The
Role of Contact Lenses in the Care of
Corneal
Surgery Patients
University
of Missouri-St. Louis
School
of Optometry
Michael
D. DePaolis, OD, FAAO
Objectives of this lecture:
1. To understand lens design and fitting for post-PK
2. To understand and apply lens designs in the contact lens management of the post-refractive surgery patient
Undoubtedly, irregular astigmatism remains
one of the greatest challenges for todays contact lens clinician. Usually the
result of disease, trauma, or contact lens wear, irregular astigmatism is
becoming increasingly prevalent by virtue of the number of therapeutic and
refractive corneal surgical procedures performed today. In this course we
address the role of contact lenses in managing patients having undergone
penetrating keratoplasty (PK), radial keratotomy (RK), excimer laser
photorefractive keratectomy (PRK), and laser assisted intrastromal
keratomileusis (LASIK). As there are few "rules" for managing these
patients, the contact lens clinician must be competent, creative, and
conservative.
1.
Patient History
a.
Preoperative Diagnosis
b.
Has Patient Worn
Contact Lenses Before?
1.
Status of the
Transplant
a.
Epithelial
Integrity/Stromal Clarity/Endothelial Viability
b.
Pre-existing
Neovascularization
1.
Altered Corneal
Topography
a.
Proud Vs Plateau Graft
Profile
b.
Irregular Astigmatism
1.
Wearing Time Will
LASIK Give Us An Alternative?
2.
Soft Lenses With or
Without an Overcorrection?
3.
RGP Lenses The Design
of Choice?
4.
Hybrid Lenses
SoftPerm Vs Epicon/Ultracon?
5.
Combination (Piggyback)
Lenses When & Why?
1.
Material Selection
2.
Fitting Philosophy
a.
Soft Lenses Are
Torics Advisable?
b.
RGP Lenses
1.
Distribution of Lens
Mass
2.
Standard Multicurve Vs
Bicurve Vs Reverse Geometry Designs
a.
Hybrid Lenses Should
We Strive for Edge Lift?
b.
Combination Lenses
Assuring Adequate Movement
1.
Persistent Edema
2.
Progressive
Neovascularization
3.
Lens Adherence
4.
Infiltrative Keratitis
5.
Allograft Rejection
1.
Patient History
a.
Previous Contact Lens
Failure?
1.
Postoperative Corneal
Status
a.
Epithelial Integrity
Wettability & Incision Stability
b.
Incision
Neovascularization
1.
Altered Corneal
Topography
a.
Irregular Astigmatism
b.
Plateau with Apical
Decentration
c.
Diurnal Fluctuation
1.
Wearing Time Can
Additional Surgery Lessen Rx Dependence
2.
Soft Lenses No Longer
a Contraindication?
3.
RGP Lenses The Design
of Choice?
4.
Hybrid Lenses Are
SoftPerm or Ultracon Justified?
5.
Combination (Piggyback)
Lenses Are They Even Indicated?
1.
Material Selection
2.
Fitting Philosophy
a.
Soft Lenses Are
Torics Advisable?
b.
RGP Lenses
1.
Distribution of Lens
Mass
2.
Standard Multicurve Vs
Customized Design
a.
Hybrid Lenses
Assuring Adequate Mvmt
1.
Progressive Corneal
neovascularization
2.
Infiltrative Keratitis
3.
Refractive Instability
1.
Patient History
a.
Prior Contact Lens
Failure?
1.
Postoperative Corneal
Status
a.
Ocular Surface Drying
b.
Epithelial Thickness
1.
Altered Corneal
Topography
a.
Plateau of Optic Zone
b.
Decentration of Optic
Zone Not As Significant as RK
1.
Wearing Time Can
Additional Surgery Lessen Rx Dependence?
2.
Soft Lenses The
Design of Choice for Residual Rx?
3.
RGP Lenses the Design
of Choice for Irregular Astigmatism?
4.
Hybrid Lenses Soft
Perm Vs Ultracon Do They Play a Role?
1.
Material Selection
2.
Fitting Philosophy
a.
Soft Lenses
1.
Adequate BC Alignment
a.
RGP Lenses
1.
Distribution of Lens
Mass
2.
Standard Multicurve
a.
Hybrid Design
1.
Assuring Adequate Mvmt
1.
Epithelial Edema
2.
Infiltrative Keratitis
3.
Late Presenting Haze
4.
Refractive Error Shifts
1.
Patient History
a.
Prior Contact Lens
Failure?
1.
Postoperative Corneal
Status
a.
Ocular Surface Drying
b.
Flap Integrity
1.
Altered Corneal
Topography
a.
Plateau of
Flap/Ablation Zone
b.
Decentration of
Flap/Ablation Zone
1.
Wearing Time Can
Additional Surgery Lessen Rx Dependence?
2.
Soft Lenses The
Design of Choice for Residual Rx?
3.
RGP Lenses The Design
of Choice for Irregular Astigmatism?
4.
Hybrid Lenses
SoftPerm Vs Ultracon Do They Play a Role?
1.
Material Selection
2.
Fitting Philosophy
a.
Soft Lenses
1.
Is BC Flat Enough?
a.
RGP Lenses
1.
Distribution of Lens
Mass
2.
Standard Multicurve
a.
Hybrid Design
1.
Assuring Adequate Mvmt
1.
Epithelial Edema
2.
Flap Apposition
3.
Deep Neovascularization
4.
Refractive Error Shift