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CECs Through the Internet
ABO
& NCLE Approved CECs
Click
a Title Below for a Course Description
ABO Approved Courses (Spectacle Dispensing)
Computer
Vision Syndrome—The Work Environment
The
vision problems of computer users are very real, they are very prevalent
and we know most of the bases for the problems. The visual symptoms can
largely be resolved with proper management of the environment and by providing
proper visual care for the computer worker. This course covers Computer
Vision Syndrome and the work environment. It includes the following topics:
- Lighting geometry and quantity
- Glare from windows or overhead lights
- Screen reflections
- Computer display design-contrast polarity, resolution, flicker
- Workstation Arrangement
2
ABO Approved Credits
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of Page
Computer
Vision Syndrome—Presbyopia & Dry Eye
Prescribing
for presbyopia is second nature to any refractionist, but the presbyopic
computer user requires special prescribing considerations. This usually
requires a different prescription and lens design from that which meets
the other daily visual needs of the patient. This course covers presbyopia
and dry eye as they relate to Computer Vision Syndrome. It includes the
following topics:
- Presbyopia and computer work
- Presscribing lenses for presbyopic computer users
- Other lens options
- A statement by the American Optometric Association
- Diagnosis and management of dry eyes
2
ABO Approved Credits
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Polycarbonate
Lenses
This course consists of a series of articles which were originally published
by the Polycarbonate Council in the Polycarbonate Handbook99 and on their
World Wide Web site. The topics covered include: A historical overview
of polycarbonate Identifying the ideal candidate Presentation techniques
Duty to Warn Polycarbonate and children's eyewear Polycarbonate for sports
and safety Polycarbonate and anti-reflection coating Polycarbonate and
Abbe value Dispensing tips Special considerations when tinting polycarbonate
The Polycarbonate Council is comprised of organizations interested in
disseminating information about polycarbonate lenses. They include: manufacturers
of polycarbonate resin, lens manufacturers, manufacturers of laboratory
equipment, optical laboratories, and AR coating laboratories.
2 ABO Approved Credits.
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of Page
Photochromic
Lenses
Photochromic technology
began with glass. Consumer fascination with the earliest glass photochromic
lenses occurred just as CR-39® lenses had begun gaining momentum. However,
it would take the industry another 30 years to develop a commercially
viable plastic photochromic lens. Today, 10 years after the introduction
of the first commercially viable plastic photochromic lenses, the various
technologies that give lenses their photochromic characteristics continue
to evolve. In 1999, the inventor of the original glass photochromic lens,
Corning, introduced a new plastic photochromic mid-index lens material
that can be processed thinner than standard index and is lighter weight
than polycarbonate.
The latest developments in photochromic lenses have taken the products into a totally different arena - the world of lifestyle dispensing. This course takes a look at lifestyle dispensing with photochromic lenses. Wearers have always liked photochromic lenses for their comfort and convenience. Now with the improved performance of these lenses, doctors and dispensers are being given additional opportunities to meet a growing array of lifestyle needs. Understanding the available photochromic technologies and how to explain them to patients is key to providing eyewear that answers and enhances the lifestyle needs of your patients. Therefore, we'll begin this course by describing the two main photochromic technologies.
We'll also help you identify potential candidates for photochromic lenses. Contact lens wearers. People with light sensitivity. Teenagers. Emerging presbyopes. Outdoor enthusiasts and weekend athletes. People who spend the day going inside and outside. Patients who simply want a stylish, fashionable look. We'll explore them all. We'll take a look at dispensing these lenses too.
Finally, to make the
process of dispensing photochromics successful and time efficient for
everyone in your office, we'll show you how to use a lifestyle questionnaire
that engages patients more fully in the discussion
of their eyewear needs.
2
ABO Approved Credits
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Anti-Reflection
Coating
This course provides an introduction to anti-reflection coatings. It begins
with a brief history then goes on to discuss the patient benefits of AR.
It continues with a description of some technical aspects such as constructive
and destructive interference and provides an overview of the current technologies
and equipment used in the actual AR coating process. The second part of
the course describes in-office techniques that should be used to help
prepare lenses for the AR coating process and includes tips for cutting
and edging lenses as well as the use of AR with certain cosmetic lens
treatments such as tinting and edge polishing. The course concludes with
techniques that can be used for effectively presenting AR coating to your
patients. Much of the information contained in this course is provided
courtesy of the AR Council. The AR Council is a non-profit industry association,
that was founded in 1989 and is comprised of a variety of companies with
a strong interest in anti-reflective coatings. It promotes the use of
anti-reflective coatings on eyewear through education, marketing, public
relations and advertising. The Council offers a variety of marketing materials,
including patient brochures, an informative handbook, a consumer video,
(which can be viewed on their web site), dispensing mats and other materials.
These materials are available for retailers and labs in North America.
Currently the AR Council is working with ISO and ANSI to create industry
standards.
