OpenOptix NCLE Study Guide v0.2

OpenOptix
NCLE Study Guide

Ver. 0.2
This document is licensed under the Creative Commons Attribution 3.0 License. 6/15/2009
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About This Document
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OPENOPTIX PROJECTS
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NCLE STUDY GUIDE SPONSORS AND CONTRIBUTORS
Laramy-K Optical
800.525.1274
www.laramyk.com
Carrie Wilson, ABO-AC, NCLEC
Harry Chilinguerian ABO-AC, NCLE-AC

www.technicalopticians.org
Keith Benjamin
3
OPENOPTIX PROJECTS.....................................................................................3
NCLE STUDY GUIDE SPONSORS AND CONTRIBUTORS ...............................3
CHAPTER 1: ANATOMY AND PHYSIOLOGY ....................................................6

Outer Structures of the Eye......................................................................................................................... 6
Globe............................................................................................................................................................ 12
CHAPTER 2: OVERVIEW OF CONTACT LENS DEVELOPMENT ...................18
CHAPTER 3: BASIC CONTACT LENS TERMINOLOGY..................................19

Refractive Errors........................................................................................................................................ 19
Contact Lens Curves .................................................................................................................................. 21
Diameter ...................................................................................................................................................... 23
Center Thickness ........................................................................................................................................ 25
Lens Power.................................................................................................................................................. 25
Lens Edge Design........................................................................................................................................ 26
Basic Contact Lens Designs ....................................................................................................................... 28
Keratometry Readings ............................................................................................................................... 30
CHAPTER 4: PATIENT SELECTION.................................................................31
CHAPTER 5: THE SLIT LAMP (BIOMICROSCOPY) ........................................32
CHAPTER 6: KERATOMETRY..........................................................................33
CHAPTER 7: SOFT CONTACT LENS FITTING ................................................33
CHAPTER 8: EXTENDED WEAR CONTACT FITTING.....................................34
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CHAPTER 9: RIGID GAS PERM CONTACT FITTING ......................................35
CHAPTER 10: CONTACT LENS VERIFICATION AND IN-OFFICE

MODIFICATION..................................................................................................35
CHAPTER 11: CONTACT LENS DISPENSING AND CARE PROCEDURES ..35
CHAPTER 12: CONTACT LENS FOLLOW UP PROCEDURES (SOAP) .........36
DOCUMENT LICENSE.......................................................................................37
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Chapter 1: ANATOMY AND PHYSIOLOGY
Outer Structures of the Eye
When it comes to the anatomy of the eye, it is important to remember that there
is more to the visual system than the eyeball itself. There are special structures
that surround the eyeball and aid in its function. These structures are called the
Adnexa Oculi.
Lashes
An Important appendage to the eye, and one that is not thought of very often by
the contact lens fitter, is the lashes. This structure is the first line of defense in
eyeball protection. The lashes are special, modified cilia that are located on the
lid margin and are especially sensitive to touch. It is this sensitivity that enables
them to act as a warning when something approaches the eye and causes the lid
to close. Also, lashes are important in lubrication due to the surrounding
sebaceous glands.
The contact lens fitter must pay special attention to the lashes in order to detect
lash abnormalities. Common lash problems include:
• Blepharitis- an inflammation of the lid margins that presents itself in
dandruff like flakes, itching, swelling, and redness. Blephartis is a chronic
condition and is a contraindication for contacts.
• Trichiasis- inward turning of the eyelash. May be helped with a bandage
contact
Eyelids
The eyelids are the most visible of the outer structures of the eye. Called
palpebrae, these seemingly simple structures are actually very complex and
perform a wide range of functions. The palpebrae help control the amount of
light that enters the eye, distributes tears across the ocular surface, and they
provide protection.
The lids are a multilayered organ. The outermost layer is the skin. Next is the
muscle that is responsible for lid closure, the orbicularis oculi. The third layer is
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the densest layer of the eyelids. It consists of orbital septum, muscles and tarsal
plate. The orbital septum is tissue that separates the fat that is in the boney orbit
from the lid itself. The muscles include the levator palpebrae superioris (upper lid
raiser in English), the contractor muscle in the lower lid, and the muscle of Muller
that helps the lid maintain shape. The tarsal plate runs the length of the lid,
provides lid structure, and houses the meibominan gland. The fourth and last
layer is the palpebrae conjunctiva. This is a clear mucous membrane that covers
the entire inner layers of the lid and the upper portion of the sclera. A complex
structure, it will be covered in greater depth in a later section.
The opening between the lids is the palpebrae fissure and its average size is
10mm wide and 30mm long. Where the two lids meet is the canthi. The nasal
canthus is called the medial canthus or inner canthus. It surrounds a hill of skin
called the caruncle that contains sweat and sebaceous glands. The temporal
canthus is called the lateral or outer canthus. Along the lid margin, close to the
inner canthus, are openings called puncta. These puncta are openings that act
as a drain for tears leading from the eye.
It is very important for the contact lens fitter to examine the lids for any
abnormalities prior to fitting. Many lid abnormalities are a contraindication for
contacts due to the insufficient wetting, increased inflammation, as well as
increased secretions that these abnormalities may cause. Common lid problems
are:
• Ptosis- drooping of the upper lid
• Ectropion- outward turning of the lid
• Entropion- inward turning of the lid
• Lagophthalmos- incomplete closure
• Growths- benign or malignant formations on the surface of the lid
Conjunctiva
The conjunctiva is a thin, clear, highly innervated mucous membrane that runs
from the inner eyelid to the limbus. It is divided into two sections: palbebral which
covers the lids and bulbar which covers the globe. The transitional areas
between these two sections are called the fornices. Contained within the
conjunctiva are an abundant amount of blood vessels, leukocytes, goblet cells,
nerves and mast cells.
The conjunctiva is highly susceptible to inflammation due to its exposure to the

elements. Wind, dust, pollen, ultraviolet, and pollution can all cause conjunctival
inflammation. Symptoms of irritation include abnormal secretions, burning,
swelling, itching, and dilation of the conjunctival blood vessels (injection). When
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the inflammation is severe, it is called conjunctivitis or “pink eye”. Conjunctivitis
can have an allergic, bacterial, chemical, or viral source. To determine the
proper origin clinical examination and patient history are critical. Common
conjunctival disorders include:
• Giant Papillary Conjunctivitis (GPC) - most closely associated with
wearing soiled contact lenses, it is when large bumps called papillae are
seen on the palpebrae conjunctiva of the upper lid. It is important to invert
the upper lid to check for GPC
• Pinguecula – a raised yellowish discoloration of the nasal or temporal
sides of the bulbar conjunctiva that is benign and does not invade the
cornea
• Pterygium – wing-like thickening of the connective tissue and blood
vessels of the bulbar conjunctiva that does invade the cornea. Usually
develops from the inner canthus and spreads past the limbus to the
cornea
• Subconjunctival hemorrhage- broken blood vessels just below the surface
• Trachoma- a leading cause of blindness throughout the world, it is a viral
infection that causes scarring of the lids that eventually effects the cornea
Precorneal Tear Film
Tears are a complex system that provides many services to ensure the health of
the eye. By being a thin film over the cornea and conjunctiva, it provides a
smooth ocular surface. In fact, it is actually the first refractive element of the eye.
In addition, it flushes away debris from the globe through blinking and it supplies
nutrients and antibacterial agents to the eye to prevent eye infections.
A trilaminar structure, tears are composed of a lipid/oily layer, aqueous/water

