OPT 413 Contact Lenses 1 Lecture Notes Nov2017

OPT 413: Contact Lenses Part 1: Prof. M. O.
Oriowo 1
University of Ilorin
Department of Optometry & Vision Science
22 May 2024
OPT 413: Contact Lenses Part 1 – Harmattan Semester 2018
Course Director: Prof. M. O. Oriowo
Course outline:
 Anatomic & physiologic basis of Contact Lens fitting (Corneal

physiology and Contact lens properties) (Lecture 1)
 History/Development of contact lenses (Lecture 2)
 Contact lens (CL) materials: 1) Soft lens materials; 2) Hard (RGP) lens
materials (Lecture 3)
 Manufacturing Methods (Lecture 4)
 Ocular surface defense & disinfection (Lecture 5)
 Contact lens Optics (Lecture 6)
 Preliminary ocular examination of the anterior eye / Dimensions

(Lecture 7)
 Contact Lens fitting procedures (Lecture 8)
 Contact Lens wear: Advantages, disadvantages; indications and

contra-indications (Lecture 9)
Reference Textbooks:
Phillips AJ, Speedwell L (2007). Contact Lenses 5th ed. Butterworth-
Heinemann, London.
Veys J, Meyer J, Davies I (2006). Essential of Contact Lens Practice.
Butterworth- Heinemann, London. London.
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OPT 413: Contact Lenses Part 1: Prof. M. O. Oriowo 2
Lecture 1
Corneal physiology and Contact lens properties
Oxygen Transmission
The passage of oxygen molecules and certain other ions and molecules
through a contact lens is very important in maintaining normal corneal
physiology.
The passage of oxygen is one of the most important aspects of a contact lens
materials, and much attention is directed to this topic by contact lens
practitioners and researchers.
The cornea has no blood vessels of its own to supply it with oxygen
necessary for normal metabolism. Therefore the cornea must obtain most of
its required oxygen from the tear film. The tear film supplies the cornea with
oxygen from the atmosphere when the eyes are open.
During sleep, the eyelids block oxygen from the atmosphere, and most of the
oxygen in the tears diffuses from the blood vessels of the limbus and the
palbebral conjunctiva (Figure 1:1). This reduces the amount of oxygen in the
tear film to approximately one third.
Figure 1:1 The blood vessels of the limbus and the palbebral conjunctiva
All the contact lenses act as a barrier between the cornea and its oxygen
supply. However, oxygen is able to reach the cornea in two different ways.
1) In the form of oxygen dissolved in the tears being pumped behind the lens
when the lens moves upon blinking, and
2) By diffusing directly through the lens material.
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Tear exchange not only provides oxygen and other nutrients to the cornea,
but also removes waste products (such as carbon dioxide and lactic acid) and
dead epithelial cells (Fig 1:2).
Figure 1:2 Removal of waste products (such as carbon dioxide and lactic
acid) and dead epithelial cells
Tear pumping is the major source of corneal oxygenation with PMMA lenses,
since these lenses have virtually no oxygen permeability. However, the tear
pumping mechanism alone is insufficient to provide adequate amounts of
oxygen to the cornea. This is shown by PMMA lenses, which cause
unacceptable levels of cornea hypoxia (lack of oxygen) even in the presence
of an active tear pump. Diffusion of significant amounts of oxygen directly
through the lens is therefore necessary to provide an adequate oxygen level
for normal cornea metabolism (Figure 1:2).
Figure 1:3 Provision of an adequate oxygen level for normal cornea

metabolism
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MEASUREMENT OF OXYGEN TRANSMISSION
Since direct diffusion is the major source of oxygen transmission with soft
lenses, it is imperative to be able to measure this parameter. The major
methods of measuring oxygen transmission will be discussed.
Oxygen permeability
Permeability refers to the degree to which a substance is able to pass
through a membrane or other materials.The oxygen permeability (P) of a
material is determined by the product of two factors: Diffusion (D) and
Solubility (K). It is for this reason that the term DK, or more commonly Dk, is
used to describe oxygen permeability.
Diffusion is the process by which molecules pass through a material, such as

contact lens; the direction of movement is always from the area of higher
concentration to the area of lower concentration.
Figure 1:4 Corneal oxygen supply in open eye situation.
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Figure 1:5 Diffusion of oxygen through a contact lens
Permeability is a natural (an intrinsic) function of the molecular composition of

a material.
Permeability is affected by extrinsic factors such as concentration,
temperature, pressure, and barrier effects.
The permeability of a material is expressed as a permeability coefficient,
denoted as Dk. In order for oxygen to pass through a contact lens material,
the molecules must first dissolve into the material and then travel through it.
Permeability is the product of the diffusion coefficient (D) and the

solubility coefficient (k).
The diffusion coefficient (D) is the rate at which oxygen gas molecules
travel (diffuse) through the material (Figure 1:6)
The solubility coefficient (k) defines how much gas (i.e., the number of
oxygen molecules within the polymer) that can be dissolved in a unit volume
of the material at a specified pressure.
The Dk values are quoted in standard units called barrers (pg 62 of Contact
Lenses by Phillip and Speedwell). The actual testing conditions may vary, but
the results must be converted to the standard Dk units.
Dk (barrers) = 10-11 (cm3) O2 (STP) x cm/sec x cm2 x mmHg. Note STP

(standard temperature and pressure) is at 25°C.
A typical Dk value, expressed in its standard units:

Dk = 8.9 x 10-11 (cm3/sec)(mlO2 / mL x mmHg) at 25°C.
Figure 1:6 Diffusion Coefficient
Solubility Coefficient : illustrate by drawing
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The temperature of the testing conditions should always be stated because

Dk increases with increasing temperature. Because increasing temperature
incrases the energy of the gas molecules, causing them to travel at a faster
rate through the material.
The oxygen permeability coefficient (the Dk value) of a contact lens

material is an inherent characteristic of the material, regardless of its
thickness. As a rule, Dk is a constant for a given lens material.
Oxygen Transmissibility
The actual rate at which oxygen will pass through a specific contact lens of a
given thickness is called its Oxygen Transmissibility denoted “Dk/L”.
The Dk value is the permeability coefficient of a material, that is how much

oxygen will actually pass through a given contact lens.
To calculate the Oxygen Transmissibility of a given contact lens, the “Dk”

value for the material is divided by the lens thickness, denoted “L”.
Lens thickness is expressed in centimeters, so care must be taken to convert

lens thickness (which is typically expressed in millimeters) to the proper units.
The lens thickness chosen to calculate Dk/L is usually the center thickness of
a -3.00D lens, as this is typically the midrange power of the minus lens range
for many manufacturers; +3.00D lenses are typically used as the midrange of
plus lenses.
It is important to remember that most published Dk/L values represent only -

3.00D lenses.
It is significant that as lens thickness increases, transmissibility decreases.

