HARD LENS PROPERTIES

MECHANICAL PERFORMANCE CONTROL

Mechanical performance dictated by magnitude of several forces
Forces depend on:
- Lens geometry
- Material characteristics
- Ocular parameters
For lens to fit correctly, a balance is necessary between those forces acting to hold the
lens against the eye and those forces acting to move/eject the lens

1. Capillary
attraction

2. Centre
gravity

of

3. Tear meniscus

4. Lid force and

position
5. Friction

Force of attraction between lens and cornea varies inversely

with distance between them
Closer the two surfaces, greater the attraction
Flatter lens reduces capillarity
Steeper lenses do as well, but because of suction effect at
edge of lens, movement of lens is reduced
Exact alignment of lens on cornea would not be tolerated by
eye due to too little movement/tear exchange
CL: COG near back surface or behind lens
The further back COG moves behind lens, the more support it
has
Position of COG affected by:
a. Overall diameter
b. Back vertex power
c. Centre thickness
d. BC
CT, OD and power most likely to affect lens position

Rule of thumb for relating parameter change of negative lenses and

weight:
Change CT by 0.01mm
change in mass of 3-12%
Change TD by 0.1mm
change in mass of 4% (-5)
2% (-1)
Change BVP by 1D
change in mass of 2-6%
Change BC by 0.1mm
change in mass 0.3 1.5%
Existence of tear meniscus under edge of corneal lens
essential for centration
Greater circumference of meniscus = better centration
When upper lid covers lens, lens is held in position
Force is not necessary to hold lens in place
Lower lid can hold lens in position if high enough
Corneal lens remains stationary due to friction
Largely due to viscosity of tears
If tears a very fluid and less viscous, friction decreases > lens
moves more
Lacrimation = increased movement

List the forces that influence the performance of a rigid contact lens
- Capillary attraction
- Gravity
- Tear meniscus
- Lid force and position
- Friction

Module 4 Slide 3 Diagrammatic representations of the centre of gravity with lenses of

differing power, thickness and BOZR

Capillary attraction
- Force of attraction between the lens and the cornea varies with distance between them
the closer the surfaces the greater the attraction
- Flatter lenses decrease capillarity
- Steeper lenses do as well but because of suction effect at edge of a steep lens,
movement of the lens is reduced
- If possible to exactly align the lens on the cornea over the width of the lens, the lens
would not be tolerated by the eye as a result of too little movement and hence tear
exchange
Discuss the concept of gravity in the contact lens arena
Effects of gravity can most easily be seen by the use of concept of centre of gravity
For a contact lens the COG is near the back surface or even behind the lens
The further the COG moves behind the lens, the more support it has above the COG.
The position of COG is affected by
o Overall diameter
o Base curve
o Back vertex power
o Centre thickness
Related to the centre of gravity is the lens weight

WEAR MODALITES AND REPLACEMENT SCHEDULES

Wear modalities
Daily wear
Wear lenses while eyes are open
Flexible wear
Daily wear interspersed with occasional overnight wear
Intermittent
Only worn for special reasons (sports/going out)
wear
Extended wear
Uninterrupted wear, usually extending to one week
Continuous wear Uninterrupted wear for extended period (1 week to 1 month)
Replacement schedules
Replaced on
1. Lens age
2. Degrees of contamination
following
3. Prophylactically
basis
RGP
Can be used for >2-3y, depending on condition of lenses and Rx chanes
SCL
Approximately 18 months
Disposable lenses depend
HARD CL FITTING PROCEDURES
Design elements of hard lenses to be achieved when fitting:
1. Moderate
edge
Allows for tear exchange via tear reservoir under peripheral
width
and
curves of lens
clearance
If too small > no tear exchange
If too wide or lift is too great > discomfort, displacement,
ejection
2. Central and mid Allows for good centration and movement
peripheral
alignment
3. Smooth movement
Hard lenses have to move on cornea
ensures dispersal of metabolic and cellular waste
Allows for tear pumping effect > ensures exchange of
tears and oxygen beneath lens
Excess movement > discomfort and visual disturbance
Lens too tight > no movement > px reports comfort
4. Adequate
Decentration
>
visual
disturbance,
discomfort,
centration
compromised corneal physiology
5. Comfort
6. Clear sight
7. Adequate wearing
Usually waking hours 8-14h/day
time
8. No
ocular
All lenses interfere with corneal function in some way
compromise
Goal: reduce such interference to minimum
9. Normal
head
Head tilt
posture and ocular
Squinting
appearance
Blepharospasm
Ptosis

