IACLE Module 7

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by  IACLE

The IACLE
Contact Lens
Course
MODULE 7
Contact Lens-Related
Complications
First Edition
Module 7: Contact Lens-Related Complications
Published in Australia by
The International Association of Contact Lens Educators
First Edition 2004
(cid:148)The International Association of Contact Lens Educators 2004
All rights reserved. No part of this publication may be
reproduced, stored in a retrieval system, or transmitted in
any form or by any means without the prior written
permission of:
The International Association of Contact Lens Educators
IACLE Secretariat,
PO Box 6328 UNSW
SYDNEY NSW 1466
Australia
Tel: [phone]
Fax: [phone]
Email: [email protected]
ii IACLE Contact Lens Course Module 7: First Edition
Module 7: Contact Lens-Related Complications
Table of Contents
Page
Acknowledgments.....................................................................................................iv
Contributors................................................................................................................v
Educators’ Guide to the IACLE Contact Lens Course...........................................vi
Symbols, Abbreviations and Acronyms Used in the IACLE Contact Lens
Course......................................................................................................................viii
Summary of Module 7: Contact Lens-Related Ocular Complications.................xi
Request for Feedback..............................................................................................xii
Unit 7.1 1
Course Overview 2
Lecture 7.1 Patient Symptoms and Clinical Signs 3
Unit 7.2 13
Course Overview 14
Lecture 7.2 Soft Contact Lens Complications and Their Management 15
Unit 7.3 191
Course Overview 192
Lecture 7.3 RGP Contact Lens Complications and Their Management 193
Unit 7.4 315
Course Overview 316
Lecture 7.4 Diagnosis and Management of Dry Eye in Contact Lens Wear 317
IACLE Contact Lens Course Module 7: First Edition iii
Module 7: Contact Lens-Related Complications
Acknowledgments
The IACLE Curriculum Project is the result of a desire to raise the standard of eyecare
education, to make contact lens wear safer and more successful, and to develop the contact
lens business by creating the educational infrastructure that will produce the teachers,
students, and practitioners of the future.
The concept of the world's best educators making available their most creative educational
contributions for the common good without any recompense, other than a sense of
satisfaction, was born out of IACLE's idealism.
The Curriculum Project could not be successful without the assistance and generosity of a
large number of talented and dedicated people. To all those contributors of lectures,
laboratory notes, videos, slides, etc., we say thank you. Your generosity of spirit will benefit
many educators, hundreds of thousands of students, and millions of patients throughout the
world.
Since IACLE’s inception, IACLE’s Vice President, Professor Desmond Fonn, has made a
tremendous contribution. More recently, he has applied his considerable expertise to the final
editing stage of the Curriculum. This project was commenced under Professor Brien
Holden’s leadership. The original plans and layout for the Curriculum were prepared by Ms
Sylvie Sulaiman, IACLE’s former Director of Education. Sylvie's dedication and excellent
understanding of practitioner and community requirements, gave the project focus and depth.
More recently, the Curriculum Project has benefited from the work of Dr Lewis Williams,
IACLE’s Manager: Educational Development.
Kylie Knox and Peter Fagan have done an excellent job as Project Editors. To complement
the efforts of the editors, layout and production coordinators Barry Brown and Shane Parker
have done an admirable job. The Cornea and Contact Lens Research Unit (CCLRU) at the
University of New South Wales has contributed substantially to this project through the
donation of time, resources, and editorial support.
The IACLE Secretariat, including Project Coordinator, Gail van Heerden and Special Projects
Officer, Pamela Capaldi, have managed expertly the considerable tasks of production and
distribution.
No acknowledgement page in an IACLE document would be complete without a reference to
its major corporate sponsors Ciba Vision, Johnson & Johnson, and Bausch & Lomb; together
with supporting corporate sponsors AMO (formerly Allergan), Ocular Sciences Inc; corporate
contributors Alcon Laboratories, CooperVision; and donor Menicon Europe, who have
generously supported the development costs for this Module of the IACLE Contact Lens
Course.
IACLE is a cooperative effort and none of its activities are more collective than the Curriculum
Project. The IACLE Contact Lens Course resulting from this project is provided to assist
educators in accredited institutions to impart eyecare and contact lens knowledge. All the
contributors deserve recognition for their selflessness and talent. I am proud to be associated
with them.