2 ABO Approved Credits.
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of Page
Polarized
Lenses
Polarized
lenses have become one of the fastest growing lens categories in recent
years. In fact, many ophthalmic professionals and their patients feel
that polarized lenses are the best sunglasses available due to their ability
to dramatically reduce glare. And new manufacturing techniques have significantly
improved the products which are now available on the market. First introduced
in the 1930s, polarized lenses are now available in a variety of lens
materials, styles and prescription ranges which include plano, flat-top
bifocals and trifocals, and progressives. And lens materials available
in polarization include CR 39, high index 1.56, polycarbonate, photochromic
plastic, photochromic glass and glass. The lens availability table summarizes
the materials, lens forms, and available colors. Wearers of early polarized
lenses would sometimes experience problems with delamination. However,
with the development of in-mold polarization techniques, lamination problems
have virtually disappeared. Also, lens manufacturers now offer a variety
of polarized colors, to suit virtually any need your patient may have
from sports to computer use to low vision.
2
ABO Approved Credits.
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of Page
Introduction to
Low Vision
With age, most people experience normal changes in vision which can typically
be corrected with standard prescription eyeglasses or contact lenses.
Age-related eye diseases, however, such as cataracts, macular degeneration,
diabetes or glaucoma, can result in vision impairment and may mean unnecessary
loss of independence and diminished quality of life for many older Americans.
Impaired vision, that which cannot be corrected by regular eyeglasses
or contact lenses or by medical or surgical intervention, can range from
partial sight to total blindness. According to the New York Lighthouse
Low Vision Services National Survey On Vision Loss, approximately 120,000
Americans are either totally blind or can experience light perception
only; three million more report an inability to read regular newsprint,
a common criterion for defining severe vision impairment. The incidence
of vision impairment increases with advancing age, and given the increasing
numbers of older Americans, the problems associated with vision loss clearly
need to be addressed. For a growing number of eyecare professionals, low
vision dispensing is a career path well worth pursuing. Upon completion
of this course, the participant should be able to: . Identify the low
vision patient . Explain how visual acuity and visual fields are measured
. Name at least four diseases which can lead to vision impairment . Describe
the symptoms associated with at least four diseases which can lead to
vision impairment . Explain how magnification is able to help the vision
impaired patient . Describe three methods by which magnification can be
achieved . Describe at least three types of optical low vision aids .
Explain how absorptive lenses can aid a low vision patient . Describe
at least four nonoptical low vision aids . Describe at lease three nonvisual
low vision aids
3 ABO Approved Credits
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Color
Vision
The color we perceive when we view an object is influenced by several
factors. These include the characteristics of the light source under which
it is viewed, the way the object absorbs, transmits, or reflects the light
waves striking it, the physical condition of the viewer's eyes, and the
psychology of the observer. Color is not a property that is a physical
part of the things we see, it is simply the effect of light waves as they
bounce off or pass through the object being viewed. If it were not for
light, the objects around us would have no color. This course begins with
a brief description of light and how light behaves to produce color, and
is followed by a discussion of the psychological, physiological, environmental,
and circumstantial factors which influence color perception. It then goes
on to cover some of the theories of color vision, and concludes with a
survey of the color vision abnormalities. Upon completion of this course
the student should be able to: . Explain how light behaves to produce
color . Describe the physiological, psychological, environmental, and
circumstantial factors that affect color perception . Describe at least
four of the theories of color vision . Explain our current understanding
of color vision perception . Describe four categories of color vision
deficiencies . Explain the subcategories of anomalous trichromasy and
dichromasy.
2 ABO Approved Credits
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of Page
Pediatric Vision
Disorders
This course covers
pediatric vision disorders which may be encountered by professional opticians
in the course of their day to day activities. This information can help
them understand the needs and communicate more effectively with their
young patients, their parents, and the prescribing practitioners as well.
2 ABO Approved Credits
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Anatomy & Physiology
Surveys the major anatomical features of the human eye along with their
physiological function. Includes a discussion of the cornea, iris, pupil,
crystalline lens, suspensory ligaments, aqueous and vitreous humor, retina,
rods & cones, choroid, optic nerve, macula, sclera and ciliary body. Certain
pathologies such as glaucoma, cataract, and scotoma are described. The
various ametropias usually correctable with spectacle lenses are surveyed.
Phorias and tropias will be presented and discussed. A glossary of important
covered will conclude this session.
2
ABO Approved Credits
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Basic Optical Principles
Begins with a discussion of the metric system of measurement followed
by a review of basic mathematical principles. The electromagnetic spectrum,
the nature and propagation of visible light, and index of refraction is
presented. This section concludes with a discussion of prism, prism diopter,
the perception of lenses as prism, and Prentice's Rule.
2 ABO Approved Credits
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Lens Form &
Analysis
Covers the actual shape and deign of modern prescription ophthalmic lenses.
Will include a discussion of spheres and radius of curvature. Corrected
curve lenses, the rationale for the use of commonly recommended base curves,
and the importance of the routine use of the "lens clock" will be presented.