This means that plus lenses (which are thickest at the center of the lens) will
have lower calculated oxygen transmibilities than minus lenses (which are
thinnest at the center of the lens) of the same material.
Dk is a function of water content in hydrogel lenses. As a general rule, this is
a linear function with Dk increasing at the same rate as water content (Figure
1:7)
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Figure 1:7 Dk versus Water Content
Although lenses with higher water content typically have higher Dk values,
they often must be made thicker than lower water content lenses for several
reasons:
1) They dry out, or dehydrate, more rapidly in thin designs, leading to corneal
drying which is observed as corneal dessication staining.
2) High water lenses are generally more fragile than thin designs.
The thicker designs of high water lenses often result in Dk/L values that are
similar to thinner lenses with lower water content (see Table below).
%H2O Dk* Minimum thickness Maximum Dk/L

38% 9 0.03 mm 30
55% 18 0.06 mm 30
70% 36 0.12 mm 30
*Example of Manufacturer’s published Dk values.
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Lecture 2
History of contact lenses (CL)
In about 1508, Leonardo da Vinci sketched the first forms of new refracting
surface on the cornea. He used the example of a very large glass bowl filled
with water. Immersion of the eye in water theoretically corrected vision (Fig 1).
Descartes in 1636 suggested applying a tube full of water directly to the eye
to correct a refractive error (Fig 2.1). Even these early suggestions show the
history of CL did not begin until 19th century.
Figure 2.1. Leonardo da Vinci’s first new refractive surface on the eye,
consisting of a bowl-like container filled with water.
Figure 2.2. Optical idea of contact lens described by Descartes. A hollow

glass (semi-spheroid) tube filled with water against the eye with a lens at the
end.
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Dr. Fick, a physician in Zurich in 1887 described the first contact lens with
refractive power known to have been worn. It was made by A. Muller, a
manufacturer of artificial eyes.
Figure 2.3. Corneal contact lens described by Fick.
Early contact lenses were crude disk of ground or blown glass and made
spherical although the cornea is not spherical. So the lenses did not conform
to the shape of the cornea, abrasions developed, and wearing time short and
frequently painful, because the developer had little knowledge of the
metabolic and physiology of the cornea. These led to the development of
larger lenses that rested on the sclera (between 1888 and 1938) and provided
a clearance between the lens and the cornea (Fig. 4). However, the edge of
the first plastic lenses formed a seal with the sclera, trapping a pool of bathing
medium under the lens and precluding vital metabolic exchange and poor
tolerance.
Figure 2.4. Scleral contact lens
The proposed therapeutic uses for contact lenses were to protect and
reshape the optical properties of irregular cornea in disease such as
keratoconus. Therefore, it becomes clear that corneal shape and physiology
are critical in CL design. The cornea obtains the bulk of its oxygen supply
from the air and that the medium of exchange is the tears. As a result the
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sclera lenses were abandoned and hard contact lenses were redesigned. The
newer lenses were smaller, thinner, and more flexible. They ride on the
surface of the tear film, and each blink of the lids provides an ebb and flow of
oxygenated tear fluid that supplies the respiratory needs of the cornea.
In 1964, Dr. Otto Wichterle in Czechoslovakia introduced soft hydrophilic

plastic contact lenses. These lenses had the advantage of comfort and
permeability by water and oxygen. The main potential in the Czechoslovakian
lens lay in the ability of mass production methods that would bring down the
manufacturing cost. In 1966, Bausch & Lomb introduced the spin-cast soft CL
on an experimental basis. In 1967, the lathe-cut Griffith lens was first seen in
the USA.
Lecture 3: CONTACT LENS MATERIALS
Contact lenses can be classified according to their material as hard or soft

contact lenses. These materials should be stable, clear, nontoxic, non-allergic
and optically desirable. There are three main types of CL materials:
Polymethylmethacrylate (PMMA), Silicone, and Hydroxyethylmethacrylate
(HEMA).
Lecture 3A: HARD CONTACT LENSES
Polymethylmethacrylate (PMMA)
In 1948, Kevin Tuohy introduced a PMMA “microlens” which covered only the
cornea, and was therefore smaller than the larger “sceral” lenses which
covered the entire front part of the eye including the sclera. This was the first
comfortable PMMA cornea lens that could be worn all day. As a result, PMMA
corneal lenses of various designs dominated the contact lens field until soft
contact lenses became available. Hard contact lenses became popular in the
1950s.
Polymethylmethacrylate (PMMA): is an organic plastic compound stable at

room temperature. The water content is 0.5%. It is easily worked material and
has refractive index of 1.48 – 1.50. It is used to produce hard contact lenses.
Example: Boston
Silicone: This is a polymer of dimethyl-silicone, permeable to oxygen and

glucose. The water content is 0%. Its refractive index is 1.43. Example – Dow
Corning (silicon) lens.
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SOFT CONTACT LENSES
Hydroxyethylmethacrylate (HEMA)
The first soft contact lens material was developed by Otto Wichterle, a
Czechoslovakia scientist, and was patented in 1963. Wichterle’s technology
was licensed to Bausch & Lomb, and in 1971 the first commercial version of
soft contact lens was approved for use in the USA. Hence it can be said that
soft lenses were introduced in the U.S. in 1971.
Hydroxyethylmethacrylate (HEMA) lenses: These are soft or hydrophilic

contact lenses that are characterized by the ability to absorb water, elasticity
and flexibility. HEMA is hydrophilic because it contains a free Hydroxyl group
that bounds with water. The water content range from 38% to 60%. Its
refractive index is 1.43. Example – Bausch & Lomb (Soflens).
There are 3 types of water content materials in soft CLs.

- Low water content materials (Bausch & Lomb, water content 38.6%,
trade-name lens Optima 38).
- Medium water content materials
- High water content materials (Bausch & Lomb, water content 70%,
trade name lens B&L 70 minus).
SOFT LENS MATERIALS (Cont’d)
More Introduction
 Soft CLs come in a variety of materials
 Made from HYDROPHILIC polymers
 Monomers are designed to increase hydrophilicity or water content in
the material.
 Dk is related to water content of the lens.
Hydroxyethylmethacrylate (HEMA)
 First soft CL material in the market
 HEMA is the monomer
 Poly HEMA is the polymer form, but also known as HEMA
 HEMA is hydrophilic because it contains a free Hydroxyl group that
bounds with water.
 Water content of HEMA is 38%
 Lenses with more than 38% water content contain other hydrophilic
monomers to increase water content (note: they are 100% HEMA).
 When polymer hydrates, pores within the lens enlarge and fill with
water.
 Water-soluble substances are allowed in and out of through the pores.
 High water materials have larger pores.
 HEMA material is a comfortable material.
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Some disadvantages of HEMA:

1. Fragility
2. Low Dk
3. Discoloration
4. Bacterial adherence
Most soft CL materials used nowadays contain some form of HEMA.
Example of some of these materials:
 Methacrylate Acid (MA): This is an acid that increases water content

in a soft lens polymer. An additional hydroxyl group is added when MA
is used.
 N-Vinyl Pyrrolidone (NVP):

- This is hydrophilic monomer
- NVP has a carboxyl group that bounds with more H20 than MA or
HEMA.
- NVP can be used separately or together with HEMA to form a co-
polymer.
- When used in combination with another monomer like HEMA or MA, it
increases H2O content of the material.
 Methyl Methacrylate (MMA):

- Adds strength and rigidity to the lens.
- It is derived from PMMA, the grandfather of CL materials.
 Acrylamide:
- Adds water content to lenses
- Contains a carboxyl group that attracts water.
 Ethyl Glycol Dimethacrylate:

- It is a cross-linking agent commonly used in contact lens materials.
 HEMA-based materials:
a) 100% HEMA-based materials
b) HEMA lenses with co-polymers to increase water content