layer, and mucin/mucoid layer. The lipid layer is the outermost layer and its
purpose is to prevent evaporation of the tear film and to keep tears from spilling
over onto the cheek. Secreted by the meibomian glands and the glands of Zeis, it
is the thinnest layer at 0.1 microns thick. The aqueous layer is the thickest layer
at 7 microns thick. It is produced by the lacrimal glands and the glands of
Wolfring and Krause. It provides hydration, oxygen and the antibacterial agents
to the eye. The innermost layer is the mucin layer is produced by the goblet cells
of the conjunctiva. It provides a hydrophilic surface for the aqueous layer to
adhere to and contributes to tear stability. The mucin layer is approximately .5
microns thick. The average pH of tears is 7.4.
In order for the tear film to function properly, it must move across the surface of
the globe properly. The first step in tear kinesis is tear secretion at the lid
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margins. The secreted tears collect at the lids in a tear pool or tear meniscus.
When the lids close in a blink, the tears spread up from the tear pool over the
surface of the globe where it stays until the next blink. When the eye closes
again, the old tear film is pushed back down the globe and into drainage holes
called the puncta. From the puncta it travels through the canaliculi into the
lacrimal sac where it would then go to the nasolacrimal duct and empty out the
nasal passage.
Disorders with the tear system are numerous and complex. The most common
are:
• Keratitis sicca or dry eye syndrome- corneal inflammation due to tear
deficiencies. Tear deficiency has many causes. To determine a tear
deficiency it is important to determine tear break up time (BUT). BUT is
usually 15 seconds, which is fine since the average blink rate is 5
seconds. One of the best methods to determine BUT is through the use of
fluorescein
• Dacryocystitis- inflammation of the lacrimal sac
• Dacryoadenitis- inflammation of the lacrimal gland
• Epiphoria- faulty drainage causing the tears to spill over lid margin onto
the cheek
Glands
Glands in the eyelids

• Meibomian glands- there is approximately 30 glands on the lid and they
open onto the lid margin and secrete the lipid layer of the tear film
• Glands of Zeis- a sebaceous gland that opens onto the lash follicles.
Located on the temporal part of the eyelid behind the meibomian glands, it
secretes the lipid layer also
• Glands of Moll- a sweat gland that opens onto the lash follicles. It is
located by the glands of Zeis
• Glands of Wolfring and Krause- an accessory gland that secretes the
aqueous layer of the tear film. It is on the inside surface of the lid near the
conjunctival fornix.
Goblet cells are glands located in the conjunctiva and they secrete the mucin
layer of the tear film.
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Muscles
Eyelid muscles
• Levator palpebrae superioris- elevates and retracts upper lid
• Orbicularis oculi muscle- closes the upper lid
• Muller’s muscle- short, smooth muscle that contracts when awake to keep
the lid open and relaxes when tired or asleep to let the eyelid droop
Extrinsic muscles- attached to the outer surface or the globe and control the
turning of the eye. There are 6 muscles of the eye: 4 recti and 2 oblique.
Recti muscles originate at the annulus of Zinn and attach at the sclera
• Medial rectus- the principal adductor
• Lateral rectus- responsible for abduction
• Superior rectus- elevates the eye and can provide intorsion
• Inferior rectus- depresses eye and can provide extorsion
Oblique muscles
• Superior oblique- originates at the annulus of Zinn, moves through a sling
made of cartilage, called the trochlea, which is suspended from the frontal
bone. The trochlea acts like a pulley for the muscle and allows it to
perform its intorsion motion of the eye
• Inferior oblique- the only muscle that does not originate at the back of the
orbit, it originates near the nasolacrimal duct and its main purpose is to
elevate the eye
Movement terms for one eye

• Adduction- movement of the eye toward the nose; medial movement
• Abduction-movement of the eye outward; lateral movement
• Elevation- movement of the eye upward
• Depression- movement of the eye downward
• Intorsion- rotation of the eye in the 12 o’clock position downward and
inward
• Extorsion- rotation of the eye in a 12 o’clock position downward and
outward
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Movement terms for both eyes
• Dextroversion- both eyes to the right
• Levoversion- both eyes to the left
• Supraverison- both eyes upward
• Infraversion- both eye downward
• Convergence- both eyes toward the nose
• Divergence- both eyes out toward the temples
Muscle Disorders
Binocular vision is when the brain fuses the two images received by the eye into
one. In order for this to happen, the eye must be held stable by the muscles.
This alignment is called orthophoria. When orthophoria occurs, the brain can
achieve stereopsis. Not only do the two eyes fuse the images into one, but they
also have depth. When the eye is not stable, then vision problems can ensue.
• Diplopia- double vision
• Suppression- when only one image from the retinas reach the brain
• Heterophoria- tendency of the eye to deviate
o Esphoria- inward deviation
o Exophoria- outward deviation
o Hyperphoria- upward deviation
o Hypophoria- downward deviation
• Heterotropia- definite turning of the eye
o Also called strabismus
o Same prefixes are the same as in the phorias
• Amblyopia- loss of vision, usually caused by strabismus
Bony Orbit
The bony orbit is a quadrangular shaped space that’s primary function is to

