Gas Permeable fitting techniques

1. Week 10 Gas Permeable fitting techniques

2. Gas perm fitting techniques Steps and rules for fitting gas perm lenses • Transpose Rx to minus cylinder. • Compensate for vertex distance, if needed. • Determine calculated residual astigmatism. • Determine flattest corneal meridian. • Determine base curve. • Compensate for tear film. ( FAP or SAM )

3. Gas perm fitting techniques transposition example • CL’s ONLY come in - cyl. • ALWAYS transpose from + cyl to - cyl or the power may be wrong in the end! • Algebraically add the +cyl to the spherical power. Change the + cyl to - cyl. Change axis by 90 degrees. • +3.00 +1.50 x90 = • +4.50 -1.50 x180 • -6.25 +2.00 x30= • -4.25- 2.00 x 120 • -0.50 +2.50 x180= • +2.00 -2.50 x90

4. Gas perm fitting techniques Compensate for vertex distance Examples ( Chart in text page 162) • Manifest refraction is usually done at 12 mm from the cornea. • CL’s are on the cornea, so the power will need to be compensated for this adjustment. • There are many conversion charts for this. • Only needs to be converted if the spherical power or spherical equivalent is +/- 4.00 D or more. • Acronym= CAP ( closer, add plus.) • - 12.25 D at 12 mm= • - 10.50 D • +6.75 D at 12 mm= • +7.50 D • +8.50 D at 12 mm= • +9.50 D

5. Gas perm fitting techniques Determine calculated residual astigmatism examples • A patient may have an Rx with 1.50 D cyl but their K readings may show 2.00 D of corneal cyl. A difference of .50D. • Most patients will tolerate 1 D or less of uncorrected residual astigmatism. • If there is more than 1 D, s steeper, larger optic zone diameter should be used or a toric gas perm lens should be fit. • 25% rule VS patient VA • K’s 39.75/41.75 x90 =2Dcyl • -3.00+3.00x90=3D cyl • = 1 D of CRA • K’s 45.75/42.00 x90 =3.75D • +6.00+5.00 x180 =5D • =1.75D of CRA • K’s44.00/44.75 x90 =.75D • -1.00+1.00 x 90 =1D • 0.25D of CRA

6. Gas perm fitting techniques Determine flattest corneal meridian examples • Most corneas have 2 principal meridians. (90 & 180) • Which is the flattest or smaller number of the two “K” readings on the right eye? • That is the “K” used as a starting point when you decide to fit either flatter than K, steeper than K, or on K. • 47.00/46.25 x 90 • Flattest K? ________ • 39.87/41.12 x90 • Flattest K?________ • 44.00/44.37 X180 • Flattest K?________ • This number is the starting point for your next step!

7. Gas perm fitting techniques Determining base curve examples • Not all gas perm lenses are fit on ”K”. • You need to look at fissure, amount of corneal astigmatism, and HVID. • Keep in mind, when you fit steeper (apical) or flatter (alignment) fits, you will have to compensate for the tear lens, FAP & SAM. • -3.00-2.00 x 90 • 47.00/45.00 x 90= 45.00 flattest • Apical fit =steeper than 45.00 . • Amount of corneal astigmatism =2.D • Look at fitting BC chart. • You will fit apical BC at 45.75. • If you fit alignment, BC will be 44.75. • Remember, once you determine from the fitting chart how much flatter/steeper to fit than flattest “K”,steeper get steeper (larger), flatter get flatter(smaller)

8. Gas perm fitting techniques Compensate for the tear film examples • When ordering a gas perm CL, there is only a spherical power. • The tear film that forms under the lens makes up for the cylinder not ground into the CL. • Fitting steeper creates a plus tear lens. • Fitting flatter creates a minus tear lens. • Whatever amount flatter or steeper you fit the lens, is the amount you need to add to the spherical power. • On “K” needs no compensation. • -3.50-2.00 x90, 44.00/42.25 x90 • Alignment fit (FAP) • Fitting chart says fit .25 flatter than “K”. • flattest “K” is 42.25 . • 42.00 is .25 D flatter than 42.25. • This will create a – 0.25 D tear lens. • We need to compensate for that by add +0.25 to our spherical power. • -3.50 plus +.25 =-3.25 D

9. Gas perm fitting techniques If you forget this step, The overall power of the lens will be wrong. Let’s see why ! 42.00/43.0 x90 -2.00-1.50 x180 Let’s fit alignment 42.00 is flattest “K” • BC fitting chart with corneal cyl=0.50D flatter than “K” • 42.00 & 0.50 D FTK= 41.50, this will create a minus tear layer. • Power is -2.00 if we add the – 0.50 created by the tear lens the final power will be the equivalent of -2.50, not the -2.00 we want. • This is why we do FAP. • -2.00, +0.50 (FAP)from the 0.50 D FTK= • -1.50 add the -0.50 tear lens and you get the intended power of -2.00D

10. Gas perm fitting techniques Optical zone diameter • Optical zone is based on total diameter. • On average, the peripheral curves, blends and finishing edges total about 1.2 mm of the CL diameter. • Remember, gas perm lenses are only 8-9 mm . I.2 mm of edging can interfere with the wearer’s VA if they have large pupils. • Patient interview can help tremendously . What type of job, what meds are they on, ect… • Why do we need to know this?

11. Gas perm fitting techniques Optic zone diameter If your patient has a smaller diameter lens and a large pupil, make sure you tell the manufacturer to make that edging smaller so it will not interfere with the patient’s VA. This can also be avoided by making the overall diameter larger if possible.

12. Gas perm fitting techniques • These 6 steps are the basic steps. There are many tricks and rules that make CL fitting such a specialized area that will take years to perfect. • Let’s tryout what we’ve learned today. Take your time, use the steps and the charts!

13. STUDY,STUDY,STUDY,test next week Test on gas perm material but you still need to know the overall basics. Email me with your questions! I’m here to help you succeed!