Rigid Gas Permeable Lenses Overview
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Questions and Answers

What is the typical size range of epithelial microcysts?

  • 10-50 um (correct)
  • 100-200 um
  • 1-10 um
  • 50-100 um
  • Which condition can lead to the formation of epithelial microcysts?

  • Increased humidity
  • Increased visual acuity
  • Chronic hypoxia (correct)
  • Ocular surface injury
  • What is the typical appearance of new endothelial bedewing?

  • Brown and irregular
  • Whitish and round (correct)
  • Yellow and elongated
  • Transparent and symmetrical
  • What immediate action should be taken if a patient experiences intolerance to contact lens wear due to endothelial bedewing?

    <p>Reduce wearing time or cease wear (B)</p> Signup and view all the answers

    What is a distinguishing feature of endothelial blebs compared to corneal guttata?

    <p>Irregular shaped black zone (B)</p> Signup and view all the answers

    What is the first step in the RGP fitting process?

    <p>General eye examination (B)</p> Signup and view all the answers

    Which parameter should always be adjusted if there is excessive movement in lens fitting?

    <p>Lens diameter (A)</p> Signup and view all the answers

    What should be monitored for during the preliminary fitting assessment?

    <p>K-reading and pupil size (B)</p> Signup and view all the answers

    What is the maximum wear time for a new contact lens wearer on the first day?

    <p>3 hours (D)</p> Signup and view all the answers

    Which of the following is NOT part of the lens care and maintenance instructions?

    <p>Use tap water for rinsing (A)</p> Signup and view all the answers

    What happens if the corneal cylinder is slightly smaller than the ocular cylinder?

    <p>A thinner lens is used with more flexible material. (C)</p> Signup and view all the answers

    What effect does eyelid force have on RGP lenses?

    <p>Lid opening lifts the lens during blinking. (A)</p> Signup and view all the answers

    Which factor is considered helpful in stabilizing a lens during a blink?

    <p>Edge clearance of the lens. (B)</p> Signup and view all the answers

    How does wider edge surface tension affect RGP lenses?

    <p>It allows for better surface tension. (A)</p> Signup and view all the answers

    What is the primary challenge of using spherical lenses when residual physiological astigmatism is high?

    <p>They can compromise vision. (C)</p> Signup and view all the answers

    What is a potential negative effect of lens rotation on vision?

    <p>Degraded vision quality. (A)</p> Signup and view all the answers

    Why is a significant astigmatism challenging when fitting lenses?

    <p>It often results in visual distortion. (C)</p> Signup and view all the answers

    What is a disadvantage of using a spherical lens to correct astigmatism?

    <p>They may not effectively address lens rotation issues. (A)</p> Signup and view all the answers

    What is the primary purpose of using cosmetic contact lenses?

    <p>To enhance or alter the appearance of a normal eye. (A)</p> Signup and view all the answers

    Which design type of contact lens has a central curve that is relatively flatter than the peripheral corneal curve?

    <p>Reverse Geometry Design (A)</p> Signup and view all the answers

    What adjustment should be made if there is inadequate vault at the limbal zone during fitting?

    <p>Increase the chord diameter or steepen curves. (A)</p> Signup and view all the answers

    Which type of contact lens is specifically used to improve the appearance and help correct vision of a disfigured eye?

    <p>Prosthetic CL (C)</p> Signup and view all the answers

    What is a characteristic of the zonal specific scleral lens?

    <p>It vaults the entire cornea. (A)</p> Signup and view all the answers

    What is the goal for central vaulting during corneal zone fitting?

    <p>Aim for 100 - 400 um. (B)</p> Signup and view all the answers

    Which type of tint is used in contact lenses to improve visibility but does not change eye color?

    <p>Visibility tints (B)</p> Signup and view all the answers

    What is a potential issue when using enhancement tints in certain occupations?

    <p>They can lead to color deficiency issues. (A)</p> Signup and view all the answers

    What is the primary consequence of overdenture syndrome on the cornea?

    <p>Decreased oxygen supply leading to edema (D)</p> Signup and view all the answers

    What is the typical recovery time for overdenture syndrome after ceasing lens wear?

    <p>Within 24 hours (D)</p> Signup and view all the answers

    What should be done first in case of tearing and moderate-to-severe irritation or discomfort with contact lenses?