protect the globe of the eye and its surrounding tissues. A pyramid with the base
to the front, it is composed of seven bones that make up the roof, floor, medial
wall (nasal), and lateral wall (temporal). The average dimensions are horizontal
4cm, vertical 3.5 cm, and depth of 4.5cm. Contained within the orbit are the
globe, extrinsic muscles, orbital nerves, blood vessels, and connective tissues.
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Globe
The globe is what is commonly called the eyeball. It is composed of the outer,
middle, and inner tunic, as well as encapsulates the vitreous humor, crystalline
lens and aqueous humor.
Outer Tunic
The outer tunic, or outer layer, consists of the sclera and the cornea. The primary
purpose of the tunic is to protect the eye from infection and trauma, as well as
help the eye maintain its shape.
Sclera
The sclera is the white part of the eye. It is densely interwoven collagen fibers
that cover the back 5/6 of the globe. The fibers give the globe strength and
prevent light from scattering within the globe. The episclera is the outer layer of
the sclera that is loose collagen fibers that contain the blood vessels that can be
seen when viewing the eye.
Cornea
The cornea is the clear portion of the globe that allows light into the eye.
Composing the front 1/6 of the cornea, the radius of curvature when viewed from
the front is 7.7 mm and when viewed from the back is 6.8 mm. Some important
facts about the cornea are:
• Index of refraction = 1.376
• Most refractive lens in the eye
• Composes 70% of the total refraction of the eye
• Anterior refractive power is +48.8D, the posterior refractive power is -5.8D,
the total refractive power is 43.00D
• Diameter is horizontal 11.5mm and vertical 11.2mm
• Completely avascular
• Transparent through all layers
• Has 5 layers, from front to back: epithelium, Bowman’s Layer, stroma,
Descmet’s membrane, endothelium
The epithelium is the outer layer and is 10% of the cornea’s thickness. It is 5-6
cells thick and is regenerated about every two weeks. The first line of defense
against infection and injury, it regenerates quickly after injury by shifting cells
12
over any break in the surface. It is this regeneration that helps the epithelium to
maintain its transparency.
The Bowman’s layer is actually the outer, condensed portion of the stroma.
The middle layer that composes the 90% of the corneal thickness is the stroma.
It is made up of collagen layers called lamellae that make up right angles to each
other. By being arranged in a very regular pattern, the lamellae help the cornea
remain transparent by allowing light to enter the eye without being obstructed.
The Descmet’s membrane is secreted by the endothelium.
The endothelium is composed of one thin layer of hexagonal cells. Called the
endothelial mosaic, it removes excess moisture from the eye, maintaining clarity,
through deturgescence.
Limbus
The limbus is the transitional zone between the cornea and sclera. It is
approximately 1mm thick.
Common Corneal Ailments
• Neovascularization- new blood vessel growth

• Edema- swelling of the tissue
• Hypoxia- lack of oxygen to the cornea
• Corneal opacities- usually due to damage to one of the layers of the
cornea. The endothelium and Bowman’s layer doesn’t regenerate after
injury and the stroma will regenerate but the cells will not be uniform
resulting in opacities.
o Leukoma- dense opacities
o Macula- medium opacities
o Nebula- faint opacities
• Infiltrates- white blood cells in the corneal tissue
• Keratitis- inflammation of the cornea
o Keratitis sicca- inflammation caused by dryness
• Keratoconus- thinning of the central cornea resulting in a cone shaped
cornea
• Ulcer- corneal nick as a result of trauma, burns or infection
• Recurrent corneal erosion- reoccurring epithelial loss after corneal injury
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• Bullous keratopathy- blisters that are called bullae, are formed by the
breakdown of the endothelium, that rise to the epithelial surface where
they burst and cause intense pain
Middle Tunic
Also called the uveal tract, its main function is to provide nutrition to the globe. It
consists of the iris, ciliary body and choroid.
Iris
The iris, or the colored part of the eye, is an outgrowth of the ciliary body. It
contains two muscles. The dilator pupillae muscle which makes the opening of
the eye (pupil) larger and the sphincter pupillae muscle which constricts the pupil.
These muscles work together to control the amount of light that enters the eye.
The observation of the pupil is important when examining the eye for health. The
pupils should be equal, round and regular. Miosis, or pupil constriction, occurs
during sleep, when the eyes converge, during bright light situations, or when
using miotic drugs. Mydriasis, or pupil dilation, occurs in low light situations or
when the person is in a state of excitement.
Ciliary Body
The ciliary body consists of the ciliary muscle and the ciliary processes. The
ciliary muscle works with the crystalline lens during accommodation. The ciliary
processes secrete aqueous humor into the eye.
Choroid
The choroid is a highly pigmented layer that extends from the optic nerve to the
ciliary body. A very dark brown layer, it consists of numerous arteries and
vessels that supply the iris, ciliary body, sclera and choroid itself, with nutrients.
Only the choroid blood vessels that extend to the episclera and limbus are visible
when examining the eye. The color of the vessels can help determine where an
eye problem is occurring. If the vessels are red and appear more in the fornices
and less at the limbus, then the problem is with the lid and/or conjunctiva. If the
vessels appear purplish and with more redness at the limbus, then an inner eye
or cornea problem may be assumed.
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Common Ailments of the Middle Tunic
Symptoms for uveal tract disorders can include: problems with accommodation,
aching pain, irregular pupil shape, injection of vessels, and abnormal pupillary
responses. Upon slit lamp evaluation, the contact lens technician may observe
flare. Some common ailments are:
• Iridectomy- surgical removal of part of the iris

• Iridocyclitis- inflammation of the iris and ciliary body
• Iritis- inflammation of the iris
• Uveitis- inflammation of the uvea
• Aniridia- congenital absence of the iris
• Anisocoria- unequal pupil size
• Heterochromia- different colored irises
• Rubeosis- Neovascularization of the iris
The Inner Tunic
The inner tunic is the retina. An outgrowth of the optic nerve, the retina is what
the eyeball is designed around. It is composed of the outer pigmented layer and
the inner nerve layer. When light enters the eye, it focuses on the nerve layer
and strikes light sensitive nerves called photoreceptors. These photoreceptors
are divided into two classifications: rods and cones
Rods are in the peripheral areas of the retina and they detect objects under low
light situations. This is called scotopic vision. In addition, rods only give a
sensation of shades of grey and gives better peripheral vision than central vision.
Cones are in the central portion of the retina and work in bright light conditions,
resulting in photopic vision. Cones are responsible for color vision as well as
clear, crisp central vision.
Once the photoreceptor nerves are activated by the incoming light, the image
then travels up the optic nerve to the brain and result in sight.
Retinal Regions
The retina runs along the globe from the optic nerve to the ora serrata. The ora
serrata is the scalloped edged front part of the retina that meets the ciliary body.
15
The macula lutea, or macula, is the central portion of the retina. It is located at
the end of the visual axis of a normal eye and measures approximately 4.5mm in
diameter. At the center of the macula is the fovea centrallis, and this is where the
sharpest.
Located 3mm nasally from the macula is the optic disk. This is the point where
the optic nerve leaves the globe and travels to the brain. Due to the lack of
photoreceptors, this is the blind spot of the eye.
Between the ora serrata and the optic disk is the peripheral retina. This is the
area where the photoreceptors change from cones to rods.
The fundus is not actually a separate region of the retina. In fact, it is just the
area of the retina that can be viewed through the pupil utilizing a retinal camera,
ophthalmoscope, or slit lamp. This area should include the fovea, retinal blood
supply, macula, and optic disk.
Retinal Diseases
Most retinal diseases are painless, but may result in loss of visual acuity,
contrast, color vision, and visual fields.
• Macular degeneration- age related breakdown of the macula resulting in

