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Prosthetic CL Fitting
- 1. Presenter: Pooja Sah (Optometry Intern) Moderator: Suraj Chaurasiya (Consultant Optometrist) Date : 25/04/2019 C L Gupta eye institute , Moradabad Grand Round 1
- 2. Complain and history • A 20 years / Male patient was visited to the hospital on 06/04/2019 with the complaint of left eye loss of vision for distance and near since childhood followed by chicken pox • Ophthalmic consultation with Dr. Salman 3 days prior where advised for corneal tatooting or corneal prosthesis and referred to CLGEI • Other history: not significant 2
- 3. RIGHT EYE LEFT EYE UCVA- Distance Near 20/20 6/6 at 33cm with reduce snellen E chart under RI HM+ <6/60 33cm with reduce snellen E chart under RI Dry retinoscopy -0.50*90 No glow Acceptance Plano (20/20) HM+ Visual acuity assessment 3
- 4. 4 Right eye Left eye Eyelid Flat Trichiatic lashes conjunctiva Normal Conjunctival xerosis sclera Normal Normal cornea clear Corneal xerosis, scaring AC Normal in contents and Depth PACD=1CD No view Iris Normal color and pattern No view Pupil Round , Regular, Reacting No view IOP (GAT) 16 mm of Hg @ 10:45 am Dig N Slit lamp examination
- 5. Differential diagnosis Nebular scar Macular Leucomatous Adherent leucomatous Textbook of ocular disease by A K Khurana: chapter cornea 5
- 6. Introduction • A prosthetic contact lens (artificial iris) is a contact lens used on both sighted and non-sighted eyes to improve their cosmetic appearance 6
- 7. Types and indications of prosthetic CL • Amblyopia therapy • Cataract • Traumatic Mydriatics pupil • Iris coloboma • Aniridia • Heterochromia • Microphthalmus • Albinism • Corneal scars/ opacities • Failed graft Type A Type B Type C Type D Occlusion Therapy 7
- 8. Fitting criteria Record the following: • Pupil size (normal room illumination) • Iris Diameter (i.e 11.5mm) • Base Curve • Diameter • Color Matching Color available : • Light brown • Medium brown • Dark brown IACLE Module 9; chapter prosthetic contact lens 8
- 9. Student corner • What is the fitting assessment for Prosthetic soft contact lens? • Coverage • Centration • Movement • Tightness • Lag • Fluting 9 IACLE module 3
- 10. CL clinic Base curve Power Diameter Remarks Median 0.00 14.00 Prosthetic contact lens Type D medium brown Iris: 11.80mm Pupil: 4.50 clear periphery: 1.10 Fitting assessment Coverage 360 limbal coverage Movement 0.20 mm Tightness 60% Impression Acceptable Centration No decentred Lag Up Gaze lag 0.1 mm Fluting Absent Inserted parameter: 10
- 11. 11 Final parameters: Same as inserted parameters Plan of management: Single Purecon Prosthetic soft contact lens was ordered
- 12. Learning objective • Differential diagnosis of corneal scar • Classification of prosthetic soft contact lens • Indications of different types of prosthetic soft contact lens • Fitting criteria of the prosthetic contact lens • Fitting assessment of the soft contact lens Faculty corner Do you want to add anything extra related to prosthetic CL fitting? 12
Editor's Notes
- Xerosis?
- Put pic of all types of scarring?/
- TYPE A –pupil only tinted , iris are clear TYPE B/O- whose lens tinted ,no separate pupil TYPE C - iris are tinted ,clear pupil TYPE D-iris are tinted ,pupil tinted separately
- In a normal room illumination the average pupil size is 4.5mm Iris dia is important to measure to ensure total coverage of any noticible disfigurement (measure from a healthy ey, if possible Many Patients have an intact cornea where proper K readings can be recorded. However, patients with disfigured, scarred corneas can be quite difficult to measure. In this type of case, we can start with initial 8.60 BC The most difficult measurement in fitting a prosthetic soft lens is color matching
- Coverage: Mainly we need to see whether the lens is covering the whole cornea or not Centration: Bynasal system (X: +N, -T; Y: +S, -I) Movement (0.2 to 0.8mm) Upgaze lag (up to 1.5 mm acceptable) Tightness: Asked the pt to look straight and with the help to lower lid margin push the lens up, so how much pressure is applying to push the lens is tightness
- Clear periphery how to calculate??? BC: median??? find out in number??