
each blink. the lens suggests
steep fit.

Centering center well, Due to large base Due to smaller

 IDEAL FLAT/LOOSE FIT STEEP /TIGHT
FIT
Vision on Vision remains Vision blurs on Vision clears
Blinking equally clear before blinking immediately after
and after blinking blinking

Compressio - - Compression
n of blood
vessels
 IDEAL FLAT/LOOSE FIT STEEP /TIGHT
FIT
Retinoscopy Retinoscopic reflex Retinoscopic Retinoscopic
remains sharp and reflex Blurs after reflex becomes
crisp before and after the blink clear
a blink immediately after
a blink
Effect of Sharp and crisp Blurs after a blink Becomes clears
blinking on before and after blink after a blink
keratometer
mires
 Lens with an ideal base curve

 Maintains 0.5-1 mm movement

 Maintains good centration
 Doesn’t cause compression of conjunctival vessels maintains
stable visual acuity with and without blinking.
 Maintains sharp and crisp retinoscopic reflex and
keratometric mires before and after blinking.
3. INSERTION AND REMOVAL OF CL
 LENS RELATED PROBLEMS
Blurred vision at the distance
Blurred vision for near
Blurred vision when contact lens are removed and spectacles
are worn
Inevitable awareness of presence of lens
Feeling of burn, hot and scratchy eyes
Feeling of lenses touching eyelids
Uncomfortable feeling in the morning
Tilting back of head
Excessive Blinking
Milky fluid coating over lenses in morning
Swelling of lids in the evening after all day wear
Swelling of lids in the evening after all day wear
Difficulty in removing the lens
Lenses fall out or too frequently get to conjunctiva
Discomfort in eye movements
Persisting photophobia
Fluctuating vision
Better vision with change in head posture
Watering
Pain immediately after putting lenses
Pain after a few hours of wear
Severe pain 3-4 hours after removal of lenses
Feeling of dryness
 LENSES DEPENDING ON DURATION OF WEAR

 EXTENDED WEAR

A. DISPOSABLE

Continuous wear for day and night for several days, weeks or
even months without removal

Can be made of hydrogel soft lenses or RGP Lenses

INDICATIONS OF EXTENDED WEAR DISPOSABLE LENSES

 Elderly aphakics
 Younger patients
 Non compliant patients
 Patients with irregular waking hours and working shifts
 Patients habitual off falling asleep with lenses on
 Habitual over wearers
TYPES

Low Water Content

38-45 %
Thinner the lens greater the oxygen permeability
Ultrathin/ membranous lenses
Lens ripples on blinking causing distortion

a. CSI Lens
Thin lens- 40 % hydration
Durable elastic small optic zone requiring minimal movement
and large lenticular zone
Non hema lens made of glycerine, methyl acrylate and MMA
14.8 mm base curve of 8.6 , 8.9 and 9.35 mm
Power range +/- 20 D
Equiliberates in 5 minutes and thus over refraction is possible
after this time.
Resistant to deposits, discoloration and effect of environment.

b. Bausch and Lombs

Rarely with 39 % hydration and thickness of 0.35 mm have
been used as EWLs.

Medium Water Content

45-60% water

a. Hydrocurve Lenses
HEMA
Hydrocurve I lens has a water content of 45 % and thickness
b. Softcon Lenses

HEMA and povidone

Hydration is a 55% and its thickness varies 0.17 to 0.64 mm
depending upon the power. Its tougher, thicker and elastic.

Base Curve: 7.8, 8.1 and 8.4 mm

Diameter: 13.5, 14 and 14.5
Power: -8.0 to + 18.0 D including plano
High Water Content

Thickness increases durability, the high water content polymer

material is usally not very durable.

a. Perma Lens
2-HEMA VP and methacrylates
Lathe cut lens having hydration 71% and thicknesss varies
0.24 to 0.43 mm

b. Sauflan Lens

HEMA and N-vinyl 12 pyrolidone

Water content 79% and thickness 0.05 mm
Problems related to Extended Soft Contact lenses

• Lens deposits
• Infectious keratitis
• Corneal Vascularization

• The Light Lens Syndrome

Acutely developing painful red eye
An immobile lens which is partially dehydrated.
Gripping cornea odematous on account of poor oxygenation

Abstaining from lens wear for a week or two, use of a looser

fitting lens after the eye is normalized.
EXTENDED WEAR RIGID GAS PERMEABLE LENSES

INDICATIONS

 Metabolic problems with hydrophilic lenses

 Visual Problems with toric extended wear soft lenses
 Allergic problems like GPC with soft lenses
 SKC due to soft lenses
 Thick lens situations; high power and high minus lenses,
toric bifocal and bigger diameter.
Wearing Schedule and follow up

Daily wear regime for the first week and then switch to an
extended wear regime.
Overnight removal schedule ; overnight removal every 5th night
useful

Follow up-
Day 1
Morning After overnight wear
1 week
2 weeks
1 month
3 monthly

Look out for: Peristent striae, 3-9 staining, back surface debris,
Problems and complications:

Adhesions phenomenon: Occurs due to lens behaving as

suction cup, first ring impression on the cornea and then
adherence to cornea.
Most commonly with High DK value lenses, steep lenses and
thin lenses.