loss of central vision
• Retinal detachment- retina separates from choroid resulting in the retina
dying from lack of nutrition
• Diabetic retinopathy- hemorrhages in the retina related to diabetes
• Retinitis pigmentosa- a hereditary condition that effects the rods that can
lead to partial to total blindness
Crystalline Lens
The crystalline lens is an important part of the eye and it enables an individual to
focus from near to distance and back again in a process called accommodation.
The lens itself
• Is biconvex
• Has an unaccomodative thickness 3.5-5mm
• Increases thickness .02mm per year due to new layers being added
• Has a Lens diameter of
o 6.5mm at infancy
16
o 9mm teenage and up
• And refractive power
o Average 20D power unaccommodated
o Maximum accommodation is between 8-12 years old
o O accommodation after 50 years of age (presbyopia)
• Is enclosed by a transparent, collagen membrane called the lens capsule
The lens is then attached to the ciliary body by thread like fibers called the
Zonules of Zinn. They are attached mostly at the ends of the lens, with a few
fibers in the center, and they aid in accommodation. Accommodation is a
complex, multi-step process that is stimulated by a blurred, near image on the
retina. Next,
• The ciliary muscles in the ciliary body contract
• The Zonules of Zinn relax
• The lens thickens anterior to posterior (bulge)
• The anterior surface moves forward causing anterior chamber to become
shallower
The crystalline lens has an accommodative power of +2.50D. This

accommodative power is lost when the crystalline lens becomes compact from
the layers being added to it and the resulting elasticity loss.
Cataracts
Cataracts are any opacity of the crystalline lens. They can be congenital, the
result of a birth defect, caused by age (senile), the result of excessive UV
exposure (sun), or caused by injury or disease. Cataracts are categorized by
how cloudy they are
• Incipient- early cataract with partial lens opacity with limited impact on
vision
• Immature- partially cloudy crystalline lens that has clear areas remaining
• Mature- fully cloudy, ready for surgery
• Hypermature- fully cloudy with fluid degeneration and swelling of lens
volume
Cataracts are treated by surgical removal. Aphakia is the name for being without
a crystalline lens, and +20.00D of power is lost. When an intraocular implant is
placed in the eye to replace the crystalline lens, the patient is then
pseudoaphakic.
17
Chambers of the Eye
Anterior Chamber
Anterior chamber contains aqueous humor and is located between the cornea
and iris. It contains the Canal of Schlemm and the trabacular network. These
structures act as an exit for the aqueous and allows for nutrient transport.
Posterior Chamber
The posterior chamber is located behind the iris and in front of the vitreous
chamber. It contains the zonule fibers and part of the ciliary processes. By
allowing the aqueous to flow around the crystalline lens, it provides nutrients and
oxygen to the lens.
Vitreous Chamber
The vitreous chamber is filled with vitreous and is the largest portion of the globe.
It is attached to the retina along the vitreous base around ora serrata, posterior
lens, optic disk, macula, and the retinal vessels by collagen fibers. Most or these
attachments weaken with age and the vitreous may become detached. Although
not an immediate threat to vision, it needs to be monitored in case it causes the
retina to detach.
The vitreous is composed of mostly water, salt and soluble proteins. Its main
functions are to provide nutrient transport, act as a shock absorber for the retina,
and to aid in the refraction of light.
Chapter 2: OVERVIEW OF CONTACT LENS DEVELOPMENT

1. Earliest contact lens theories and designs
2. Scleral contacts
3. First corneal contacts
4. Development of RGPs
5. Earliest soft contact lenses
6. Introduction of disposables
7. Silicone Hydrogels developed
8. Basic manufacturing procedures
18
Chapter 3: BASIC CONTACT LENS TERMINOLOGY
Refractive Errors
Emmetropia
Emmetropia is defined as the state in which the eye sees an object clearly at
infinity, without accommodation. This is a neutral state and is often referred to as
perfect vision, 20/20 vision, or normal vision. This state of vision is a result of the
eye’s focal power and the axial length of the eye being coincident so that objects
come to a focus on the retina.
Hyperopia
Hyperopia is the condition in which the eye focuses objects at infinity behind the
retina. This can be attributed to less power than the average eye and/or a
shorter axial length then the average eye. Hyperopia is commonly referred to as
far-sightedness. This condition results in excess accommodation to see distant
objects at infinity. If the degree of hyperopia is too great, images close up can be
blurred due to the lack of accommodation required to neutralize the error and
focus the eye on close objects. Other complaints and conditions that may arise
due to hyperopia are asthenopia (headaches or strain), accommodative and/or
binocular dysfunctions, amblyopia, and/or strabismus. Due to the eye’s ability to
create power through accommodation an individual with hyperopia can appear to
have 20/20 vision, when refracted. This patient is said to be a latent hyperope
and only through cycloplegia can the latent and manifest amounts of hyperopia
be fully realized and the total hyperopia be corrected.
Myopia
Myopia is a condition in which the eye focuses objects at infinity in front of the
retina. This condition can be attributed to more power than the average eye
and/or a longer axial length than the average eye. Myopia often presents itself
with poor distance vision often referred to as near-sightedness.
Astigmatism
Astigmatism can be defined as the eye having two foci perpendicular or 90
degrees apart from one another. This leads to a loss of fine detail for the viewer;
can cause objects to appear as though they are leaning or skewed; and/or cause
19
objects to appear elongated. Astigmatism can exist in combination with myopia
or hyperopia. There are two types of astigmatism regular and irregular
astigmatism.
Irregular astigmatism can be caused by irregularities of the cornea and/or

crystalline lens, like scars. The condition can be defined as a different refractive
error along the same meridian. Corneal astigmatism can be corrected with
contact lenses by allowing the tear film to neutralize the irregularities, where
irregularities in the crystalline lens cannot be corrected.
Regular astigmatism is caused by the toricity of the cornea or crystalline lens.