- HEMA and NVP (e.g. B&L Optima lens)
- HEMA, and NVP and MMA (e.g. Ciba Vision Focus lenses)
- HEMA and MMA (e.g. Wesley Jessen DuraSoft lenses)
- HEMA and Acrylamide (e.g. Wesley Jessen Hydrocurve lenses)
- HEMA and MA (e.g. Ocular Sciences Edge III lenses)
- HEMA, and NVP and MA (e.g. Cooper Vision 71% Permalens)
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Non-HEMA-based materials:
 NVP and MMA: The NVP supplies a higher (70%) water content and
the MMA gives extra strength and resistance to tearing.
 GlycerylMethylMethacrylate (GMA): Glyceryl gives the material high
hydrophylicity (each molecule has 2 hydroxyl groups). MMA is included
for rigidity.
SOFT LENS GROUPINGS USED BY FDA

 Low water content (less than 50% H20)
 High water content (more than 50% H20)
 Ionic versus non-ionic
Group I: Low H20 non-ionic polymers e.g. 100% HEMA

Group II: High H20 non-ionic polymers
Group III: Low H20 ionic. They contain MA
Group IV: High H20 ionic. H20 content from 55-60%.
Lecture 3B: TYPES OF SOFT CONTACT LENSES
Soft contact lenses can be divided into four categories:
Daily wear
These are lenses worn on daily basis for 12 to 14 hours and removed before
bedtime for cleaning and disinfection. Methods of disinfection are heating,
chemical and oxidation (hydrogen peroxide).
Flexible/Extended wear
In contact lens practice, it means lenses are given to patients who can wear
lenses overnight only on an occasional basis such as weekend, and should
be cleaned and disinfected upon removal. Most practitioners now recommend
lens wear without overnight removal for 3 to 7 days, depending on the lens
type, however, the FDA recommends a 7 day-limit. Contact lenses under the
extended wear category are usually high-water contact lenses, that is, those
lenses with a water content greater than 60%, are soft and flexible, yet may
be difficult for the patient to handle. The high-water concentration means a
significant advantage relative to lens oxygen transmission.
Methods of disinfection involve chemical and oxidative. These lenses are also
available in planned replacement, tinted and toric forms.
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Planned Replacement
These lenses allow the patient to replace lenses weekly or biweekly
depending on their preference. For example, disposable lenses are worn for
one-week extended wear period and discarded, therefore a care regimen is
not required.
Tints
These are usually cosmetic soft contact lenses in different colors or shades of
colors.
Therapeutic Lenses or Bandage Contact Lenses

There are different types of hydrophilic polymer (soft) contact lenses that can
be used as bandage lens, and/or for drug delivery. These lenses were
introduced as soon as Wichterle and Lim of Czechoslovakia reported the use
of hydrophilic polymer for soft contact lenses in 1960. Bandage contact lenses
are used for a variety of corneal disorders.
Lecture 4: MANUFACTURING METHODS
Soft contact lens can be manufactured either by spun cast, lathe cut and cast-
molded or combination of these methods. For example, the Optima 38 lens
(Bausch & Lomb) is spun cast on the front surface and lathe cut on the back
surface.
Spin-casting
This technique involves injecting solution onto a spinning mold. The rate and
time of spin is computerized and hydration process of the CL occurs after the
lens is formed. The final CL design depends on the curvature of the concave
mold, rate of spin, amount of monomer mixture, physical properties of
monomers, rate of polymerization and time span of polymerization. CL
produced by this method has aspheric posterior curves with relatively thin
edge design compared to lenses produced by lathe-cut method.
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Figure 5. Profile of spin-cast edge for B & L lens.
Lathe-cutting
This technique involves cutting long, plastic cylinder into lens buttons, and
then the button is shaped into the lens with a lathe and then hydrated.
Figure 6. Profile of lathe-cut edge for B&L lens.
Casting-molding
This method is known as the simplest and least expensive mode of production
because the multiple molds can be used to produce large quantity of lenses at
one time. It involves injecting material into a mold with anterior and posterior
curved surfaces, after a period the mold is then broken and polymerization is
introduced by ultraviolet light.
Lecture 5: Ocular surface defense & Disinfection
The tear film is vital. Not only does it provide oxygen exchange as the lens is
moved, but it also possesses lysozyme, an antibacterial enzyme that inhibits
bacterial proliferation.
Patient with a tear deficiency are more prone to infections and often cannot be
fitted comfortably with lenses.
Many complications with soft contact lens wear occur after lenses are
successfully fitted, when patients care for and handle their lenses. Problems
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arise due to nature of hydrogel lens materials which may be susceptible to

contamination by bacterial and fungi.
LENS CARE:
Routine lens care includes disinfection and cleaning. Soft contact lens
systems are changed and updated frequently.
There are three methods of disinfection used with SCL: Thermal, Chemical,
and Oxidative. Each of these methods has advantages and disadvantages
which will aid the practitioner in selecting the care regimen best suited for
each patient and lens.
Thermal disinfection
This technique is not expensive and most effective system in the short term.
Thermal care regimen consists of saline, surfactant cleaner, enzymatic
cleaner and rewetting or lubricating drops. After lens removal, it should be
cleaned with surfactant cleaner and stored in a case filled with saline and
enzymatic cleaner should be used weekly.
Its advantages: quick (20 minutes) and require very few steps, solutions and
preservative-free for patients sensitive to preserved solutions, and effective
against all forms of bacteria such as pseudomonas and AIDS virus. However,
the heat bakes on the deposits so lens not cleaned, and lens life shortened,
and not interchangeable with all systems and complications such as giant
papillary conjunctivitis (GPC), or red eye occurs due to deposited lens. This
disinfecting technique is contraindicated with lenses containing greater than
55% water.
Chemical disinfection
This method consists of a disinfecting solution that contains preservatives,
surfactant cleaner, enzymatic cleaner and rewetting or lubricating drops, and
many of these solutions may be used for rinsing and insertion of the lenses.
For example, ReNu Multi-purpose solution can be used as a cleaner, saline
and the enzymatic tablets; however, disinfection must still be performed
following enzymatic cleaning. The advantages for the chemical system; it can
be used for all types of SCL, little effect on the lens life, it removes 90% of a
measured amount of bacteria placed and the reduction of the solutions
numbers and steps make it simple and convenient for patient. The main
drawback is the use of preservatives such as thimerosal and chlorhexidine
that were toxic to some patient so it is more likely that the lens will have to be
replaced.
Oxidative disinfection
This method consists of a 3% hydrogen peroxide solution, neutralizing

solution, tablet or disc, saline, surfactant cleaner, enzymatic cleaner and
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rewetting or lubricating drops. Hydrogen peroxide is effective against bacteria

and it can be used in a disinfecting cycle of 10 minutes with 10 min of
neutralization, but longer exposure time is recommended to be effective
against fungi and Ancathamoeba. Disadvantages are: the number of solution
and steps involved in the method, storing the lens in hydrogen peroxide for
lengthy periods may affect the base curve radius of the lens, especially in
high-water content, ionic lens material, although these changes are reversible.
The advantages: safe, effective, and preservative free.
The acidity of hydrogen peroxide could cause mild to moderate punctuate

