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Contact Lens
History
Leonardo Da Vinci (1508)
Leonardo Da Vinci (1508)
• First idea regarding contact lens
• Proposed that a water filled globe
into which observer had to immerse
his face can correct refractive error
Rene Descartes (1637)
Rene Descartes (1637)
John Herschel (1845)
• Correction of irregular
cornea
– Proposed taking
impression of cornea
– a mold that perfectly
conform to the cornea
can correct an irregular
cornea
Galezowsky (1886)
• Applied a gelatin disc impregnated with
cocaine and mercury chloride to the
cornea immediately after cataract
extraction
• Anesthetic and antiseptic
• First form of therapeutic contact lens
F.A. Muller (1887)
• German glassblower
• used Herschel's ideas to create the
first known glass contact lens.
Adolf Fick (1888)
• Put the first ever scleral
lens on human eye to
correct refractive error
• Used 2% grape sugar
solution for comfort-
first contact lens
solution used
• Postulated pinhole CLs,
prosthetic & cosmetic
CLs
Subsequent developments
• 1936 – CL made up of glass and plastic
• 1948 – PMMA lens
• 1971- first commercially available soft CL by B&L
• 1979- RGP lens
• Extended wear CLs
• Disposable CLs
• Bifocal CLs
• Disposable bifocal CLs
• Disposable PAL CLs
Related Anatomy and
Physiology
• Corneal Dimensions
• Oxygen supply to cornea
• Compromised oxygen supply
• Tears
Contact Lens Materials
Contact Lens Materials
• Nowadays – all plastic materials
• Polymers
– Constituents
• Carbon that can form covalent bond with
hydrogen, oxygen, nitrogen and chlorine
Types of Contact Lens
Materials
• Thermoplastics
• Synthetic Elastomers
• RGP Materials
• Hydrogels
Types of Contact Lens
Materials
• Thermoplastics
Can be shaped and moulded by heat and
pressure
Rigid at room temp
PMMA, CAB
• Synthetic Elastomers
More flexible (rubber like) than
thermoplastics
Silicone rubber
Types of Contact Lens
Materials
• RGP Materials
– PMMA + silicone rubber
– Better oxygen permeability
• Hydrogels
– Hydrophilic polymers
– Soft & elastic
– Can absorb water
– PHEMA
Properties of Contact Lens
Materials
• Optical transmittance
• Rigidity (Dimensional Stability)
• Flexibility
• Water content
• Oxygen Permeability/Transmissibility
Oxygen
Permeability/Transmissibility
• Oxygen Permeability (Dk) – meeting the
oxygen requirements of cornea
• Oxygen transmissibility
– Dk/t (t = thickness)
– Important for high power CLs (aphakic
lens)
Water content
• Weight of water X 100 %
Weight of hydrated gel
• Important parameter for pt’s with dry
eyes
Classification of Materials on the
basis of Water content
• Low Water Ionic, 35%-45%
• Low Water Non-ionic
• High Water Ionic, 55%-80%
• High Water Non-ionic
RGP better than hydrogels
Physiologically
• Higher Dk/t
• Less corneal coverage
• Better tears exchange
Contact Lens Solutions
• Wetting agents/Viscosity building agents
– Polyvinyl alcohol, methylcellulose
• Preservative/Antimicrobials
– Thimerosal, chlorhexidine, benzalkonium
chloride
• Buffering agents
– Sodium chloride
CL Optics