Regular astigmatism can be corrected with toric lenses and with contact lenses.
Regular astigmatism can be further classified as simple or compound. Simple

astigmatism is the condition in which one of the meridians is emmetropic or
contains no power while the other can be either myopic or hyperopic in power.
Compound astigmatism is where both meridians contain either hyperopic power
or myopic power. There is a special case of compound astigmatism where one
meridian is hyperopic and the other myopic and this is referred to as mixed
astigmatism.
Examples:
Plano -1.00 x 180 = Simple Myopic Astigmatism

+1.00 -1.00 x 180 = Simple Hyperopic Astigmatism (can be written Plano +1.00 x
090)
-1.00 -1.00 x 180 = Compound Myopic Astigmatism
+2.00 – 1.00 x 180 = Compound Hyperopic Astigmatism (can be written +1.00
+1.00 x 090)
+0.50 -1.00 x 180 = Mixed Astigmatism (can be written -0.50 +1.00 x 090)
Anisometropia
Anisometropia is the condition in which the powers between the two eyes differ to
a significant degree, most opticians agree to a difference in refractive error of
greater than 2.00 diopters. This can be either myopic or hyperopic with a special
case referred to as Antimetropia where one eye is myopic and the other
hyperopic. Anisometropia can lead to asthenopia (headaches or strain) or
amblyopia in younger patients. Contact lenses are the best solution to this
condition, because they allow the refractive error between both eyes to be
corrected as well as allow the difference in magnification between both eye’s to
be better managed. In the case of a young patient, where amblyopia is a
20
concern; the difference in image can be a cause for suppression of the image as
well as the blurriness.
Contact Lens Curves
Base Curves
Base curves in contact lenses refer to the back surface of the lens which
contacts the corneal surface. This is different than spectacle lens design where
the base curve is the front surface of the lens. The base curve is often chosen to
follow the contour of the cornea, which is why it is also referred to as the fitting
curve. The average cornea has eccentricity of 0.5 which means the cornea gets
flatter from the apex to the periphery so this change in curvature has to be
accommodated. The most common way to account for the flattening of the
cornea is with the use of tables called nomograms. Nomograms take the
measured K’s and the diameter of the lens and give a compensated value.
There are many nomograms and each contact lens manufacturer has
nomograms for their particular lens. Another method to determine compensated
value is purely mathematical. This method is how nomograms are created. With
the use of the most common values and a formula a nomogram can be created.
A simple formula for the sag of the cornea could be used, but it’s much more
accurate to use a formula that incorporates the eccentricity of the cornea.
Eccentricity is a value that refers to the change in curvature of the cornea. Most
corneas flatten from the apex to the periphery and the accepted average
eccentricity value for this degree of flattening is 0.5. If we were to use a the
saggital height of the cornea with an eccentricity of 0.5 we can then use that
same saggital height to figure out what spherical base curve corresponds to the
same height. This will provide us with a three point touch.
p = shape factor
e = eccentricity
K = power in diopters of the cornea (K readings)
r = radius in mm of the cornea
y = semi diameter in mm of the lens (diameter/2)
s = saggital height of the cornea
r1 = radius in mm of the base curve
D1 = power in diopters of the base curve
p = 1- e2
s = y2 / [r + √(r2 – p*y2)]
21
r1 = (s2 + y2) / 2*s
The base curve can either be used as the radius measure or converted to
diopters with the following formula:
D1 = 337.5 / r1
This formula can be used to create ones own nomograms. The relationship
above is to match the saggital height. If the fitter’s philosophy is flatter or steeper
then these computed figures should be compensated by the fitter’s philosophy
further.
Optical Zone
The optical zone of a contact lens, also known as the central posterior curve, is
the back surface of the lens which has the base curve ground into it and is used
for the fitting and power. This curve is usually smaller in diameter that the entire
contact lens. The remainder of the lens is used to create blending as well as
used for a tear reservoir. The optical zone diameter is very important in fitting
contact lenses as this is the portion of the lens that is used for viewing, too small
and the patient will view skewed rays from outside the optical zone and complain
of halo’s, too large and the lens diameter will increase risking lid interaction and
binding.
Intermediate Curves
Intermediate curves are the curves between the optical zone and the peripheral
curves of the lens. They are mainly used to increase comfort by gradually
blending the curves between the peripheral and the optical zone of the lens.
Lenses may contain as many as two intermediate curves and in rare cases more
as necessary. The curve immediately adjacent to the optical zone is known as
the secondary curve, and the curve following that is known as the tertiary curve.
If more curves are present the quandary curve would follow and so on.
Peripheral Curves
Peripheral curves are the outermost curve of the lens and used to both create a
tear reservoir to help facilitate the flushing effect blinking has on the tears under
the contact lens. Peripheral curves also allow the lens a sufficient angle to avoid
negatively interacting with the cornea/sclera transition (limbus). If this curve is fit
22
too steep, it can create a cutting effect on the limbus, cause binding, and/or not
provide sufficient tear fluid exchange (tear pump).
Blend Curves
Blended curves are not in and of themselves separate sections of the lens but
rather an attempt to blend the junctions of the optical zone and intermediate
curve, and/or the intermediate curve and the peripheral curves together more
seamlessly. Most RGP labs today apply blended curves to all lenses as they
provide better comfort. A second advantage of blended curves to the labs
processing is that it becomes difficult to verify the diameter of the various curves
due to blending which leads to less rejects due to off tolerance. Most labs allow
the fitter to specify the degree of blending in No Blend, Touch or Light Blend, or
Complete or Heavy Blend. No blend can be seen as the junction having a clear
and separate line of demarcation between the two curves. Touch or light blend
can be seen as a blending with a noticeable difference between the two curves.
Finally Complete or Heavy Blend will leave the two curves unidentifiable from
one another as they should blend together completely.
Anterior Curve
The anterior curve commonly referred to as the power curve, is the front surface
of the lens which is used to create the power of the contact lens. In most cases
the fitter will specify to the lab the base curve, power, material, diameter, optical
zone diameter and design. The lab determines the best thickness and anterior
curve to match the power specified by the fitter. The anterior curve is computed
to provide the correct back vertex power specified by the fitter. The anterior
curve is also at times lenticulated to reduce the lens lid interactions which can
lead to discomfort in lens wear as well as reduce the weight of the lenses.
Diameter
Optical Zone Diameter

The optical zone diameter, measured in mm, is chosen based on the base curve
of the lens, also referred to as the optical zone radius. The proper optical zone
diameter can be determined by using a diameter that is 0.83 mm shorter than the
optical zone radius. The average lens is anywhere from 7.0 to 9.0 mm in
diameter. The optical zone diameter should be 1.3 to 1.5 mm smaller than the
total lens diameter.
23
It is important to note that the relationship between the diameter and the radius of
the optical zone will affect both the fit and power. A rule of thumb exists for the
relationship where every 0.10 mm change in lens optical zone diameter must
have a change in radius of the optical zone by 0.01mm. This relationship exists
due to the change in saggital height. For example: when the diameter is
increased, the lens fits flatter, therefore the lens radius must be reduced which
leads to the lens becoming steeper leading to a balance. Some fitters suggest
that the optical zone diameter be equal in length to the radius of the optical zone.
Intermediate Curve Width

