Special Prescribing Considerations

OPTM 2072 FALL 2011 HIGH MYOPES AND HYPEROPES

Review of Ophthalmic Optics Prism questions

Prentices Rule Datum centre distance = 70mm (A + DBL) Lens size = 52 mm

PD = 66 mm
A +DBL PD / 2 = decentration Minimum uncut lens size =

Lens size + 2(decentration)

Considerations and Objectives

Vertex Distance Frame Selection, centration/decentration Field of View

Lens material Refractive index Aberrations Form Full and reduced aperture lenses

Vertex Distance
Distance from the corneal apex to the visual point of

the lens Include a VD in any lens Rx if the power of any meridian is +/- 5.00 D and above. VD changes the effective power of the lens All lenses become more + if moved away from the eye Opposite occurs when lenses moved closer to eye

Vertex Distance
You have 3 options 1) Ensure that the chosen frame sits at the prescribed

VD (use nose pad pliers) 2) Choose another frame that sits at the prescribed VD 3) Chose a frame that sits at a different VD, but alter the power of the lenses accordingly

Vertex Distance

Vertex Distance
Measure using mm ruler Consult a computer chart or graph If VD is decreased: F = F old/ 1- (dFold) If VD is increased: F = F new/ 1+ (dF new) d is in metres Toric prescriptions should be compensated for in each

meridian Dont forget: VD changes will also affect spectacle magnification

Increase VD = Magnifying for + lenses Decrease VD = Minifying for - lenses

Frame Selection for Centration and Decentration

Why do we want to center a lens on the patients

visual axis?

Prescription is most effective Reduces unwanted prismatic effects Reduces the possibility of the formation of ghost images

Decentration: Any displacement, horizontal and/or

vertical of the centration point from the OC Correct centration is important in simple as well as complex Rxs However, higher powered Rx can have larger consequences

Decentration in High Powered Lenses

Decentration is only necessary when the IPD and the

box and the frame size (A + DBL) are not the same. Only exception is if decentration is used to produce prescribed prism Try to keep decentration at a minumum by choosing a frame close to the PD of the patient

High Myopia- Lens Material and Form

Primary consideration is Edge Thickness

Decentration inwards will show large temporal thickness Dont forget there is still glass N= 1.90 glass (Zeiss Lantal)

Use higher refractive index materials

Aspheric surfaces AR coatings Be Careful! Low Abbe Values will cause TCA (Transverse

Chromatic Aberration) Use higher Abbe Value materials Use Best Form designs

Abbe Values and Index of Refraction

MATERIAL Crown Glass High Index Glass High Index Glass INDEX 1.523 1.60 1.70 ABBE VALUE 59 42 39

Plastic CR-39
Mid Index Plastic Mid Index Plastic High Index Plastic High Index Plastic Trivex Polycarbonate

1.49
1.54 1.56 1.60 1.66 1.53 1.58

58
47 36 36 32 43 30

High Myopia- frame and fitting

Fit as close to the eye as possible (less VD keeps

Visual points close to OCs and minimizes TCA) Minimize horizontal and vertical decentration and pantoscopic tilt Small frame and eye size with wider bridges Thicker eye wires and rims to hold thicker edges Be careful of nose pads and arms because ET can obstruct Real field of view is greater than the apparent field of view

High Myopia- Reduced Aperture Lenses

This lens has reduced

edge thicknesses using smaller lens apertures Super Lenti (Norville)

Decreased ET- aspheric Decreased Bottle Bottom appearance -11.00 D and above Must have Monocular PD

Vertical and horizontal centration data

Fit with zero Panto Tilt

Advantages of the Super Lenti

Good VA Good Field of Vision Controlled peripheral aberrations

Good edge thickness and weight

Allows for wide range of frame selection Reasonable cosmesis Removal of the minification of the face seen with full

aperture lenses

High Myopia- Lentilux

Aspheric, Single Vision Rodenstock lens Available up to -24.00 D Claims same advantages as the Super Lenti

Edge Thickness will not exceed 4.50 mm (even at -

24.00) Made of high index glass material (which reduces the thickness)

High Myopia- Lenticular

Edge thickness flattened Youll see a step where the margin and aperture meet Margins are convex or plano

Aperture shape can be round or oval.

High Myopia- Frame Selection

Thicker eye wires and rims to hold thicker edges Be careful of nose pads and arms because ET can

obstruct Go with smaller eye sizes with wider bridges Real field of view is greater than the apparent field of view

Presbyopia
Problem with lens availability Only available bifocal and multifocals are full aperture

lenses Many high myopes delay the need for reading addition Can push glasses down nose, increasing VD Norville Solid 30mm bifocal (1.701 glass, up to -12.00) Essilor Panamic Lineis (1.74 Resin, up to -20.00) Zeiss Tital Gradal 3 (1.706 glass, 1.80 glass, up to -20.00)

High Hypermetropia
What kind of problems? Nasal Edge Thickness Centre Thickness

Overall Weight
Oblique performance with off axis view Ring Scotoma Jack in the box effect Magnification Restricted Field of View Centration and prescribed prism

High Hyperopes
Use Asphericity- dramatically improves optical

performance Polynomial Designs are higher order aspheric surface lenses that are ellipsoidal and flexes back on itself at larger diameters Since polynomial designs introduced, lenticular lenses not used Aphakia Use UV 400 filter/coating

High Hyperopes: Polynomial Designs

No visible dividing line Good mean oblique power in off-axis viewin Reduced distortion

Slightly thinner
Increased field of view Reduction in Jack in the box effect Flatter Less magnification Less TCA

High Hyperopes: Prescribing Points

Pantoscopic Tilt of trial frame VD of the trial frame Consider choosing frame first before doing the refraction

When selecting a frame, use same considerations as the

high myope.

Maximise the Field of View Reduce the convergence demand Reduce the retinal image size Reduce distortion and chromatic aberration Vertical centration and pantoscopic tilt should match: 1 degree to 2mm below the pts pupil

Presbyopia and High Hyperopes

Same problem as high myopes Availability more in bifocals than PAL