Deborah Sweeney
President of IACLE
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Module 7: Contact Lens-Related Complications
Contributors
Editor-In-Chief
Desmond Fonn, Dip Optom, MOptom
Associate Professor
School of Optometry
University of Waterloo
Waterloo Ontario Canada N2L 3G1
Robert Terry, BOptom, MSc (cid:120)(cid:3) Patient Symptoms and Clinical
Cornea and Contact Lens Research Unit Signs
School of Optometry and Vision Science (cid:120)(cid:3) Soft Contact Lens Complications
UNSW and Their Management
Sydney NSW 2052 (cid:120)(cid:3) RGP Contact Lens
Australia Complications and Their
Management
(cid:120)(cid:3) Diagnosis and Management of
Dry Eye in Contact Lens Wear
Lewis Williams, AQIT(Optom), MOptom, (cid:120)(cid:3) Patient Symptoms and Clinical
PhD Signs
IACLE Secretariat (cid:120)(cid:3) Soft Contact Lens Complications
PO Box 6328 UNSW and Their Management
Sydney NSW 1466 (cid:120)(cid:3) RGP Contact Lens
Australia Complications and Their
Management
(cid:120)(cid:3) Diagnosis and Management of
Dry Eye in Contact Lens Wear
With Additional Input From:
Rènée du Toit, Dip Optom, MPhil (cid:120)(cid:3) Diagnosis and Management of
(Optom) Dry Eye in Contact Lens Wear
Cornea and Contact Lens Research Unit
School of Optometry and Vision Science
UNSW
Sydney NSW 2052
Australia
Adrian Bruce, BScOptom, PhD (cid:120)(cid:3) Soft Contact Lens Complications
Clinical Vision Research Australia and Their Management
Victorian College of Optometry
Cnr Keppel and Cardigan Sts
Carlton Vic 3053
Australia
Richard Lindsay BScOptom, MBA (cid:120)(cid:3) RGP Contact Lens
Richard Lindsay & Associates Complications and Their
5th Floor, 376 Albert Street Management
East Melbourne Vic 3002
Australia
IACLE Contact Lens Course Module 7: First Edition v
Module 7: Contact Lens-Related Complications
Educators Guide to the IACLE Contact Lens Course
Overview
The IACLE Contact Lens Course is a comprehensive package of educational
materials and other resources for teaching the subject of contact lenses. This
package was designed to encompass The IACLE Contact Lens Course Syllabus and
consists of 360 hours of lectures, practicals, and tutorials in ten modules. It contains
material at basic, intermediate, and advanced levels.
The teaching resources have been designed for flexibility. They allow the educator to
select the materials appropriate to the students' knowledge and the educational
requirements of the class, school, institution, or country.
The English language reference used for the IACLE Contact Lens Course is: Brown L
(Ed.). The New Shorter Oxford English Dictionary. 1993 ed. Clarendon Press, Oxford
(UK). The only spelling exception is mold and mould. The Oxford dictionary suggests
mould in all contexts. We chose to use mold for manufacturing-related matters and
mould for fungi since both meanings and spellings appear regularly in contact lens
literature. This differentiation is based on common usage. Where words are
‘borrowed’ from a language other than English, they are reproduced in their native
form where possible.
Where standards have been ratified by the International Organization for
Standardization (ISO), or where draft ISO standards are at an advanced stage, their
relevant terminology and symbology are used. Système International (SI) units of
measure are used wherever possible.
Many major contact lens textbooks from around the world, and some important
journal articles, are referenced in the Course, and copyright illustrations are
reproduced with permission of the original publishers and/or copyright owners. The
References section at the end of each unit details the information sources used
throughout.
Teaching Resources - Module 7
Module 7 of the IACLE Contact Lens Course consists of the following materials:
1. Contact lens manual
The contact lens manual, containing:
(cid:120)(cid:3) Course overviews
(cid:120)(cid:3) Lecture outlines and notes
(cid:120)(cid:3) Practical outlines, exercises and notes*
(cid:120)(cid:3) Tutorial exercises and notes*
* Not all units contain all these sections.
The recommended allocation of time for the lecture, practical, and tutorial
components of the module are outlined in the Summary of Module 7 on
page xi. In the interests of standardization, this manual provides
recommended activities, references, textbooks, and evaluation techniques.
Ultimately however, the design and methodology of the course is left to the
discretion of the contact lens educator.
