1. Basic Principle of Soft Contact Lens Fitting
Miss Sarah Iqbal D.Optom, D.Orthop Orthoptist Pediatric ophthalmology & Allied Units AL-SHIFA TRUST EYE HOSPITAL RAWALPINDI

2. Introduction
Contact lenses were thought of as early as 1508 when Leonardo da Vinci sketched and described several forms of them.
Contact lenses are a changing area of optometry with new lenses being constantly developed
There are different types of contact lenses
RGP lenses
Soft lenses
Disposable or non-disposable
Coloured or clear
Spherical or toric
Extended wear
Multifocal

3. Soft lenses
Soft contact lenses are essentially flexible lenses that mold to the corneal topography.
Most commonly used (90%)
Made from hydrogel plastic material containing water
Are 1-2mm larger than cornea
Soft lenses are very comfortable, easy to adapt to.

4. Soft contact lens

5. Achieving Primary Goal of Contact Lens Fitting
Visual acuity
Lens comfort
Maintenance of normal ocular physiology
Considerable skills and judgment of contact lens practitioner
Collaboration between
Lens wearer
Lens manufacturer
Contact lens practitioner

6. Contact Lens Fitting Protocol
History of patient
Patient screening
Preliminary examination
Trial lens fitting
Lens dispensing
Aftercare

7. Patient Screening Factors considered for patient selection
Anatomical and physiological
Psychological
Pathological
Personal and occupational needs
Refractive

8. History of Patient General health Ocular health Medication
Ocular history
Occupational, recreational, and environmental

9. Preliminary Examination
Slit lamp examination of anterior segment
Measurement of ocular dimension
Assessment of tears
Spectacle plane refraction

10. Slit lamp Examination

11. Slit lamp examination of anterior segment
Eyelids
Conjunctiva
Tears
Cornea
Anterior chamber
Iris and lens

12. Measurement of ocular dimension
Keratometry (central and peripheral)
Corneal measurements
Pupil size measurements
Lid characteristics
Palpebral aperture
Lid tension
Blink rate
Partial
Complete
Twitched

13. Keratometry

14. Assessment of tears Invasive Non invasive Breakup time Schimer test
Phenol red thread test
Rose Bengal staining
Non invasive
Non invasive breakup time
Tear prism height
Lipid layer evaluation

15. Spectacle plane refraction
Baseline refraction
Objective
Subjective
Vertex distance
Accommodation
Convergence

16. Trial Lens Fitting Soft contact lens fitting philosophy
Fitting Methods
Trial Lens Fitting Requirements
Lens Selection
Fitting procedure
Desired soft contact lens fit
Final lens order

17. Soft Contact Lens Fitting Philosophy
Soft contact lens should always be larger than cornea
BOZR of lens is flatter than cornea
Lens movement

18. Trial Lens Fitting Empirical fitting method Diagnostic fitting method
Inventory fitting method

19. Trial Lens Fitting Requirements
Trail set
Contact lens solution
Slit lamp
Documentation

20. Lens Selection Back optic zone radius (BOZR) Total diameter (TD)
Central thickness (tc)
Water content
Lens design
Lens type
Lens Material
Back vertex power

21. Fitting procedure
Initial lens selection
Trail lens fitting and vision assessment
Subsequent trail lens selection

22. Desired soft contact lens fit
Corneal coverage
Lens centration
Lens movement with blink
Lens lag on up gaze
Lens movement with push up test
Patient comfort response
Patient visual response

23. Final lens order Specification Lens parameter Lens material and type
Special requirement
Delivery date

24. Lens Dispensing Informed consent Lens handling
Lens insertion and removal
Lens care regimen
Lens wearing schedule
Lens replacement schedule
Follow up visit schedule

25. Follow Up VA CC SC Biomicroscopy Keratometry Other test as necessary
Review lens care and wear schedule
Schedule next visit

26. Prevention Cleanliness is essential of hands and Contact-lens cases.
Maintain lens hygiene
In general, lens care involves rinsing of the lenses upon removal, cleaning the lenses, and storing them in a disinfecting solution
Once a week they should be washed with hot water and allowed to air dry afterward

27. Thank you

28. Name: Sarah Iqbal
BSc Punjab University, Pakistan
Dipolma in Optometry Pakistan Institute of Ophthalmology
Al-ShifaTrust Eye Hospital Rawalpindi Pakistan
Diploma in Orthoptic Pakistan institute of ophthalmology AL-Shifa
Trust Eye Hospital Rawalpindi, Pakistan
FIACLE - Fellowship 2007
DLP (Complete) IACLE
Faculty Member Pakistan Institute of Ophthalmology
Al-Shifa Trust Eye Hospital Rawalpindi Pakistan (2002 to date)
Membership: International Orthoptic Association Germany
Pakistan optometrist Association
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