The width of the intermediate curve is typically 0.35 to 0.50 mm. This zone is
used more for blending and should align parallel with the cornea. Generally this
is done by using an intermediate curve that is 4 to 8 diopters flatter than the
average K’s of the optical zone. This can be split between 2 intermediate curves
with each being 4 diopters flatter than the previous for a total outside
intermediate curve of 8 diopters flatter than K’s.
Peripheral Curve Width

The peripheral curve width is defined as the outter most curve on the posterior
(back surface) of the contact lens. Once again this curve is crucial to create a
lens pump and should be flat enough to not cut into the sclera upon movement.
A good rule of thumb is to make this curve 3 to 4 diopters flatter than the outside
intermediate curve. The width should be anywhere from 0.3 to 0.4 mm in width.
Lens Diameter
The total lens diameter is equal to:
TLD = Total Lens Diameter

OZD = Optical Zone Diameter
ICW = Intermediate Curve Width
PCW = Peripheral Curve Width
TLD = OZD + 2 * ICW + 2 * PCW
Reminder: a good rule of thumb to determine the lens diameter is to add 1.3 to
1.5 mm to the optical zone diameter.
24
Center Thickness
The center thickness of a RGP contact lens is determined by the power,
diameter, and minimum thickness the material can be worked down to. It is
important to keep in mind that the minimum thickness a material can be worked
down to doesn’t necessarily mean the thickness one should order or even get. A
great advantage to RGP lenses is that they can be modified once fabricated to
allow for slight changes to improve comfort. However, if the lenses were worked
to their limits then no further modifications can be carried out. This leads to
higher spoilage, wasted time, and higher fees as an end result. If the center
thickness is specified the lab should comply within a tolerance of ±0.02 mm.
Lens Power
Lens power is not as straight forward in an RGP lens as it is in spectacles or
even soft lenses. First the spectacle power must be vertex compensated to the
corneal plane, then the fitter must also take into consideration the tear or
Lacrimal Lens created and subtracts this out from the total power of the lens, this
leaves the fitter with the contact lens power to be ordered. To vertex
compensate a spectacle prescription to the corneal plane first the fitter must
know the vertex measure the patient was refracted at as well as the spectacle
power, cylinder and axis. Using these parameters the following formula can be
used to compensate.
CLV = Contact Lens Vertex in mm

RVD = Refracted Vertex Distance in mm
D = Power in Diopters
Dc = Compensated Power in Diopters
Dc = D / [1 – (RVD – CLV)*D]
This must be done for both meridians of power and then converted back to
sphero-cylinder form. This is the total power that the lens must have on the
corneal plane. The total power is still comprised of the contact lens power and
the lacrimal lens power.
Total Power = Contact Lens Power + Lacrimal Lens Power
To determine the lacrimal lens power the base curve and the K readings are
necessary. The lacrimal lens an be described as a tear lens having a front
surface to match the base curve of the contact lens the fitter has chosen and a
back surface to match the corneal plane or K readings in our example. Since this
lens is comprised of tears the index of the lens would be the index of the tears or
25
1.3375 for our purposes this matches the average or Gullstrand index of the eye
1.33 so in essence neutralizes any corneal astigmatism. So in an example:
Power = -2.00 -1.50 x 180

K’s = 45.00@090 / 43.50@180
Fit on K
The lacrimal lens front surface would be equal to the flat K (43.50) the back
surface would be -45.00@090 and -43.50@180, using a thin lens formula:
Power = Front Surface Power + Back Surface Power
Lacrimal Lens Power = +43.50 + (-45.00@090 / -43.50@180)

Lacrimal Lens Power = -1.50@090 / Plano@180
Now in our contact lens power formula:
Total Power = Contact Lens Power + Lacrimal Lens Power

Contact Lens Power = Total Power – Lacrimal Lens Power
Total Power -2.00 -1.50 x 180

Lacrimal Lens Power Plano -1.50 x 180 –
--------------------
Contact Lens Power -2.00 Sph
This power is spherical due to point discussed earlier about the refractive index
of the tears and eye being so close the corneal astigmatism is neutralized.
Lens Edge Design
Anterior Edge
The anterior edge describes the front surface of the lens at the periphery. This
portion of the lens is often in higher powers lenticulated to create a more
comfortable lens/lid interaction. The anterior edge can be described as the
portion of the lens that starts to deviate from the anterior curve in anticipation to
blend with the posterior curve to form the edge apex.
26
Posterior Edge
The posterior edge describes the back surface of the lens at the periphery. The
posterior edge can be described as the portion of the lens that starts to deviate
from the peripheral curve in anticipation to blend with the anterior curve to form
the edge apex.
Edge Apex
The edge apex is the meeting of the anterior edge and the posterior edge. It is
recommended that the edge be as smooth as possible to avoid interactions with
the lids, limbus, or sclera.
Lenticular Curve
In higher powers it is difficult to impossible to create a lens with edge thickness of
0.08 to 0.12 mm in thickness which can be described as the optimal thickness.
To create this edge profile plus powers lenses will have a secondary carrier lens
cut onto the periphery of the lens flattening the anterior curve and minus lenses
will have a steeper curve cut into the anterior periphery. These secondary
curves on the anterior surface are called Lenticular curves.
Prism Ballast
In toric and bifocal RGP lenses often times base down prism is added the front
surface or anterior surface of the lens. The prism is know as prism ballast and is
used to stabilize the lens and prevent rotation in toric lenses. In bifocal lenses
this additional prism also helps the lens to translate better; this means that the
lens will move up on down gaze to allow the patient to see through the reading
portion of the bifocal lens. This is caused by the lower lid and lens interaction.
This interaction is often referred to as the “watermelon seen principle”. When
trying to hold a watermelon seed between two fingers the thick center in
combination with the thin edges causes the seed to slip through the fingers, with
contact lenses the thin upper portion of the lens slides under the upper lids and
creates this same effect on the thicker lower portion of the lens.
Peri-Ballast
Peri-ballast also short for peripheral ballast is the thinning of the lower and upper
portions of the lens. With the “watermelon seed principle” in mind, this allows the
lens to rotate so that the thicker portions in the center horizontal regions of the
27
lens orient themselves properly. Peri-ballast lenses are also referred to as
dynamically stabilized lenses, and dual slab off designs.
Truncation
A truncated lens is a contact lens that has a section of the lens, often times the
bottom of the lens removed. Truncation is used to help stabilize the lens and can
be applied to both the top and bottom portions of the lens although the most
common is to the bottom.
Basic Contact Lens Designs
Spherical
Spherical lens designs are called for when there is no astigmatism and/or when
the degree of astigmatism is corneal. A spherical RGP design will have both a
spherical anterior curve as well as a spherical optical zone curve. The spherical
design allows the lacrimal lens to neutralize any astigmatism. The spherical
design is also advantageous in the fact that rotation has no effect on the optics.
An example:
Power = -2.00 -1.50 x 180