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Module 7: Contact Lens-Related Complications
2. Slides for lectures, practicals and tutorials
All slides are numbered according to the sequence in which they appear in
each lecture, practical, or tutorial, e.g. 28. Each slide is also identified by a
code based on a cataloguing system in use at the IACLE Secretariat, e.g.
7L497400-281. The identification code(s) should be used in any
communication with IACLE regarding slides.
NIBUT:
CORNEA vs SOFT LENS
For example:
100 Pre-Lens Tear Film
CCLRU data
Pre-Corneal Tear Film
80
60
60 50
To re-order this slide please quote BUTs in SECONDS
its identification code 40 25 25
20 10 15
0 5 0 0 5 5
0
0-4 5-9 10-14 15-19 20-24 25-30
97400-172S.PPT
7L497400-172
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The IACLE Contact Lens Course: Symbols, Abbreviations, and Acronyms
SYMBOLS
(cid:110) increase, high { collectively produced by
(cid:112) decrease, low } collectively produces
(cid:111) produces, towards (cid:153) sum of
(cid:109) produced by, from ± plus or minus the value of
(cid:108) no change, not obvious + plus, add, include, and
(cid:110)(cid:110) significant/great increase – minus, reduce
(cid:112)(cid:112) significant/great decrease (cid:124) approximately
% percentage = equal to, the same as
< less than, earlier than & and, as well as
> greater than, after x(cid:113) degrees: e.g. 45°
(cid:116) equal to or greater than @ in the meridian of
(cid:100) equal to or less than D dioptres
? unknown, questionable X axis: e.g. –1.00 X 175. –
1.00D cylinder, axis in 175°
meridian
n, nsub, nsub´ refractive indices (cid:39) prism dioptres or difference
(cid:118) proportional x– mean of data
ABBREVIATIONS
(cid:80)g micrograms (.001 mg) min minute, minutes
(cid:80)L microlitres (.001 mL) mL millilitres (.001L)
(cid:80)m micrometre (.001 mm) mm millimetres
(<1968: micron)
(cid:80)mol micromoles, micromolar mmol millimole, millimolar
cm centimetres (.01m) mOsm milliosmole
d day, days nm nanometres (10-9 m)
Endo. endothelium Px patient
Epi. epithelium Rx prescription
h hour, hours s second, seconds
Inf. inferior Sup. superior
kg kilograms t thickness
L litre
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ACRONYMS
ADP adenosine diphosphate LPS levator palpebrae superioris
ATP adenosine triphosphate NADPH nicotinamide adenine dinucleotide
phosphate
ATR against-the-rule NIBUT non-invasive break-up time
BS best sphere OD right eye (L.: oculus dexter)
BUT break-up time OO orbicularis oculi muscle
CCC central corneal clouding OS left eye (L.: oculus sinister)
CCD charge-coupled device OU both eyes (L.: oculi uterque, or
oculus uterque - each eye)
cf. compared to/with PD interpupillary distance
CL contact lens PMMA poly(methyl methacrylate)
Dk oxygen permeability R right
DW daily wear R&L right and left
e.g. for example (L.: exempli gratia) RE right eye
EW extended wear RGP rigid gas permeable
GAG glycosaminoglycan SCL soft contact lens
GPC giant papillary conjunctivitis SL spectacle lens
HCL hard contact lens TBUT tear break-up time
HVID horizontal visible iris diameter TCA tricarboxylic acid
i.e. that is (L.: id est) UV ultraviolet
K keratometry result VA visual acuity
L left VVID vertical visible iris diameter
LE left eye WTR with-the-rule
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Module 7: Contact Lens-Related Complications
ACRONYMS: Module 7
AI Asymptomatic Infiltrates IK Infiltrative Keratitis
AIK Asymptomatic Infiltrative LCP Lens Care Product
Keratitis
CLARE Contact Lens-induced Acute MGD Meibomian Gland Dysfunction
Red Eye
CLPC Contact Lens-induced Papillary MK Microbial Keratitis
Conjunctivitis
CLPU Contact Lens-induced RH Relative Humidity
Peripheral Ulcer
CNPU Culture Negative Peripheral SEAL Superior Epithelial Arcuate Lesion
Ulcer
FB Foreign Body ST Surface Tension
x IACLE Contact Lens Course Module 7: First Edition