Discuss the factors/ aims/ goals that need to be achieved when fitting rigid contact
lenses
Moderate edge width and clearance
Allows for tear exchange via the tear reservoir under peripheral curves of lenses
If too small no tear exchange
If too wide or lift too great discomfort, displacement and ejection
Central and mid-peripheral alignment
Allows for good centration and movement
Smooth movement
Movement ensures dispersal of metabolic and cellular waste
Allows for tear pumping effect that ensures exchange of tears beneath a lens along the
associated O2
Excess movement discomfort and visual disturbance
If lens is tight - no movement
Adequate centration
Decentration visual disturbance, discomfort and compromised cornea physiology
Comfort
Provide clear vision
Adequate wearing time
No ocular compromise
Normal head posture and ocular appearance

Protocol:
1. Routine visual exam
2. Discussion
3. CL preliminary exam:
- First lens to try
- Parameter changes and their effects
- Astigmatism
4. Tolerance trial and check
5. Dispensing
6. After care schedule
1. Routine exam
Usual examination
All patients considered binocular unless they only have one eye
Thorough visual exam including phorias, ranges, stereo
All patients have pathology until shown otherwise
Ophthalmoscopy
Case Hx
2. Discussion
Purpose

Informed
decision

Px motivation

Cost

Allow patient opportunity to ask any questions

Get impression about patient, why they want CL, special requirements
etc
Give patient all information about lenses, procedures to follow and
risks/benefits of CL
Inform patient about different types of lenses, potential dangers of lens
wear, ADV and DDV of different types of lenses etc
Inform about hassles involved with CL wear
Risks, time needed, insertion/removal
Visual exam fee
CL fee
Cost of lenses
Monthly costs of solutions

3. Preliminary Exam:
Objective
1. Is px suitable for CL
2. Obtain baseline info
3. Advise px of options
Factors
to
1. Anatomical and physiological
2. Psychological
consider
3. Pathological
4. Personal and occupational need
5. Refractive

Preliminary
Ocular
dimensi
ons

Keratom
etry

Tear
layer
assessm
ent

Slit lamp

Exam: data to be obtained:

1. HVID (vertical?)
2. Pupil diameter (light and dark)
3. Vertical palpebral fissure
4. Lid position (top and bottom)
5. Exophthalmos
6. Lid tension (when everting lids)
7. Check tarsal plat for papillae
8. Blink quality (incomplete/twitch, etc)
1. Focus on cross-hair inside instrument
2. Focus mires from cornea properly (defocus affects
accuracy of measurement)
3. Align mires along astigmatic axes
4. Take measurement of radii
(Remember: only approximately 3.5mm of corneal surface is
measured with keratometer)
While doing this measurement, assess the following:
1. Quality of mires (important with keratoconus)
2. TTT
Tear film instability, dry eyes and excessive lipid in tears
can result in poor CL wear
The following can be assessed: Tear flow, volume, TBUT,
osmolality, pH
Invasive
Non-invasive
1. TBUT
1. TTT
2. Schirmer
2. Non-invasive TBUT
3. Phenol red thread test
3. Tear prism height
4. Rose Bengal staining
4. Interference patterns
5. Expression of glands
5. Debris in tears
Non invasive tear evaluation
Positive and negative record keeping important
Flow chart:
1. Lid margins and lashes
General view of structures
Absence of inflammation
Normal redness and anatomy
Smooth surface
Creepy-crawlies
2. Bulbar and palpebral conjunctiva
Papillae/follicles
Normal redness
Pathological changes
Bitot spots
Dryness
3. Limbus
Injection/engorgement
Neovascularization
Pterygia
Dellen
4. Anterior chamber angle
5. Tears
6. Cornea
Endothelium
Striae
Stippling
Retro-illumination