keratitis. To prevent this, there are many methods to neutralize it. Two
examples:
1. Allergan Optical has two step systems – Oxysept and UltraCare both
are preservative-free tablets that are placed in the vial containing hydrogen
peroxide
a. the first one is two step process, placing Oxytab in the vial after proper
time interval of disinfection (10min to 12 hours)
b. The second tablet in one step process, placing UltraCare neutralizing
tablet (coated with a viscosity agent that prevents activation of tablet
for 20-30 mins) in the vial allowing disinfection with hydrogen peroxide
to occur prior to neutralization.
2. Ciba Vision has one step system called AODisc, it is a platinum disc
attached to the lens cage that begins neutralizing AOSept immediately upon
contact when the lens cage is placed in the AOSept. The disc should be
replaced after 3 months of daily use.
Saline solution
It is necessary part of hydrogel CL care because the hydrogel CL must stay

hydrated.
- Saline is non toxic to the eye and sterile used to rinse the lens from
foreign body as well as to dissolve enzyme tablets.
- Distilled water not suitable since it is not sterile and easily
contaminated.
- Saline is not capable of disinfecting the lens when used alone.
- It is available in preserved (with thimeresol or ascorbic acid) and
unpreserved (e.g. aerosol saline) solutions.
Surfactant cleaners
- It prevents buildup of lens deposition thus it should be used after every
lens removal.
- It acts as a soap to remove debris, unbound proteins, lipid deposits and
some microbial contamination.
- The lens is placed in the palm of the hand with few drops of the
cleaner, then rubbed gently back and forth for 20 to 30 seconds, and
the lens is finally rinsed and soaked in disinfection solution.
Alcon introduced three generations of cleaners for hydrogel CL:

- Opticlean (preservative was Thimerosal)
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- Opticlean II (preservative was Polyquad)

- Opti-Free Daily (preservative was Polyquad)
Ciba Vision introduced Mira Flow which contains among other cleaning
ingredients, isopropyl alcohol. Isopropyl alcohol eliminates the need for a
preservative because of its broad-spectrum antimicrobial effects. It is an
excellent cleaner especially for patients with tendency toward lipid deposits,
but the lens should be rinsed to avoid the risk of parameter changes.
Enzymatic cleaner
- It is used once a week to break down peptide bonds, allowing protein
to be rubbed off mechanically.
- The proper care sequence to use enzymatic cleaner for hydrogel
lenses are cleaning, rinsing, enzymatic cleaning, rinsing, and
disinfecting.
Lens Lubricants / rewetting

- It is optional, but may be beneficial in cases of dry eyes, foreign body
sensation, and irritations and for morning and evening use in extended
wear.
- Lens lubricants used directly in the eye with and without the lenses.
- It is not suitable to use ophthalmic medication as lubricants because
this could cause discoloration and toxic reaction.
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LECTURE 6
Contact Lens and brief overview of visual optics
Unequifocal Systems
It is pertinent at this juncture to discuss unequifocal optical systems. The eye

is an example of such a system, one in which the first and the last media have
different refractive indices.
In general, such systems have six important points (figure 7.4, note the figure
will be 4 under lecture 7, and others in sequence):
1. F and F¹ - The first and second principal foci, which are just, like F
and F¹ for a single refracting surface.
2. P and P′ - The first and second principal points.
3. N and N′ - The first and second nodal points.
These points are always positioned such that; PP¹ = NN¹ and, FP = N¹F¹
The whole system has an equivalent power F such that:
F = nk+1 / f¹ = -n1 / f ------------------------------ equation 7.1
Where f¹ = P¹F¹ and f = PE, n1 = refractive index of the first medium, nk+1 =
refractive index of the last medium, and the whole system has k surfaces.
Also, L = L+ F
Where L = n1/l and L′ = nk+1 / l¹.
Let us assume that a ray from an object Q, moves towards P, making an

angle u with the optical axis (figure 5). The corresponding emergent ray (from
the lens system) will appear to emerge through P¹ making an angle u¹ with
the optical axis, such that:
nk+1u¹ = n1u ------------------------------------------- 7.2
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Now, let us assume that another ray from Q moves towards the first nodal
point N. the corresponding emergent ray will appear to have passed through
the second nodal point N¹ without undergoing a change in direction (i.e. w =
w).
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These two different rays from Q, can now be used to construct the image
B¹Q¹ from the object BQ.
Transverse Magnification
m = h¹/h = L / L¹ ------------------------------------- 7.3
m is transverse magnification, h is the object size, and L is object

vergence.
The equation above holds true for refraction, reflection, thin lenses and optical
systems.
Effectivity of lens power (Vertex distance principle)
Let us assume a pencil of rays are traveling towards their focus (as in figure 6
a). Assuming the rays start off from the point, O, after traveling a distance d,
they reach another point, X. Thus,
Lx = lo - d ---------------------------------------- 7.4
and, Lx = n/lx = n/lo – d = n / (n/Lo) – d = Lo / 1 – (d/n) Lo

This generally effectivity relationship describes the change of vergence as
light passes from one surface (or reference point) to another.
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Refractive Index
The refractive index of a transparent medium varies with wavelength, and to a

lesser extent, with temperature. The term refractive index usually refers to the
‘mean refractive index’, vis-à-vis the refractive index for the wavelength of
587.6 nm. Measurements of refractive index are usually made within the
temperature range of 18-20ºC.
Components of the eye’s optical system
The Cornea
This is a highly transparent structure with a 12 mm diameter of curvature,

which is slightly smaller vertically than horizontally. The visible iris diameter
(VID) is dictated by the diameter of the cornea.
The central thickness of the cornea is between 0.5 and 0.6 mm. this tends to
be thinner in moderate to severe myopia, as well as in pathological conditions
such as keratoconus and keratoglobus.
The surface of the cornea is covered by the pre-ocular tear film, which
(refractively) serves to provide a smooth refractive surface at the front of the
eye.
Figure 7 depicts the parameters of the cornea. The refractive index of the
cornea is approximately 1.376.
The Anterior chamber
The anterior chamber is the fluid-filled space lying between the back surface
of the cornea, and the front surfaces of the iris and crystalline lens. It is filled
with aqueous humor which is 98% water.
The average value for anterior chamber depth in the human eye, is 3mm
Optically, the anterior chamber depth is important because it affects the total
power of the eye. If everything else remains constant, a reduction of 1mm in
anterior chamber depth (caused by a forward shift of the anterior lens
capsule) will result in an increase in the eye’s total power of 1.4D. An increase
in anterior chamber depth of 1mm will have the exact opposite effect.
The Pupil
The pupil is a circular aperture (or hole) in the iris that regulates the amount of
light that enters the eye. Normally, the pupil contracts in reaction to Near,
Direct, and, Consensual reflexes. Failure of any of these reflexes, points to an
underlying neurological disorder.
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Assignment: Read up on the following topics:
1. Adie’s tonic pupil

