Pertemuan Ilmiah Tahunan Perdami ke-40

Adaptive Symptoms of RGP

Dr. Christina A, SpM
RSUD Dr. Soetomo - Fk. Unair Surabaya

Types of CL Adaptation
A. Physiological
B. Neurological
CL Adaptation
A. Physiological:

Lacrimation contributes to 3% corneal

Altered tear protein levels, NaCl and K ions affect equilibrium of tear
layer (Gildos-Donnan)

Tear layer becomes diluted of proteins and ions (ie. hypotonic)

B. Neurological:

Corneal sensitivity decreases with lens wear

As the Dk of the material decreases, the corneal thickness increases and

the corneal sensitivity decreases (Millidot)

Neural adaptation coincides with CL adaptation (Lowther and Hill)

CL Adaptation versus Abnormal Symptoms:

Adaptive Symptoms:

expected during the first 2-4 weeks of wear

diminishes with each day

Abnormal Symptoms:

persist beyond the expected period

due to an identifiable physical cause

lens /solution related

procedural errors

environment related

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Bandung, 13-15 Agustus 2015

Pertemuan Ilmiah Tahunan Perdami ke-40

NORMAL ADAPTIVE SYMPTOMS occur:

* Normal ocular response for the first couple of weeks

* in drop-outs when refitted
* in occasional wearers
* Greater with rigid lenses
* Usually only some, not all, reported
* Usually only in very early stages of wear
NORMAL ADAPTIVE SYMPTOM (diminish gradually):

Mild sensitivity to light as extra sensitivity to wind,smoke,dust

Slight headache

Tearing- foreign body sensation

Dryness

Increases blinking

Difficulty looking up and to side

Abnormal head posture

Palpebral aperture narrowing

Itchiness of lids and eyes after removal

Photophobia

mild redness at the end of wearing period. It is common for patient

with allergies or chronic sinus problems.

fluctuating vision

halo or flare at night, reflections, fluttering of light, haze

lid swelling

mild blur after each blink excess tears

mild discomfort or irritation cause lense contact with the upper lid on
upward gaze

lens/eye dry at the end of wearing time

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Bandung, 13-15 Agustus 2015

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Spectacle blur after the removing the CLs should not last over 15 20
minutes good central corneal response

Abnormal Symptoms ( Sudden):

Sudden pain/burning during and after CL wear

Excessive tearing

Severe redness / irritation that does not clear up

Severe/ persistent halo around lights

Blur with specs > 1 hour after removal

Increasing discharge or mattering

Lens adhering to eye

At any time occur should remove the lenses

Abnormal Symptoms ( Persistent):

Vision reduction/fluctuation

Discomfort/pain

Dryness

Redness

Abnormal Symptoms: Vision

Immediate

constant :
improper refraction
significant uncorrected astigmatism
poor optics
inverted lens
lens switched
lens surface defects/scratches

intermittent/fluctuate :

loose fit

optic zone not centred

optic zone too small/ only in dark

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Bandung, 13-15 Agustus 2015

Pertemuan Ilmiah Tahunan Perdami ke-40

dry environment

dry eyes

improper/incomplete blink

Delayed

becomes worse :
flat/steep fit (punctate staining)
excessive/minimum lens movement
mechanical trauma to cornea
poor tear circulation
change in lens parameters/warpage
deposits
discolouration

fluctuate :
excessive secretions
incorrect lens bearing
secretion with bad lens edge
BV anomaly/accommodation

Spectacle Blur (GP) :

<1 hour
low DK causing corneal warpage
modify lens edge
modify lens parameters
change lens power
change lens design
give BV training
clean/polish lens
go to disposable lens

Reduced Vision with GP

flexure
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Bandung, 13-15 Agustus 2015

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warpage
decentration
poor surface wettability
power change
Flexure: Causes
high astigmatism
steep BOZR
thin design
large BOZD
Flexure: Diagnosis
toricity with over-K
spherical on radiuscope
Warpage: Causes
digital pressure when cleaning
former PMMA wearer
improper placement in case
Warpage: Diagnosis
toric values with radiuscope
Decentration: Causes
decentered apex
unusual corneal topography
tight or loose lid tension
thick lens design
high specific gravity material
Decentration: Diagnosis
biomicroscopic evaluation during & after the blink
Poor Surface Wettability: Causes
Initial
too much heat during manufacturing
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Bandung, 13-15 Agustus 2015

Pertemuan Ilmiah Tahunan Perdami ke-40

poor polishing techniques

improper diamond
residual pitch
Poor Surface Wettability: Causes
Acquired
poor tear quality
improper blinking
poor compliance
improper solution
hand creams, cosmetics
scratches
Poor Surface Wettability: Diagnosis
poor surface wettability;
break-up of tears
presence of hazy or mucoprotein deposits
Power Change: Causes
aggressive digital cleaning
use of an abrasive cleaner
Power Change: Diagnosis
increase in minus power & or
decrease in centre thickness during progress visit

Abnormal Symptoms: Discomfort

Immediate

Becomes worse
loose lens
excessive movement
tear, bad edge
trapped foreign body

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Bandung, 13-15 Agustus 2015

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hypersensitive/psychological

Subsides
environmental
smoking
low humidity
dirty environment

Delayed

Becomes worse
asthenopia
residual astigmatism
accommodation
BV anomaly

upon insertion
after removal
constant
immediate (after a period of wear)
Upon insertion
torn lens
solution sensitivity
prism ballast
After Removal
abrasion
infection
ulcer
Constant
tight lens
edema
lens deposits
Immediate
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Bandung, 13-15 Agustus 2015

Pertemuan Ilmiah Tahunan Perdami ke-40

trapped FB
torn lens
lens deposits
Leposits
inverted lens
abrasion
defective lens
edema
pathology
Causes of Abnormal Symptoms :

Refractive - flexure, optics

Mechanical - edge, fitting, wettability

Toxic/Allergic - solution

Hypoxic - Dk, overwear

Inflammatory - deposits

Infectious microorganisms

How to manage adaptation successfully ?

Tell to the patient about adaptation process

Some patient to be totally satisfied at 4 weeks

Increase their wearing time everyday

Starting off using lens for 3 hours on the first day increasing the
wearing time by an hour a day.

RGP lens do not induce more initial awareness than SCL because they are
rigidfelt more initiallysmaller and move more with the blink.

Wearing Schedule is as follow :

Day 1 2 : 4 hours
Day 3 4 : 6 hours
Day 5 6 : 8 hours
Day 7 8 : 10 hours
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Bandung, 13-15 Agustus 2015

Pertemuan Ilmiah Tahunan Perdami ke-40

Day 9 - ... : full 12 hours wearing

CONCLUSION

Adaptive symptoms normally occur during the first 2-4 weeks of wear

Awareness that increases towards end of wearing period

Slight redness

Slight tearing

Awareness of lens edge > at night

Halo or flare >at night

Slight spectacle blur

Increasing wearing time (follow the wearing schedule) everyday can

reduce the symptoms

Trans Luxury Hotel,

Bandung, 13-15 Agustus 2015