Soft Contact Lens Clinical Pearls Vivianle Freeman, O.D., F.A.A.

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Effectivity • Change in refractive power at different vertex distances • Clinically significant at +/- 4.00 D • Myopes – Less minus at corneal plane – More minus at spectacle plane • Hyperopes – More plus at corneal plane – Less plus at spectacle plane • Formula: FCL = Fsp 1- d Fsp

FCL= Power of Contact Fsp = Power of Spectacle d = dist between spectacle and CL in meters Look it up in the Vertex conversion charts Residual Astigmatism • Astigmatism remaining after correction with contact lens – 0.75 D cylinder may be symptomatic • High myopes tolerate cyl better • ATR or oblique axis less tolerated • Variable among patients • RA = Spec cyl – Corneal Cyl – WTR : (-) cyl x 180, vertical K’s steeper – ATR: (-) cyl x 090, horizontal K’s steeper • Example: – Spec Rx: pl-2.50X180, K’s: 44.00/46.00 @090 • Spec cyl: 2.50 WTR • Corneal cyl: 2.00 WTR • RA = 2.50 WTR -2.00 WTR • RA = 0.50 WTR or -0.50 x 180 • For WTR cornea: – Spec Cyl is WTR and equal to corneal cyl à no RA – Spec Cyl is WTR and greater than corneal cyl à WTR RA – Spec Cyl is WTR and less than corneal cyl à ATR RA For ATR cornea, the opposite will be true Oblique cylinder, RA may be variable if axes do not match

00 à Flat to Median K 43. coverage – Rotation – Stability of rotation • Rotation to Left X° à Add X° to spec axis • Rotation to Right X° à Subtract X° from spec axis • Note that “Left” and “Right” designate the movement of the inferior edge .00 to 43.00 à Median K 44.00 to 44. axis stability becomes critical • Perform sphero-cylinder refraction • Rotate cyl axis until patient definitely notices blur – Rotation ± 20° à 90% soft toric success rate – Rotation ± 15° à 90% success with 2 lenses – Rotation ± 10° à 70% success with 3 lenses – Rotation ± 5° à patient must accept variable VA with lenses • Vertex both meridians – Spec Rx: -6.50x180 • Choosing a trial lens – Axis is most important – Then cylinder power – Last is spherical LARS fitting • Evaluate trial CL of similar power and axis • Allow for proper lens settling (20 minutes) and evaluate • Evaluate fit – Movement.00 à Flat BC suggested K 42.00 à Median to Steep K > 45.Spherical Soft Lenses • Base curve: based on average K reading K≤ 42.00x180 becomes -6.00 to 45. centration.00-2.50-3.75D • Consider toric lens if cylinder > 30% of overall RX • As cyl increases.00 à Steep Toric Soft Lens • Advised if refractive cyl >0.

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