fluorescein patterns. general information hydrostatic forces from the tear film holds the cl to the...
TRANSCRIPT
![Page 1: Fluorescein Patterns. General Information Hydrostatic forces from the tear film holds the CL to the eyeHydrostatic forces from the tear film holds the](https://reader036.vdocuments.mx/reader036/viewer/2022062423/56649cf55503460f949c41bc/html5/thumbnails/1.jpg)
Fluorescein PatternsFluorescein Patterns
![Page 2: Fluorescein Patterns. General Information Hydrostatic forces from the tear film holds the CL to the eyeHydrostatic forces from the tear film holds the](https://reader036.vdocuments.mx/reader036/viewer/2022062423/56649cf55503460f949c41bc/html5/thumbnails/2.jpg)
General InformationGeneral Information
• Hydrostatic forces from the tear film holds the CL to Hydrostatic forces from the tear film holds the CL to the eyethe eye
• Fluorescein shows us where there are tears between Fluorescein shows us where there are tears between the lens and corneathe lens and cornea– Fluorescein turns green when a cobalt blue or UV light hits itFluorescein turns green when a cobalt blue or UV light hits it
• Variations in the intensity of the green will tell us Variations in the intensity of the green will tell us where the lens is close to and far from the corneal where the lens is close to and far from the corneal surfacesurface
• These variations appear as “fluorescein patterns” that These variations appear as “fluorescein patterns” that tell us how the lens is fittingtell us how the lens is fitting
![Page 3: Fluorescein Patterns. General Information Hydrostatic forces from the tear film holds the CL to the eyeHydrostatic forces from the tear film holds the](https://reader036.vdocuments.mx/reader036/viewer/2022062423/56649cf55503460f949c41bc/html5/thumbnails/3.jpg)
Viewing the Fluorescein PatternViewing the Fluorescein Pattern
• Instill a small amount of fluorescein into the Instill a small amount of fluorescein into the tearstears– Wet the strip with salineWet the strip with saline– Shake off excess fluid from stripShake off excess fluid from strip– Lightly touch the strip to the inferior palpebral or Lightly touch the strip to the inferior palpebral or
bulbar conjunctivabulbar conjunctiva– Do not swab or paint the conjunctivaDo not swab or paint the conjunctiva– Do not touch the corneaDo not touch the cornea– Have the patient blink 2-3 times to distribute the Have the patient blink 2-3 times to distribute the
fluoresceinfluorescein
![Page 4: Fluorescein Patterns. General Information Hydrostatic forces from the tear film holds the CL to the eyeHydrostatic forces from the tear film holds the](https://reader036.vdocuments.mx/reader036/viewer/2022062423/56649cf55503460f949c41bc/html5/thumbnails/4.jpg)
Viewing the Fluorescein PatternViewing the Fluorescein Pattern
• Use the cobalt blue filter in the slit lampUse the cobalt blue filter in the slit lamp
• Use a yellow (Wratten 12) filterUse a yellow (Wratten 12) filter– In front of the objective or ocularIn front of the objective or ocular
– Not in front of the light sourceNot in front of the light source
• Use low mag: 10xUse low mag: 10x
• Use a wide beamUse a wide beam– Slit beam to see FP profile in one meridianSlit beam to see FP profile in one meridian
• Alternatively, use a Burton lampAlternatively, use a Burton lamp– Does not work if the RGP material has a UV blocker: Does not work if the RGP material has a UV blocker:
Boston materialsBoston materials
![Page 5: Fluorescein Patterns. General Information Hydrostatic forces from the tear film holds the CL to the eyeHydrostatic forces from the tear film holds the](https://reader036.vdocuments.mx/reader036/viewer/2022062423/56649cf55503460f949c41bc/html5/thumbnails/5.jpg)
Viewing the Fluorescein PatternViewing the Fluorescein Pattern
Cobalt blue filter without Cobalt blue filter without yellow filteryellow filter
Cobalt blue filter with Cobalt blue filter with yellow filteryellow filter