2. Argyll-Robertson’s pupil
3. Homer’s syndrome
Apart from illumination and accommodation, papillary size also varies with
age. It decreases with increasing age at a uniform rate, which tends to slow
down in later life.
Papillary diameter ranges from 3-7.5mm depending on the age of the person
and on the ambient (surrounding) illumination. For example, in complete
darkness diameter in a 10 year old is about 7.5mm, while in the light-adapted
eye, papillary diameter is about 4mm at 45 years and about 3.4mm at 80
years.
The Crystalline lens
The most important function of the crystalline lens is to focus the optical
system of the eye for different distances. This process is called
accommodation. The crystalline lens is a complex structure made up of
different parts. This includes a lens cortex that surrounds a biconvex nucleus.
The whole lens is enclosed in a highly elastic (flexible) capsule. The elasticity
for this capsule facilitates accommodation (i.e. makes accommodation easy)
such that, everything else remaining constant, as the capsule becomes less
elastic, accommodation becomes more difficult. The lens capsule becomes
less elastic with increasing age.
The centre thickness of the crystalline lens is 3.6mm in the young adult
human. It can change depending on whether the eye is fully accommodated
or completely relaxed.
The refractive index is not constant throughout the lens body. It varies from
about 1.4 at the centre of the nucleus, to 1.385 at the poles and 1.375 near
the equator. For practical purposes though, a uniform refractive index of 1.42
is assumed for the crystalline lens.
Though the lens surfaces are assumed to be spherical, there is a marked

peripheral flattening especially of the anterior surface in the accommodated
state. As a result of this, plus the peripheral flattening of the cornea, spherical
aberration of the eye is kept under control.
The Vitreous humor
The back surface of the crystalline lens is in contact with the vitreous humor, a
transparent gel that fills the posterior segment of the eyeball. The vitreous
humor has nearly the same composition as the aqueous humor and its
refractive index may be taken as the same (1.336).
24
The Retina
The retina is a forward extension of the brain and it is the level at which visual
information begins to be processed. The retina can be regarded as the screen
on which real images are formed by the eye’s optical system. The image
resolution of the retina is maximal in the macula region, where the sharpest
vision is attained at the fovea.
The retina can be regarded as part of a concave spherical surface, with a
radius of curvature in the neighborhood of -12mm. the curvature o the retina
has 2 advantages:
1. Images formed by optical systems tend to have curved surfaces.

2. The steeply curved retina is able to cover a much wider field of view
than would be otherwise possible for its area.
SCHEMATIC AND REDUCED EYE CONCEPTS
For the study of the eye as an optical instrument, the schematic eye retains
the average dimensions, but, omits the complications, of the eye’s optical
system.
Taking the concept of the schematic eye a step further, convenience and
simplicity form the basis of the concept of the reduced eye. In this concept,
the entire refractive system of the eye (i.e. the cornea and the crystalline lens)
is represented as a single convex surface separating air from a medium of
refractive index n¹ similar to that of the vitreous humor.
THE SCHEMATIC EYE
General Properties
The equivalent power of the schematic eye is about +60D and its main points
are shown in fig. 10.
P and P¹ lie in the anterior chamber at distances of 1.6mm and 1.9mm

respectively from the front surface of the cornea. N and N¹ are also separated
by 0.3mm and are located on either side of the back surface of the crystalline
lens.
The first principal focal length PF is about -16.7mm. The second principal
focal length P¹F¹ is about +22.2mm.
Every detail in ray diagram schematics 4 and 5 apply exactly to the schematic
eye.
Optical Centration
The crystalline lens is tilted (demonstrate) with respect to the cornea and so
its principal axis does not coincide with that of the cornea. So, there is no
single line representing a ‘true’ optical axis of the eye. However, the principal
points of the cornea very nearly coincide, as do those of the lens. Therefore, a
line drawn as close as possible to all these points would represent a close
approximation of an ocular optical axis.
25
Lecture 7
Preliminary ocular examination of the anterior eye segment /

Dimensions
1. External examination
The anterior segment is composed of the eyelids (and margins), conjunctiva,
sclera, cornea, limbus and iris. A knowledge of the normal anatomy, histology
and physiology of the eye is required to enable detection of changes induced
by disease or contact lens wear. This knowledge is also required to facilitate
the diagnosis of the signs and symptoms of any such changes.
- CL is contraindication if there is any active pathology of the eye, e.g.

inflammation, injury of the lid, conjunctiva or cornea.
- The external examination can be done with a penlight combined with hand
magnifier or a slit-lamp which is better choice.
Procedure for penlight:

- Seat the patient comfortably in room with good light condition
- Direct the penlight illumination at the area to be examined while you
look through the magnifier
- Examine the eyelid skin, lid margin (blepharitis marginalis), conjunctiva,
cornea (for scars), sclera, anterior chamber and iris.
- You may need to evert the lids to examine the conjunctiva properly for
follicles or papillae.
- Note any inflammation or injury of the area examined.
Procedure for slit-lamp:
- Seat the patient comfortably at the slit-lamp by adjusting either the

patient seat or the slit-lamp height and chin rest.
- Examine all the tissue mentioned above. Particularly those directly
related to contact lens fitting.
- Diffuse illumination used to examine the conjunctiva and the lids.
- Direct illumination used to examine the cornea and the limbus.
- The patient tear quality and quantity should be tested, because
wearing CL on dry cornea can cause poor tear circulation, corneal
edema, blurry vision and burning sensation.
Therefore, there are two tests commonly used for tear analysis:
- Tear quality (Tear break-up time (TBUT))
- Tear quantity (Schirmer test).
26
Tear quality (Tear break-up time (TBUT)
- Blinking helps in distributing tear over the cornea, immediately after a

blink, evaporation begins and tear film begin to thin. Therefore, the tear
break-up time is often used an index for an abnormal tear formation.
- Tear break-up time is the interval time between a complete blink and
the first randomly distributed dry spot.
- If an eye is kept open without blinking for 15-34 seconds, the tear will
show dry spot areas. When fluorescein applied to these dry areas
appear black when examined with Ultraviolet Light (Button Lamp).
Observing any dry areas occurring in less than 10 seconds is
considered a negative factor in patient selection for CL fitting.
Schirmer Test
- It is used to evaluate the rate of tear flow thus provide information on
hypo and hyper secretion of tears.
- A special filter paper (5x35mm) is used; this paper has an indentation
at the upper 5mm of its length.
- After 5 minutes, the paper is removed and the length moistened by tear
is measured with a ruler. Normal tear secretion moistens 10-15mm of
the strip, but the older the patient the less the reading.
Ocular Dimensions
- Corneal shape is elliptical because of the encroachment of the opaque

limbus into the cornea's superior and inferior borders. Horizontal visible
iris diameter (HVID) is 11.7 mm and vertical visible iris diameter (VVID)
is 10.6 mm on average. These may be about 0.1 mm less in females.
- Corneal area is 1.3cm or 1/14 of the total area of the globe.
- The globe is bispherical with the cornea having the smaller posterior
spherical radius of curvature of 6.2 to 6.8 mm (average 6.5 mm).
- The average corneal thickness is 0.52 mm in the centre and 0.67 mm
at the limbus (Maurice, 1969).
- Sagittal depth of the cornea is 2.6 mm with variations largely
dependent on the radius of corneal curvature.
- The corneal diameter has effect on the specification of the CL
prescribed especially lens diameter. It is assumed to be equal to the
diameter of the iris (a.k.a – horizontal visible iris diameter).
- The actual measurement is made with a P.D. ruler
- The pupil diameter can be approximated by using the iris as reference
scale. For older children and adult the iris is usually about 12 mm in
diameter. This measurement is difficult since the pupil size will fluctuate
with varying emotions and external stimulus.
- The palpebral aperture height is important factor in determining corneal
contact lens dimension.
27
- With the patient relaxed and fixating straight ahead, a measurement

should be made of the maximum vertical distance when the lids are
separated. This measurement is difficult to obtain since the lid aperture
is under voluntary control, so patient tend to squint when ruler is placed
near their eyes.
- The refractive error of the patient must be measured and final
prescription written in minus cylinder form for ordering the contact lens.
- If the refractive astigmatism is over 1.00D with-the-rule or 0.75D
against-the-rule or oblique, the use of toric surface lens should be
considered.
- Three readings of keratometer measurement for the patient to obtain
maximum accuracy, then the median value of the three are recorded.
28
Lecture 8:
Contact Lens Fitting procedures
Selection of contact lens diameter
Obtain patient’s horizontal visible iris diameter (HVID) measurement