 Normal structure
7. Iris
8. Lens
9. Expression of glands
Discuss the data that you would need to obtain from your preliminary exam of a
contact lens patient
1. Ocular dimentions
- HVID of the cornea
- Pupil diameter in light and dark
- Vertical palpebral fissure
- Lid position top and bottom
- Exophthalmos present or not
- Lid tension
- Check tarsal plate for papillae
- Blink quality: incomplete, twitch
2. Keratometry
- Make sure the mires are focused and accurately aligned
- Assess the quality of the mires
- Assess the TTT
3. Tear layer assessment
- Important to asses the quality of the tear layer
- 2 techniques
Invasive
Non-invasive
TBUT
TTT
Schirmer
Non-invasive TBUT
Phenol red thread testing
Tear prism height
Rose Bengal staining
Interference pattern
Expression of the glands
Debris in the tears
Assess the tear flow, volume, TBUT, osmolality and pH
4. Slitlamp
Lid margins and lashes
Bulbar and palpebral conjunctiva
Limbus
Anterior chamber angle
Tears
Cornea
Iris
Lens
Expression of the glands
5. Refractive state
6. Other considerations
High refractive status
High astigmatism
Progressive myopia
Keratoconus
Anisometropia
General health
Occupation

3. A-- Trial Lens fitting

Method of choice
Choose lens from trial set and place on eye
to evaluate fit

Keratometer method
Phone lab technician, give
findings, and have lens made
Method strongly discouraged

relevant

Important consideration: what does patient want?

1

2
3
4
5
6

Other considerations:
High
>4
refractive
Compensate for vertex distance
status
Keep lenses as thin as possible lenticulate
Need for high DK/L materials
Progressive
Consider costs of frequent replacement of lenses as Rx changes
myopia
Disposable lenses? RGP?
High
astigmatism
keratoconus
Anisometropia
General
Diabetes
PRPH
health
Prone to infection
Healing takes longer
Decreased sensitivity
Allergies
Solutions
Hay fever
Seasonal problems
RA
Iritis
Insertion problems
Dry eyes
Scleritis
Pregnancy
Always
big
problem
Can change curvature of cornea
Decreased sensitivity
Increased thickness
Oedema
Medications
Discolouration
Decreased tear volume
Change in focus of eye
Occupation
Recreational and environmental factors
Sports
Hobbies
Dust
Fumes
Radiation

3. B-- First lens

Determination of appropriate lens parameters:
1. Base curve
2. Total diameter
3. Optic zone
4. Power
5. Design
6. Lens type
The lens you choose to use for a trial lens fitting will depend on:
1. Corneal topography
2. Corneal size
3. Prescription
4. Pupil size
5. Lid position
6. Lid tonus
Factors you would use to choose an initial contact lens
1. Corneal topography
2. Corneal size
3. Prescription
4. Pupil size
5. Lid position
6. Lid tonus
Factors affecting trial lens selection:
Corneal
Initial BC chosen will depend on curvature of cornea
Topography
BC chosen = 0.1mm steeper than flattest K
Corneal size
Diameter of lens selected on basis of corneal diameter
Average HVID = 11 11.5mm
Lens usually fitted 2mm smaller than HVID
Average lens diameter = 9.2 9.5mm
If PA is very small, lens diameter might also need to be reduced
Prescription
Average trial set has power of -3.00 for all lenses
Pupil size
For best visual results, OZ of lens must be big enough to cover
largest pupil that patient might have (darkness)
Allow for movement of lens
If no allowances made for larger pupil in dark > complaints of
halos and flare
Lid tonus
If lids are very loose, larger diameter indicated to help centre lens
Very tight lid may dictate diameter changes, but usually not
3.