![Page 6: Fluorescein Patterns. General Information Hydrostatic forces from the tear film holds the CL to the eyeHydrostatic forces from the tear film holds the](https://reader036.vdocuments.mx/reader036/viewer/2022062423/56649cf55503460f949c41bc/html5/thumbnails/6.jpg)
Viewing the Fluorescein PatternViewing the Fluorescein Pattern
• Minimum tear thickness visible = 0.0022 mmMinimum tear thickness visible = 0.0022 mm– If tear film is thinner than this, FP appears blackIf tear film is thinner than this, FP appears black– A thin tear film is almost always present between A thin tear film is almost always present between
lens and cornea, so some green will be visible lens and cornea, so some green will be visible even where lens is closest to the corneaeven where lens is closest to the cornea
• Gradation of 0.02 mm visible as changes in Gradation of 0.02 mm visible as changes in FP green intensityFP green intensity
![Page 7: Fluorescein Patterns. General Information Hydrostatic forces from the tear film holds the CL to the eyeHydrostatic forces from the tear film holds the](https://reader036.vdocuments.mx/reader036/viewer/2022062423/56649cf55503460f949c41bc/html5/thumbnails/7.jpg)
Viewing the Fluorescein PatternViewing the Fluorescein Pattern
• Too much fluorescein will obscure the true FPToo much fluorescein will obscure the true FP– Front surface fluoresceinFront surface fluorescein– Artificially thick post-lens tear filmArtificially thick post-lens tear film– Wait for most of the Fl to dissipateWait for most of the Fl to dissipate
• Too little will not reveal true FPToo little will not reveal true FP– Will appear “alignment” even if notWill appear “alignment” even if not
![Page 8: Fluorescein Patterns. General Information Hydrostatic forces from the tear film holds the CL to the eyeHydrostatic forces from the tear film holds the](https://reader036.vdocuments.mx/reader036/viewer/2022062423/56649cf55503460f949c41bc/html5/thumbnails/8.jpg)
Viewing the Fluorescein PatternViewing the Fluorescein Pattern
![Page 9: Fluorescein Patterns. General Information Hydrostatic forces from the tear film holds the CL to the eyeHydrostatic forces from the tear film holds the](https://reader036.vdocuments.mx/reader036/viewer/2022062423/56649cf55503460f949c41bc/html5/thumbnails/9.jpg)
Pattern RelationshipsPattern Relationships
• AlignmentAlignment– Back surface of lens matches the Back surface of lens matches the
corneal curvaturecorneal curvature
• ClearanceClearance– There is space between the lens There is space between the lens
and corneaand cornea
• TouchTouch– The lens is close to the cornea The lens is close to the cornea
compared to another part of the compared to another part of the lenslens Flat
Steep
Aligned
![Page 10: Fluorescein Patterns. General Information Hydrostatic forces from the tear film holds the CL to the eyeHydrostatic forces from the tear film holds the](https://reader036.vdocuments.mx/reader036/viewer/2022062423/56649cf55503460f949c41bc/html5/thumbnails/10.jpg)
Pattern LocationsPattern Locations
• ApicalApical– Central portion of the FPCentral portion of the FP– Area under the optic zoneArea under the optic zone
• Mid-peripheralMid-peripheral– Area under the intermediate curvesArea under the intermediate curves– Determines lens positioning and Determines lens positioning and
movement patternsmovement patterns
• PeripheralPeripheral– Area under the peripheral curveArea under the peripheral curve– Determines tear exchangeDetermines tear exchange
![Page 11: Fluorescein Patterns. General Information Hydrostatic forces from the tear film holds the CL to the eyeHydrostatic forces from the tear film holds the](https://reader036.vdocuments.mx/reader036/viewer/2022062423/56649cf55503460f949c41bc/html5/thumbnails/11.jpg)
Pattern DynamicsPattern Dynamics
• Static patternStatic pattern– FP when the lens is centered on the corneaFP when the lens is centered on the cornea– If lens decenters, must manually center lens using If lens decenters, must manually center lens using
patient’s lidspatient’s lids– Gives true apical relationshipGives true apical relationship
