NCLE Contact Lens Exam 2 Questions
with Complete Solutions58
Selection of Toric lens depends on: - ANSWERS-1) ocular health and exam findings
2) agreement with patient on which best fits their needs
frequency of replacement depends on tendency for coatings, wearing schedule, etc
Other things to keep in mind for toric follow ups and ordering - ANSWERS-Order trial lens and
perform f/u before ordering multipacks
-Power should be close enough to be functional and allow adaption
-VAs with trials can be 20/15 to 20/25 if exact power is not available
Demonstrate OR to patient and add it to the CL trial order
Do not have to trial every single adjustment made
-Follow-ups are meant for making tweaks to the lens parameters, if needed
-NEVER finalize and order on the dispense visit
Fit may be different esp. if CLs have never been worn before
Types of torics - ANSWERS-
Which type of SCL torics are particularily expensive? - ANSWERS-SiHy Daily Disposables (DD)
Which type of toric lens has a lower dK, and are better for occasional or short-term wear -
ANSWERS-non-SiHy (hydrogel) daily disposables
,What is a unique feature of SiHy BiWeekly Torics - ANSWERS-UV blocker
What are Extended Range (XR) series? - ANSWERS-high degrees of sphere and/or cyl
more axis choices (1 degree or 5 degree steps)
more expensive
What does it mean that a soft toric CL is lathe cut? - ANSWERS-cutting the secondary/peripheral
curve/power with tools on every individual lens, which requires a wait when ordered
more parameters
more expensive
single lens or quarterly
For toric lenses, ____________________ is the type of ONLY SiHy lateable lens material -
ANSWERS-definitive
DW - ANSWERS-remove nightly to clean and disinfect, reapply the next day
EW
how long it it worn? - ANSWERS-worn one week at a time
FW
how long it it worn? - ANSWERS-occasional overnight wear
CW
how long it it worn? - ANSWERS-worn for 30 consecutive days (remove once a month)
,A CW lens _________ (cannot/can) be worn on a DW wearing schedule - ANSWERS-can
Most doctors advise against habitually sleeping in torics due to ____________ ________,
UNLESS: - ANSWERS-lens thickness
SiHy and approved for overnight
Greatest risk for microbial keratitis is in _____ use - ANSWERS-EW
Patient management of toric SCLs
What are symptoms and recommendations for someone with allergies? - ANSWERS-
Patient management for toric SCLs
What are the symptoms and recommendations for someone with intense near work? -
ANSWERS--more problematic with torics b/c they are larger and tend to do under the lid
-lid interaction affects lens position
What are the important things we need to do in a toric CL dispense/follow up? - ANSWERS-1)
Obtain history
2) check acuity
3) check compliance
4) note any mislocation
5) determine any other problems
How does mislocation change over time? Why is this so detrimental to CL - ANSWERS-
Mislocation may occur at dispense but less movement occurs over time with adaption
, -Potentially causes decreased VA (use 20/40-20/15 chart)
-Always verify mislocation in both eyes first in primary gaze
-If good VA with spherical OR, STOP here (Spherocylindrical OR only if indicated)
What should you consider in the follow up appointment when you perform the tear film and lid
evaluation? - ANSWERS--artificial tears
-allergy meds
-PF solutions
-more frequent replacement
Case #1:Acuity decreased from last visit and Rx has -2.25 cyl. You see 0 mislocation now. You
saw 10° R last week. Trial lens axis is 160. Spectacle axis is 170.What axis do you try next? What
other test could you do to see what axis is needed? - ANSWERS-try axis 170. if necessary, check
axis with SCOR when acuity is reduced
What does a Spherocylindrical ORx (SCOR) indicate when doing a contact lens follow up? -
ANSWERS-It indicates the cyl axis was off
SCOR + toric lens sphere and axis gives a _______________ __________ ______________ effect
- ANSWERS-oblique cross cyl effect
What are the steps of the spherocylindrical ORx (SCOR)??? - ANSWERS-Basically the JCC portion
of the manifest refraction
1. Do spherical OR first
2. Next fish for cyl using .50D cylin parallel positionin all major meridians (45, 90, 135, 180)
3. If accepted, go back and refine axis in straddle position then recheck cyl power