C-- Pre-insertion chat

Tell patient they will be aware of lens like an eyelash
Tell them to keep both eyes open
Tell them that once lens is on eye, they must look down at knees > more comfortable
Lid is bouncing over lens edge, causing discomfort (not the lens)
Lif lids away from lens and they will see that you are right
Insertion:
Try to look and act confident > help patient to relax
Insert lens, tell them to look at their knees, ask if they are surviving
Lens settles 5-10min, then assess fit

3. D-- Lens assessment

Dynamic assessment
Patient looks straight
normal head posture
Use Burton lamp and Fl

ahead

Observations:
1. Decentration
2. Stability
3. Movement after blink
4. Movement with lateral gaze
5. Lower lid influence
6. Upper lid influence

Optimal fit
Static:
1. Minimal
central
clearance
2. Light
mid-peripheral
contact zone
3. Optimal edge lift
4. Average
edge
clearance
Dynamic:
1. Lens must be centred
2. Stable
3. Superior lid coverage
(not always possible)
4. Movement should be
smooth vertical and 12mm

with

Static assessment
Patient looks straight ahead with
normal head posture
Lens in natural resting position
If necessary, use lids to centre lens on
cornea
Use Burton lamp and fluorescein
Observations:
1. Central zone (flat, steep, aligned)
2. Mid peripheral zone
3. Peripheral zone (width of edge lift)
4. Contact/clearance
5. Horizontal and vertical meridians
6. Axial edge lift vs clearance
7. Radial edge lift vs clearance

Types of fit
Tight fit
Static:
1. Excessive
apical
clearance
2. Heavy mid-peripheral
contact
3. Narrow edge
4. Decreased
edge
clearance
Dynamic:
1. Centred
2. Stable
3. Superior lid coverage
4. Little movement

Loose fit
Static:
1. Excessive cenral touch
2. Flat
mid-peripheral
contact zone
3. Excessive edge width
4. Excessive
edge
clearance
Dynamic:
1. Decentred
2. High/low riding
3. Unstable
4. Excess movement
2mm

>

Key factors in lens assessment

Dynamic assessment
Patient looks straight ahead with normal head posture. Use Burton lamp and fluorescein
Observe the following
1. Decentration if any
2. Stability
3. Movement after blinking
4. Movement with lateral gaze
5. Lower lid influence
6. Upper lid influence
Static assessment
Patient looks straight ahead with normal head posture. Lens should be in natural resting
position
If necessary use lids to centre the lens on the cornea.
Use Burton lamp and fluoresecein
Observe the following
1. Central zone: steep, flat or on alignment
2. Mid-peripheral zone
3. Peripheral zone, width of edge lift
4. Contact and clearance
5. Horizontal and vertical meridians
Axial edge lift vs. clearance
Radial edge lift vs. clearance
Optimal fit
Static
1. minimal central clearance
2. light mid-peripheral contact zone
3. optimal edge lift
4. average edge clearance
Dynamic
5. the lens must be centered
6. stable
7. superior lid coverage
8. movement should be smooth vertical 1-2 mm

4. Tolerance trial
Every new patient should undergo tolerance trial
Once lens has been determined that fits well and gives adequate vision, appointment
for TT should be scheduled
Procedure
1. Come in and insert lenses
2. 3h of wear
3. Return and check:
How does patient appear
How does patient feel
4. Over refraction
5. Check fit
6. Remove lenses and assess corneal status
7. Discuss findings with patient
8. Discuss success rates
9. Order lenses
Assessment
1. CCC
2. Staining
of cornea
3. Polymegathism/blebs
4. Striae
5. Folds
6. Haze
7. Limbal engorgement
8. Hyperemia
Ordering
1. Design
2. BC
3. Power
4. Material
5. Diameter
6. OZ
7. Thickness
8. Lenticular
Why

conduct a 3 hour tolerance trail?

Every new patient should undergo a tolerance trail
To see: how does the patient appear with the lenses on
How does the patient feel about the lenses that they are wearing
Over-refraction
Check fit
Remove lenses and assess corneal status
1. CCC
2. staining
3. polymegathism
4. striae
5. folds
6. haze
7. limbal engorgement
8. hyperaemia
discuss the findings with the patient
discuss success rates
order lenses

5. Dispensing:
Rules
1. No sleeping with lenses
2. Always right eye first
3. Clean hands
4. If you drop a lens, do not move your feet
5. Follow schedule and regimen
Cleaning
Daily cleaner
Soaking solution
Protein pills
Insertion
Schedule
1. Practice:
3h for 3d
4 for 3
5 for 3
2. See me
3. Add per day and see me in 2 weeks
4. See me in 1 month
5. See me in 2 months
6. See me in 6 months

6 for 3

7 for 3

6. After care
Major factor in continuing good CL performance, px satisfaction and corneal health
Involves regular, periodic, routine consultations to assess ocular response to CL and
condition of lenses
Good contact lens practitioner attributes:
1. Attempts to fit difficult cases
2. Concerned about cornea
3. Exemplary after care
1.
2.
3.
4.
5.
6.
7.

