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    orthokeratology book

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    orthokeratology book

    Copyright:

    © All Rights Reserved
    Download as PDF or read online from Scribd
    Flag for inappropriate content
    6 views10 pages

    2017-07-27

    Uploaded by

    Gsz Eli Wong
    orthokeratology book

    Copyright:

    © All Rights Reserved
    Download as PDF or read online from Scribd
    Flag for inappropriate content
    of 10
    The second trial lens: Z Night Lens (NKL) 8°/ Height = 0.54 / © 10.2 mm / Target 6 D / Menicon Z er than the previous lens) 8C9.2 ager (effectively 30 um flatt | After first overnight lens wear: Fluorescein pattern revealed a wider area of apical bearing with a narrower tear reservoir. Edge lift and tear exchange were both adequate, Lens movement. was good with smooth recovery. Fluorescein showed ‘ears flowing in and out of the fenestrations | Topographical response showed resolution of central island Residual Rx: -4.50 DS (VA: 6/9) Corneal health: Grade 1 central stain Management: Stopped lens for 3 days. Resumed lens Wear after recovery of corneal health was confirmed, Coy wear ths lens and observe if further myopie is possible ntiNued to "eduction REMARK: Since there was central omeal stain ang te corneal tissue across the trestment Zone Was not even after the first night trial the acuity was compromised, It should improve with continuation of lens wear, Conclusion from this case: , A false central island may resolve with time. Lens wear may continue ifthe ocular health is not Compromised. Reducing the lens sag can help to resolve central island ifthe situation does not improve a Figure 2.14b Tangential map for the same patient as in Fig igure 2.149 Use anlahmap to assess the general profile of the cornea * Spherical cornea shows gradual flattening towards the limbus (Figure 2.6) Astigmatic cornea will show bow-tie pattern * Vertical bow-tie pattern: with-the- * Record any localized defect (.9, id mari *) (Figures 2.5e, 2.8) or irregularity (e.g, tilted comea) (Figures 2.54) Figure 2.13 The horizontal iris diameter (HVID) is determined by drawing a line from limbus to limbus passing through the apex (yellow line) TLE | map captured by Medmont. Colour scale is normalized scale by default. Figure 2.14a Axial apical radius of curvature and pupil location are shown Simulated K-readings, e-values, Figure 2.12 Extensive ring jam due to disruption of tear film (red a 2.4 Interpretation of topographical maps + Review the ring image to ensure no ring jam (Figure 2.12) * HVID and pupil « HVID size and pupil diameter (Figures 2.13 and 2.14) can be determined by using) function (Figure 2.13) or estimated from the 1 mm x 1 mm grid pattern (Figure Pupil center is shown as the small black cross in the center of Figures 2.13 and Pupil size may or may not be shown on the map. The default pupil may be i especially in patients with dark irises. It can be redrawn using the circle function + Default display on the colour map (Figure 2.14a) Pupil * Simulated k-readings * Evalues * Apical radius of curvature * Select the scale On Figure 2.11c Axiabsubtractive map of the same patient as in Figure 2.11b. The pre- and post-treatment maps in Figures 2.1:1b and 2.1.1 look different but the subtractive maps look similar in terms of colour pattern, profile and refractive changes. Note that the colour scales in this subtractive map is the same as that in Figure 2.11b 2.3.5 Tips for taking good topographical maps The eye must be wide open (eyelids or eyelashes should be out of the way) « Tilthead slightly (up/down) for deep-set eyes and tum head slightly (left/right) for flat nose to vid the nose getting in the way «Alow the patient to blink normally to ensure a stable tear film (Unstable fim eanlances is isa quality and the reliability of that image) rake at least four captures and compare thelr appearance (e.g, using axial map Wit normalized ; «Delete capture with poor image, e.g. ring Jams (Figure 2.12) from Pook tear film «Keep three to four good captures as baseline 24 jal, (b) tangential, (c) refractive, and Figure 2.10 Corneal topography (3) @ elevation maps of an astigmat 2.3.3 Maps and displays faxiahfonSagittal)amap (see Figures 2.6-2.10) corneal surface relative to the optical axis Can be displayed in millimeters (curvature map) or diopters (power map) ient’s fixation and corneal asymmetry « Ishig! ati + Gives a general view of the corneal contour (eg. any corneal astigmatism) (see Figu vs 2.7b) ‘Tangential (or Instantaneous or-TrueGurvature)»map (Figures 2.6-2.10) ‘Describes the surface of the comeal surface independent of the optical axis + Shows small localized changes on the comea (eg, lid mark, Figure 2.8) 2 Can be displayed in millimeters (curvature map) or diopters (power map) + Isexcellent for * Locating the apex of the cone in keratoconus (Figure 2.5f) * Showing centration after ortho-k or refractive surgery (Figures 2.59-h) + Refreietivettiap (Figures 2.10c) + Describes the refractive power of © power of the comea by converting the surface power into a1 +-Customized)-seale (Figures 2.6, 2.7) default 0 stomized by the examiner ult scale is pre-set by instrument (in contrast to the normalized scale) 1" comparison for differences between topographical maps Of the different time or with other patients (eg. keratoconus VS: amended fe patient take nal cornea) locmalizech(orsRelative)scale docoalets (Figures 2.6, 2.7) + Determined steepest ned by the steepest and the flattest readings measured on that particular apture for a particular cornea . detail illustration of the corneal profile (Figures 2.6a vs 2.6b, Figures 2.7a VS 2.7b) (a) tin tangential map (b) a localized defect and is more prominen' TrOW)- rather than axial map (a) (see an (b) ) Axial map shows centrally aligned = (@) Figure 2.9 Axial and tangential maps of a post-LASIK cornea, (2 central flattening (blue area) and (b) the tangential map shows treatment zone ial: te scale (default setting, « | topographical maps (4) axial: absolu nat cea (b) mS le, (c) tangential: absolute scale (defa i ), and (4) axial: normalized scal nO scale for the same patient (spherical cornea) tangential: norm: Figure 2.7 Corneal topographical maps axial: normalized scale, (c) tangent tangential: (a) axial: absolute scale (default — tial: absolute scale (default setting), a normalized scale for the same patient (toric cornea) 11 Srmine the treatment zone size as in refractive subtractive map (See) tive subtractive map below) Ref

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