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Advanced Techniques

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Course Introduction
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.

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