Soft Contact Lens Clinical Pearls

Vivianle Freeman, O.D., F.A.A.O

Effectivity
• Change in refractive power at different vertex distances
• Clinically significant at +/- 4.00 D
• Myopes
– Less minus at corneal plane
– More minus at spectacle plane
• Hyperopes
– More plus at corneal plane
– Less plus at spectacle plane
• Formula:

FCL = Fsp
1- d Fsp

FCL= Power of Contact

Fsp = Power of Spectacle
d = dist between spectacle and CL in meters

Look it up in the Vertex conversion charts

Residual Astigmatism
• Astigmatism remaining after correction with contact lens
– 0.75 D cylinder may be symptomatic
• High myopes tolerate cyl better
• ATR or oblique axis less tolerated
• Variable among patients
• RA = Spec cyl – Corneal Cyl
– WTR : (-) cyl x 180, vertical K’s steeper
– ATR: (-) cyl x 090, horizontal K’s steeper
• Example:
– Spec Rx: pl-2.50X180, K’s: 44.00/46.00 @090
• Spec cyl: 2.50 WTR
• Corneal cyl: 2.00 WTR
• RA = 2.50 WTR -2.00 WTR
• RA = 0.50 WTR or -0.50 x 180
• For WTR cornea:
– Spec Cyl is WTR and equal to corneal cyl à no RA
– Spec Cyl is WTR and greater than corneal cyl à WTR RA
– Spec Cyl is WTR and less than corneal cyl à ATR RA
For ATR cornea, the opposite will be true
Oblique cylinder, RA may be variable if axes do not match
Spherical Soft Lenses
• Base curve: based on average K reading
K≤ 42.00 à Flat BC suggested
K 42.00 to 43.00 à Flat to Median
K 43.00 to 44.00 à Median
K 44.00 to 45.00 à Median to Steep
K > 45.00 à Steep

Toric Soft Lens

• Advised if refractive cyl >0.75D
• Consider toric lens if cylinder > 30% of overall RX
• As cyl increases, axis stability becomes critical
• Perform sphero-cylinder refraction
• Rotate cyl axis until patient definitely notices blur
– Rotation ± 20° à 90% soft toric success rate
– Rotation ± 15° à 90% success with 2 lenses
– Rotation ± 10° à 70% success with 3 lenses
– Rotation ± 5° à patient must accept variable VA with
lenses
• Vertex both meridians
– Spec Rx: -6.50-3.00x180 becomes -6.00-2.50x180
• Choosing a trial lens
– Axis is most important
– Then cylinder power
– Last is spherical
LARS fitting
• Evaluate trial CL of similar power and axis
• Allow for proper lens settling (20 minutes) and evaluate
• Evaluate fit
– Movement, centration, coverage
– Rotation
– Stability of rotation
• Rotation to Left X° à Add X° to spec axis
• Rotation to Right X° à Subtract X° from spec axis
• Note that “Left” and “Right” designate the movement of the inferior edge