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Contact Lens Notes
Contact Lens Notes
Cleaning Products
MPS vs H2O2: equally effective methods. In one-step peroxide systems (built-in catalyst), ineffective
against acanthamoeba cysts compared to two-step systems (catalyst added in manually after
disinfecting in H2O2)
MPS usually take 6hours+ (preferably overnight) for disinfection to become effective.
Lens Deposits:
- Occurs within minutes of wear. Most effective way of removing build-up is rub and
rinse + proper hygiene.
- Hydrogel:
o Main protein deposited on lens = denatured lysozyme (easily deposits on
HWC ionic CL) –
proteins are detrimental to ocular health as there could be
inflammatory reactions
o HWC nonionic hydrogels can attract lipids
- SiH:
o Attract more lipid deposits than hydrogel. Lipid deposits may not be
detrimental to comfort can represent a healthy tear film
- RGP:
o Silicone increases protein deposition
o Fluorine increases lipid deposition
- Calculi localized elevations on anterior of lens. Composed of calcium, lipids,
mucoproteins. Due to lens overwear past replacement schedule causing wetting
agents to focally degrade of lens surface. More frequent in HWC (hydrogel).
JnJ OxySept
------------------
Causes of ghosting: decentred lens, pupil not covered by optic zone, rotated lens,
Silicon hydrogel:
- Generally higher modulus > hydrogel. Consider hydrogel for CLPC and SEALs.
- Silicone is hydrophobic, so requires addition of wetting agents for comfort
UV protection:
Class 1: >90% of UVA and >99% of UVB
Class 2: >50% of UVA and >95% of UVB
PureVision vs PureVision 2: PV2 has greater Dk/T > PV. However, PV has fitting range of either 8.3 or
8.6mm BC, while PV2 only has 8.6mm.
Daily
Comes in MF
MyDay Toric +6 0 (0.50 steps) 8.6 14.5 0.4 SiH 85% UVA 80 $64 30pk
0 -10 (0.50 after -6) Stenfilcon A 95% UVB
-0.75, -1.25, -1.75, -2.25 in axis
20, 10, 180, 170, 160 and
70, 80, 90, 100, 110 (ATR/WTR
ONLY)
Clariti +8.00 to -10.00 (0.50D steps after 8.6 14.1 0.5 SiH 50% UVA 86 $42 30pk
±6.00D)
Somofilcon A 95% UVB
Clariti Toric +4.00D to -9.00D (0.5 steps after -6) 8.6 14.3 0.5 SiH 50% UVA 57 $48 30pk
Somofilcon A 95% UVB
-0.75, -1.25, -1.75, -2.25 in axis 10
steps
Proclear 1 day SPH: -0.25 to -6.00DS with 8.7 14.2 0.4 Hydrogel NO 25 $53 30pk
0.25 steps
Omafilcon A
Acuvue Trueye + 6 -12 (0.50 steps after -6) 8.5/9 14.2 0.66 SiH Class 1 118
(older SiH than (Narafilcon A)
Oasys)
Acuvue Moist + 6 -12 (0.50 steps after -6) 8.5/9 14.2 0.3 Ionic Hydrogel 88% UVA 33 $44 30pk
(Etafilcon A) 95%UVB
$98 90pk
Comes in MF
Acuvue Moist +4 -9 (0.50 steps after -6) 8.5 14.5 0.3 Ionic Hydrogel 82% UVA 24 $58 30pk
Astigmatism (Etafilcon A) 97% UVB
-0.75, -1.25, -1.75, -2.25 in axis $128 90pk
20, 10, 180, 170, 160 and
Comes in MF 70, 80, 90, 100, 110 (ATR/WTR