Cylindrical shapes and their use in prescription ophthalmic lenses for
the correction of astigmatism are discussed. The power cross will be covered
to aid in determining the power of compound lenses in the various meridians
and to better understand lens transposition. Finally, vertex distance
compensation for higher powered lenses will be covered.
2 ABO Approved Credits
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Lens Materials
& Coatings/Multifocal Designs
Surveys the common materials from which ophthalmic lenses are made along
with a description of their general characteristics and potential uses.
The relative merits of three common spectacle lens materials are compared-
these include crown class, CR-39 plastic, and polycarbonate. Tints and
coatings will be discussed as they are used for absorptive, protective,
and cosmetic purposes with glass and plastic lens materials.
Surveys common styles of multifocal lenses currently available to include
flat top, executive, ultex, blended, progressive- the relative merits
and uses of each will be outlined. The concept of the reading addition
and "image jump" along with a rationale for the development of improved
multifocal lens designs will be discussed along with a comparison of fused
and one piece lenses. Bicentric grinding or "Slab-off" is included in
this session along with a discussion of spectacle lenses which are used
for the correction of aphakia.
2 ABO Approved Credits
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Ophthalmic Frames
The basic parts of the ophthalmic frame are discussed the various measurement
criteria are summarized. Horizontal and vertical lens decentration is
explained and the theoretical as well as practical minimum lens blank
sizes are calculated based on frame dimensions, pupillary distance, and
other practical considerations. Common frame materials will be surveyed
with a brief discussion of the general characteristics of each. An outline
of the various frame styles and bridge designs will emphasize the importance
of proper bridge selection and temple length. Frame adjustment includes
a discussion of the fitting triangle as well as the various frame tilts
and face forms. A summary of fitting problems will be presented along
with possible solutions.
2 ABO Approved Credits
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Instrumentation/Regulations
& Standards
Begins with a study of the lensometer to include a survey of its principal
parts as will as a summary of the measurements it is capable of reading.
Includes a step by step procedure for verifying a lens from a known prescription
as well as neutralizing a lens from an unknown prescription. The methods
of interpreting prism power as well as the direction of its base are followed
by a description of when and how to "split" vertical prism for improved
cosmetics and patient comfort. A survey and brief description of some
basic tools used in the optical dispensary concludes this section.
The governmental and non-governmental regulatory agencies are surveyed
to include ANSI, OSHA, FDA, and ASTM. An abbreviated table of ANSI Standards
is included to list the most commonly referenced tolerances for prescription
ophthalmic lenses along with a table of other ANSI publications of interest
to the optical dispenser. Professional liability for the products, services,
and information dispensed to the public is addressed. Emphasis is placed
on maintaining adequate, up-to-date product knowledge and of demonstrating
genuine concern for the needs and well-being of the patient
2 ABO Approved Credits
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of Page
The information in this course is provided by the Occupational Safety and Health Administration (OSHA) which was established in 1971 and is a federal agency operating under the auspices of the U.S. Department of Labor. OSHA's mission is to ensure safe and healthful workplaces in America. Since the agency was created in 1971, workplace fatalities have been cut in half and occupational injury and illness rates have declined 40 percent. At the same time, U.S. employment has doubled from 56 million workers at 3.5 million worksites to 111 million workers at 7 million sites.
This course begins
with the OSHA statement on eye protection and continues with information
on selecting eye and face protection against impact, heat, chemicals,
dust, and optical radiation. The course continues to survey OSHA requirements
for eye and face protection and summarizes the ANSI Z-87.1 1989 standards.
It goes on to cover the fitting, maintenance and care of Personal Protective
Equipment (PPE) and includes excerpts from the actual OSHA standards.
The course concludes with a listing of some frequently asked questions
and a glossary of terms.
3
ABO Approved Credits
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of Page
This course provides an overview of the visual acuity examination. The visual acuity exam is comprised of two main components: refractometry, a multifaceted measurement of refractive errors with a variety of specific instruments and techniques, and clinical judgement, which is required to prescribe appropriate optical correction.Ophthalmic personnel are often responsible for many of the measurements involved in refractometry which can assist the optometrist or ophthalmologist in evaluating the findings, assessing related patient needs, and prescribing the appropriate correction. While the visual acuity exam is essential in helping to assess the functional behavior and anatomic status of the eye, in itself, it only comprises a portion of a comprehensive medical eye examination.
The course begins
with an overview of the components of refraction: retinoscopy, refinement,
and binocular balancing. The techniques used in streak retinoscopy are
described and the reflexes produced by the streak retinoscope are illustrated.
The use of the trial frame and phoroptor for subjective refinement is
described. The course goes on to cover the basic techniques employed
in performing refractometry which include the procedures used in the
distance acuity test, the pinhole acuity test and the near acuity test.
2 ABO Approved Credits
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of Page
Progressive Lens
Design
This course provides
certified and state licensed opticians with information on the latest
developments in progressive and variable focus lens technology. It presents
new technology and describes how it differs from conventional PAL designs
enabling the professional dispenser to offer their patients the best
lenses available for their visual needs.