• Dynamic patternDynamic pattern– FP when the lens is in its normal resting positionFP when the lens is in its normal resting position– May be different from static patternMay be different from static pattern– Pattern not as flat as when centered because Pattern not as flat as when centered because
peripheral cornea is flatterperipheral cornea is flatter
![Page 12: Fluorescein Patterns. General Information Hydrostatic forces from the tear film holds the CL to the eyeHydrostatic forces from the tear film holds the](https://reader036.vdocuments.mx/reader036/viewer/2022062423/56649cf55503460f949c41bc/html5/thumbnails/12.jpg)
Pattern DynamicsPattern Dynamics
Dynamic pattern:Dynamic pattern:Normal resting positionNormal resting position
Static pattern:Static pattern:Lens in central positionLens in central position
![Page 13: Fluorescein Patterns. General Information Hydrostatic forces from the tear film holds the CL to the eyeHydrostatic forces from the tear film holds the](https://reader036.vdocuments.mx/reader036/viewer/2022062423/56649cf55503460f949c41bc/html5/thumbnails/13.jpg)
PatternsPatterns
• Apical alignment (AA)Apical alignment (AA)
![Page 14: Fluorescein Patterns. General Information Hydrostatic forces from the tear film holds the CL to the eyeHydrostatic forces from the tear film holds the](https://reader036.vdocuments.mx/reader036/viewer/2022062423/56649cf55503460f949c41bc/html5/thumbnails/14.jpg)
PatternsPatterns
• Apical clearance (AC)Apical clearance (AC)
![Page 15: Fluorescein Patterns. General Information Hydrostatic forces from the tear film holds the CL to the eyeHydrostatic forces from the tear film holds the](https://reader036.vdocuments.mx/reader036/viewer/2022062423/56649cf55503460f949c41bc/html5/thumbnails/15.jpg)
PatternsPatterns
• Apical touch (AT)Apical touch (AT)
![Page 16: Fluorescein Patterns. General Information Hydrostatic forces from the tear film holds the CL to the eyeHydrostatic forces from the tear film holds the](https://reader036.vdocuments.mx/reader036/viewer/2022062423/56649cf55503460f949c41bc/html5/thumbnails/16.jpg)
PatternsPatterns
• Mid-peripheral alignmentMid-peripheral alignment
![Page 17: Fluorescein Patterns. General Information Hydrostatic forces from the tear film holds the CL to the eyeHydrostatic forces from the tear film holds the](https://reader036.vdocuments.mx/reader036/viewer/2022062423/56649cf55503460f949c41bc/html5/thumbnails/17.jpg)
PatternsPatterns
• Mid-peripheral touchMid-peripheral touch
![Page 18: Fluorescein Patterns. General Information Hydrostatic forces from the tear film holds the CL to the eyeHydrostatic forces from the tear film holds the](https://reader036.vdocuments.mx/reader036/viewer/2022062423/56649cf55503460f949c41bc/html5/thumbnails/18.jpg)
PatternsPatterns
• Mid-peripheral clearanceMid-peripheral clearance
![Page 19: Fluorescein Patterns. General Information Hydrostatic forces from the tear film holds the CL to the eyeHydrostatic forces from the tear film holds the](https://reader036.vdocuments.mx/reader036/viewer/2022062423/56649cf55503460f949c41bc/html5/thumbnails/19.jpg)
PatternsPatterns
• Peripheral clearancePeripheral clearance
Minimal / noneMinimal / none Moderate / mediumModerate / medium High / excessiveHigh / excessive
![Page 20: Fluorescein Patterns. General Information Hydrostatic forces from the tear film holds the CL to the eyeHydrostatic forces from the tear film holds the](https://reader036.vdocuments.mx/reader036/viewer/2022062423/56649cf55503460f949c41bc/html5/thumbnails/20.jpg)
Toric PatternsToric Patterns
• With-the-ruleWith-the-rule
![Page 21: Fluorescein Patterns. General Information Hydrostatic forces from the tear film holds the CL to the eyeHydrostatic forces from the tear film holds the](https://reader036.vdocuments.mx/reader036/viewer/2022062423/56649cf55503460f949c41bc/html5/thumbnails/21.jpg)
Toric PatternsToric Patterns
• Against-the-ruleAgainst-the-rule
