Exam (elaborations)
NCLE Contact Lens Exam 2 Updated
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NCLE Contact Lens Exam 2 Updated
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NCLE Contact Lens Exam 2 Updated__________ (smaller/larger) OAD is less likely to dislodge during wear - ANSWER-
larger
.05mm radius of curvature change = approximately _____D - ANSWER-.25 D
(NOT a clinically visible change)
.1mm radius of curvature change = approximately _____D - ANSWER-0.50 D
(for a clinically visible change)
7.80mm BC for a 9.0 OAD lens, what BC and OAD would you chose for a lid
attachment lens design? - ANSWER-Example #1: 7.80 mm BC for a 9.0 OAD lens
Choose around 7.9 BC for a 9.5 OAD lid attachment
A CW lens _________ (cannot/can) be worn on a DW wearing schedule - ANSWER-
can
A good example of diagnostic fit:
Photo: Good peripheral pooling, more pooling temporally than nasally but good
distribution everywhere. Dense/harsh band of bearing in mid-periphery 360°.
Dense/heavy
central pooling. This is a POOR FIT b/c it's too steep. Must determine how GP behaves
when
patient blinks - ANSWER-
A narrow palpebral fissure is considered:
A wide palpebral fissure is considered: - ANSWER-<9mm
>10mm
a small HVID is considered:
A large HVID is considered: - ANSWER-<11.5mm
>11.5mm
After performing a spherocylindrical ORx (SCOR), how do you determine the resultant
axis? - ANSWER-As the lab to calculatre the resultant or use online CL manufacturing
resources
All-in-one for GP lenses
What functions do they do?
What is the advantage?
How long do you need to soak?
,List 4 examples - ANSWER--What functions do they do? Cleaning, soaking,
wetting/conditioning
-What is the advantage? easiest for patients to comply, especially when begginer in GP
lenses
-How long do you need to soak? 6 hours
1) Boston Simplus multi-action solution
2) menicon unique pH
3) alcon clear care
4) Equate Sterile CL conditioning solution: or other store brands
Always evaluate the GP CL when it is __________________ - ANSWER-centered
may need to center the lens manually
note how the pattern appears MOST of the time
an example of excessive fluorescein - ANSWER-
Areas of yellowish-green colored NAFL dye indicates ______________ - ANSWER-
tears
Artificial tears vary in composition including preservatives and viscosity
What 3 things might artifical tears contain? And how does each one function? -
ANSWER-1) PVA: increases length of contact time
2)celllulose derivatives: increases viscosity and aid in surface wetting. remind patient
they might experience slight blur initially
3) mild, non-ionic detergent: oosens and solubizes mucus and debris
As flatter lenses are fitted, the _________________ becomes more harsh - ANSWER-
bearing
As flatter lenses are fitted, the bearing becomes more harsh. Describe how the bearing
changes - ANSWER-Darker and distributed over a smaller area
Pooling in the periphery and mid-periphery increases
As steeper lenses are applied, how does the NaFl pattern change? - ANSWER-o More
dense central pooling distributed over a smaller area
o Bearing in the mid-periphery increases in width and density
Based on Bennett's General Guidelines, what diagnostic CL BC (relative to flattest K)
would you chose for the following corneal cyl powers?
0.00 to 0.50 - ANSWER-0.25 D flatter to on-K
,Based on Bennett's General Guidelines, what diagnostic CL BC (relative to flattest K)
would you chose for the following corneal cyl powers?
0.75 to 1.50 - ANSWER-on K to 0.25 D steeper
Based on Bennett's General Guidelines, what diagnostic CL BC (relative to flattest K)
would you chose for the following corneal cyl powers?
1.75 to 2.50 - ANSWER-0.25 to 0.50 D steeper
Based on Bennett's General Guidelines, what diagnostic CL BC (relative to flattest K)
would you chose for the following corneal cyl powers?
2.75 and up - ANSWER-Consider toric BC
Based on the SCCO method for choosing initial BC, what would you chose based on
the following data?
Ks 42.00/44.00 - ANSWER-Mean = 43.00
.10 mm (0.50 D) flatter than 43.00 D -> 42.50 for BC
Based on the SCCO method for choosing initial BC, what would you chose based on
the following data?
for a 9.0/7.4 GP,
Ks: 42.50 @180/43.50 @090 (7.94/7.75)
Spec RX= -2.00 -1.00 x 180 - ANSWER-A) BC selected using vertex chart: 7.94 mm
B) BC selected using SCCO method:
43.00 (7.84) = mean K
Add .10 mm to mean K -> 7.94 mm BC
Always compare to the spec cyl (vertexed) to
corneal cyl. All cyl is corneal (1.00 D WTR) so
there's no RA
When choosing BC and power, the TL will
correct the astigmatism so we only need to
worry about the -2.00 now. Remember:
charts and formulas are helpful to get an
initial starting point
Bearing is the most harmful aspect of GP fits because if affects what two things? -
ANSWER-1) oxygen exchange
2) debris removal
, Before trying to correct decentration of any kind, what should you figure out first? -
ANSWER-figure out why the lens is decentering and manually center to see BC to
cornea relationship
Case #1:Acuity decreased from last visit and Rx has -2.25 cyl. You see 0 mislocation
now. You saw 10° R last week. Trial lens axis is 160. Spectacle axis is 170.What axis
do you try next? What other test could you do to see what axis is needed? - ANSWER-
try axis 170. if necessary, check axis with SCOR when acuity is reduced
Case #2: New fit with spec Rx cyl vertexed is -1.25 axis 020. Closest lens in stock is
axis 010but it does have the same sphere and cyl amount as specs. The VA with the
lens is an easy 20/15. Zero mislocation. You should:A.Dispense this lens anddo 1-week
f/u.B.Do not dispense today. Order x 020C.Do not dispense today. Order x 030 -
ANSWER-Answer: A
Vision is 20/15 and if everything is the same as the initial evaluation at the follow-up and
patient is happy with the CLs, Rx can be finalized. With this scenario, check the
specaxisbecause there is probably an error.
Case Scenario #1: You give a patient, who has 1.50 D of cyl, a spherical GP that is fit
in-b/w the K's (i.e., a spherical surface sitting against a toric cornea) and it fits well.
Patient RTC with GPs in the afternoon after wearing them all day. You perform an OR
and now refract less cyl (0.50 or 0.75 D) on this visit. What happened? - ANSWER-Did
not permanently lose cyl. Light molding is not harmful! For Rxing specs:
• Occasional wear: give lesser cyl or go in b/w
• Constant or weekend wear: give full cyl
• No wrong answer, just know what to do and the reasoning behind it!
Changing peripheral clearance Rule of thumb
What is the minimum change for clinical difference, and what would you do it adequate
on/too little clearance for SCR or PCR, and SCW or PCW? - ANSWER-SCR or PCR: at
least 1.0mm, Ex) 11.0 mm PCR à flatten in-office to 12
mm or reorder
SCW or PCW: at least 0.20mm, ex) With 0.40 PCW à widen in-office to 0.60 mm or
reorder
Combo cleaning and disinfection solutions (CDS) function by...
What is the example of a cleaner ? - ANSWER-1) surfactant soaking
-RED CAP think "soapy soaking," don't put directly into eye!
2) dissolve deposits during overnight soaking cycle
-MUST rinse the next morning with a rinsing agent
Lobob optimum CDS (cleaning, disinfecting, storage)
CW
how long it it worn? - ANSWER-worn for 30 consecutive days (remove once a month)
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