Tests:
Case Hx
Procedure review
VA and OR
Check fit
Check physiology
Lens inspection if necessary
Summary and advice

In point form detail a contact lens progress evaluation (after care)

1. Case History
Sight
Comfort
Hyperaemia
Loose lenses
Cleaning regimen
Daily wear of lenses: Wearing time
2. Measure VA with contact lenses
Still adequate vision
3. Over- refraction
4. Fit of contact lenses
Steep
Flat
Good
Movement
5. Physiology of the cornea
Staining
Neovascularization
Infiltrates
Any other irregular physiological changes
6. Check lenses
Chipped
Coated
7. Advice to patient

EFFECTS OF PARAMETER CHANGES

Lens parameters:
1. Monocurve lens
2. Bicurve lens
3. Tricurve lens
4. Multicurve lens (5-6 peripheral curves)
5. Reverse geometry lens
6. Lenticular designs
7. Blending
8. Toric BC
9. Bitoric lenses
10.Bifocals
11.Aspheric BC
Rigid
1.
2.
3.
4.
5.
6.
7.
8.

lens parameters that affect fitting:

Base curve
Back surface design
Optic zone diameter
Front surface design
Lens thickness
Edge configuration
Overall diameter
Peripheral curves

1. Base curve
Usually described as the fit of the lens
Design = major factor controlling lens-cornea relationship
Design influences centration and movement
2
main Spherical
Aspheric
--Monocurve-multicurve
--Conic sections/non-spherical
designs
--Usually tricurve does job well
--Curves approximate corneas actual
--Back
surfaces
are
mostly
a shape more exactly
continuous curve
--Fit flatter/more on alignment than
equivalent spherical lens
1. Better vision
1. Better alignment
2. Better centration
2. More difficult to make
3. Difficult to verify
4. More decentration
Clinical
Central Fl
Sensitive technique for comparing shape of cornea with
consideratio
that of BC
pattern
Only method we have to make fit decisions about BC
ns
Corneal
The way hard lenses are fit can influence corneal
curvature over time
curvature

Can warp cornea

changes
Vision
BC influences tear layer beneath lens
By changing shape and thickness of tear layer, can
influence power of lens
Irregular/highly astigmatic cornea requires special BC
considerations and vision can be altered as direct result
of this relationship
Changing BC
Fl pattern
will
affect
Centration
following:
Movement
Tear exchange
How
to
To steepen BC, reduce radius of BC
change BC
To flatten BC, increase radius of BC
2. Back surface mid-periphery
Characteristi
Should align flattening cornea
cs
Affects stability of fit
Too flat
Too steep
Unstable and lose
Too little tear exchange
Decentration
Indentation
Following
1. Width of each secondary curve
2. Radius of each secondary curve
can
be
3. Shape of back surface
changed:
4. Number of curves
Fit

3. Back surface
BOZR/BOZD

relationship
BOZR/BVP

relationship

BOZR/CA

relationship

Back

peripheral

radius
Tricurve lens
design

design
For every 0.5mm increase in BOZD, there must be 0.05mm increase in
BOZR to maintain the same Fl fitting pattern
BVP compensation for BOZR changes if BOZR is increased (flattened) by
0.05mm
Tear lens power will increase by -0.25D
For Corneal astigmatism > 1.50D
Decrease BOZR 0.05mm for each 0.50D increase in CA
Increasing BPR increases edge clearance
Fitting set with constant axial edge lift important
Curve
Central
2nd
Peripheral