    <p>Remove, clean, rinse, and reinsert the lenses. (D)</p> Signup and view all the answers

    Which factor increases the risk of developing corneal warpage syndrome?

    <p>Long-term wear of poorly fitted RGP lenses (A)</p> Signup and view all the answers

    During fitting assessment, what is assessed with white light to ensure proper lens centration?

    <p>Whether the pupil is within the Back Optical Zone Diameter (BOZD). (A)</p> Signup and view all the answers

    Which of the following symptoms is NOT typically associated with overdenture syndrome?

    <p>Improved vision (B)</p> Signup and view all the answers

    What is a key management strategy for corneal warpage syndrome?

    <p>Cease contact lens wear (A)</p> Signup and view all the answers

    What does a normal lens movement indicate when checking a patient's blink?

    <p>The lens drops smoothly and vertically to its original position. (D)</p> Signup and view all the answers

    What is the grading system for endothelial polymegethism based on cell size irregularities?

    <p>0 - 4 (D)</p> Signup and view all the answers

    If there is excessive lens tearing, what action should be taken regarding its settling time?

    <p>Allow 10 minutes or longer, depending on the tearing. (D)</p> Signup and view all the answers

    Which interaction type is least likely to produce corneal edema when assessing lid-lens relationships?

    <p>Inter-palpebral interaction. (B)</p> Signup and view all the answers

    What might indicate a potential issue if contemplating extended wear lenses?

    <p>Increased age (A)</p> Signup and view all the answers

    What is the suggested action to take until abrasions are treated in overdenture syndrome?

    <p>Cease lens wear (C)</p> Signup and view all the answers

    What should be observed when assessing the fluorescein pattern during fitting assessment?

    <p>Edge clearance on the top of the RGP lens. (A)</p> Signup and view all the answers

    What indicates a flat lens during lens movement assessment?

    <p>Quick movement with apical rotation. (C)</p> Signup and view all the answers

    What should be done if the lens is decentered during the fitting assessment?

    <p>Move it back to center using the aid of the lids. (D)</p> Signup and view all the answers

    Flashcards

    Lens Damage Assessment

    Evaluating lens damage through observing tearing and irritation.

    Lens Settling Time

    Allow a minimum of 10 minutes to observe lens settling (tear/comfort).

    Centration Assessment

    Evaluate lens positioning by observing pupil position and movement while blinking.

    Lid Interaction Types

    Classify lid-lens relationships as attached to the upper lid, extra-palpebral, or inter-palpebral.

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    Lens Movement on Blink

    Assess lens movement during natural blinking and external movement of the lens using lid.

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    Lens Movement Description

    Describe lens movement during blinking, noting speed, direction and smoothness (flat vs steep).

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    Fluorescein Pattern Analysis

    Visualize the fluorescein pattern on the superior conjunctiva to assess lens clearance.

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    Decentralization Adjustment

    Adjust lens centration if it is off center, using appropriate aids.

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    Epithelial Microcysts

    Small, fluid-filled sacs in the cornea, often from lens wear or inflammation, that can affect vision if numerous.

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    Microcysts: Cause

    Epithelial microcysts can be caused by various factors like lens wear, dry eye, inflammation, or hypoxia (lack of oxygen).

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    Endothelial Bedwing

    A whitish, rounded deposit on the back surface of the cornea, appearing new and gradually turning orange/brown, often due to lens wear.

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    Endothelial Bleb

    A small, irregular, dark, and transient zone on the cornea due to corneal edema and fluid buildup, often related to lens wear and oxygen deprivation.

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    Bleb vs. Guttata

    Endothelial blebs are temporary, whereas corneal guttata are permanent, both appearing as dark zones on the corneal surface.

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    RGP Consultation Goals

    The main objectives of an RGP consultation are to gather patient information, assess suitability for RGP lenses, and plan the fitting process. This includes understanding patient history (prior contact lens wear, eye health), evaluating their expectations for vision, comfort, and health, and gathering preliminary data.

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    Preliminary RGP Data

    During an initial RGP assessment, essential information needs to be collected to evaluate the patient's candidacy for RGP lenses and plan the fitting process. These include their refractive error, corneal curvature measurements (Keratometry or K-readings), pupil size, horizontal visible iris diameter (HVID), palpebral aperture, and eye opening height.

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    RGP Lens Information

    Once the decision to proceed with RGP lenses is made, specific parameters need to be determined. These parameters include the lens type (e.g., materials, design), price, lens care routine, and any additional information needed for the lens order.