ONLY)
Alcon Dailies Total 1 +0.50 +8.00 (0.50 after 6.50) 8.5 14.1 0.7 SiH NO 156 $70 30PK
-0.50 -15.00 (0.50 after 6.50) (Delefilcon A) $180 90PK
Comes in MF
Precision +0.50 +8.00 (0.50 after 6.50) 8.3 14.2 0.6 SiH Class 1 100 $61 30PK
-0.50 -12 (0.50 after 6.50) (Verofilcon A) $158 90PK
Dailies +0.50 +8.00 (0.50 after 6.50) 8.7 14 0.5 Non-Ionic No 26 $54 30PK
Aquacomfort -0.50 -15.00 (0.50 after 6.50) Hydrogel $126 90PK
Nelfilcon A
Dailies +4 -8 (0.50 steps after -6.50) 8.8 14.4 0.5 Non-Ionic No 26 $66 30PK
Aquacomfort Hydrogel $160 90PK
Toric -0.75, -1.25, -1.75, -2.25 in axis Nelfilcon A
20, 10, 180, 170, 160 and
70, 80, 90, 100, 110 (ATR/WTR
ONLY)
Focus Dailies +0.50 +6.00 8.6 13.8 0.9 Hydrogel - 26 -
-0.50 -15.00 (0.50 after 6.50) Nelfilcon A
Bausch BioTrue +6 -12 (0.50 after 6.50) 8.6 14.2 0.5 Nonionic Class 2 42 $52 30pk
and Hydrogel $125 90pk
Lomb Nesofilcon A
Comes in MF
Biotrue Astig +4 -9 (0.50 after 6) 8.4 14.2 0.5 Nonionic Class 2 42 $66 30pk
Hydrogel
-0.75, -1.25, -1.75 at axis 10 steps Nesofilcon A
-2.25 in axis
20, 10, 180, 170, 160 and
70, 80, 90, 100, 110 (ATR/WTR
ONLY)
Soflens +6.50 -9 (0.5 after 6.50) Nonionic 20 $65 30pk
Hydrogel
Hilafilcon B
Fortnightly
RE Range BC Dia Modulus Material UV block Dk/t Cost
(mm) (mm) (MPa)
Cooper- CAir +8.00D to -12.00D (0.50D steps after 8.4 14.2 0.6 SiH Class 1 110 $43 6pk
±6.00D)
Vision Fanfilcon A
Improved >
Avaira on water
content and UV
CAir Toric +4.50 -10 (0.50 steps after 6) 8.5 14.5 0.6 SiH Class 1 110 $60 6pk
Fanfilcon A
-0.75, -1.25, -1.75, -2.25 in axis 10
steps
Avaira Vitality +0.25 +8 (0.50 after 6) 8.4(+) 14.2 0.5 SiH Class 2 125 $43 6pk
-0.25 -12 (0.50 after 6)
8.5(-) Enfilcon A
Avaira Toric +6 -10 (0.50 after 6.50) 8.5 14.2 0.5 SiH Class 2 91 $60 6pk
Enfilcon A
-0.75, -1.25, -1.75, -2.25 in axis 10
steps
JnJ Acuvue Oasys +0.50 +8.00 (0.50 after 6) 8.4/ 14 0.7 SiH Class 1 147 $48 6pk
(up to 6 -0.50 -12.00 (0.50 after 6) 8.8 (Senofilcon A) $150 24pk
nights EW)
Acuvue Oasys +6 -9 (0.50 steps after -6) 8.5 14.3 0.7 SiH Class 1 121 $71 6pk
Astigmatism (Senofilcon A)
(up to 6 -0.75, -1.25, -1.75, -2.25, -2.75 in axis
nights EW) 10 steps
Acuvue Oasys +0.25 +8 (0.50 after 6) 8.4/ 14 0.7 SiH Class 1 121 $79 6pk
Transition -0.25 -12 (0.50 after 6) 8.8 (Senofilcon A)
Monthly
Monthlies can be worn EW up to 6 continuous nights, unless indicated otherwise.
Biofinity XR +8.50 +15 (0.50 steps) 8.6 14 0.75 SiH No 160 $200/6m
-12.50 -20 (0.50 steps)
Comfilcon A
Biofinity Toric +8 -10 8.7 14.5 0.75 SiH No 160 $120/6m
Comfilcon A
-0.75, -1.25, -1.75, -2.25 in axis 10
steps
Biofinity Toric +10 -10 (0.50 after 6) 8.7 14.5 0.75 SiH No 160 $205/6m
XR -0.75 -5.75 in axis 5 steps Comfilcon A
Biofinity +8 -12 8.6 14 0.75 SiH No 160
Energy Comfilcon A
For those
with accom.