![Page 22: Fluorescein Patterns. General Information Hydrostatic forces from the tear film holds the CL to the eyeHydrostatic forces from the tear film holds the](https://reader036.vdocuments.mx/reader036/viewer/2022062423/56649cf55503460f949c41bc/html5/thumbnails/22.jpg)
Toric PatternsToric Patterns
• 1 D corneal toricity1 D corneal toricity
![Page 23: Fluorescein Patterns. General Information Hydrostatic forces from the tear film holds the CL to the eyeHydrostatic forces from the tear film holds the](https://reader036.vdocuments.mx/reader036/viewer/2022062423/56649cf55503460f949c41bc/html5/thumbnails/23.jpg)
Toric PatternsToric Patterns
• 2 D corneal toricity2 D corneal toricity
![Page 24: Fluorescein Patterns. General Information Hydrostatic forces from the tear film holds the CL to the eyeHydrostatic forces from the tear film holds the](https://reader036.vdocuments.mx/reader036/viewer/2022062423/56649cf55503460f949c41bc/html5/thumbnails/24.jpg)
Toric PatternsToric Patterns
• 3 D corneal toricity3 D corneal toricity
![Page 25: Fluorescein Patterns. General Information Hydrostatic forces from the tear film holds the CL to the eyeHydrostatic forces from the tear film holds the](https://reader036.vdocuments.mx/reader036/viewer/2022062423/56649cf55503460f949c41bc/html5/thumbnails/25.jpg)
Toric PatternsToric Patterns
• 4 D corneal toricity4 D corneal toricity
![Page 26: Fluorescein Patterns. General Information Hydrostatic forces from the tear film holds the CL to the eyeHydrostatic forces from the tear film holds the](https://reader036.vdocuments.mx/reader036/viewer/2022062423/56649cf55503460f949c41bc/html5/thumbnails/26.jpg)
Toric PatternsToric Patterns
• Alignment, clearance and touch patternsAlignment, clearance and touch patterns
Apical touch:Apical touch:On Flat KOn Flat K
Apical alignment:Apical alignment:Splitting KSplitting K
Apical clearance:Apical clearance:On Steep KOn Steep K
![Page 27: Fluorescein Patterns. General Information Hydrostatic forces from the tear film holds the CL to the eyeHydrostatic forces from the tear film holds the](https://reader036.vdocuments.mx/reader036/viewer/2022062423/56649cf55503460f949c41bc/html5/thumbnails/27.jpg)
Toricity and Lens PositionToricity and Lens Position
• With-the-rule corneasWith-the-rule corneas– Superior or inferior positionSuperior or inferior position– Good for LA but poor if inferiorGood for LA but poor if inferior– Steeper fits tend to center betterSteeper fits tend to center better
• Against-the-rule corneasAgainst-the-rule corneas– Temporal or nasal positionTemporal or nasal position– Poor comfort when decentered Poor comfort when decentered
laterallylaterally– Difficult to stabilizeDifficult to stabilize– Steeper fits tend to center betterSteeper fits tend to center better
![Page 28: Fluorescein Patterns. General Information Hydrostatic forces from the tear film holds the CL to the eyeHydrostatic forces from the tear film holds the](https://reader036.vdocuments.mx/reader036/viewer/2022062423/56649cf55503460f949c41bc/html5/thumbnails/28.jpg)
Changes in FP with DecentrationChanges in FP with Decentration
• FP is not as flat as when centeredFP is not as flat as when centered– Central cornea is steeper than peripheryCentral cornea is steeper than periphery
• Mid-peripheral arcuate poolingMid-peripheral arcuate pooling• Companion touch in peripheryCompanion touch in periphery
– In direction of decentration In direction of decentration
![Page 29: Fluorescein Patterns. General Information Hydrostatic forces from the tear film holds the CL to the eyeHydrostatic forces from the tear film holds the](https://reader036.vdocuments.mx/reader036/viewer/2022062423/56649cf55503460f949c41bc/html5/thumbnails/29.jpg)
Changes in FP with DecentrationChanges in FP with Decentration
![Page 30: Fluorescein Patterns. General Information Hydrostatic forces from the tear film holds the CL to the eyeHydrostatic forces from the tear film holds the](https://reader036.vdocuments.mx/reader036/viewer/2022062423/56649cf55503460f949c41bc/html5/thumbnails/30.jpg)
Toricity and Lens MovementToricity and Lens Movement