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    Initial RGP Delivery

    The first time the patient receives their RGP lenses, the focus is on proper lens assessment, education, and a planned adaptation schedule. This includes reviewing the patient's history, verifying their visual acuity, checking their eye opening height, assessing the delivered lenses, giving clear instructions on lens insertion and removal, detailing lens care and maintenance, and setting a tailored wearing schedule.

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    RGP Adaptation Schedule

    The adaptation period for RGP lenses is crucial for the success of the fitting. It's a gradual process that involves increasing wearing time over several days and weeks. The schedule should be individualized based on the patient's response and can be adjusted based on the presence of normal or abnormal symptoms.

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    RGP Lens Power

    The power of a rigid gas permeable contact lens, determined by the lens's base curve (BC) and its desired sphere power. This power is crucial for correcting refractive errors.

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    Lens Toricity

    The cylindrical component of an RGP lens power, used to correct astigmatism and achieve optimal vision especially in cases of corneal astigmatism.

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    Corneal Cylindrical Power

    The cylindrical power of the cornea measured by a keratometer, this value is crucial for determining the required toricity of the RGP lens.

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    Spherical Lens Power

    The spherical component of an RGP lens power, used to correct myopia or hyperopia. It is often adjusted based on the toricity to achieve optimal vision.

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    Lens Flexure

    The ability of an RGP lens to bend or flex under pressure (like eyelid force). This can benefit the fit and comfort, allowing for a thinner lens.

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    Lens Stability

    The ability of an RGP lens to remain centered and stable on the eye, influenced by eyelid forces, surface tension, and lens design. Stability is key for optimal vision.

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    Edge Tears Meniscus

    The thin liquid film that forms between the edge of the RGP lens and the eye, influenced by edge clearance and surface tension. A good meniscus improves lens stability.

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    Edge Clearance

    The space between the edge of the RGP lens and the eye, affecting lens stability and comfort. A wider clearance promotes better surface tension and stability.

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    Corneal Lens Design

    A lens design where the central curve is steeper than the peripheral corneal curve, often used for keratoconus.

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    Reverse Geometry Lens Design

    A lens design where the central curve is flatter than the peripheral corneal curve, used for irregular corneas.

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    Value Reduction Method (VRM)

    A fitting method for corneal lenses that involves gradually flattening the lens until it nearly touches the cornea.

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    Limbal Clearance

    The space between the lens edge and the limbus (edge of the cornea) during lens fitting.

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    Scleral Lens Fitting

    The scleral lens should rest evenly on the conjunctiva (white part) without blanching (turning white).

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    Cosmetic Contact Lens

    A tinted contact lens designed to enhance or alter the appearance of a normal eye.

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    Prosthetic Contact Lens

    A tinted lens used to improve the appearance and potentially correct vision for a disfigured eye.

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    Tinted Contact Lens

    A general term encompassing both cosmetic and prosthetic contact lenses.

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    Endothelial Polymegethism

    A condition where endothelial cells in the cornea vary in size, with a higher ratio of small to large cells compared to normal. This can be linked to contact lens wear, increasing age, and corneal surgeries.

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    Overwear Syndrome

    A condition caused by insufficient oxygen supply to the cornea due to prolonged contact lens wear, leading to corneal edema, epithelial cell death, and desquamation.

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    Corneal Warpage Syndrome

    A condition characterized by changes in corneal curvature (flattening or steepening) caused by prolonged wear of poorly fitted rigid gas permeable (RGP) lenses.

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    What are the signs of Overwear Syndrome?

    Signs of Overwear Syndrome include hyperemia (redness), lid edema, central corneal clouding, central corneal punctuate staining, and corneal distortion.

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    What are the symptoms of Overwear Syndrome?

    Symptoms of Overwear Syndrome can include severe ocular pain, excessive lacrimation, foreign body sensation, lens intolerance, photophobia, and blurred vision.

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    What is the usual treatment for Overwear Syndrome?

    Overwear Syndrome requires immediate cessation of lens wear, pain management, antibiotic treatment, and patient education. Refitting with a higher Dk/t lens or a different type of lens (RGP) may be necessary.

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    What is the usual management for Corneal Warpage Syndrome?

    Management of Corneal Warpage Syndrome involves ceasing contact lens wear and possibly lens refitting.

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    What are the risk factors of Endothelial Polymegethism?