CL Optics
• Considered as thick lenses
• Thickness considerable in comparison
to radius of curvature
CL Optics
• Soft spherical CL conform to cornea
– No correction of astigmatism
• Hard lens spherical
– Tear lens b/w CL and cornea
– Correction of astigmatism
CL Optics
Optical differences b/w CL &
Spectacles
• Field of View increased
– In spectacle,
• blur through periphery
• FOV reduced by frame
Optical differences b/w CL &
Spectacles
• Oblique aberrations
– Reduced in CL as lenses move when
you move your eyes
– Occur in spectacle when you see
through periphery
Optical differences b/w CL &
Spectacles
• Prismatic Effect
– Spectacles – myopes will have
BI effect while converging
– With CL- no prismatic effect
Prismatic Effect
Prismatic Effect
Optical differences b/w CL &
Spectacles
• Relative spectacle magnification
– Generally less in CL
• Anisometropia and Retinal image
size
– 2 % per D with spec
– 0.3% per D with CL
– CL far better in anisometropia
Types of CLs for correction of
refractive error
• Soft contact lens
• Soft toric contact lens
• Spherical RGP lens
• Toric RGP lens
• Bifocals
Contact Lens
Fitting
Patient Selection
• Psychological factors
– Patients motivation
– Time taken for fitting
– Initial discomfort
– Extra hygiene
– Cost
– Cosmetic reason
– Safety
Patient Selection
• Pathological factors
– Indications
• Keratoconus
• Corneal irregularities
• Protection against radiation – lead contact lenses
• Protection against light and UV radiation
– Albinos
• Prosthetic CLs
• Bandage Cls
• Aphakia
• Microphthalmos
• Ocular conditions needing medications
Patient Selection
• Pathological factors
– Contraindications
• General debility
• Diabetes – unless refraction is stable
• Hyperthyroidism – lack of complete blink
• Herpes Simplex of mouth
• Pregnancy
• Arthritis
• Xerophthalmia
• External ocular diseases
– Blepharitis, dry eye, conjunctivitis
Patient Selection
• Occupations
– Indications
• Drivers
• Civil pilots
• Army
• Police
– Contraindications
• Chemists
– working in fumes
Patient Selection
• Refractive
– Anisometropia
– Aphakia
– Astigmatism
– High myopia/hyperopia
Measurement of Ocular
Dimesnions
• Corneal diameter
• Keratometry
• Videokeratography
• Pupil size
• Palpebral fissure height
• Lid tension
• Blink rate
• Corneal sensitivity
• Corneal thickness
Soft Contact Lens
Fitting
Advantages of Soft CL
• Greater comfort
• Ease of Adaptation
• Normal head posture and facial
expression
• Absence of spectacle blur
• Occasional wear
• Lower risk of loss
Disadvantages of Soft CL
• Compromised distance vision
• Variable vision
• Breakage and tearing
• Difficulty of cleaning
• Limited life span.
• Vascularization and other complications
• Cost factors
Soft CL Indications
• Low to High refractive errors
• Astigmatism < 0.75 D
• RGP intolerance
• Sports
• Working environment – SCL are better
than RGP in dust
SCL Fitting
• Empirical
• Diagnostic
SCL Fitting
• Begin with base curve:
Flatter K + 0.7 mm
• Assess fit
– Centration
– Coverage
– Movement
• DO NOT USE
FLUORESCEIN!!!!
