RGP TORIC LENS DESIGN
Forms
1. FST
2. PCT
3. BST
4. Bitoric
Indications for fitting toric CL
1. Improve vision in cases where spherical lenses cannot do the job
2. Improve physical fit in cases where spherical lenses fail to provide adequate physical fit
Problems that can occur when fitting spherical lenses on toric corneas:
1. Poor vision
2. Poor centration
3. Rocking on flat meridian (harsh bearing)
4. Unstable fitting
5. Lens flexure
6. Corneal distortion
7. 3 and 9 oclock staining
8. Poor blinking due to poor comfort
9. Spectacle blur due to corneal distortion
What happens when astigmatic cornea is fitted with a spherical BC lens?
FS of tear lens is spherical
Toric interface between tear lens and cornea has its optical effectiveness significantly
reduced
90% of astigmatism that exists in cornea will be neutralized
Astigmatism we measure usually is due to toricity of FS of tears interfacing with air
Toric lens advantages (over spherical
hard and soft lenses)
1. Stabilized fitting
2. Improved lens to cornea fitting
relationship
3. Better corneal physiology than sot
lenses
Toric lens disadvantages
1. Relatively thick lenses
2. Less control over edge profile
3. Possible misalignment of corneal and
spectacle Rx cylinder axis
- To compensate for this problem,
lens with FS cylinder oblique to BC
cylinder needed
4. Expensive
5. Difficult to make and replicate
Calculations:
Power
n' n
F=
r
Vertex distance
F2 =
Indices
F1
1d F 1
F1 = Spectacle plane
Nominal n of keratometer = 1.3375
Tears = 1.336
Cornea = 1.376
Air = 1
FITTING FST
Indications to
fit FST
Measurement
Rotation
stability
Prism
DDV
ballast
How to fit FST
Diameters
Lens rotation
1. Spherical cornea but spectacle Rx has cylinder
- Why fit FST over toric SCL?
- Physiology of cornea needs lots of oxygen
- Trying to eradicate GPC
2. Spherical hard lens fits well but over-refraction reveals 0.75 1.00DC
Best way to measure RA: put a spherical hard lens on eye and measure
RA
Reasons why calculated and measured RA might not be the same:
1. Inaccurate keratometry measurement
2. Inaccurate refraction
3. Significant misalignment of axes of refractive and coneal cylinders
BD prism 1-1.75pd (increased thickness and allow for rotation)
Truncation (removes some of the prism effect)
Double truncation (maintain rotational stability
1. Increased lens mass
2. Lower riding lens
3. Limited movement
4. Poor tear exchange
5. Oedema
6. Discomfort
7. Dissication
Disadvantages to using prism ballast to prevent rotation of a contact
lens
1. Fit spherical BC lens to get idea of fit
2. Order prism ballast trial lens with correct BC that has spherical power
3. Ask lab to mark base of prism/axis of lens with dot
Used to get indication of rotation of lens on eye
Need measurement to compensate for axis swing when
ordering
4. Do over-refraction through this lens to get cyl power and axis
5. Order lens allowing for lens rotation on eye so that axis of lens and axis
of refractive cyl coincide
6. Lens needs to fit adequately on eye
Check movement, centration, on alignment
Use smaller diameter lenses for:
Use larger diameter lenses for:
1. Wide PA
1. Normal lid margin location
2. Steeper corneas
2. Flatter and larger corneas
3. Minus powers
3. Plus powers
4. When lens centres well
4. Strong lid force
Different forces applied to CL on eye (by lids, tears, etc.) usually result
in base of lens rotating towards nose
Must allow for rotation when ordering lens
Maximum of 10-15 allowable
Beware: rotation of base/apex of meridian vs lens decentration
Ensure that meridian you think you are measuring is correct, as
different directions of gaze might alter amount of rotation
How to measure rotation:
Slit lamp with scale
Trial frame with low power lens and line drawn onto lens
Diagram
FITTING PCT
Theory
Uses
Optimal
performance
Main
advantage
Shape
Diagram
Slide 2
In some px, peripheral corneal toricity may be greater than expected
Spherical lens may provide adequate central and mid-peripheral fit, but
peripheral corneal toricity may cause excessive edge clearance in
steeper meridian
Optics of system remains spherical
Low to moderate corneal toricity
Corneas with greater peripheral toricity relative to central cornea
Improving:
1. Lens centration
2. Lens stability
3. Lens movement
4. Tear exchange
Secondary and other curves should be sufficiently wide enough to
enhance lens to cornea fitting relationship
More likely to rotate than full BS toric lens > steeper meridian will
impinge on flatter meridian
Can cause localized corneal damage and discomfort
More likely to occur if insufficient toricity is generated on lens or if
attempt is made to fit cornea that has too little peripheral toricity
Simplest solution to fitting problem toric cornea
Helps to improve fit of lens by using toric periphery, but keeps things
simple optically
Oval shape to optic zone
Slide 1
FITTING BST
Indication
Neutralization
of
astigmatism
Astigmatic
cornea fitted
with spherical
BC:
CA
Rule of thumb
Decision must be made on patient to patient basis
BC considered when spherical lens in unable to provide satisfactory
physical and/or physiological fit
Refractive indices of cornea (1.376) and tears (1.335) are not vastly
different
Effectiveness of interface between them (as an optical system) is
reduced
Cornea/tears interface is optically insignificant
FS of tear lens will be spherical
Toric interface between tear lens and cornea > optical effectiveness
reduced
- 90% of astigmatism on ccornea neutralized
- Astigmatism measured = toricity of FS of tears interfacing with air
- Fitting toric cornea with spherical BC > compensates astigmatism
- Toric
BC
not
used
for
optical
reasons
but
rather
physical/physiological fitting reasons
Needs to be considered in 2.5 3.00D of corneal astigmatism
At least 2D of corneal toricity needed for BC to function reliably
Approximately90% of corneal astigmatism is neutralized by spherical
BC rgid lens
Calculation:
Assume K readings of 8mm by 7.6mm
RI cornea = 1.376 RI tears = 1.336
Corneal powers in air:
'
F=
n n
r
BS of tears r = FS of cornea r
D 1=
1.3761
=47 D
0.005
D 2=
1.3761
=49.47 D
0.0076
Astigmatism=D2D1=2.47 D
Corneal powers under tears:
D 1=
1.3761.336
=5.00 D
0.005
D 2=
1.3761.336
=5.26 D
0.0076
Astigmatism=5.26 D5.00=0.26 D
Ratio:
astigmatismsitu 0.26 D
=
=10.64
astigmatismair 2.47 D
BITORIC LENSES
Required when BS toric/spherical FS lens results in unacceptable amounts of residual
astigmatism
Use: physical fit associated with toric FS to compensate for any residual astigmatism