K’s = 45.00@090 / 43.50@180
Corneal cylinder = +1.50 on the 090 (same as the refractive power)
The K’s show that the astigmatism is corneal which means that a spherical lens
would neutralize the astigmatism leaving only a spherical error for the anterior
curve to further neutralize.
Front Surface Toric

Front toric designs are indicated when very little of the refracted cylinder is due to
the cornea. Front surface torics have toric surfaces on the anterior surface of the
lens and a spherical surface for the back surface optical zone. A front surface
toric will need a form of stabilization such as prism ballasting to allow the lens to
align properly. A good rule of thumb is if the amount of cylinder is 0.75D more
than the corneal astigmatism of K readings, then a front surface toric is indicated.
Also, if the axis of the cylinder is off from the K readings, usually by more than 15
degrees, a front surface toric may be indicated. The best method for fitting front
surface torics is to use trial lenses with an over refraction, however the proper
28
powers can be determined through mathematical calculations as well. An
example:
Power = -2.00 -1.50 x 180

K’s = 45.00@090 / 44.50@180
Fit on K (44.50)
Corneal cylinder = +0.50 at 090
This would still leave +1.00 diopters on the 090 to neutralize with the contact
lens, so in this case a front surface toric will accomplish this.
Back Surface Toric

A back surface toric lens is rarely used since the effects of the toricity on the
back surface are increased optically. This change in cylinder power is the result
of the change in index from lens to tears being less than the change in index of
air to lens as in the case of the front surface toric. The relationship that best fits
the back surface toric model is one where the refractive cylinder is roughly 1/3
higher than the corneal cylinder or K’s. An example:
Power = -2.00 -6.00 x 180

K’s = 45.00@090 / 41.00@180
Corneal cylinder = +4.00 on the 090
The corneal cylinder is 1/3 less than the refractive cylinder. So, in this case the
cylinder would be neutralized by the back surface toric and the higher degree of
cylinder would benefit from the stabilization of a toric back surface.
Bitoric
Bitoric lens designs are indicated in cases where the corneal cylinder is high. A
bitoric lens will allow the fitter to use a toric on the back surface of the lens to
stabilize the lens and use a toric on the front surface to reduce the residual
astigmatism. Since these bitoric lenses provide stabilization and correct for
residual astigmatism their use is much more common. An example:
Power = -2.00 -6.00 x 180

K’s = 45.00@090 / 40.00@180
Corneal cylinder = +5.00 on the 090
29
Since a back surface toric would be 1/3 stronger optically if a lens with a back
toric surface were used of 39.75 / 43.75 then:
Lacrimal Lens = +39.75@180 / +43.75@090 + (-40.00@180 / -45.00@090)

Lacrimal Lens = -0.25@180 / -1.25@090
Lacrimal Lens = -0.25 -1.00 x 180
Total Power -2.00 -6.00 x 180

Lacrimal Lens Power -0.25 -1.00 x 180 -
--------------------
Contact Lens Power -1.75 -5.00 x 180
This remaining power would need to be incorporated onto the front surface of the
contact lens.
Keratometry Readings
Keratometry often referred to as just K’s are the dioptric measurements of the
corneal surface. This is done with an ophthalmometer which goes by a trade
name Keratometer which has become synonymous with ophthalmometers like
Kleenex has become synonymous with tissues. The operation of the
keratometer takes a little practice but once accomplished is fairly easy and
straight forward.
Operational steps:
1. Focus Eyepiece – like other ophthalmic equipment the eyepiece must be

focused to reduce the effects of accommodation and get accurate
readings. This is done by placing the occluder down over the front of the
keratometer and focusing the eyepiece from most counter clockwise to the
clockwise position until the internal crosshairs are focused.
2. Position Patient – The patient should be seated comfortably with their
forehead against the upper rest and their chin in the chin rest. This
position must be maintained throughout the following procedures.
3. Position Keratometer – the keratometer must be positioned both
horizontally and vertically so that the patient is properly aligned to view an
internal target, this is done by swinging the keratometer off to one side
and aligning the silver posts on the side with the patients pupil, then
swinging the keratometer back and the fitter aligning the light with the
pupil from a viewing position above the keratometer. The other eye
should be occluded at this point.
30
4. Focus and Position Internal Mires – at this point the patient should be
viewing the inside of the keratometer focused on a blinking light inside or
target. With the patient in place, the keratometer should be adjusted until
the cross hairs are inside of the lower right hand circular mires. Once this
is done, the mires should be focused by adjusting the keratometer along
the visual axis with the knob located along the track which holds the
keratometer body. Once the mires are in focus, the machine should be
locked in place with the locking knob located on the base of the
keratometer.
5. Measure Axis and Power – with the cross hairs centered and the mires
focused, the only thing left to do is measure axis and power. The
keratometer body should be rotated until the crosses (+) on the left hand
circular mire and the center mire are aligned, then the horizontal power
drum should be adjusted until the mires are superimposed. Upon aligning
the horizontal axis the vertical axis should also be aligned so that the (-)
signs below the top circular mire and the center circular mire can be
superimposed use the vertical power drum to superimpose.
6. Record reading – both the power and axis should be noted for both
vertical and horizontal measures. It is common to write down the
measures: first horizontal then vertical or even flat and then steep
meridian. Their really in no right or wrong way but the format is often
written as:
K’s = 45.00@180 / 47.00@090

45.00@015 / 47.00@105
Of course the proper format requires right over left eye.
Chapter 4: PATIENT SELECTION

1. Optical considerations to pick contacts over glasses
a. Keratoconus
b. Irregular astigmatism
c. Fields of vision
d. Magnification/minification
e. Anisometropia
f. Aberrations
2. Ocular Health Needed to Wear Contacts
a. Lids
b. Tear film
c. Conjunctiva
31
d. Cornea
3. Contraindications for Contact Lens Wear
a. Systemic Diseases
b. Medications
4. Initial Evaluations
a. Occupations
b. Hobbies/sports
c. Patient motivation
d. Ability to follow recommendations for care
Chapter 5: THE SLIT LAMP (BIOMICROSCOPY)