The course begins
with a presentation of the evolution of progressive lens design and
goes on to cover the inherent limitations found in conventional progressive
lens design. The course illustrates how advanced lens design such as
atoric lenses, compensated prescription, and "internal" progressive
channel lenses can minimize many of these limitations. It goes on to
describe the methodology for successful dispensing of advanced progressive
addition lenses which includes ascertaining the patient's needs, patient
education, and recommendations for implementing appropriate fitting
and measuring procedures. The course continues with a brief description
of visual problems often encountered by advanced presbyopes when using
the computer and concludes with a representative listing of variable
focus lenses designed to help relieve symptoms of Computer Vision Syndrome.
2 ABO Approved
Credits
Working with Premium Lenses
Premium lens materials have made their way into mainstream use, requiring that optical personnel be familiar with their properties and the best ways to work with them effectively. Considerations in handling these materials go beyond proper surfacing and finishing techniques. High-index materials are often packaged with special coatings, including anti-reflective, scratch-resistant, hydrophobic and oleophobic. In addition, many other premium lens attributes, such as progressive addition lenses (PALs), aspheric or atoric, polarized and photochromic, are often employed with high-index materials. In addition, the combined popularity and relative fragility of drilled-rimless mountings dictates that high-index materials will be frequently employed.
Because of the high-value nature of today’s high-index eyewear, it is imperative that optical personnel understand how to work with them effectively. In order to minimize breakage and re-do rates and maximize the performance of these premium products, premium lenses require special handling. This course discusses the types of high-index materials, coatings and designs in common use, the properties of each, and the best ways to work with them for maximum effectiveness.Premium lens materials have made their way into mainstream use, requiring that optical personnel be familiar with their properties and the best ways to work with them effectively. Considerations in handling these materials go beyond proper surfacing and finishing techniques. High-index materials are often packaged with special coatings, including anti-reflective, scratch-resistant, hydrophobic and oleophobic. In addition, many other premium lens attributes, such as progressive addition lenses (PALs), aspheric or atoric, polarized and photochromic, are often employed with high-index materials. In addition, the combined popularity and relative fragility of drilled-rimless mountings dictates that high-index materials will be frequently employed.
2 ABO Approved
Credits
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of Page
Dispensing to Children
Fitting pediatric patients can be a challenge. With adults, only one customer needs to be satisfied – the patient. But with kids, both the child and the parent must be happy with the glasses – and children and their parents don’t always see eye-to-eye. Compounding the problem is the fact that while adults comprehend the need for eyeglasses, kids sometimes just don’t understand why they have to wear these things on their faces. Throw a prescription for multifocals into the mix, and fitting children can become even more difficult. But by adhering to good practices, fitting children can be much easier for both the optical professional and the youngster.
This course begins with a report of a study conducted by the Centers for Disease Control and Prevention (CDC) which found that children under the age of six are receiving inadequate vision care. It goes on to discuss common ocular conditions experienced by children categorized by age.
After reviewing phorias and tropias, amblyopia, and strabismus, the course discusses the best methods for fitting kids who require, eyeglasses including understanding the reasons children might require multifocals. The course continues with a discussion of ascertaining a legitimate need for multiple pair and appropriate lens treatment options. We conclude with a discussion of children’s eyewear for sports and safety.
2 ABO Approved
Credits
Prescription Sunwear/Rimless Eyewear
This course begins with a presentation of the potentially adverse effects of ultraviolet radiation (UV) on the eyes and then identifies ways to protect the visual system from over exposure to UV. It goes on to include a brief presentation of the electromagnetic spectrum and illustrates where ultraviolet, visible light, and infrared fit in to the overall spectrum. The subject of tints, coatings, density designations for plastic and glass lenses, is covered.
Photochromic lenses have always been about change, beginning with the first photochromic lenses that were invented back in the 1960’s. Then, as now, the primary motivation behind photochromic lenses was to create a lens that was clear indoors and would darken automatically into an effective sunglass when the wearer went outside. Photochromic technology began with glass. Consumer fascination with the earliest glass photochromic lenses occurred just as CR-39® lenses had begun gaining momentum. However, it would take the industry another 30 years to develop a commercially viable plastic photochromic lens. Today, years after the introduction of the first commercially viable plastic photochromic lenses, the various technologies that give lenses their photochromic characteristics continue to evolve.
Polarized lenses have become one of the fastest growing lens categories for prescription sunwear in recent years. In fact, many ophthalmic professionals and their patients feel that polarized lenses are the best sunglasses available due to their ability to dramatically reduce glare. And new manufacturing techniques have significantly improved the products which are now available on the market.
First introduced in the 1930s, polarized lenses are now available in a variety of lens materials, styles and prescription ranges which include plano, flat-top bifocals and trifocals, and progressives. And lens materials available in polarization include CR 39, high index 1.56, polycarbonate, photochromic plastic, and photochromic glass.