4. See if acuity improves
with Complete Solutions58
Selection of Toric lens depends on: - ANSWERS-1) ocular health and exam findings
2) agreement with patient on which best fits their needs
frequency of replacement depends on tendency for coatings, wearing schedule, etc
Other things to keep in mind for toric follow ups and ordering - ANSWERS-Order trial lens and
perform f/u before ordering multipacks
-Power should be close enough to be functional and allow adaption
-VAs with trials can be 20/15 to 20/25 if exact power is not available
Demonstrate OR to patient and add it to the CL trial order
Do not have to trial every single adjustment made
-Follow-ups are meant for making tweaks to the lens parameters, if needed
-NEVER finalize and order on the dispense visit
Fit may be different esp. if CLs have never been worn before
Types of torics - ANSWERS-
Which type of SCL torics are particularily expensive? - ANSWERS-SiHy Daily Disposables (DD)
Which type of toric lens has a lower dK, and are better for occasional or short-term wear -
ANSWERS-non-SiHy (hydrogel) daily disposables
,What is a unique feature of SiHy BiWeekly Torics - ANSWERS-UV blocker
What are Extended Range (XR) series? - ANSWERS-high degrees of sphere and/or cyl
more axis choices (1 degree or 5 degree steps)
more expensive
What does it mean that a soft toric CL is lathe cut? - ANSWERS-cutting the secondary/peripheral
curve/power with tools on every individual lens, which requires a wait when ordered
more parameters
more expensive
single lens or quarterly
For toric lenses, ____________________ is the type of ONLY SiHy lateable lens material -
ANSWERS-definitive
DW - ANSWERS-remove nightly to clean and disinfect, reapply the next day
EW
how long it it worn? - ANSWERS-worn one week at a time
FW
how long it it worn? - ANSWERS-occasional overnight wear
CW
how long it it worn? - ANSWERS-worn for 30 consecutive days (remove once a month)
,A CW lens _________ (cannot/can) be worn on a DW wearing schedule - ANSWERS-can
Most doctors advise against habitually sleeping in torics due to ____________ ________,
UNLESS: - ANSWERS-lens thickness
SiHy and approved for overnight
Greatest risk for microbial keratitis is in _____ use - ANSWERS-EW
Patient management of toric SCLs
What are symptoms and recommendations for someone with allergies? - ANSWERS-
Patient management for toric SCLs
What are the symptoms and recommendations for someone with intense near work? -
ANSWERS--more problematic with torics b/c they are larger and tend to do under the lid
-lid interaction affects lens position
What are the important things we need to do in a toric CL dispense/follow up? - ANSWERS-1)
Obtain history
2) check acuity
3) check compliance
4) note any mislocation
5) determine any other problems
How does mislocation change over time? Why is this so detrimental to CL - ANSWERS-
Mislocation may occur at dispense but less movement occurs over time with adaption
, -Potentially causes decreased VA (use 20/40-20/15 chart)
-Always verify mislocation in both eyes first in primary gaze
-If good VA with spherical OR, STOP here (Spherocylindrical OR only if indicated)
What should you consider in the follow up appointment when you perform the tear film and lid
evaluation? - ANSWERS--artificial tears
-allergy meds
-PF solutions
-more frequent replacement
Case #1:Acuity decreased from last visit and Rx has -2.25 cyl. You see 0 mislocation now. You
saw 10° R last week. Trial lens axis is 160. Spectacle axis is 170.What axis do you try next? What
other test could you do to see what axis is needed? - ANSWERS-try axis 170. if necessary, check
axis with SCOR when acuity is reduced
What does a Spherocylindrical ORx (SCOR) indicate when doing a contact lens follow up? -
ANSWERS-It indicates the cyl axis was off
SCOR + toric lens sphere and axis gives a _______________ __________ ______________ effect
- ANSWERS-oblique cross cyl effect
What are the steps of the spherocylindrical ORx (SCOR)??? - ANSWERS-Basically the JCC portion
of the manifest refraction
1. Do spherical OR first
2. Next fish for cyl using .50D cylin parallel positionin all major meridians (45, 90, 135, 180)
3. If accepted, go back and refine axis in straddle position then recheck cyl power
4. See if acuity improves
