Basics of Contact Lens Fitting (5 ECTS)

Objective

Students are able to describe the main features of the history of contact lenses. They know the structures and functions of the eye relevant to the use of contact lenses as well as restrictions on their use. Students can classify the main characteristics of the different lens materials and describe
the influence of the lens design on their optics and application. Students are able to evaluate the benefits and limitations of contact lenses as a vision correction. Students are able to determine the signs, symptoms and management options for contact lens complications. They know how to use the grading scales in assessing the anterior eye, and can identify indications and contraindications for the use of contact lenses based on the preliminary examination. Students can clean and care for contact lenses, and they know the most common contact lens solutions and their active ingredients. Students are able to choose the suitable lens type, soft or rigid, for their customer, as well as insert and remove contact lenses safely. They can assess the fit and suitability of soft contact lenses, and give appropriate instructions on how to use and care for the lenses.

Content

History of contact lenses, anatomy and physiology of the eye relevant to contact lens wear, limitations and benefits of contact lens use, eye examination in the contact lens fitting, lens materials, designs and optics. Selecting and fitting lenses, contact lens complications, grading scales, recommending contact lenses, contact lens solutions, teaching the use of contact lenses.

Materials

Lecture notes, articles
Web-source: https://www.jnjvisioncare.co.uk/educational-moments-clinical-topics
Suggested literature:
Elliott (2014) Clinical Procedures in PRIMARY EYE CARE. Ch. 5 Contact Lens Assessment, pages 112-146.
Phillips & Speedwell (2007) Contact lenses (5th Ed.)
Veys, Meyler, Davies (2002) Essential Contact Lens Practice
Efron (2004) Contact Lens Complications
Additional materials:
CL materials: e.g.
Purslow C (2010) Current materials and care regimes– implications for clinical practice. Optometry Today CET 29.1.2010
Grading scales: Brien Holden, Alcon, Efron, Johnson & Johnson
Efron, Nathan (2010 and 2018) Contact lens practice editions 2 and 3.

Teaching methods

Interactive lectures
Guided practicals and assignments
Learning assignments

Exam schedules

Written examination x.x.2020. Retake 1 x.x.2020. Retake 2 x.x.2020.

Student workload

Lectures: 3 ECTS, approx. 30h lectures
Laboratory instruction: 2 ECTS, 40h

Further information

In case a student has a decision on special support arrangements affecting the course the student needs to contact the teacher in charge right after enrollment period.
PRACTICALS:
- Practicals consist of instructions at the start of the session and supervised contact lens practice where students examine and fit contact lenses to fellow students.
- There are ten four-hour practical sessions with two supervisors (lecturers). After ten practical sessions the student has examined ten fellow students.
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Teaching may be conducted partly in English
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Detailed content
Lens types and materials:
- Hard lenses, Lathe cut, Moulded , Spincast soft lenses
- Centre and edge thickness
- Asphericity
- Sagittal depth
Insertion and removal techniques SCL
Design of wearing schedules
Contraindications
Patient handling and control
The examination of a new prospective contact lens patient including
- History
- Anterior segment examination
- Measurement of anterior segment
- Care of lenses:
Handling
Cleaning
Preservatives available
Disinfection methods
Solutions
- Follow-up care
- Adaptation
- Physiologic and post-fitting complications
- Allergic responses
- Lens changes
- Mechanical problems
Strong powers/aphakia:
- Magnification
- Field of view
- Spatial distortion
- Convergence requirements
Treatment and management of refractive/oculomotor/sensory integrative conditions using contact lenses
Eyelids
- Blink reflexes and protective functions
- Role in production, distribution and drainage of tears
Tears
- Physical characteristics
- Functions of tears
- Source and function of each layer of tears
- Basic and reflex tear secretion
Lacrimal system evaluation
- Clinical use
- Instrumentation
- Clinical procedure
- Clinical implications
Cornea
- Physical characteristics (water content, protein content, cells, resistance to trauma)
- Permeability characteristics of various layers
- Metabolic characteristics of various layers
- Factors influencing corneal thickness/hydration and theories of transparency
- Physiological parameters, necessary to maintain corneal integrity
- Physiological characteristics of corneal nerves
- Temperature
Ocular Adnexa
- Observation, inspection, recognition of signs, and techniques and skills including:
Lid eversion
Diagnosis and management of marginal lid disease
Biomicroscopic appearance of relevant structures in health and disease
External photography and documentation
Signs and symptoms of related systemic diseases
Lacrimal System
- Observation, inspection, recognition of signs, and techniques and skills including:
Biomicroscopic appearance
Use of fluorescein and rose Bengal dyes
Tests of basic and reflex secretion
Fluorescein transit tests to nose and oropharynx
Qualitative & quantitative tear assessment
Observation, inspection, recognition of signs, and techniques and skills including:
- Biomicroscopy to highlight and describe morphology and location of irregularities, deposits, opacities, etc.
- Biomicroscopic appearance of varied appearance of the lids and cornea in primary conjunctival disease
- Signs and symptoms of related systemic diseases
- Differential diagnosis of viral, bacterial and allergic conjunctivitis
- Treatment of conjunctivitis