fatigue/early
presby
Proclear +8.00D to -12.00D (0.50D steps after 8.6 14.2 0.4 Hydrogel No 27 $74/6m
±6.00D)
Omafilcon A
Proclear Toric +4.50 -10 (0.50 steps after 6) 8.8 14.4 0.4 Hydrogel No 27 134/6m
Omafilcon A
-0.75, -1.25, -1.75, -2.25 in axis 10
steps
Proclear Toric +10 -10 (0.50 steps after 6.50) 8.4/ 14.4 0.4 Hydrogel No 27 $206/6m
XR 8.8. Omafilcon A
-0.75 -5.75 in axis 5 steps
JnJ Acuvue Vita +8 -12 (0.50 after 6) 8.4/ 14 0.77 SiH: Class 1 147 $76/6m
8.8 Senofilcon C
Acuvue Vita +4 -9 (0.50 after 6) 8.6 14.5 0.77 SiH: Class 1 129 $89/6m
Astigmatism Senofilcon C
-0.75, -1.25, -1.75, -2.25 in axis 10
steps
Alcon Air Optix +0.25 +8 (0.50 after 6) 8.6 14.2 1 SiH No 138 $69/6m
Aqua -0.25 -12 (0.50 after 8) Lotrafilcon B
Air Optix
Aqua (or
Hydraglyde)
can only be
worn 6 Comes in MF
continuous
nights. Air Optix +6 -10 (0.50 after 6) 8.7 14.5 1 SiH No 108 $120/6m
Aqua Astig Lotrafilcon B
Night and
Day can be
-0.75, -1.25, -1.75, -2.25 in axis 10
worn for 30 steps
continuous
days.
Air Optix +0.25 +8 (0.50 after 6) 8.6 14.2 1 SiH No 138 $69/6m
Hydraglyde -0.25 -12 (0.50 after 8) Lotrafilcon B
**hydraglyde
increases
wettability and
decreases deposits
Air Optix +6 -10 (0.50 after 6) 8.7 14.5 1 SiH No 108 $120/6m
Hydraglyde Lotrafilcon B
Astig -0.75, -1.25, -1.75, -2.25 in axis 10
steps
Air Optix +6 -10 (0.50 after 8) 8.4/ 13.8 1.5 SiH No 175 $130/6m
Night and Day 8.6 Lotrafilcon A
24% WC
Bausch PureVision 2 +6 -12 (0.50 after 6) 8.6 14 1.1 SiH No 130 $80/6m
and Balafilcon A
Lomb
36% WC
Ultra +6 -12 (0.50 after 6) 8.5 14.2 0.7 SiH 114 $90/6m
Samfilcon A
Comes in MF
Ultra Astig +6 -9 (0.50 after 6) 8.6 14.5 0.7 SiH 114 $120/6m
Samfilcon A
-0.75, -1.25, -1.75, -2.25 in axis 10
steps
Soflens 38 +4 -9 (0.50 after 6) 8.7 14 Hydrogel 20 $105/6m
Polymacon
Multifocals
Choosing suitability between Monovision or Multifocals
Monovision:
- suitable for lower adds/younger presbyopes as binocular vision is still possible. More options
available/cheaper than MF CLs.
- Better success: when doing dominance testing reveals that one eye is dominant at distance
and the other eye is dominant at near
- Binocular vision (stereopsis): consider visual demand, e.g. driving, fine details trial lenses
- Fitting aspheric designs depends on pupil size. Pupil size less dependent with concentric
designs.
o Avg: 3mm (photopic), 6mm (scotopic)
o Central zone: differs between brands but around 2-3mm.
o Pupil size decreases with age (senile miosis) – also poorer dilation in scotopic
- Includes D and N-centre CLs: uses high order aberration (spherical aberration/SA) to
influence pinhole effect/depth of focus at retina; positive SA = extendedDOF
o Generally fit N-centre CLs (negative SA) for presbyopes/MF wearers and D-centre for
myopia control. Better for small pupils
o D-centre (positive SA) also for those who prioritize distance/those who need low
near power (as the pupils get smaller at near, then less +ve will be used in a D-centre
CL)/myopia control
- More expensive and less options (esp if toric)
- Better success: dominance reveals that one eye is dominant for both distance and near
**Dominance testing: +1.50 each eye @ distance. -1.50 each eye @ near.
Spherical CLs are suitable for px with 0.75 cyl or less. Determine spherical equivalent. Set
expectations.
Progressive design of MF CLs allows for px to use it at various distances. If px wants a CL more for
intermediate, then still follow the normal fitting guide.