3-9 Staining: RGP-EW Lenses than with DWL lensesFactors that

increase the cances of occurrence of 3-9 staining are low riding
lenses, thick edged lenses and partial blinkers.
 SPECIAL CONTACT LENS FITTING SITUATION

 ASTIGMATISM

Spherical RGP Lens

Patients with minimal astigmatism.
High comfort.

RGP with Toric Peripheral Curves

1.5-2.0 D Corneal astigmatism.
In such cases a spherical posterior surface lens may fit
inadequately because the lens edge may lift over the steepest
corneal meridian
The standard peripheral curve used as flattest meridian and in
steepest meridian the peripheral curves are made steeper by
BITORIC RGP Lenses
Toric posterior curve lenses necessary to provide an adequate
lens fit in patients with higher degrees of corneal astigmatism
usually 2.5 D
Or greater
Lenses are fit with posterior curve same as keratometric
readings.
Anterior toric curve to nullify induced astigmatism -> Bitoric
Lens
Posterior Central Curve and Posterior optical zone
On both corneal meridian
Arbitary POZ 7.5 mm
For every 0.5 mm change in POZ a compensatory change in
both radii of curvature of PCC by 0.05 mm should be made.
Lens Power
Ocular correction for vertex distance for both corneal meridian.
Spectacle correction at 12 mm is -6.25, -4.75 x 180 degrees
will require -5.75, -4.00 x 180 degrees.
PCC steeper; add minus to spherical power only
PCC flatter , add plus to spherical power
For every 0.05 mm a 0.25 D of sphere power should be
changed.

Peripheral Curves
Made toric to have a round POZ

Centre thickness
Calculated from spherical thickness chart, using spherical
equivalent of bitoric lens
4. FRONT SURFACE TORIC RGP LENSES
Required in patients having spherical corneas with significant
astigmatism. Such an astigmatism is called residual
astigmatism. It usually reflects the lenticular astigmatism.
When a front toric lens is ordered for a spherical corneal
surface, a special change in the shape of contact lens is
necessary to prevent it from rotating (to stabilize the relative
cylinder axis)

A prism Ballast
SOFT LENSES FOR ASTIGMATISM

Spherical Contact Lenses

Can correct upto 1 D (Provided total astigmatism is not more

than 1/3rd of spherical correction)
since pt wont be comfortable and thinner correct less
compared to thicker.

Toric Soft Lenses

When astigmatism is more than 1 D or when spherical lenses

are not able to correct it/ when pt is unable to tolerate rigid
contact lens
Toric soft lenses have different radii of curvature in opposing 90
Needs stabilization by: Double slab- off lenses (most comfrtble)
Prism Ballasting
Truncation
Prism Ballasting with trunctation
Aspheric Back surface
 APHAKIA

RGP Lenses

A single cut lens

High power Thick in center  heavy  ride lower

Thus small lens ; will centre better; 7.4-8.4 mm in diameter

Large lenticular lens

Central optical zone anteriorly and peripheral thinner flange 9-

10 mm
Aphakic soft contact lens

Extended wear type

Lathe cut lenticular design best stability provides sharpest and
most stable vision
 KERATOCONUS

• Ideal CL for keratoconus

• Minimal apical touch or apical clearance (3 point touch
provides stable fitting and good vision)
• Nonexcessive areas of tear/ debris pooling beneath optic
zone
• Good circulation of tear film under lens
• Good stability and comfort
• Mild or High DK lens for adequate o2 permeability
Rigid contact lens fitted with three point touch
technique
Neither should move excessively nor should it compress the
cone forcefully.

Soper’s technique
Two posterior curves one to fit the central cone and the other
to fit the normal cornea surrounding the apex. 3 fitting sets:
Mild D=7.4 mm, OZ= 6.0 mm
Mod D= 8.5, OZ= 7.0 mm
Severe D= 9.5 mm, OZ= 8.0 mm

Mc Guine lens
Prescribed for more oval and more advanced cones. Uses 4
peripheral curves with wide blends
Rose K lens

Utlizes light apical touch and optimal peripheral clearance.

Computer generated peripheral curves are used. Toric Surfaces
are available on frnt, back and periphery.

