Contemporary orthokeratology.

Orthokeratology is the temporary reduction or elimination of myopia and astigmatism with rigid contact lenses having a tetra-curve reverse geometry back surface design are currently utilised for this purpose. The essential features of this construction are described. Those clinical characteristics which are favourable, and those which are unfavourable, for the technique of orthokeratology are listed. Reverse geometry lenses can either be fitted empirically or by the use of diagnostic lenses. Videokeratoscopy is of value in identifying corneal distortion induced by problems such as poor centration.

Assessment of ophthalmology residents' contact lens training.

PURPOSE: To characterize the nature and duration of contact lens training in ophthalmology residency training programs and to ascertain the comfort level of residents in fitting various types of contact lenses and in dealing with common contact lens-related complications. METHODS: Surveys were mailed to 126 ophthalmology residency program directors/coordinators and requested to be distributed to 1,381 ophthalmology residents. The questionnaire addressed issues related to contact lens training, hours of clinical and didactic training, comfort with fitting a variety of different types of contact lenses and dealing with common contact lens-related complications, and plans for incorporation of contact lens dispensing into future practice. RESULTS: Two hundred and forty-nine residents (18%) responded from 84 programs (67%). Most programs (87%) have some form of supervised contact lens training, frequently conducted by an optometrist (61% of programs), that consists of 20 hours or less of clinical experience and 20 hours or less of didactic training. A majority of the responding graduating residents (66%) feel comfortable fitting spherical soft contact lenses, while less than half of all residents feel comfortable fitting any other type of contact lens. In addition, most residents (65%) feel comfortable diagnosing and treating common contact lens-related complications. CONCLUSIONS: Most ophthalmology residency programs offer some form of supervised contact lens training which allows a majority of residents to feel comfortable fitting only spherical soft contact lenses, while also dealing comfortably with most contact lens-related problems. A comparison with previous data suggests increasing comfort with fitting most types of contact lenses over the last decade.

The effect of contact lens cleaners on lens parameters and surface quality of the Novalens.

The purpose of this study is to evaluate the effect of one abrasive cleaner, one non-abrasive cleaner and one non-abrasive alcohol-based cleaner on the lens parameter stability of the NOVALENS. Twenty-four lenses, all NOVALENS material of identical design, were cleaned 100 times each. Eight lenses were cleaned with MiraFlow (CIBA Vision), eight lenses with Optic-Free Daily Cleaner and eight lenses with the Gas Permeable Daily Cleaner (PBH). The base curve radius, center thickness and power were verified immediately before, immediately after and (per manufacturer's recommendation) 4 hours after cleaning at baseline, 25, 50, 75 and 100 cleanings. Lens toricity of approximately 0.50D was found with all three cleaners after 100 cleanings. No change in lens power or center thickness was found. It was concluded that extreme care must be taken in handling the NOVALENS due to the potential of induced warpage.

The effect of modification procedures on rigid gas permeable contact lenses: the UM-St. Louis Study.

The purpose of this study is to evaluate the effect of frequently performed modification procedures on quality of vision, surface wettability, optical quality and subjective response. One subject was optimally fitted with both silicone/acrylate (S/A) and fluoro-silicone/acrylate (F-S/A) lens materials of identical design. Two methods of surface polishing, edge polishing and repowering were used in addition to three different spindle speeds. Each pair of lenses was worn by the subject for a period of 4 hours and the subjective response was then compared to the baseline or premodification data. In addition, both low magnification photography and Scanning Electron Microscopy (S.E.M.) were performed on each lens. The results showed that the addition of 0.50D minus power reduced visual acuity, contrast sensitivity function and optical quality with one of the methods used. Front surface polish and edge polish procedures did not appear to affect short-term performance. Controlling polish, application and tool pressure on certain procedures resulted in similar findings. Further studies would be beneficial to evaluate the effect of longer wearing periods and the use of other modification procedures. The authors conclude that S/A and F-S/A lens materials can be successfully modified in-office with adherence to recommended guidelines.

Role of spherical aberration in contrast sensitivity loss with radial keratotomy.

A technique is described to determine the change in image contrast as a result of the spherical aberration induced by the radial keratotomy procedure. The hypothesis that the loss in contrast sensitivity of the RK eye is due to the change in spherical aberration postsurgically, is found to be acceptable for some patients. However, this is not a sufficient explanation in all cases. This conclusion may be due to assumptions inherent in the technique derived for calculating spherical aberration or to other factors of importance in the post-RK eye.

Irregular astigmatism after radial and astigmatic keratotomy.

Eleven eyes of six patients, who had been referred for management of irregular astigmatism after receiving crossed incisions for myopic astigmatism, had moderate to marked irregular corneal astigmatism with marked flattening in the meridians of intersecting incisions. All six patients had a decrease in best-corrected visual acuity with spectacles after surgery. Visual acuity with spectacles was 20/40 in five of 11 eyes; with contact lenses it reached 20/40 in ten of 11 eyes. However, two patients could not wear the contact lenses because of lens decentration caused by the marked distortion in corneal topography. Even with contact lenses, visual acuity could only be improved to 20/25 or better in six of 11 eyes.