Frames requiring lenses with steeper than usual base curves, also known as “wrap” eyewear, have become popular as sunglasses in recent years. Here, we discuss the potential optical problems and possible solutions that can be created when steeper than usual base curves are used.
The late 20th century saw a resurgence in the popularity of the clean unobtrusive style of rimless eyewear. Today’s rimless mountings offer many of the same benefits that made them popular in the past: light weight, inconspicuous, possibilities of making the lens virtually any shape. Modern technology available in both lenses and frames make them strong and remarkably durable while still achieving the “barely there” look.
2 ABO Approved
Credits
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of Page
The population is ageing and people are living longer. The average life expectancy in the United States is now more that 75 years and this bodes well for the optical industry. The “baby boom” generation, that large segment of the population born between 1946 and 1963, have all now reached their fortieth year and well beyond. As we know when we turn 40 the crystalline lens in our eye has lost enough of its flexibility so that we are now required to wear corrective lenses for near vision activities such as reading. The point is that almost everyone over the age of 40 requires some sort of visual correction.
Not only are people are living longer, but they are often engaging in active, visually intensive life styles much longer than was customary in the past. Many seniors are entering new careers, some are going back to school while others spend time doing volunteer work. Ascertaining the needs of the patient is always important, but it is especially so when working with seniors. A questionnaire can be a valuable tool for getting to better know your patients. Some questionnaires ask the patient to rank each activity they mention in the order of importance.
With age, the transparent structures of the eye begin to lose their clarity. Therefore, your older patients should be advised to re-evaluate their lighting at home since it often provides inadequate illumination for comfortable reading. Weaker bulbs should be replaced as needed. Arthritis can also make reading difficult and this can be helped with reading stands or other aids. It is especially important, however, to demonstrate care, concern, and knowledge regarding the special needs of your older customers.
2 ABO Approved
Credits
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of Page
Anatomy & Refractive States of the Eye
A competent optician requires a basic understanding of the anatomy of the human eye, how it works, and what conditions or vision abnormalities might occur which may require his/her services. With this knowledge he may interact more confidently with his patients and the prescribing practitioner as well.
This course begins with an overview of the eye as an optical system as we survey its transparent and non-transparent structures. We follow a ray of light as it passes through the cornea, the aqueous humor, the pupil, crystalline lens and the vitreous humor on its way to the retina.
The course continues with a discussion of the refractive states of the eye which include emmetropia and the various ametropias such as myopia, hyperopia and regular astigmatism.
The optical cross is a graphical device which can be useful in illustrating the powers of the front and back surfaces of a lens in order to arrive at its total power. With this information a professional optician can read a prescription and identify which ametropia it is designed to correct as well as identify the meridians of maximum and minimum lens thickness.
A Glossary of important terms is included at the end of this course.
2 ABO Approved
Credits
Dispensing Progressive Lenses
Today, progressive lensses account for over 50% of all multifocal lenses sold in the United States In fact, many multifocal wearers have never worn a “lined” bifocal; their first pair of multifocals were progressive and they stayed with them as their presbyopia advanced. There are several reasons for this. For one, the optics of progressives lenses continues to improve as lens manufacturers create more sophisticated lens designs. And they are available in virtually every lens material and type from CR39 to high index plastic, photochromic, polycarbonate, Trivex, and polarized. There are “specialty” progressives for use in frames with a relatively narrow vertical measurement requiring a low seg height as well as lenses designed specifically for “Wrap” eyewear which utilize steeper than usual base curves.
2 ABO Approved
Credits
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of Page
NCLE Approved Courses (Contact Lens Dispensing)
Basic Contact Lens
Design
This course begins with a discussion of the various contact lens designs
to include scleral, corneal and semi-scleral lenses. Some basic terminology
is covered and the various materials from which contact lenses can be
made are surveyed and placed into historical perspective. The uses, advantages
and disadvantages of the lens materials are discussed. The parts of a
contact lens will be covered to include optic zone, peripheral curve,
base curve, junction zone, and radius of curvature. The need for diopter
to millimeter conversion is presented and a table is included. Part 1
also discusses the relationship between sagitta depth and fit. Changing
sagitta depth by manipulating lens diameter and/or base curve radius is
presented. The section concludes with a brief glossary of the terms covered
2 NCLE Approved Credits
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Optical Principles of Contact Lenses
There are many reasons why a contact lens prescription can differ significantly
from a spectacle prescription belonging to the same patient. By studying
the principles of optics which need to be considered when fitting rigid
and soft lenses, many of these reasons will be explained. We'll begin
with a review of the anatomical features of the human eye with a special
emphasis on the tear film and the cornea. This will be followed by proper
patient selection through the use of appropriate pre-fit testing and interviewing
techniques. An attempt will be made to identify those contact lens candidates
with the best prognosis as well as those with a reduced prognosis for
successful fitting. Following this will be a discussion of vertex distance
compensation, a subject which assumes added importance when fitting contact
lenses. A prescription in excess of ±4.00D at the spectacle plane must
be compensated for contact lenses which are fit at the corneal plane.