Piggy Back Lens

Rigid lens fitted on top of a soft lens. Rgp lens is fitted with
good centeration.

Hybrid Lens Sytem

Utilizes CLs with RGP central portion and soft lens material
skirt.
Scleral RGP Lens
In advanced Keratoconus where corneal lenses do not work
and corneal surgery is contraindicated.

Custom toric soft contact lenses

In early stages or in form fruste keratoconus.

Early KC
Ker I and II (No. 7) Acquity K
Rose K

Moderate KC
Rose K2
Woodward KC3/ SOPPER Lenses
Kera II
Quasar KN07

Moderate/ Advanced KC
Rose K2/ IC
Kera II/ III
Profile K (J Allen)

Advanced KC
Small diameter lenses
S-Lim (J Allen)
Dyna- intralimbal
Scleral Lens
Gas permeable (innovative scleral)
 HIGH MYOPIA

Patients with more than -8.0 D need contact lens with relatively
flat anterior surface. These lenses tend to ride high because of
the larger diameter and because of increased edge thickness.

Thickness can be reduced by ordering a lenticular bevel..

 PRESBYOPIA

Monovision Contact lenses

One eye corrected for distance other for near. Brain learns to
suppress the blurred image and patient adapts to see clearly
for distance as well near with alternative eye..
Modified monovision contact lenses
One eye corrected for distance and other eye fitted with bifocal
CL..
 BINOCULAR BIFOCAL CONTACT LENSES

Expensive and difficult to fit. Available in both rigid and soft

types.

i. Annular Bifocal
Distance and near arranged concentrically. Centre distance
or centre near elements.

ii. Segmental Bifocal

Upper two third for distance and lower one third for near.
 iii. Aspheric Bifocal

These lenses have distance correction in centre with

gradually progressive add for near towards periphery..

iv. Diffractive Bifocal

These lenses have concentric bifocal rings which focus

approximately equal amounts of light from both near and
distance objects.
 COMPLICATIONS OF CONTACT LENS WEAR

Corneal de-epithelization

punctuate epithelial keratopathy, epithelial abrasions, foreign body tracks, dellen,

microcysts, vacuoles, mucin balls, dimple veiling. The presence of epithelial defects should
be monitored closely, and they may require both temporary cessation of contact lens wear

Corneal edema

This may result from either acute or chronic hypoxic corneal conditions, contact lens
materials, and contact lenses that are inadequately fitted. To treat this condition one should
select a lens material with higher oxygen permeability, decrease contact lens wearing time,
and ensure an optimal contact lens fits.
 COMPLICATIONS OF CONTACT LENS WEAR

Corneal distortion
Alteration of the corneal curvature that results from a molding effect produced
by contact lens wear. Treatment consists in making sure there is no irregular
astigmatism, contact lens refitting, and change material of lens.

Sterile infiltrates
Represent an immunologic reaction, and are the greatest diagnostic dilemma
to early keratitis. It may result from contact lens wear itself, from endotoxins
created by bacteria or from combination of two. Treatment usually consists of
topical steroid drops along with prophylactic antibiotic coverage.
 COMPLICATIONS OF CONTACT LENS WEAR

Neovascularization
response to the same inciting factors that causes neovascularization in non-contact lens
wearer, corneal hypoxia and inflammation. Treatment involves removing the inciting stimuli,
and depending on the severity, a pulse of topical nonsteroidal anti-inflammatory drug or
corticosteroids to aid in vessel regression.

Microbial keratitis

Etiology: Pseudomonas Aeruginosa is the most common pathogen, also Staphylococcus,

Streptococcus and Serratia are common microorganisms found in these patients. Another
pathogen that is closely related to the use of contact lenses is Acanthamoeba. 88% of
patients with Acanthamoeba keratitis wore contact lenses. This may be diagnosed through
cultures, smears biopsy and confocal microscopy.
CONTACT LENS SOLUTIONS AND PRESERVATIVES
Examples of Oxidative disinfection

1- Allergan Optical has two systems Oxysept and UltraCare both are preservatives-
free.

A- The Oxysept is two step processes

1- The CL is placed in the case containing hydrogen peroxide after proper time
interval of disinfection (10min-12hours).
2- Place neutralizing tablet in the case to neutralize hydrogen peroxide acidity.
B- The UltraCare is one step process

- The CL is placed in the case containing hydrogen peroxide and place UltraCare
neutralizing tablet at the same time.

- The UltraCare neutralizing tablet is coated with a viscosity agent that prevents
activation of tablet for 20-30mins this allow disinfection with hydrogen peroxide
to occur prior to neutralization.
CONTACT LENS SOLUTIONS AND PRESERVATIVES