Intraocular lens

and
contact lens
Keerthi N S

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Intraocular lens
Implanted lens in the eye.
Replaces the existing crystalline
lens, because:-

Page 2

History: Sir Harold Ridley was

the first to successfully
implant an intraocular
lens on November 29,
1949, at
St Thomas' Hospital ,
London.
That first intraocular
lens was manufactured
from
Polymethylmethacrylate
(PMMA.).
Page 3

What would have made him

think about the idea of

implanting a lens in cataract
surgery???

It is said that the idea of implanting an

intraocular lens came to him

after an intern asked him
why he was not replacing the lens he

had removed during cataract surgery.

Why did he use acrylic plastic

material???

The acrylic plastic material was chosen

because Harold Ridley noticed that it

was inert,
after seeing RAF (Royal air Force)

pilots of World War II with pieces of

shattered canopies in their eyes.

Parts of
IOL
Central part
overlying the optic
axis , called as
optic and
peripheral arms,
called haptics
use of haptics:
to hold the lens in
place within the
capsular bag inside
the eye.
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Materials used for

intraocular lenses
Optic materials

Haptic materials

Non-foldable
Polymethyl
methacrylate

Polypropylene
PMMA
Acrylic

Foldable
Silicone
Hydrophobic acrylic
Hydrophilic acrylic
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Features of IOL

Page 10

Rigidity :flexible or rigid

Optic size :5-7mm
Shape:Round or oval
Spheric or aspheric
Plano convex or biconvex
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 Edge : Square or rounded

Holes in the optic: Present or absent
To keep IOL in position

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Different types of haptic angulation

relative to the plane of optic:-

For posterior chamber lens:100

anterior angulation to keep

the optic part away from the pupil.

For anterior chamber lens:Posteriorly

angulated lens to vault

the intraocular lens away from the
pupil

Suitable position for implanting

IOL in eye
Best placed
in posterior
chamber in
the capsular
bag.

Other positions:In the ciliary sulcus supported by the anterior capsule.

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Power of intraocular lens

Importance:-

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Power of intraocular lens

Calculated by various formula
Widely used formula

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Modified Sanders-RetzlaffKraff formula

Based on
the statistical correlation between

calculated and observed refractive error

after ocular implantation.

Modified SRK Formula

E=A - 2.5L - 0.9K
Parameters used in the formula are

estimated by
A-scan ultrasonographic
sonometry and keratometry

E=A - 2.5L - 0.9K

K:
L:
A:
E:

 Most IOLs fitted today are fixed

monofocal lenses matched to
distance vision.

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CONTACT LENS

Contact lens
is a thin optical lens
worn on the eye
Resting on the
surface of cornea.
Contact lenses are
considered medical
devices and can be
worn to correct
vision, for cosmetic
or therapeutic
reasons.

Adolf Fick
In 1888, Adolf Fick was the
first to successfully fit
contact lenses, which were
made from blown glass

Purpose of wearing contact lens

. Aesthetics and
cosmetics, to avoid
wearing glasses
For more visual
reasons.

Uses of contact lens

Corrective contact lenses

To

improve vision, by correcting

refractive error
By directly focusing the light with
the proper power for clear vision
Spherical contact lens :myopia
and hypermetropia , aphakia
Aniseikonia; in unilateral aphakia

Toric

contact lens has a different

focusing power horizontally than
it does vertically, astigmatism
Some spherical rigid lenses can
also correct for astigmatism.
Presbyopia presents an additional
challenge in the fitting of contact
lenses.

Other types of vision

correction: colour blindness
For

those with certain

color deficiencies, a red-tinted "XChrom" contact lens may be
used.
Although the lens does not
restore normal color vision,
it allows some colorblind
individuals to distinguish colors
better

Contact lens : In
management of nonrefractive disorders

Bandage contact lens protects:

Bullous keratopathy,corneal edema
Dry eyes
Corneal abrasions and erosion
Keratitis
Descemetocele
Corneal ectasis
Mooren's ulcer
Anterior corneal dystrophy
Neurotrophic keratoconjunctivitis

Cosmetic contact lenses

To

change the appearance of the

eye.
Also correct refractive error.

Merits over spectacles

Typically provide better peripheral vision
Do not collect moisture such as rain, snow,

condensation, or sweat.
This makes them ideal for sports and other
outdoor activities.
Keratoconus and aniseikonia that are
typically corrected better by contacts than by
glasses.

Types of contact lens

Hard
Soft
Rigid-gas permeable

Hard contact lens

1930-1970
Made

of PMMA
Do not allow enough oxygen to
reach the eye.
Difficult to adapt
But visual clarity is good
Used in astigmatic corneas
Less acute infective
Indications for use are now

Soft contact lens

Made from gel like plastic, hydroxy methyl

methacrylate
Contains 79% water
Better initial comfort
But prone to deposits;is disposables;15 hrs
Difficult to keep clean and and to handle

Continuous wear soft contact

lens
Increased water content
Increased oxygen permeability
Allow up to 6 times more oxygen to
cornea than ordinary contact lens
Can be worn upto 30 nights and day
But has increased risk of infections
than daily wearing lenses.

Rigid gas permeable lenses

Oxygen permeable lenses
Made from:firm,durable plastic that
transmits oxygen
A co-polymer of PMMA and silicone and
cellulate acetate butyrate
Do not contain water; resists deposits;
decreased risk of bacterial infections

Easy to clean
Disinfect
Do not dehydrate
Last longer than soft lenses
Rigid; easy to handle than soft lenses
Retain their shape; provide sharp vision

Risks of cosmetic contact

lens
Carry

risks of mild and serious

complications
ocular redness,pain
irritation, and infection.

Complications

due to contact
lens wear affect roughly 5% of
contact lens wearers each year
Improper use of contact lenses
may affect the eyelid, the
conjunctiva, and the various
layers of the cornea.
Poor lens care can lead to
infections by various
microorganisms including

Measures to be taken prior to use a

contact lens
To measure anterior curvature of lens

Tear film examination

Fluorescein that Highlight tear film are
useful in fitting rigid lens

Ideal lens show a minimal , uniform film

behind the contact lens
Pooling of dye in centre denotes: a steep
fit
Absence of dye in centre: a flat fit

HARD CONTACT
LENSES

Oxygen delivery
Visual clarity
Use in
astigmatism
Adaptation
Deposits

Durability

SOFT CONTACT
LENSES

RIGID GAS
PERMEABLE
LENSES

HARD CONTACT
LENSES

SOFT CONTACT
LENSES

RIGID GAS
PERMEABLE
LENSES

Oxygen delivery

Poor

High

Moderate to high

Visual clarity

Good

Need to refocus
after a blink

Clear vision

Use in astigmatism

Possible

Less suitable

Possible

Adaptation

Required

Not required

Required

Deposits

Few

Accumulate over
time

Few

Durability

May scratch

Tend to tear

Do not scratch or
tear

Lens case to store contact lens