1. Design
2. What it is used for
a. Eye health
b. Contact lens fitting
c. Detecting contact lens defects
3. Slit lamp illumination types and when to use them
a. Direct
b. Diffuse
c. Indirect
d. Retro
e. Sclerotic scatter
4. Filters and their purpose
a. Blue colbalt
b. Wratten #12 yellow
c. Green
5. Fluorescein Patterns
a. Ideal
b. Steep
c. Flat
d. With the rule
e. Against the rule
6. Staining
a. Stippling
b. Punctuate
c. Arcuate
d. Abrasion
e. Foreign body
f. Dimple veil
g. 3-9 o’clock
32
Chapter 6: KERATOMETRY
1. History and Design
2. How it is used for
a. Measuring convex surfaces
b. Measuring concave surfaces
3. How to use
a. Focusing the eyepiece
b. Extending the range
c. Attaching the topogometer
4. Measuring the central cornea
5. Measuring the peripheral cornea
6. Interpreting the K readings
7. Common errors
8. New topographical mapping software
Chapter 7: SOFT CONTACT LENS FITTING

1. Candidates
a. Children
b. Athletes
c. RGP failures
d. Occasional wearers
2. Contraindications
a. Environment
b. GPC
c. Irregular astigmatism
d. Conjunctival irregularities
3. Wearjng Schedules
a. What is the patient looking for
b. What is feasible
c. The different types
4. Materials
a. Group I ~ low water, non-ionic
b. Group II ~ high water, non-ionic
c. Group III ~ low water, ionic
d. Group IV ~ high water, ionic
33
e. Oxygen permeability
5. Parameters
a. Base curve
b. Diameter
c. Power
d. Tints
e. Thickness
f. Edge design
6. Fit Evaluation
a. Corneal coverage
b. Movement
c. 3 point touch
d. Visual acuity
e. Comfort
7. Lens ordering and verification
8. Delivery Procedures
9. Follow up visits
10. Problem solving
Chapter 8: EXTENDED WEAR CONTACT FITTING

1. Definition of extended wear
a. Benefits
b. Most common risks
2. Candidates
a. Previous wearing history
b. Occupations
c. Contact sports
d. Medical history
3. Fitting procedures
a. Much the same as soft or rigid contact fitting
b. Special attention to slit lamp
c. Watch for corneal swelling
4. Materials
a. High Dk
b. Deposit resistant
c. Water content
d. Silicone hydrogels
e. RGP - Fluoro-silicone acrylates
5. Lens Delivery and Care procedures
6. Common Complications
34
a. Edema
b. Solution reaction
c. Corneal changes
d. GPC
e. Blurry vision
7. Follow up appointments
Chapter 9: RIGID GAS PERM CONTACT FITTING

1. Patient selection
2. Spectacle RX conversion
3. K readings
4. Apical Clearance
5. Corneal Alignment
6. SAM/FAP
7. Over-refraction
a. Diagnostic lenses
b. Residual astigmatism
Chapter 10: CONTACT LENS VERIFICATION AND IN-OFFICE

MODIFICATION
Chapter 11: CONTACT LENS DISPENSING AND CARE

PROCEDURES
1. Soft contact
a. Insertion
b. Removal
c. Cleaning
d. Wearing schedule
e. Adaptation
f. Emergencies and complications
2. RGP
a. Insertion
b. Removal
c. Cleaning
d. Wearing schedule
35
e. Adaptation
f. Emergencies and complications
3. Cleaning Solutions
4. Wetting Solutions
5. Salines
6. Rewetting Drops
7. Disinfection Systems
8. Preservatives and Disinfectants
9. Written Instructions
Chapter 12: CONTACT LENS FOLLOW UP PROCEDURES

(SOAP)
1. Subjective Examination
2. Objective Examination
3. Assessment
4. Plan
36
DOCUMENT LICENSE
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NCLE Study Guide

The OpenOptix NCLE Study Guide is a product of the OpenOptix initiative.

• Improve optical care worldwide by providing free and open access to

For more information about OpenOptix visit www.laramyk.com,

OpenOptix ABO Study Guide

OpenOptix NCLE Study Guide

OpenOptix Finishing Lab Manual

Free Lens Availability Database and PAL Identifier

NCLE STUDY GUIDE SPONSORS AND CONTRIBUTORS

Carrie Wilson, ABO-AC, NCLEC

Harry Chilinguerian ABO-AC, NCLE-AC

NCLE STUDY GUIDE SPONSORS AND CONTRIBUTORS ...............................3

CHAPTER 1: ANATOMY AND PHYSIOLOGY ....................................................6

CHAPTER 2: OVERVIEW OF CONTACT LENS DEVELOPMENT ...................18

CHAPTER 3: BASIC CONTACT LENS TERMINOLOGY..................................19

Contact Lens Curves .................................................................................................................................. 21

Center Thickness ........................................................................................................................................ 25

Lens Edge Design........................................................................................................................................ 26

Basic Contact Lens Designs ....................................................................................................................... 28

Keratometry Readings ............................................................................................................................... 30

CHAPTER 4: PATIENT SELECTION.................................................................31

CHAPTER 5: THE SLIT LAMP (BIOMICROSCOPY) ........................................32

CHAPTER 7: SOFT CONTACT LENS FITTING ................................................33

CHAPTER 8: EXTENDED WEAR CONTACT FITTING.....................................34

CHAPTER 10: CONTACT LENS VERIFICATION AND IN-OFFICE

CHAPTER 11: CONTACT LENS DISPENSING AND CARE PROCEDURES ..35

CHAPTER 12: CONTACT LENS FOLLOW UP PROCEDURES (SOAP) .........36

Outer Structures of the Eye

The conjunctiva is highly susceptible to inflammation due to its exposure to the

Precorneal Tear Film

A trilaminar structure, tears are composed of a lipid/oily layer, aqueous/water

Glands in the eyelids

Movement terms for one eye

The bony orbit is a quadrangular shaped space that’s primary function is to

The Descmet’s membrane is secreted by the endothelium.

Common Corneal Ailments

• Neovascularization- new blood vessel growth

• Iridectomy- surgical removal of part of the iris

The Inner Tunic

• Macular degeneration- age related breakdown of the macula resulting in

The crystalline lens has an accommodative power of +2.50D. This

Chapter 2: OVERVIEW OF CONTACT LENS DEVELOPMENT

Irregular astigmatism can be caused by irregularities of the cornea and/or

Regular astigmatism is caused by the toricity of the cornea or crystalline lens.

Regular astigmatism can be further classified as simple or compound. Simple

Plano -1.00 x 180 = Simple Myopic Astigmatism

Contact Lens Curves

Optical Zone Diameter

Intermediate Curve Width

Peripheral Curve Width

TLD = Total Lens Diameter

TLD = OZD + 2 * ICW + 2 * PCW

CLV = Contact Lens Vertex in mm

Total Power = Contact Lens Power + Lacrimal Lens Power

Power = -2.00 -1.50 x 180

Power = Front Surface Power + Back Surface Power

Lacrimal Lens Power = +43.50 + (-45.00@090 / -43.50@180)

Now in our contact lens power formula:

Total Power = Contact Lens Power + Lacrimal Lens Power