When a rigid contact lens is placed on the cornea, a tear layer is formed
between the back surface of the lens and the front surface of the cornea.
This liquid or lacrimal lens can sometimes assume the shape and power
of a plus or minus lens. The added power must then be considered when
determining the final power of the contact lens. Examples and practice
exercises will be presented to cover instances of rigid lenses fit on
K, steeper than K and flatter than K
2 NCLE Approved Credits
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Fitting & Verification
Although PMMA lenses are rarely fit today, the principles applied in fitting
them are fundamental to all rigid lenses and are covered in this course.
We'll begin with a discussion of palpebral lenses as well as larger lenses
with wide peripheral curves. The general characteristics, advantages,
and disadvantages of each will be discussed. This will be followed by
methods and procedures for selecting base curve, diameter, optical zone
width, peripheral curves, and thickness through the use of diagnostic
lenses, nomograms and charts. Examples and practice exercises are included.
Dynamic flourescein patterns are used to assist in the evaluation of the
fit of rigid contact lenses. How and why this is accomplished is covered
in the second half of this section. We'll illustrate flourescein patterns
of a spherical base curve on a spherical cornea, and spherical base curves
on a toric cornea are presented. Astigmatism with the rule, against the
rule, and oblique will be discussed and observed. Soft lens evaluation
is then covered to include fitting goals and the characteristics of a
good fitting soft lens. We conclude with a presentation of rigid and soft
lens verification techniques to include the use of the measuring hand
magnifier, diameter gauge, projector inspection devices, slit lamp, radiuscope,
thickness gauge, lensometer, and profile analyzer. We'll see that soft
lenses too can be verified through the use of a hand magnifier, plastic
templates, a soft lens analyzer, and the use of a water cell.
2 ABO Approved Credits
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of Page
Anatomical Considerations
Although this course is entitled Anatomical Considerations, it might just
as easily be called Potentially Adverse Effects of Contact Lens Wear.
In effect, this course catalogues many of the potentially negative aspects
of contact lens wear. However, with diligence on the part of the fitter
and compliance on the part of the patient, many of these adverse effects
can be greatly minimized. Proper patient selection, well-fit lenses, and
adequate follow-up will usually result in healthy corneas and satisfied
patients. However, lack of concern, laziness, or simple negligence on
the part of either the fitter or the patient can often cause the sort
of problems we're about to study. Detecting many of these conditions will
often require considerable clinical experience, and treating them should
always be left to the prescribing practitioner. The course begins with
a review of certain anatomical structures which effect the contact lens
fitter. These include the tear film, eyelids, conjunctiva, cornea, and
limbus. It is followed by a presentation of some of the potentially adverse
effects of contact lens wear which include corneal edema, corneal striae,
conjunctival and episcleral injection, giant papillary conjunctivitis,
and corneal vascularization. Flourescein, in addition to its value in
helping to evaluate the fit of a contact lens, is also used to facilitate
the precise delineation of specific corneal epithelial defects. It acts
either by pooling in the area of the defect or by staining the underlying
exposed basement membrane or Bowman's layer. Corneal epithelial staining
patterns could possibly be caused by direct trauma or by defective distribution
of the tear film. This section will illustrate staining patterns which
might be caused by a poorly edged or damaged lens, or by improper insertion,
removal and recentering techniques. We will also discuss staining which
might be the result of defective tear distribution such as "three and
nine-o-clock" staining, or limbal peripheral staining. This section will
conclude with a discussion of the biomicroscope or slit-lamp and will
emphasize the importance of this instrument in contact lens fitting. The
various illuminations are discussed, illustrated, and the uses of each
are described.
2 NCLE Approved Credits
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Advanced Techniques
This course covers contact lenses which are fit for the correction of
presbyopia, astigmatism, aphakia, and keratoconus. These, indeed, are
advanced techniques and require the skill and experience of the seasoned
contact lens fitter. While the study of this section by itself will not
produce an expert fitter, it will provide an introduction to and a survey
of the various lens designs and fitting procedures which are employed.
The section begins with the study of presbyopia by presenting the various
options available to the presbyopic contact lens wearer. Among these are
spectacle lenses for near vision to be worn over the distance vision contact
lenses, monovision, concentric style multifocal contact lenses, and segment
style contact lenses. The discussion of contact lenses for the correction
of astigmatism includes the fitting of front toric, back toric, and bitoric
lens designs. Lens stabilization techniques designed to inhibit lens rotation
in cylindrical and segment multifocal lenses will be discussed. These
include prism ballast, truncation, double slab-off and posterior toric
surfaces. The section on contact lenses for the correction of aphakia
will survey the various lens materials and shapes that can be used to
help the cataract patient. These will include conventional lenticular,
minus carrier lenticular (myoflange), and single cut lenses. Emphasis
will be placed on the special problems encountered by the elderly aphakic
contact lens wearer. We continue with a discussion of keratoconus, a degenerative
hereditary condition of the cornea. The various stages of the disease
will be defined and contact lens fitting methods and philosophies designed
to help improve visual acuity will be surveyed.