1. Determine new max plus CL rx from scratch even if rx was done recently
2. Determine dominant eye for distance.
3. Add +0.25 each eye
4. Determine lowest expected add for that px’s age
a. Lo (up to +1.25), Med (+1.50 +2.00), Hi (+2.25 +2.50)
5. When trialling lenses, allow px to explore environment for 5-10 mins
6. After adapting to lenses: over-rx:
a. Distance over-rx:
i. OU open, +0.25 flippers over each eye until distance VA declines. This can be
a significant amount due to high amount of -ve in CL periphery. If >+0.75
each eye, consider new rx
ii. If px accepts +ve (allow px to look around with over-rx) adjust distance
power in that particular eye
iii. If issues with near vision: add +0.50 to distance rx of non-dominant eye (will
make near better, but distance should be acceptable). Not given
1. If vision is not functional at near AND distance, remove +0.50 and
adjust add:
iv. If distance over-rx is satisfactory but makes near vision unsatisfactory: adjust
Add:
1. Determine distance rx
2. Dominance testing
3. Select lowest expected add
Recommended to fit CN in +2 ADD and above because typically at that age, there is senile miosis. CD
OU may be unsuitable as px may not be able to access the ADD. CN OU may be unsuitable as there is
a large transitional zone, and px may not be able to use Distance.
In many other brands, with larger ADDs, CN-centre is smaller with a steeper transition to periphery
compared to lower ADD options (so that poorly dilating pupils can still access the distance section).
Dailies
JnJ Acuvue Moist +6 -9 8.4 14.3 0.3 Ionic Hydrogel Class 2 26 $64 30pk
MF (Etafilcon A) $167 90pk
Low, Med, High, aspheric design
Centre N
Alcon Dailies Total 1 +6 -10 8.5 14.1 0.7 SiH NO 156 $88 30PK
MF (Delefilcon A) $225 90PK
Low, Med, High, aspheric design
Centre N
Dailies +6 -10 8.7 14 0.5 Non-Ionic No 26 $72 30PK
Aquacomfort Hydrogel $177 90PK
MF Low, Med, High Nelfilcon A
Fortnightly
Monthly
Biofinity Toric +10 -10 (0.50 after 6) 8.7 14.5 0.75 SiH No 128 $195/6m
MF Comfilcon A
-0.75 -5.75 (0.50 steps) in axis 5
steps
Proclear MF +20 -20 (0.50 steps after 6.50) 8.4/ 14.4 0.4 Hydrogel No 38 228/6m
Toric 8.8 Omafilcon B
-0.75 -5.75 (0.50 steps) in axis 5
Uses dynamic steps
stabilisation
Centre D or N for:
+1, +1.50, +2, +2.50
Proclear MF +20 -20 (0.50 steps after 6.50) 8.4/ 14.4 0.4 Hydrogel No 27 $240/6m
XR 8.8. Omafilcon A
Centre D or N for:
+3 +4 (0.50 steps) for +6 -8
+1 +4 (0.50 steps) for _>+6, -8
Alcon Air Optix +6 -10 8.6 14.2 1 SiH No 138 $160/6m
Aqua MF Lotrafilcon B
Low, Med, High
Aspheric
Comes in MF
Air Optix +6 -10 8.6 14.2 1 SiH No 138 $160/6m
Hydraglyde Lotrafilcon B
MF Low, Med, High
Aspheric
Fitting RGPs
Specifications: BOZR:OZD / Secondary curve radii: SCR diameter / Peripheral CR : PCRD; BVP
Cosmetics
Dailies
Blue, green,
grey, hazel
Freshlook 0 -8 (0.50 after 6) 8.6 13.8 Hydrogel $55 30pk
Illuminate Nelfilcon A
Brown/black-
Enlarges iris in
Asian eyes
Fortnightly
Blues, brown,
greens, greys, hazel,
honey, sapphire,
turquoise
Freshlook +6 -8 (0.50 after 6) 8.6 14.5 Hydrogel $75 2pk
Colors (Phemfilcon A)
Blue, green,
sapphire, violet
Freshlook +6 -8 (0.50 after 6) 8.6 14.5 $120 6pk
Dimensions
Aqua, blue,
green
Monthly
Blues, brown,
greens, greys, hazel,
honey, sapphire,
turquoise