CL diameter = HVID + (1 to 3mm, Ave. = 2mm)
Increase or decrease lens diameter in 0.50mm step if necessary during
evaluation process.
Lens must completely cover cornea.
Most soft CLs are available from diameter of 13.5m to 15mm. However, large
diameter e.g. 15 mm tends to tighten on the cornea and may result in
complications e.g. ulcers or neo-vascularisation.
Selection of Base curve (BC)
 SCLs are usually fitted flatter than the flatter K

 BC=flattest K – 3.00D
 Convert the diameter value to millimetres using a converting table
 Increase or decrease BC in 0.3mm steps if necessary.
 Clinical experience shows that majority of patient can be fitted with an
average or median BC. This is usually in the 8.50 – 9.00 mm range.
 As a guide an alternative method of BC selection, the following table
can be used:
K-reading Soft CL Base Curve

< 41.00D Flat (>9.00mm)
41.00 – 45.00 D Medium (8.00 – 9.00 mm)
> 45.00 D Steep (<8.00mm)
Selection of lens power
 Refraction prescription must be converted to minus cylinder form:

1. If cylinder in refraction is <0.50D, power = spherical component
2. If cylinder in refraction is between 0.50D – 1.00D, power =
spherical equivalent (i.e. spherical component + ½ Cyl).
 If overall spherical component in 1 and 2 is greater than ±4.00D,
compensate for vertex distance using either method 1 or 2:
Method 1
Fc = Fs / 1- dFs
Where:
Fc = power of CL
d = distance between spectacle lens and CL in meter.
Fs = power of spectacle lens (D)
29
For example:
Refraction: –6.00 +1.00x90 (plus cyl form)
–5.00 – 1.00 x 180 (minus cyl form)
Vertex distance = 13mm (in meter, vertex distance = 13/1000 = 0.013m)
Add ½ of cyl to sphere power –5.00D

This is greater than ±4.00D, so compensate for vertex distance e.g. 13 mm
(calculations or using Table)
Solution: using Fc = Fs / 1- dFs

Fc = 5.50 / 1- (0.013 x 5.5) = 5.5 / 1-0.0715 = 5.5 / 0.9285 = 5.924 ≈ –6.00D
Method 2
Add ½ of cyl to sphere power
Example 2:
Ref: –6.00 +1.00x90 (plus cyl form)

–5.00 – 1.00 x 180 (minus cyl form)
Contact lens power = –5.00 + (–0.50) = –5.50D
The contact lens power from the table = –5.50D. This is greater than ±4.00D,
so compensate for vertex distance, e.g. 13mm (by calculation as above or
using table).
Lecture 8 (cont’d)
Fitting of spin-cast lenses
- The proper choices of lens require selecting the optimum lens diameter,
power, and the appropriate lens thickness
1- Measure the cornea diameter, and then select the initial lens diameter from
table 18.4
2- Select the initial thickness after consideration of the guidelines there are
two types of thickness standard (0.12mm) and ultra thin (0.07mm) e.g. from
table 18.4 standard thickness (B3,B4) ultra thin (U3,U4).
- Ultrathin lens provides superior performance in the area of comfort and

physiological response. But some patient find ultra thin difficult to handle.
- Some patient fitted with standard thickness may cause edema and require a
change to Ultrathin. Thus, the practitioner may decide on the following
guidelines.
- Unless clinical consideration or practitioner preferences dictate otherwise
ultrathin is recommended.
- Patient with long history of CL wearing can easily adapt to ultrathin CL.
30
- Ultrathin lenses of power greater than 1.5D, are easier to handle because of
increased peripheral lens thickness reduces the flexibility.
- Patient with poor skill may need to be fitted with standard thickness.
- In very dry environment, some patients may be better fitted with standard
thickness.
3- Full coverage of the cornea is achieved when the lens edge extended
about 0.75mm beyond the visible iris in all directions.
- Final lens selection should not be considered complete until the patient
lenses are evaluated at a post-fitting progress check with at least four
continuous hours of lens wear.
At the post-fitting progresses, you check:
- If patient experiences excessive lens awareness, unstable vision during

blinking, or vertical striae are observed then change the lens diameter.
- If the lens does not cover the cornea fully then change to a larger diameter.
4- The spin-cast lens design does not always conform exactly to the cornea
contour thus the power of refractive error must be modified occasionally.
Fitting of lathe-cut lenses

- Regular lenses with minus power usually have corneal thickness range from
0.06 – 0.12mm; ultrathin lenses were 0.03 – 0.06mm. For plus lenses
thickness ranges from 0.25 – 0.7mm.
- The diameter range from 13.5 – 15.0mm, CL usually manufactured in 0.5mm
steps.
- The base curve is considered the central posterior curve which range from
7.5mm – 9.5mm in 0.2 – 0.3mm steps.
- The peripheral curve is usually from 0.5 – 0.9mm wide and has radius of
11.0 – 13.0mm.
The patient keratometer reading provides a starting point:

- A smaller eye requires a smaller diameter and shorter base curve radii.
- A larger eye requires a larger diameter and flatter base curve.
- A good fitting will center well on the cornea, with possibly a small lag of no
more than 1mm in downward direction. While a larger diameter will extend
about 1mm past the limbus and immediately follow the blink.
- Tight lens does not appear to have any movement on the cornea following
blinking or after eye movement in any direction.
The following tests are diagnosis of tight fit:

- Unstable vision: with the best subjective over correction vision is
slightly blurred
31
- Patient will note temporary clearing in vision immediately following

blinking
- Retinoscopy: the retinoscope reflex shows a dark, shadowy area in
the central portion of the papillary area, which disappear immediately
after blinking.
- Keratometry: performed with the CL in place, the mires appear
distorted but distortion may be reduced immediately following blinking.
- Blanching of peripheral vessels: during blinking it may be noted that
the lens movement also pulls the vessels and near by conjunctiva in
the same direction.
The following tests are diagnosis of loose fit:

- A loose lens has an excessively flat fit relative to the cornea. With the
eye in the straight – a head position, the lens will lag downward on the
eye from 2mm – 4mm.
- In extreme cases of loose lenses the lens will slide off the cornea.
- Unstable vision: with the best subjective over correction vision in
place and as long as the lens is centered reasonably well, vision is
good in the straight – ahead position. But immediately following
blinking vision will decrease one to three lines on the visual acuity
chart.
- Retinoscopy: the retinoscopic reflex shows a dark, shadowy area in
the inferior portion of the pupil, which get worse immediately after
blinking but then return to it original state.
- Keratometry: performed with the CL in place, the mires appear slightly
distorted but distortion increased immediately following blinking.
Characteristics of good fitting