2 NCLE Approved Credits
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Modification &
Delivery
This course covers the subjects of in-office contact lens modification
of rigid lenses, and delivery to the patient. Also included in this section
is some supplementary information on the use of the radiuscope, on DK
value and gas permeable lenses, and ANSI standards for rigid and soft
lenses. The in-office modifications which are possible with rigid lenses
include: reducing the overall lens diameter, flattening the base curve,
blending transition zones, removing scratches, adding minus power, adding
plus power and dotting the lens for identification. The use of the radiuscope
will be described and illustrated as it is used to verify the radius of
curvature of a spherical surface. We continue with a discussion of the
uses of contact lens solutions for rigid and soft lenses. These include
wetting, cleaning, and soaking solutions for rigid lenses, and cleaning,
disinfecting, rinsing, and re-wetting solutions for soft lenses. This
is followed by a discussion of patient instruction techniques for lens
insertion and removal as well as recommended "breaking-in" wearing schedules.
An abbreviated table of ANSI standards is also part of this section. This
table consists of the most referenced standards for rigid and soft lenses-
those which you may be called upon to know. We conclude with a glossary
of important terms which were used throughout this course, as well as
some which you may be seeing for the first time.
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RGP Lens Alterations
The ability to carry out modifications of rigid contact lenses in the
office provides benefits to the patient as well as to the contact lens
practitioner. It enables the patient to continue their wearing schedule
without interruption and minimizes the necessity for extra visits. Also,
the practitioner may know best exactly which modification is required
which may be difficult to describe to the laboratory. Any subsequent modifications
become apparent and can be done immediately. Further, practitioners who
carry out modifications are better able to evaluate lenses which have
been made or which have to be modified by a laboratory. All the adjustments
that can be made to a lens have the effect of loosening the fit or increasing
tear flow between the lens and cornea. Any adjustments required to tighten
the fit of a lens necessitate the fabrication of a new lens. In-office
modification of rigid lenses may take the forms listed below. . reducing
overall lens diameter . polishing and refinishing lens edges . power adjustments
. polishing lens surfaces . blending transition or junction zones . adjusting
peripheral curves . flattening intermediate curves . reducing optic zone
diameter Upon completion of this course, the participant should be able
to: . Identify the materials and tools necessary to perform in-office
modifications of rigid contact lenses. . Explain special care required
when altering rigid contact lenses . Describe at least two techniques
which can be used to reduce the diameter of a rigid contact lens. . Describe
the instruments used to assess the diameter of a lens . Explain when and
how to polish a rigid lens, modify its power and adjust the peripheral
curves . Describe at least three methods of examining the edge of a lens
. Describe an ideal contact lens edge . Identify the signs and symptoms
associated with thick edges, square edges, sharp edges, rolled in and
rolled out edges, and the office modification techniques used to create
an improved edge.
2 NCLE Approved Credits........... $33700
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RGP Fitting &
Evaluation
Studies have shown that rigid gas permeable (RGP) lenses are indicated
for, at minimum 30% of all new contact lens patients. Nevertheless, the
percentages of new patients being fit into RGPs-especially among younger
practitioners-are much less. Some practices do not fit RGPs at all despite
the visual quality, oxygen transmission, durability and wettability benefits!
Certainly, the ease of fitting soft lenses is a motivating factor.
Fitting RGPs is an art. Practitioners who fit RGPs take great pride in providing the most appropriate contact lens for any given patient ( RGPs, soft torics, bifocals) and do not simply fit a patient into their available inventory of lenses. RGP fitters are often very successful practitioners whose patients perceive their contact lenses to be of value and their eyecare professional to be quite competent.
It is well known
that adding a small amount of sodium fluorescein to the tears causes them
to fluoresce a bright yellow-green color when viewed under ultraviolet
or cobalt light. This makes it possible to view the tears that are present
between the lens and cornea and to dynamically evaluate the fit of a contact
lens. The brightness of the fluorescent tears increases with the thickness
of the tear layer and may be used to estimate the amount of clearance
between the lens and cornea. Any area under the lens where fluorescein
is absent appears as black or dark, thus indicating a position of lens/cornea
bearing or touch. Fluorescein is invaluable if not essential in the assessment
of rigid lens fitting. Without the use of fluorescein the practitioner
cannot view the true lens-to-cornea fitting relationship.
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Contact Lens Instrumentation
This
course covers the uses of two pieces of equipment, the keratometer and
the slit lamp, which are indispensable to the successful fitting and evaluation
of rigid and soft contact lenses.