Up-gaze lens lag assessment
Lateral version lens lag Lower lid push-up test
SCL Parameters
• Total Diameter: 13.5 to 14.5 mm
• Base curve
SCL Wearing Regimen
• Daily wear
– Annual replacement
– Monthly disposable
– Daily disposable
• Extended wear
– High water content lenses
– Day and night throughout week
Extended wear
• Poor lens handlers
– Aphakics
– Aged patients
– Children
• Therapeutic use
• Corneal bandage CLs
RGP CL Fitting
RGP Indications
• Better visual acuity-astigmats & irregular
astigmats
• Only for some conditions –
– Keratoconus
– Traumatised corneas
– post-grafts etc
• Better in some clinical situations
– GPC
– CLPC
– superior epithelial arcuate lesions (SEAL)
• In certain specialized area- orthokeratology
RGP Indications
• Rigid contact lens candidates:
– Spherical RGP
• Corneal cylinder ≤ 3.00D
• Residual astigmatism ≤ 0.75D
– Bitoric RGP
• Corneal cylinder >3.00D
RGP Fitting
• Start from average K
• Assess fit and change base curve
RGP Fit Assessment
• Dynamic fitting
position and movement
• Static fitting
lens to cornea relationship
Use Fluorescein
RGP Dynamic Fitting
• Upper lid attachment
• Smooth fall after blink
RGP Static Fitting
Over refraction
• After acceptable fit is obtained
– Over refraction
– To finalise power
RGP Parameters
• Total Diameter: 9.2-9.8 mm
• Base Curve
• Optic zone diameter
Soft Toric Lens
• Indications
– Cyl: > 0.75 D upto – 3.00 D
– If > 3.00 D, RGP bitoric
• Rotation important
Bifocal Contact Lenses
• Monovision
– Dominant eye corrected for distance
– Next eye corrected for near
• Bifocal and Multifocal Lenses
• PAL Contact Lenses
Bifocal CLs
Contact Lenses in Abnormal
Ocular Conditions
Keratoconus
• Early K-conus
– Satisfactory UCVA
• Moderate and Advanced K-conus
– CL give far better vision
Keratoconus
• Contact Lens Options
• Soft
– Limited role
• Combination lenses system
– Piggy back lens
– Hybrid lens
• Corneal Lenses
• Scleral Lenses – in advanced cases
Piggy Back CLs for Keratoconus
RGP CLs for Keratoconus
• Best choice
• Fitting
– Three point
touch
Three Point touch
Postkeratoplasty
• Therapeutic CL
– Soft, high water content
• Indications
– Protruding sutures
– Leakage due to faulty suturing
– Failure to re-epithelialise
– Epithelial ulceration
Postkeratoplasty
• CL for refractive use
• After re-epithelialisation
– RGP lenses
Aphakia/Infants/ Pre School
Children
• Soft CL
– High water content
– High Dk/t
– Extended wear
Therapeutic CLs
• Mainly fitted to restore the integrity of ocular
tissues
• Aims
– Relief of pain (epithelial disorders)
– Mechanical protection of cornea from lids, lashes,
Palpebral conjunctiva (GPC, conjunctival scar,
trichiasis)
– Maintenance of conjunctival fornices (chemical burns)
– Maintenance of corneal hydration (dry eyes)
– Maintenance of integrity of cornea and AC (impending
perforation, perforation, sealed perforation,
postkeratoplasty)
– Drug delivery ( low water content CL soaked in 2 hrs
controls IOP for 12 hrs)
Microphthalmos
• High hyperopia expected
• Extended wear CLs
Cosmetic/Prosthetic CLs
• Cosmetic with refractive correction
• Cosmetic/Prosthetic in abnormal apperance
– Aniridia, Iris coloboma, albimism (reduce
photophobia also)
– Heterochromia Iridis/Iridum
• Opaque soft CL with clear pupil
– Corneal scars
• Opaque soft CL with
– Clear pupil- seeing eye
– Black pupil- non-seeing eye
Cosmetic CL
Cosmetic CL
Cosmetic/Prosthetic CLs
Prosthetic CLs
Contact Lens
Complications
Soft CL Complications
• Causes
– Poor lens fit
– Over wear
– Poor hygiene
Soft CL Complications
• Corneal edema
• Management
– Decrease wearing
time
– Increase Dk/t
Soft CL Complications
• Corneal
vascularisation
– Cause – tight fitted
CL
Soft CL Complications
• Superior epithelial
arcuate lesions
(SEAL)
Soft CL Complications
• Contact Lens-
induced Papillary
Conjunctivitis
(CLPC)
• Cause – deposits in
the lens
Soft CL Complications
• Microbial Keratitis
– Swimming with CL
– Poor hygeine
RGP Complications
• CLPC
• 3-9 staining
• Ptosis
Orthokeratology
• Non surgical clinical technique that uses
specially designed and fitted Rigid CLs
(flat fit)
– To reshape the corneal contour
• For temporary reduction or elimination of
ā€œRefractive Error ā€œ
• CL fitted up to 0.20 mm flatter than
flattest K
Thank you