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Contact Lens Fitting

Ganesa Wardana I.K. Mata FK Unhas

Contact Lens Glossary

The 3 most important terms: base curve,

diameter, and power

Features of Contact Lens Optics

4 parameters in common for Contact lenses

and conventional lenses:

base curve
2. power curve
3. diameter
4. Power

Contact lenses differs from that of spectacle

shorter vertex distance
2. tears

Optical Considerations of contact

field of vision,
image size,
convergence demand,
the tear lens,
correction of astigmatism,
correction of presbyopia.

Patient Examination
Specific information to select a contact lens:
o the patients daily activities
o reason for using contact lenses
o If already a contact lens user: the number of years
the patient has worn contact lenses, the current type
of lens worn, the wear schedule, and the care system
o whether the patient currently has or previously had
any problems with lens use
o Factors that may suggest an increased risk of
o Other relative contraindications to contact lens use

Patient Examination
Key areas to observe during slit-lamp examination:
the eyelids (to rule out blepharitis or mechanical lid
abnormalities such as trichiasis, ectropion, and
the tear film and the ocular surface (to rule out dry
eyelid movement and blink
Cornea and conjunctiva should be evaluated carefully
for signs of ocular surface disease, allergy, scarring,
symblepharon, or other signs of conjunctival scarring
diseases, such as ocular cicatricial pemphigoid
(mucous membrane pemphigoid)

Patient Examination
Refraction and keratometry to determine

whether there is significant corneal, lenticular,

or irregular astigmatism (keratoconus)

Contact Lens
A complex process. Optical, biological,

mechanical, and social considerations.

Contact Lens Fitting

The goals is patient satisfaction
good vision that does not fluctuate with
blinking or eye movement
good fit, the lens is centered and moves
slightly with each blink vary between soft
and RGP lenses

Soft Contact Lenses Fitting

Comfortable (the material is soft and the

diameter is large, extending beyond the

cornea to the sclera)
Most of lens that varies in only 1 parameter
from 3 base curves fit empirically
A good soft contact lens fit : having a 3-point
touch (corneal apex and the limbus on either
side of the cornea)
Choose a lens with a different sagittal depth
(lens diameter and the base curve)

Soft Contact Lenses

Evaluating the soft lens fit:
the lens movement and centration
Good Fit : move approximately 0.51.0 mm with upward gaze

or blink, or with gentle pressure on the lower eyelid to move

the lens
A tight lens will not move at all, and a loose lens will move
too much

patients vision and comfort, slit-lamp findings (eg, lens

movement, lens edge, limbal injection), and keratometry

overrefraction is performed to check the contact lens
the final lens parameters should be clearly identified

Soft Contact Lenses


Soft Contact Lenses

Teach the patient how to insert and remove

the contact lenses, how to care for them, and

how to recognize the signs and symptoms of
eye emergencies
Follow-up care: assessment of symptoms and
vision and performing a slitlamp examination.
(scheduled for 1 week after the initial fitting)

Rigid Gas-Permeable Contact

Lenses (RGP) Fitting
Small overall diameter center over the

cornea but move freely with each blink to

allow tear exchange
Parameters of RGP lenses often are not
determined by the manufacturer but are
individualized for each patient
The fit is optimized first; then the vision is
optimized by overrefraction

RGP Fitting

RGP Fitting
Base curve
maintains its shape when placed on a cornea
a tear layer forms between the cornea and contact lens
The type of fit is determined by the relationship between

the base curve and the curvature of the cornea (K)

The following options for selection of the initial base
o Apical alignment (on K)
o Apical clearance (steeper than K)
o Apical bearing (flatter than K).

RGP Fitting
The most common type of RGP lens fit

is the apical alignment fit allows the

lens to move with each blink, enhances
tear exchange, and decreases lens
A central or interpalpebral fit, the lens
rests between the upper and lower
eyelids (apical clearance) very large
interpalpebral opening, astigmatism >
1.75 D, and against-the-rule
Apical bearing is not typically used with
normal eyes

RGP Fitting
The diameter is approximately 2 mm shorter

than the corneal diameter

Central thickness and peripheral curves can
also be selected often assumes standard
The lens edge enhancing tear exchange
and maintaining lens position, as well as for
providing comfort

RGP Fitting
The tear lens power is determined by the base

On K. The tear lens has plano power.
Steeper than K. The tear lens has plus power.
Flatter than K. The tear lens has minus power.

The rule for calculating the needed contact lens

power from the spectacle sphere power and the

base curve of the RGP lens is SAM-FAP (steeper
add minus; flatter add plus)
The lens power can also be determined empirically

RGP Fitting
vision quality, lens movement, and the

fluorescein evaluation
Overrefraction determines whether a power
change is needed
Vision should be stable before and immediately
after a blink the lens covers the optical axis
The peripheral zone of the cornea flattens
toward the limbus the central vault is
determined by base curve and diameter

RGP Fitting
Insufficient movement suggests that the lens is

too tight decrease the sagittal depth

Excessive movement suggests that the lens is
too loose increase its sagittal depth
Evaluation of the fluorescein pattern with a
cobalt blue light at the slit lamp can help in
assessing RGP lens fit
apical clearing of the cornea, pooling or a bright

green area will be observed;

RGP lens is touching the cornea, dark areas will be

RGP Fitting

RGP Fitting
Once the lens parameters are determined, the

information is given to a laboratory, which then

makes the lens to these specifications
When the lens is received, the major parameters
must be checked: base curve (by use of an optic
spherometer), lens diameter, and lens power (by
use of a lensmeter)

Toric Soft Contact


Toric Soft Contact

Soft toric contact lenses are readily available in

several fitting designs

front toric contact lenses, the astigmatic correction is

on the front surface

back toric contact lenses, the correction is on the back

To prevent lens rotation, one of several

manufacturing techniques is used:

adding prism ballast on the bottom edge
truncating or removing the bottom of the lens to form a

straight edge that aligns with the lower eyelid

creating thin zones on the top and bottom

Toric Soft Contact

The fitting is similar to fitting other soft

lenses, except that lens rotation must also be

Typically have a mark to note the 6-oclock
position (does not indicate the astigmatic
Slit-lamp examination shows that the lens
mark is rotated away from the 6-oclock axis
rotation noted in degrees (1 clock-hour
equals 30)

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