The keratometer (also known as ophthalmometer) is used for measuring the curvature of the cornea. It is capable of measuring two curves, the steepest and the flattest, which are also referred to as the principal meridians. These measurements provide the contact lens fitter with information about the cornea's curvature, focusing power, and whether or not astigmatism is present. In addition to its uses for fitting contact lenses, keratometry is also used for evaluating and following patients with keratoconus, and in the determination of appropriate intraocular lens implant power for patients undergoing cataract surgery.
The
slit lamp (or biomicroscope) is an instrument designed primarily to observe
the transparent structures of the human eye under a magnification of from
10 to 50 times. Its two principal parts include a lamp equipped with an
optical system designed to project a slit of light upon the eye, and a
stereomicroscope which is mounted horizontally for direct viewing of the
patient's eye. The slit lamp may be adjusted to project a variety of light
beams. By varying the light beam and the viewing position, it is possible
to improve the view of the various structures of the eye. Since the biomicroscope
is particularly useful for examining the cornea it plays an especially
important role in the fitting of contact lenses. Symptoms of a poor fitting
contact lens, for example, can usually first be detected through the use
of the slit lamp.
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To best understand the art of fitting soft contact lenses is to first understand the criteria of an optimal fitting scenario. Many techniques for lens evaluation have remained unchanged since the inception of hydrogel lenses. These evaluations include the characteristics of lens centration, corneal coverage, lens movement, tightness, physical comfort, visual acuity, and visual quality. When fitting hydrogels, a diagnostic lens fit will expedite and optimize the results. Selection of the diagnostic lens is based on material and parameter availability.
A diagnostic lens
should meet the requirements predetermined by the subjective and objective
measures in the pre-fitting examination. There are literally hundreds
of hydrogel lenses available. Using diagnostic lens sets allow for ease
of fitting without creating an excessive inventory. The fitter should
document the lens fitting characteristics that are consistent and reproducible.
An optimal fit is well-positioned, centered, and moves well without hesitation
(more on this later). A more precise method is to describe the specific
characteristics in detail, such as lens position in primary, upward, and
lateral gaze, decentration, tightness, and surface quality.
2 NCLE Approved
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If the patient is well educated on the proper techniques, it is less likely that he or she will have serious problems. A videotape or pamphlet is quite helpful in explaining the proper procedures. A checklist of procedures should be reviewed with the patient prior to and after training. The checklist can also act as a "report card," identifying areas that require further training or attention. A contact lens agreement form should be used as a contract between the doctor and the patient. This form should identify that the fitter has reviewed I & R techniques and has advised the patient of any possible adverse reactions.
This course begins
with a presentation of insertion and removal techniques for rigid and
soft lenses and goes on to cover proper handling techniques for gas permeable
rigid lenses. Next, we cover the elements of the contact lens care system
which includes daily cleaners, rinsing agents, disinfectants and enzyme
products. The course concludes with a presentation of chemical care systems
designed to promote compliance by making the care product system safe
and easy to use while maintaining a high level of effectiveness.
2 NCLE Approved
Credits
Prescribing and fitting contact lenses have become an integral part of today's comprehensive eyecare practice. More than 30 million people in the United States wear contact lenses, with the majority using them for cosmetic purposes. Other reasons for wearing contact lenses include occupational preferences, sports, and therapeutic uses. Ophthalmic dispensers may function in a contact lens practice by taking a patient history, obtaining basic preliminary refractive measurements, and performing lensometry and keratometry. With experience, responsibilities may include the fitting of the lenses, confirming lens parameters, and suggesting lens modifications. Because opticians often are required to help educate patients in the proper use and care of their contact lenses and to help assess patients' related problems, a basic understanding of contact lens principles, types, appropriate use, and problems is necessary.
This course describes
how contact lenses work to correct vision, how they differ from eyeglasses,
and the types of lenses available and their uses. Lens care is emphasized
because improper care can lead to problems. Procedures for inserting and
removing lenses are presented, as well as a discussion of commonly encountered
problems and of the types of patients who may be unable to wear contact
lenses successfully. Although you can read extensively on the subject
of contact lenses, the most productive and practical knowledge will come
from observing contact lens fitting, talking to patients who have worn
contact lenses, and actually trying on contact lenses yourself.
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Contact Lens Patient Selection
The following subjects are covered in this course. Applying them in practice will increase the likelihood of a successful fit and a happy patient.
The first contact person, usually a member of the office staff, sets the tone for the examination and the aftercare.
A survey should be used to collect pertinent information regarding health (systemic and ocular), occupation, hobbies, previous eyecare and/or correction, contact lens use (if any), and insurance coverage.
The psychological and motivational aspects of contact lens wear are the most important factors in long-term success.
A patient who is verbally interactive and able to reason is never too young for contact lenses. The limiting factor is the patient’s ability to understand the need to follow a maintenance schedule or to comply with a set wearing and care schedule without deviation.
The cylinder sensitivity test determines the patient’s appreciation for uncorrected astigmatism in spectacles and contact lenses.
By interrelating the patient’s needs with clinical experience and knowledge, the choice of contact lens design and material becomes streamlined.
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