Radius
BOZR
BOZR + 0.8
BOZR + 2.5

Diameter
BOZD (TD 1.4)
BOZD + 0.6
BOZD + 1.4

4. Optic Zone diameter

Important
When BC is constant and OZ is increased, sag increases (steeper)
concepts
Cornea flattens toward periphery
Flatter periphery: lens held away from corneal apex, increasing tear
layer thickness
Larger the OZ, further the lens is held away from apex of lens
(steeper)
5. Front surface design
Controlled
BVP required
by
Spherical/aspheric front surface
FS optic zone diameter
BVP
If BVP of lens starts getting high (>5D), need to consider lenticulation of
lens for following reasons:
Reduce centre thickness in positive lenses
Reduce lens mass
Increases oxygen transmission
Comfort
Lenticulation
Defines front optic zone diameter
Can purposely order negative carrier so that lens attaches to top lid and
centres better and moves with top lid
6. Lens thickness
Determined
1. Rigidity of material
2. Permeability
by
3. BVP
Factors
to
On eye flexure of lens
consider
Flexure on astigmatic corneas
DK/t
Effects
Thinner the lens, the less minus power it has
The more corneal astigmatism, the more the lens will tend to flex on the
eye
Centre
Thicker > COG moves forward
thickness
Decreased oxygen
7. Edge design
Can change
1. Position of apex of edge
2. Roundness
following:
3. Thickness

Configuratio
1. Comfort interaction between edge and lids
2. Durability too thin = increased chipping
n of edge
3. Tear meniscus
effects
8. Overall Diameter
Affects
COG (larger = COG backwards)
following
Stability larger diameters more stable
Comfort larger lenses more comfortable
Affects fitting Centration
Increase diameter, increase centration
in the following
Fit lens effectively steeper due to increase in sag
way:
Corneal
Affects physiology
cover
Lens
Larger lens = steeper = less movement
movement
Mid Larger diameter = steeper with more mid-periphery
bearing
peripheral
Decreased tear flow beneath lens results
bearing
Lid
Larger lens = more interaction with lids (esp top lid)
interaction
Better comfort
Can induce 3 and 9oclock staining due to increased
lift of lid away from cornea
9. Peripheral curves
Following
Width = 0.3-0.5mm
changes can
Radius = 2.5mm flatter than BC
be
Shape = spherical vs aspheric
introduced
Can
affect
Fl pattern at periphery of lens
the
Excessive edge clearance results in poor centration and poor comfort
following:
Wider-flatter PC means increased tear exchange
3 and 9 oclock staining may occur due to poor PC design
PC changes
Too much edge clearance > smaller peripheral curve

The effects of parameter changes

When changing existing lens parameter, effects of other parameters need to be allowed
Rigid lens parameter that effect fitting are the following
1. Overall diameter
If the diameter changes, the following also change:
COG (increase diameter the COG moves backwards, decrease diameter the COG
moves forward)
Optic zone
Peripheral curve width
Axial edge lift
Edge profile, edge thickness and centre thickness
Changing the diameter effects
Centration increase diameter, lens steeper. Visa versa for decrease diameter
causes the lens to be more flat.
Physiology cover more or less of the cornea
Movement increase diameter, lens steeper, tighter fit thus decreasing
movement.
Tear flow increase diameter, steeper lens with more mid-peripheral bearing and
decrease tear flow beneath the lens
Interaction with the lids increase diameter, decrease interaction, and increase
comfort, or 3 and 9 oclock staining with increased lift of the lid away from the
cornea
2. Centre thickness
Increase thickness = COG moves forward, decrease O2
3. Base curve
If the base curve changes the following also change:
fluorescein patterns
centration
movement
tear exchange
To steepen the base curve, decrease the radius of the base curve
To flatten the base curve increase the radius of the base curve
With steeper lenses
increase the NaFl under the central portion
better centration
less movement
4. Optic zone diameter
There are 2 important concepts involved
increase optic zone and base curve constant = sag increase, lens steeper
cornea flattens towards the periphery
Flatter periphery lens held away from the corneal apex, increase tear layer
thickness
The larger the optic zone the further the lens is held away from the apex
lens steeper
Increase optic zone = steeper, tighter fit with better centration
5. Peripheral curves
Increase back peripheral radius = increase edge clearance
Fitting set with constant axial edge lift is important
6. Base curve shape

