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1、Fitting Procedures: Preliminary Examination,School of Optometry & Ophthalmology Wenzhou Medical College,Preliminary Examination,Case History Visual acuity & Visual functions Slit Lamp Biomicroscopy Measurement of Ocular Dimensions Assessment of the Tear Layer Refraction,Welcome to the Clinic,Prelimi
2、nary Examination,Case History Visual acuity & Visual functions Slit Lamp Biomicroscopy Measurement of Ocular Dimensions Assessment of the Tear Layer Refraction,Case History,Purpose of contact lens wear Current Lens type, modality and replacement schedule Current Care and maintenance,General health c
3、ondition,Diabetes Arthritis Thyroid problems Parkinsons Disease Pregnancy,Medications/therapeutics,Preliminary Examination,Case History Visual acuity & Visual functions Slit Lamp Biomicroscopy Measurement of Ocular Dimensions Assessment of the Tear Layer Refraction,Visual acuity Visual functions:Amp
4、, NPC,CV,CT, stereopsis, pupil, VF, EOM,Preliminary Examination,Case History Visual acuity & Visual functions Slit Lamp Biomicroscopy Measurement of Ocular Dimensions Assessment of the Tear Layer Refraction,Slit Lamp Biomicroscopy,96114-,3,S.PPT,BIOMICROSCOPY,BIOMICROSCOPY,Performed:,Before CL fitti
5、ng or CL wear, to,establish a Baseline,During trial lens fitting(s) and,after-care visits to assess:,-,lens fit,-,any anterior eye changes,Performed:,Before CL fitting or CL wear, to,establish a Baseline,During trial lens fitting(s) and,after-care visits to assess:,-,lens fit,-,any anterior eye chan
6、ges,Slit lamp biomicroscopy,Anterior segment health assessment Tear film examination Fitting assessment Lens surface check,PARTS OF THE SLIT LAMP BIOMICROSCOPE,Mechanical support Observation system Illumination system,BIOMICROSCOPE OBSERVATION SYSTEM Features,Variable magnification Binocular system,
7、SLIT LAMP BIOMICROSCOPY,SLIT LAMP BIOMICROSCOPYLow Magnification (7X 10X),General eye: Lids Bulbar conjunctiva / sclera Cornea / limbus Tears Anterior chamber / iris / crystalline lens,SLIT LAMP BIOMICROSCOPYMedium Magnification (20X 25X),Structures: Epithelium Stroma Endothelium Lens fit / surface,
8、SLIT LAMP BIOMICROSCOPYHigh Magnification (30X 40X),Details: Epithelial changes Stromal striae, folds Endothelial folds,BIOMICROSCOPE ILLUMINATION SYSTEM,Features Variable light intensity Filters Width Height Angle,ILLUMINATION TECHNIQUES,Diffuse Retro-illumination Direct Specular reflection Indirec
9、t Sclerotic scatter Tangential,Direct,Direct retro,FILTERED ILLUMINATION,Most valuable: Cobalt blue & Wratten #12,FILTERED ILLUMINATION,Valuable for observing: Tear layer Staining RGP lens fitting patterns,Wratten Filter No Filter,Preliminary Examination,Case History Visual acuity & Visual functions
10、 Slit Lamp Biomicroscopy Measurement of Ocular Dimensions Assessment of the Tear Layer Refraction,水平可见虹膜直径Horizontal Visible Iris Diameter,Measurement of Ocular Dimensions: Assessment of Lid Characteristics,Assessment of Lid Characteristics,Significant differences between the lid characteristics of
11、different races Especially in terms of the palpebral aperture and lid tension,94N34-,18,S.PPT,Lens-lid interaction,Upper lid lower lid,角膜,镜片周边,镜前泪膜,镜后泪膜,眨 眼 时 镜 片 运 动,Blink rate,Normal involuntary blinking is a result of tear evaporation and tear film break-up being sensed by the cornea An adequate
12、blink rate is necessary to prevent dessication of the ocular surface Partial blinking may result in superficial puncate staining of the cornea How to measure: During the preliminary slit-lamp examination While talking to the patient without alerting them to what is being done Averagely 12 blinks per
13、 minute,Preliminary Examination,Case History Visual acuity & Visual functions Slit Lamp Biomicroscopy Measurement of Ocular Dimensions Assessment of the Tear Layer Refraction,Break-up-time (BUT or TBUT),A measure of the stability of the tear film BUT is the time taken(in seconds) for the first break
14、 in the tear film(dry spot) to appear following a complete blink Tear film breaks appear as dark spots or streaks Normal TBUT:1545s 10s:unstable tear film Consistently breaks up in the same position: defect in the corneal epithelium,Schirmer test: tear production,To evaluate the integrity of the lac
15、rimal secretion system #1: measures the amount of total tear secretion within a 5 minute period Total secretion: the sum of basal Krause and Wolfring and reflect secretion by the main lacrimal gland. #2:basic lacrimation test, a topical anesthetic is used to eliminate the reflex secretion,NIBUT,Avoi
16、d any artefacts resulting from fluorescein instillation Diffused white light of a slit-lamp or a Tearscope Slit lamp: generates heat and cause evaporation of the tear film thus affecting the NIBUT Tearscope:cold light source allowing truer estimation of the NIBUT,TEARSCOPE,(Tear prism),Tear prism height:tear reservoir volume,A tear reservoir associated with the lower lid margin The upper lid spreads tears Normal height:0.1-0.3mm Dry eye:0.1mm,Preliminary Examination