    Risk factors for Endothelial Polymegethism include increasing age, contact lens wear with low Dk/t, and corneal surgical procedures.

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    Study Notes

    Rigid Gas Permeable Lenses (RGP)

    • RGP lenses are made of silicone, fluorine, and PMMA (Fluorosilicone acrylate) or silicone acrylate
    • These materials improve oxygen permeability and wettability, which improves comfort and reduces complications like keratitis
    • Larger diameter lenses lead to less movement, and better optical quality than scleral contact lenses (SCL)
    • RGP lenses may stain more easily than PMMA
    • RGP initial discomfort is common initially due to a transition from PMMA
    • Indications for wearing RGP include increased corneal astigmatism, distorted or irregular corneas, or corneal scarring. RGPs are less suitable for patients with eyelid problems that do not cover the superior and inferior limbus. Other conditions for RGP use may require assessment of the individual situation.
    • Parameters such as Total Diameter (TD), and Peripheral curves (PC) can affect the lens fit and comfort
    • Aspheric lens design may enhance tear flow and reduce lens sensation
    • Toric lenses provide astigmatism correction, and can be used in conjunction with Spherical RGP lenses
    • Radial (normal to lens edge) and Axial (parallel to primary axis of lens) parameters are used to compare the fitting of the lens against the corneal topography
    • Edge lift is a critical consideration: Steeper BOZR results in greater edge lift

    Fitting Philosophies & Assessment of Fitting

    • Fitting goal: good alignment and slightly flatter than the central touch
    • Assess pupil coverage, comfort and vision
    • Central touch assessment of lens fitting
    • Edge clearance, if too steep, may cause excess tear pooling and/or lens displacement; conversely, a flat fit may lead to central pooling
    • Lid & Lens movement during blinking is evaluated
    • Fitting process (wearing): clean and insert to locate any issues or difficulties. Check for trapped bubbles
    • Check lens centration (using white light) and effect of lid interaction after checking blinking and movement

    RGP Considerations

    • Ask the patient to blink naturally, observe any movement
    • Lens movement (norm = 1.5-2.0mm) and speed (medium to fast) should not excessively deviate from the limbus.
    • Flat lenses move quickly and remain at the corneal apex after movement, causing it to not drop down. Steep lenses cause a jerky movement and remain at the corneal apex, thereby leading to no drop-down.
    • Evaluate and assess the cornea; a good fit is one that does not induce pain or alter visual acuity after wear.
    • Evaluate the lens fit, centration, and overall comfort. Factors such as tear exchange and edge pressure should be assessed.
    • Analyze blinking using blue light for lens centration evaluation: If decentration observed, reposition the lens to correct the issues
    • Consider peripheral cornea fit as well as the central cornea fit

    Fitting Assessments

    • Assess lens fitting/fitting strategies on a range of variables using fitting goals, testing and assessment techniques/methods.
    • Evaluate and consider additional factors
    • Evaluate the lens parameters, including the total diameter, peripheral curves, and others, to determine if the fit and centration are acceptable
    • Evaluate any symptoms and evaluate and consider appropriate actions
    • Evaluate tear exchange adequacy (assess the tear film in the upper and lower areas of the lens)
    • Ensure lens stability, including any movements, during various movements of the patient’s head or eyes
    • Evaluate lens fitting and visual acuity. Appropriate actions or next steps for the fitting.

    Considerations for Extended Wear (EW)

    • Higher Dk lenses are ideal to reduce corneal complications of EW
    • Increased risk factors for microbial keratitis in EW lenses, thus proper hygiene and cleaning methods are necessary for effective use. Proper instruction to the patient is needed, as well as proper aftercare.

    Complications

    • Potential complications of CL wear include corneal edema, epithelial microcysts, endothelial bed-weeping, corneal infiltrates, and associated CL-associated capillary conjunctivitis
    • Other factors that can cause complications are environmental factors & microbiological factors
    • Other potential causes of CL-associated complications include improper lens fitting or maintenance, lens material properties, and underlying medical conditions.
    • Symptoms of complications may include pain, irritation, discomfort, reduced visual acuity, and dryness, as well as tearing

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    Description

    This quiz explores Rigid Gas Permeable (RGP) lenses, including their materials, benefits, and indications for use. Learn about their comfort levels, fitting parameters, and differences compared to other lens types. Ideal for students and professionals in optometry.

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