Evaluation scale

0-5

Assessment criteria, satisfactory (1)

The student is able to:
- display learning in professional knowledge and core content in the field
- search information from a variety of sources
- work in various duties in a variety of operating environments
- show that he has achieved the targets for core competence
- display learning in the key safety practices in the field
- act according to ethical principles
- to contribute his learning for the benefit of a group or project

Assessment criteria, good (3)

The student is able to:
- use concepts and knowledge in his field systematically
- find information and assess and use information sources with a critical eye
- apply professional information in professional assignments
- apply professional expertise in various work assignments
- act independently and responsibly in professional contexts
- plan operations with safety in mind
- act according to professional ethics
- act purposefully in working groups and projects

Assessment criteria, excellent (5)

The student is able to:
- use concepts and knowledge in his field professionally
- argue the use of his sources - argue a course of action on the basis of research information or findings
- operate in a range of duties and work situations, also in international contexts
- to act in a way that is customeroriented and displays entrepreneurial spirit
- to act responsibly, taking safety issues into consideration
- argue his choices on the basis of professional ethics
- organise and manage the operation of a group and project

Assessment criteria, approved/failed

The student is able to:
- The student does not know or appreciate knowledge in the field sufficiently
- The student does not know or cannot use concepts in his field properly
- The student's professional level is insufficient
- The student is not acting in accordance with his training and guidance
- The student is not trying to develop himself or his actions
- The student is unconcerned about professional safety or ethical principles
- The student is not motivated by or participating in group or development work

Assessment methods and criteria

Written examination represents 90 % of the final mark.
Learning assignments (History of contact lenses-essay, endothelial pump-essay, calculations regarding contact lens optics): Pass / Rewrite
Written assignments must be returned and approved.
Attendance at the practicals. All practical work sheets must be returned at the end of the course to be approved by the lecturers.
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Practical competency assessment: Practical competency assessment represents 10% of the final course mark. In the exam the students demonstrate their ability to use required illumination techniques when examining the contact lens patient and ocular health. The assessment includes:
- General communication skills, instructions to the patient and microscope adjustments
- Focusing oculars without the focusing rod
- Specular reflection tear film and endothelium, temporal side and center of the cornea
- Conical beam anterior chamber cell and flare
- Sclerotic scatter
- Van Herick angle temporal and nasal
- Lid eversion on slit lamp
- Good hand hygiene
Written examination: 50% is required to pass. Clinical exam points are then added to the written points.
Learning assignments: Pass / Rewrite
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Practicals: Absences must be covered by attendance during another session. All practical work sheets must be returned at the end of the course and approved by the lecturers as Pass / Rewrite
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Permitted aids at the examination:
Standard: Pen, pencil, eraser, calculator and ruler.

Qualifications

Function of the Eye and Refraction