There are general characteristics of good fitting for soft contact lens:
- Comfortable and well fitting in all directions of gaze
- Gives complete corneal coverage and appears properly centered
- Normal blinking results in up to 0.5mm of vertical movement when the
eye is in the primary position.
- The lens lags by no more than 1.00mm on upwards gaze or lateral
movements of the eye.
- Vision is good remaining stable on blinking.
- Refraction gives a precise end-point, correlating with the best visual
prescription of the spectacles.
- The retinoscopy reflex is crisp and sharp both before and after blinking.
- The slit-lamp shows no irritation of the limbal vessels or compression of
the conjunctiva.
- The keratometry of the front surface of the lens on the cornea shows
the mires to be stable and undistorted.
Characteristics of steep fitting

There are characteristics of steep fitting for soft contact lens:
- Little or no movement either on blinking or as the eye changes fixation.
32
- Tight fit is quite comfortable, sometimes more so than a correct fit,

because a complete immobile lens produces the minimum of lid
sensation.
- Usually good centration.
- The slit-lamp may show irritation of the conjunctiva or limbal vessels
and, with very light lenses an annular ring of conjunctica compression
may be seen this often visible when lens is removed.
- Vision unstable and poor because momentary pressure on the eye
during blinking occurred with steep fitting vault the corneal apex.
- Subjective refraction is difficult with no clearly defined end point, and
more negative power than predicted may be required because of a
positive liquid lens.
- Retinoscopy and keratometer mires both show irregular distortions,
these mires improve with blinking.
Characteristics of loose fitting
There are characteristics of loose fitting for soft contact lens:

- Easily to diagnose because of poor centration, greater lens mobility on
blinking and excessive lag on lateral eye movements.
- Very uncomfortable especially on looking upwards, lower lid sensation
experienced if the lens drops.
- Vision and over-refraction are variable, but nevertheless may still give
satisfactory results.
- The retinoscopy reflex may be clear centrally but with peripheral
distortion.
- The keratometry mires change according to the lens movement
Tolerance trials
Once the initial fitting characteristics has been confirmed as satisfactory the
next step of clinical routine is a long tolerance of about 2-4 hours using lenses
of correct power and fitting.
Patients can the wear lenses in their normal daily environment. This provides
a fairly reliable assessment of their potential success, and latent problems
such as dry eye or near vision difficult may be discovered.
When long trial is not practicable it is recommended to start with a minimum of
20 to minutes.
Correction
The following steps should be taken to correct a loose lens:
Either changing the base curve by decreasing it by 0.2 to 0.3 mm or
increasing the diameter of the lens by 0.5mm up to 1.5mm.
The following steps should be taken to correct a tight lens:

Either changing the base curve by increasing it by 0.2 to 0.3 mm or
decreasing the diameter of the lens by 0.5mm.
33
Lecture 8 (cont’d)
Inspection and verification of soft CL
Characteristics of SCLs are more difficult to check than those of hard lenses.
However, the practitioner should not give up trying to evaluate the fit of the
lenses.
Base curve
Measurements of base curve are difficult and cannot be done with the usual
radiuscope. A series of spherical templates ranging from 6.9 to 9.2mm in
diameter can be used.
The lens should be hydrated, and moved from one template to another until
perfect fitting is obtained.
A steep lens arches over the template and has air bubbles under it and in the
middle, while the peripheral of flat lens lift off the template.
Power
The power of the SCL can be measured with the lensometer.
After dehydrate the lens slightly, the fitter holds it or place it on a slide while
the reading is taken. The measurement should be taken rapidly so the lens
does not dry excessively.
Diameter
The lens diameter is determined by the use of measuring magnifier.
The examiner should hold the lens so that it is not supported by the fingers,
care should be taken no to apply any pressure on the lens.
Lecture 9 – Benefits and contra-indications of CONTACT LENSES
Lecture 9: CL advantages, disadvantages; indications and contra-

indications
Review of CL development
Soft contact lenses mass-production in the world started in 1960s when
Wichterle and Lim invented soft contact lens synthesis. History provides that
the first soft contact lens material was developed by Otto Wichterle, a
Czechoslovakia scientist, and was patented in 1963. HEMA was intended to
be used for a broad range of applications, including artificial blood vessels
and organs. Wichterle recognised its application for contact lenses and
developed a manufacturing method for making contact lenses out of this new
material. Wichterle ‘s technology was licensed to Bausch & Lomb, and in
1971 the first commercial version of a soft contact lens was approved for use
in the United States.
Nowadays, soft CLs are the most prescribed lenses, i.e. 88% of all CL
wearers.
34
CIBA Vision was the first CL manufacturer to introduce both tinted and bifocal
soft lenses to the world CL market.
A- Advantages of Soft CLs:
- Immediately comfortable due to minimal movement and less tearing

compared with rigid gas permeable lenses (RGP).
- Suitable for variable wearing times.
- Relatively inexpensive.
- Come in different colours.
- Cause minimal corneal distortion.
- Less foreign body sensation than with RGP lenses.
- Good for sporting activities, since they are rarely dislodged.
- Good as bandage or protective lenses.
B- Limitations of soft CLs:
- Have relatively short life span due to fragile (tearing) or rapid

accumulation of surface deposits.
- Lens care takes a significant amount of time. However, the recent
generation of CL solutions (multipurpose solutions) eliminates this
disadvantage.
- Difficulty to verify soft lens parameters.
- Most soft lenses have limited oxygen transmissibility that may result in
corneal hypoxia.
2- Soft lens modalities:
I- Daily wear lenses.

II- Extended wear lenses.
III- Disposable lenses.
IV- Tinted lenses.
I- Daily wear: wearing lenses during the day and remove them at
bedtime.
II- Extended wear: wearing of lenses without removal during eye
closure, for period ranging from occasional overnight wear up to 30
days or more of continuous wear. The principal advantage of EW is
that of convenience as patient does not have to insert and remove
lenses each day which is good for patients who difficulty in lens
handling such as old people and children.
III- Disposable lenses: Introduced in the mid-1980s, and the aim was
to eliminate lens deposits which play role in many contact lens
35
related complications. Most currently marketed disposable lenses

fall into 2 categories:
- Low water content (<50%) non-ionic lenses, e.g. SeeQuence
- High water content (>50%) ionic lenses, e.g. Acuvue and NewVue.
Advantages of Disposable lenses:

- Daily, weekly or monthly.
- No protein-remover tablets required.
- No cleaning or disinfecting solutions or lens storage case.
- Usually thinner hence enhancing oxygen permeability.
- Slightly tinted for easy handling.
IV- Tinted lenses:
1- Tint for an easy handling: of about 10% density without cosmetic affect
on the eye.
2- Enhancement tint: modify lightly colored iris.
3- Opaque tint: change the apparent iris color.
4- Custom painted lenses: for cosmetic purpose.
5- Occluded lenses: with opaque pupils (artificial pupils).
V- Therapeutic and Bandage Contact Lenses
Bandage contact lenses are used in common conditions such as:

