cornea + contact lens final à adaptation to gps 角膜接触镜à+最终适应gps

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1、CORNEA+CONTACTLENSFINALàADAPTATIONTOGPsINTRODUCTION-ADAPTATIONcontainsandO2-componentandafit-component-PRIOR:adaptationusedtobedrivenbylackofO2-CURRENT:adaptationnowdrivenbyedgecomfortandmechanicsoflensRESEARHSTUDIESSTUDYSET-UPFINDINGSMandell,Harris(1969)-Fitoneeye

2、of4unadaptedpatientsw/PMMAlens-Measuredcornealswellingofcontralateraleye-3-4%cornealswellingincontralateraleyeduetoreflextearingfrominteractionofGPedgew/cornea-ReflextearinglowersteartonicityandresultsinK-edemaMandell,Polse,Fatt(1970)-FitPMMAbilaterallyto4unadapted

3、patients-Measuredmaximumcornealswelling&adaptation-A-adaptors:maximumK-swellingof5%(swellingduetoreflextearing);K-swellingdecreasedto2%afterday1(swellingduetolackofO2);fullyadaptedbyday9-B-adaptors:maximumK-swellingof7%;K-swellingdecreasedto4%afterday1;fullyadapted

4、byday17-MaximumK-swellingoccurredafter3hoursofwearoBasisofCLf/uàinstructpatienttowearCL2-4hrspriortovisitbcwanttoseeCLatworstMandell,Polse,Fatt(1971)-Fit1A-adaptorw/ACPMMA-MaximumK-swellingof9-10%2hrsafterfitting-AdaptationisrelatedtofitoSteepfit(AC)willkeeptearsfr

5、omsufficientlygettingunderlensàlackoffreshO2tocorneaBrungardt,Potter(1971)-101eyesof53patientsfittedw/PMMA-Kmsteepenedduring1st5daysoDuetoswelling(reflextearing,lackofO2)-K-moldingoccurredoDistortionnolongerseenfromlackofO2oDistortionduetofitoflens+lensbearingoncor

6、nea§Lensfit/bearingwillreshapecorneaàcanmoldawaysometoricity+makecorneamorespherical§Moldingcancausespectacleblur-Adaptationcompleteby30days-75%weregoodadapters(A-adapters)Portz,Brungardt-Fittedunadaptedpatientsw/PMMA,CAB(Dk5),andSA(Dk10)-Fasteradaptationwithhigher

7、DkmaterialBennet(1997)-40unadaptedsubjectsreceivedanesthetic-40unadaptedsubjectsreceivedplacebo-AnestheticgroupratedoverallGPcomfort/satisfactionhigher-PROSofanestheticsoBetterinitialexperienceoFewerdropouts-CONSofanestheticsoMustadapttotheedgew/oanestheticeventual

8、ly§AnestheticwearsoffoAnestheticsoftensthecorneaàgreaterriskofabrasion§CannotfeelifanythingcaughtunderlensoCannotputanestheticinrewettingdropsGPT