Spheric vs. aspheric

Aspheric fit closer to the cornea with flattening of the periphery of the cornea
Fit flatter or more on alignment than the equivalent spherical lens
Slide 4 - Lens parameters: diameters Back optic zone diameter =
and edge thicknesses
Front optic zone diameter =
Back peripheral zone diameter =
Total diameter =
Radial edge thickness =
Axial edge thickness =

Slide 5 Lens parameters: Front and

Back radii and thicknesses

Simple tricurve lens

Back optic zone radius =
Back peripheral radius (1st) =
Back peripheral radius (2nd) =
Front optic zone radius =
Front peripheral radius (1st) =
Geometric centre thickness =
Peripheral junction thickness (1st)=
Peripheral junction thickness (2nd) =

Slide 6 Axial edge lift, radial edge lift,

tear layer thickness

Slide 6 Fit of lens

Fluorescein patterns
Procedure
Instil Fl into eye
Observe brightness of tear layer trapped under CL
Use Burton lamp to excite Fl which emits green light
Fl absorbs radiation maximally between 485 and 500nm
Re-emits greenish light at wavelengths between 525 and 530nm
Contrast improved by using yellow filter ifo objective lens on slit lamp
Fl patterns
Pictures one sees when evaluating fit of lens
Changes as lens moves on eye due to thickness changes in tear layer
Dynamic picture > photos and drawings are only a guide
False Fl patterns possible where pattern is totally unexpected
False
1. Unusual corneal topography
2. BC too steep > no Fl under lens dt tight fit
patterns
3. PC too deep > same as above
caused by:
4. Fl may dissipate quickly > impression of apical bearing
5. Fl sometimes collects on FS of lens > steep impression
Optimum Fl
1. Alignment or very slight apical clearance
2. Mid-peripheral alignment 1-2mm wide
pattern
3. Edge clearance 0.5mm wide
4. Obvious tear meniscus at edge of lens
Slide 8 Fluorescein patterns

Causes of false fluorescein patterns

1. Unusual topography
2. If the Base curve is too steep, no fluorescein under the lens due to too tight fit
3. If the Peripheral curve is too steep, no fluorescein under the lens due to too tight fit.
4. Fluorescein may sometimes dissipate very quickly and give impression that there is
apical bearing
5. Fluorescein sometimes collects on the front surface of the lens, giving a steep
impression.

Discuss fluorescein and its use in contact lens fitting

- Fluorescein helps with the fit of contact lenses: rigid contact lenses
- It indicates epithelial and other insults
- Absorbs radiation maximally between 485 and 500nm
- Reemits greenish light between 525 and 530 nm
- 3 D picture of 3 D situation
- If fluorescein to thin, you wont see anything
- Evaluate steep/ flat fits and peripheral curve lift
- Keratoconus see excessive bearing
- Assess tear film
- TBUT, Johnson test
- Be aware of false fluorescein patterns
1.
Unusual topography
2.
If the Base curve is too steep, no fluorescein under the lens due to too tight fit
3.
If the Peripheral curve is too steep, no fluorescein under the lens due to too tight
fit.
4.
Fluorescein may sometimes dissipate very quickly and give impression that there
is apical bearing
5.
Fluorescein sometimes collects on the front surface of the lens, giving a steep
impression.
Fluorescein
- Fluorescein helps with the fit of contact lenses: rigid contact lens
- It indicates any damage to epithelial and other insults
- Absorbs radiation maximally between 485 and 500nm
- Reemits greenish light between 525 and 530 nm
- 3 D picture of 3 D situation
- If fluorescein to thin, you wont see anything
- Evaluate steep/ flat fits and peripheral curve lift
- Keratoconus see excessive bearing
- Assess tear film
- TBUT, Johnson test
- Be aware of false fluorescein patterns
Unusual topography
If the Base curve is too steep, no fluorescein under the lens due to too tight fit
If the Peripheral curve is too steep, no fluorescein under the lens due to too tight
fit.
Fluorescein may sometimes dissipate very quickly and give impression that there
is apical bearing
Fluorescein sometimes collects on the front surface of the lens, giving a false
steep impression.