1- Filamentary keratitis
2- Dry eye
3- Epithelial defect after penetrating keratoplasty or keratorefractive
surgery
4- Corneal perforations and descemetocele
5- Tamponade of postoperative wound leaks
6- Corneal melting associated with connective tissue disorders
7- Trauma (mechanical, chemical or radiation)
8- Eyelid abnormalities like trichiasis, entropion, and ectropion.
Therapeutic lenses can be used in cases of occlusion for amblyopia

treatment, and corneal ulceration. Amblyopia therapy with contact lens
has been reported to be successful (Eustis and Chamberlain, 1996).
Therapeutic lens enhances epithelialisation of the cornea, provides very
effective relief of pain, and it is good as temporary measure until definitive
treatment can be undertaken.
Therapeutic lenses help the corneal epithelium to heal in cases such as:
1- Persistent epithelial defect,
2- Recalcitrant recurrent corneal erosion syndrome
3- Painful corneal endothelial decompensation with epithelial edema.
36
Lecture 9 (cont’d): Indications and contra-indications for contact lens

wear
A. Advantages of contact lenses (indications)
Magnification: For an aphakic or high hyperopia - with glasses, magnification

can be as much as 33% with significant field of vision problems. With
contacts, the magnification is held to approximately 7%.
Distortions: With eyeglasses the scanning of different thickness and powers

produced by the differences in the principle meridians create distortions not
experienced with contact because contact lenses move with the eye.
Anisometropia: Image size differences are greatly reduced with contacts.
High myopia: With glasses objects in the field of view are minified, wearing
contacts gives “normal” view of Image size.
Irregular astigmatism: This is astigmatism that is not 90 degrees apart,

therefore not correctable with glasses. This can be due to disease, trauma, or
scaring. Rigid contact lenses provide a means to create a smooth undistorted
surface.
Keratoconus: This condition creates a very abnormal corneal surface and is

a challenge to provide good vision. The conical steepening of the cornea
creates unusual refractive errors, irregular astigmatism and recurrent corneal
abrasions due to the thinning of the cornea. The use of rigid contact plays a
big role in the management of keratoconus.
Cornea disease: Though not your normal candidate for contact lenses, when
used as a therapeutic bandage it can be used to deliver medications or as
protective barrier.
Aniridia/Ocular Albinism: Aniridia is the absence of an iris; therefore there is

no way to control the amount of light entering the eye creating poor vision and
photophobia. Ocular albinism is the absence of significant pigment in the iris
to help control unwanted light entering the eye. Both of these conditions can
be aided by the use of specially designed colored lenses.
Nystagmus: Involuntary, rapid eye movement vertical, lateral or rotating.

Contacts used in this situation can help in visual acuity and in some reports
patients have a decrease in movement.
B. Contra-indications to use of contact lenses
Sinus or allergy problems: Rhinitis, sinusitis, hay fever, asthma and other
nasal and ocular conditions cause an increase in sensitivity, injection and
mucus build-up. These conditions may not exclude the patient from wearing
37
contacts but should reduce or refrain from wearing contact on a full time
basis.
Diabetes: Due to the decrease healing process that diabetics experience,

corneal abrasion will be slow to heal and be more susceptible to more severe
infections, especially if the patient is not in good control of their diabetes
(brittle diabetic).
Endocrine changes: Pregnancy, menopause and other conditions affecting

body hormones and fluid levels can create corneal drying due to the fact the
cornea is 75% water. Therefore making contact lens wear difficult or
impossible.
Thyroid disease: Drying of the eye and also be due to the protrusion of the
eyeball making a difficult fitting situation in which case the contact lens is
easily ejected or dislodged.
Rheumatoid arthritis: On the outset this would look like a good situation for
contact lens use, with the reduction in hand dexterity. Often people with
rheumatoid arthritis have precorneal tear film problems.
Medications with ocular side effects: Being completely successful in

contact lens wear may be hindered by some medications that cause drying of
soft tissue, vision fluctuation, photosensitivity, decreased corneal sensitivity
(unaware of abrasions), ocular irritation and medications used to control
anxiety that may cause a decrease in light reaction and decrease in blink rate
causing corneal drying.
38

OPT 413 Contact Lenses 1 Lecture Notes Nov2017

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OPT 413: Contact Lenses Part 1: Prof. M. O.

OPT 413: Contact Lenses Part 1 – Harmattan Semester 2018

Course Director: Prof. M. O. Oriowo

 Anatomic & physiologic basis of Contact Lens fitting (Corneal

 History/Development of contact lenses (Lecture 2)

 Manufacturing Methods (Lecture 4)

 Ocular surface defense & disinfection (Lecture 5)

 Contact lens Optics (Lecture 6)

 Preliminary ocular examination of the anterior eye / Dimensions

 Contact Lens fitting procedures (Lecture 8)

 Contact Lens wear: Advantages, disadvantages; indications and

Corneal physiology and Contact lens properties

Figure 1:3 Provision of an adequate oxygen level for normal cornea

MEASUREMENT OF OXYGEN TRANSMISSION

Diffusion is the process by which molecules pass through a material, such as

Figure 1:4 Corneal oxygen supply in open eye situation.

Figure 1:5 Diffusion of oxygen through a contact lens

Permeability is a natural (an intrinsic) function of the molecular composition of

Permeability is the product of the diffusion coefficient (D) and the

Dk (barrers) = 10-11 (cm3) O2 (STP) x cm/sec x cm2 x mmHg. Note STP

A typical Dk value, expressed in its standard units:

Figure 1:6 Diffusion Coefficient

Solubility Coefficient : illustrate by drawing

The temperature of the testing conditions should always be stated because

The oxygen permeability coefficient (the Dk value) of a contact lens

The Dk value is the permeability coefficient of a material, that is how much

To calculate the Oxygen Transmissibility of a given contact lens, the “Dk”

Lens thickness is expressed in centimeters, so care must be taken to convert

It is important to remember that most published Dk/L values represent only -

It is significant that as lens thickness increases, transmissibility decreases.

Figure 1:7 Dk versus Water Content

%H2O Dk* Minimum thickness Maximum Dk/L

History of contact lenses (CL)

Figure 2.2. Optical idea of contact lens described by Descartes. A hollow

Figure 2.3. Corneal contact lens described by Fick.

Figure 2.4. Scleral contact lens

In 1964, Dr. Otto Wichterle in Czechoslovakia introduced soft hydrophilic

Lecture 3: CONTACT LENS MATERIALS

Contact lenses can be classified according to their material as hard or soft

Lecture 3A: HARD CONTACT LENSES

Polymethylmethacrylate (PMMA): is an organic plastic compound stable at

Silicone: This is a polymer of dimethyl-silicone, permeable to oxygen and

SOFT CONTACT LENSES

Hydroxyethylmethacrylate (HEMA) lenses: These are soft or hydrophilic

There are 3 types of water content materials in soft CLs.

- Medium water content materials

SOFT LENS MATERIALS (Cont’d)

Some disadvantages of HEMA:

Most soft CL materials used nowadays contain some form of HEMA.

Example of some of these materials:

 Methacrylate Acid (MA): This is an acid that increases water content

 N-Vinyl Pyrrolidone (NVP):

 Methyl Methacrylate (MMA):

 Ethyl Glycol Dimethacrylate:

a) 100% HEMA-based materials

b) HEMA lenses with co-polymers to increase water content

SOFT LENS GROUPINGS USED BY FDA

Group I: Low H20 non-ionic polymers e.g. 100% HEMA

Lecture 3B: TYPES OF SOFT CONTACT LENSES

Soft contact lenses can be divided into four categories: