Aspect Os Fundamental Es

Aspectos Fundamentales de los lentes RGP

Really Get Practical123

Candidatos idneos para los lentes RGP de hoy en daPacientes que deseen excelente visinPacientes con astigmatismo corneal.Pacientes HipermtropesPacientes Post cirugaPacientes con astigmatismo refractivoNios

Candidatos idneos para los lentes RGP de hoy en daPacientes que necesitan fcil insercin y remocinPacientes con astigmatismo irregularPrsbitasPacientes que quieren una opcin saludable en lentesPacientes que necesitan fcil manejo y cuidado

Candidatos idneos para los lentes RGP de hoy en daAdolescentesPacientes que deseen usar los lentes todo el daPacientes que deseen lentes de uso prolongadoMiopesPacientes que deseen un lente durable Pacientes Post trauma

Candidatos IdealesEstilo de vida del Paciente y Decisin Personal Excelente visinFcil manejo y cuidadoUso prolongado de lentes (Diario/ Extendido)Opcin saludable de lentesFcil insercin y remocinOpcin Durable en lentes

Candidatos Ideales Anatoma y Condiciones Refractivas del PacienteAstigmatismo CornealAstigmatismo Refractivo Astigmatismo IrregularRefraccin esfricaMiopa, Hipermetropa, Presbicia

Diseo de lentes RGPDimetroCurva base PoderMaterialCurva intermediaCurva perifrica Espesor central Diseo del bordeLevantamiento axialDimetro de la zona ptica

Diseo de lentes Blandos TricosCurva Base Poder esfricoPoder CilindrcoEjeDimetroCurva intermediaCurva PerifricaDametro de la zona pticaLevantamiento axialEspesor centralDiseo del bordeMaterial

Adaptacin a los RGP ....en solo tres pasos

Diseando el Lente en el Papel.Un Mtodo sencillo.11.5 mm

Paso #1 Seleccione el Diametro del lente12.0mm=9.5 diametroHVIDGrande

Paso #2 Seleccione la Curva BaseCilindro Corneal0.00 D a 1.25 D

8.5 dia. 0.25 STK 9.0 dia = a K9.5 dia.0.25 FTKCilindro Corneal1.50 D a 2.25 D

8.5 dia. 0.75 STK 9.0 dia 0.50 STK9.5 dia 0.25 STK Cilindro corneal > 2.25 D Considere un diseo torico especial

Paso #3 Poder de los Lentes Conozca SAM FAPSteep Add MinusCurvo Aumente (-)Flat Add PlusPlano Aumente (+)

Ejemplo

Paso#2

Ks= 43.00 @ 180 / 44.75 @ 90

K Plana= 43.00

Cilindro Corneal = 1.75 D

Curva Base = 0.50 D Ms curvo que la K

= 43.50

Steep Add Minus Curvo Aumente -Aumente () Al lente

Ejemplo

Paso#3

K Plana = 43.00

Curva Base = 43.50

Rx del Paciente = -3.00 -1.75 X 180

Poder del Lente = -3.50

Lente Final = 43.50 -3.50 9.0

Steeper Add Minus Curvo Aumente (-)

Ejemplo

Paso#2

Ks= 42.25 @ 180 / 43.00 @ 90

K Plana= 42.25

Cilindro Corneal = 0.75 D

Curva Base = 0.25 D ms plana que la K

= 42.00Paso#1>12.0mm=9.5 dametroHVIDGrande

Flat Add Plus Plano Aumente (+)Aumente (+) al lente

Ejemplo

Paso#3

K Plana = 42.25

Curva Base = 42.00

Rx Paciente = -2.00 -0.75 X 180

Poder del Lente = -1.75

Lente Final = 42.00 -1.75 9.5

Flatter Add Plus Plano Aumente (+)

VerticeTodos los Poderes > 4.00 D

Si desea mover el lente ms cerca de la crnea central :

Aplane la Curva Base

Si desea mover el lente lejos de la crnea central :

Ajuste la Curva Base

Principios de diseo de lentes RGP

Principios de diseo de lentes RGPLos Lentes RGP DEBEN!Moverse arriba y abajo en el ojoProveer buena visin

Principios de diseo de lentes RGPLos lentes RGP siempre se movern en la direccin que les d menos resistencia. Esto significa que los lentes siempre se movern en la direccin de la curva ms pronunciada sobre la crnea.42.0046.0042.0046.00

Principios de diseo de lentes RGP

Principios de diseo de lentes RGPLos lentes RGP NO DEBEN!Moverse de lado a ladoComprometer la crnea

Principios de diseo de lentes RGPLos lentes RGP siempre se movern menos en la direccin del meridiano ms plano . Esto significa que el lente tocar ms la crnea a lo largo de la curva ms plana.42.0046.00

EvaluacinMovimientoPosicinPatrones de Fluoresceina

Movimientos IdealesLos lentes deben seguir al prpado con el parpadeo y luego regresar lentamente a la posicin de reposo.

Movimientos Ideales

Demasiado MovimientoSi el lente se mueve de un lugar a otro, aumente la curvatura de la curva base para estabilizar la adaptacin.

Demasiado Movimiento

El lente se cae de repenteSi el lente se cae muy rpidamente, ajuste la curva base.

El lente se cae de repente

Si el lente no se mueveSi el lente no se mueve libremente con el parpadeo, no habr intercambio de la pelcula lagrimal

Si el lente no se mueve

LocalizacinEl Lente debe localizarse sobre la pupila para asegurar una buena visin.

Localizacin

Posicin InferiorUna posicin inferior es la nica posicin inaceptable para un lente RGP.

Posicin Inferior

Patrones de FluoresceinaTincin de FluoresceinaFiltro Azul de Cobalto (Blue cobalt filter)Filtro Amarillo (Yellow Wratten filter)

Patrones de Fluoresceina

Yellow Wratten FilterCobaltWrattenBlue Cobalt Filter

El centro del lente

La mitad del lente

El borde del lente

Trabajando con los nmeros

Trabajando con los nmeros43.25 -5.75 9.0

Trabajando con los nmerosKs 42.25 @ 180 / 43.50 @ 90Rx -4.00 +1.00 x 90

Trabajando con los diagramas

Gracias

Welcome the attendees! Let the attendees know that you are going to begin the hour long seminar with a few questions that will evaluate how they utilize RGP lenses in their own practice. Direct the attendees to the questionnaire in the workbook. Give them no more than five minutes to complete the survey. When they have finished, the discussion can begin! Stress that these answers are for their personal use only so they can be honest!

WORKBOOK PAGE #1

Were there any candidates that the attendees did not choose? Realistically, they should have marked every option.Make certain that the attendees agree that these are indeed good candidates for RGP lenses. Work through each of these examples and make sure that there are no questions about the candidacy of these patients.The first four candidates should be easy to understand for even those that are not prolific RGP fitters. Patients who want excellent vision, those with corneal astigmatism, those with hyperopic corrections and patients after surgery, are all traditionally good candidates.Patients with refractive astigmatism may generate some discussion. Remind the attendees that most of the time refractive astigmatism is found on the cornea. However, even when there is a mismatch, or the cylinder is all refractive, there are RGPs that will work great!Children will be discussed in module six in greater detail. WORKBOOK #1For those patients with irregular astigmatism, RGP lenses are the only option. No other modality will work for these patients. If there are some attendees who are not familiar with irregular astigmatism, make sure that it is defined for them.Presbyopes, that rapidly growing population, will be discussed in much greater detail in module five. But, now is the time to grab this population and there are no better options available than RGPsWORKBOOK #1

Teens will be discussed along with children in module six. However, it is a good point to make that if you begin a patient with RGPs, they are likely to remain RGP wearers for a very long time. Since there are so many health benefits to RGP lens wear, when a child or teen is involved, it is highly beneficial to look to the most healthy option first.Yes, even patients who are traditionally thought of as ideal soft lens candidates, those with spherical Rxs, are excellent RGP candidates. Remember, RGPs meet lifestyle needs as well as refractive needs. Dont assume you know the patients motivation because you know their Rx. If you assume that all spherical refractive patients are good soft lens candidates, are you choosing the lens that is best for the patient, or the lens that is easiest for you?WORKBOOK #1There are many patients whose lifestyle and personal choices make them ideal RGP candidates. These patients are crying out from their place behind the slit lamp for RGP lenses. Work through the list of lifestyle and personal choice issues and make sure that the attendees do not have any disagreements on the listingWORKBOOK #2Discuss the anatomy and refractive issues that make some patients ideal candidates for RGP lenses. Point out that irregular astigmatism is only managed with RGP lenses and bring up examples of irregular astigmatism if necessary.Emphasize again that all refractions can be handled with RGP lenses. Admit that there are rare instances in which RGPs arent the ideal option. That would include those patients who require immediate comfort over long term comfort, those that require part time wear and those patients with significant amounts of against-the-rule astigmatism. But, highlight that even those patients can be successful if the motivation is great. Contact lens success is as much a result of patient motivation as practitioner skill. You cant succeed without both.Stress that previous RGP wearers who have discontinued for some reason as recently as a few years ago, should reconsider todays RGPs. Too much has improved in the way of materials, designs and production to discount them simply because they were tried in the past without success. If you had trouble with a computer from three years ago, you dont revert back to a typewriter--you get a newer, better, sleeker RGP, I mean computer. WORKBOOK #2Walk the attendees through the choices for lens design necessities found on WORKBOOK #3. Ask them to take a moment and decide which of the listed parameters are necessary when ordering an RGP lens. While all practitioners will be different, we would expect that base curve, diameter and power would be the bare minimum--unless a number of practitioners are already simply calling in Ks and Rx. There may be some who determine lens material and a small number who recommend replacement cycle.It would not be expected that any of the other parameters would be absolutely necessary in the determination of an RGP lens. However, it would be interesting to see how many attendees feel they are necessary.WORKBOOK #3Walk the attendees through this checklist for soft torics as well. Soft torics were chosen as a comparison because they appear to be the closest competition for RGP lenses today. With soft toric lenses, the practitioner must determine the base curve, diameter, spherical power, cylinder power, axis, lens material (manufacturer), replacement cycle. There should be more parameters checked with a soft toric lens than with an RGP. Ask the attendees why they dont have to indicate the extra parameters for the soft toric lens. Is it because they dont exist? No, it is simply because they are taken care of by the manufacturer. The same is true for todays RGPs. Those extra parameters are most often controlled by the lens designer. Yet, the beauty of RGP lenses is that the degree of customization is controlled by the contact lens professional. But, we are here to show the simple method of RGP lens design.WORKBOOK #3Some practitioners are most comfortable allowing the labs to design a lens by providing Ks and Rx. Assure them that this is a valid way to get that first lens and if that is the most comfortable way for them, encourage it! However, some practitioners may want to learn to design the lens themselves. Most lens manufacturers have developed lenses that are easily designed with the help of a few simple nomograms. Bring the attendees attention to the example on page #4 in the WORKBOOK. Describe the steps involved in determining the power of a rigid lens. Soft lenses also have to have the patients Rx converted to make it work for a soft lens (spherical equivalent). This is no different for RGP lenses. By remembering this simple acronym, the contact lens professional can easily determine the correct lens power for their patient.WORKBOOK #5Describe the steps involved in determining the power of a rigid lens. Soft lenses also have to have the patients Rx converted to make it work for a soft lens (spherical equivalent). This is no different for RGP lenses. By remembering this simple acronym, the contact lens professional can easily determine the correct lens power for their patient.WORKBOOK #5Point out the resulting plus power tear lens that is created when tears are pooled behind a lens that is fit steeper than flat K. Explain that this must be compensated for in the Rx or the patient will have the wrong correction. WORKBOOK #5

Describe the steps involved in determining the power of a rigid lens. Soft lenses also have to have the patients Rx converted to make it work for a soft lens (spherical equivalent). This is no different for RGP lenses. By remembering this simple acronym, the contact lens professional can easily determine the correct lens power for their patient.WORKBOOK #5Describe the steps involved in determining the power of a rigid lens. Soft lenses also have to have the patients Rx converted to make it work for a soft lens (spherical equivalent). This is no different for RGP lenses. By remembering this simple acronym, the contact lens professional can easily determine the correct lens power for their patient.WORKBOOK #5Point out the resulting plus power tear lens that is created when tears are pooled behind a lens that is fit steeper than flat K. Explain that this must be compensated for in the Rx or the patient will have the wrong correction. WORKBOOK #5

Describe the steps involved in determining the power of a rigid lens. Soft lenses also have to have the patients Rx converted to make it work for a soft lens (spherical equivalent). This is no different for RGP lenses. By remembering this simple acronym, the contact lens professional can easily determine the correct lens power for their patient.WORKBOOK #5The opposite is true when the lens sits too far away from the cornea. In that case, when you wish to move the lens closer to the eye, you can decrease the diameter and keep the base curve the same or flatten the base curve and keep the diameter the same.WORKBOOK #7The opposite is true when the lens sits too far away from the cornea. In that case, when you wish to move the lens closer to the eye, you can decrease the diameter and keep the base curve the same or flatten the base curve and keep the diameter the same.WORKBOOK #7Imagine a cornea is this football with two separate curves. The shorter, steeper curve is where the player would grip the football. If you imagine a flat surface (like a frisbee), were to be superimposed on this shape, if you rubbed it up and down, it would move most easily in the direction of the steepest curve.WORKBOOK #8Now that the principles of sagittal depth have been explored, we will apply these to RGP lens design.There are only two things that an RGP lens must do--move up and down on the eye to freely exchange tears and keep the cornea healthy and they must provide good vision (otherwise, why bother with contact lenses?)WORKBOOK #8Now, this principle of RGP design fits in perfectly with the general scheme of things. State this as a rule, a mantra, a principle of movable objects: an RGP lens will move in the area that it encounters its least resistance.WORKBOOK #8If this is the same cornea, the horizontal curve where the laces are located, is where that very same frisbee would rub the football the most. Flattest curve does not mean furthest from the lens. It means, longest, least curved. If the attendees have been paying attention, they will have noticed that this shape is the same as a patient whose cornea exhibits with-the-rule astigmatism. Luckily, this is the most dominant corneal astigmatism shape found among patients. And, it is this shape that is ideal for RGP lens wear since it promotes the two principles of RGP design--the lens must go up and down and should not go side to side.WORKBOOK #8While there are only two things that an RGP must do,there are really only two things that we try to avoid. An RGP must not move from side to side (as vision will not be stable and discomfort will result) and an RGP lens must not compromise the cornea in any way by altering the surface by molding or staining. WORKBOOK #8Its easy to deduce then, that if the lens is going to move in the direction of the steepest curve, it will move the least in the direction of the flattest curve.This is the area where the greatest amount of touch will occur.WORKBOOK #8Sagittal depth is the dominating principle in contact lens fit regardless of whether it is a soft or rigid lens. But, once the first lens is placed on the eye, it must be evaluated in order to determine whether this is indeed the best lens for the patient, meeting all of the requirements of a rigid lens. A soft lens is also evaluated, but we can only rely on movement and position. With a rigid lens, we can be even more certain that we have the best lens, because we can also evaluate fluorescein patterns.We will go through each of these areas in greater detail.WORKBOOK #9The first evaluation can be done without the aid of fluorescein and involves how the lens moves on the eye.If the lens moves too much, the patient will certainly notice it. If the lens moves too little, the cornea will certainly notice it. The goal is to allow the lens to have unobstructed movement in the vertical meridian while not moving horizontally. This means that the lens should be able to move freely up and down with the blink, but not side to side. The lens will be pushed down on the close of the blink, be pulled up on the opening of the blink and then come slowly to rest in its proper position.WORKBOOK #9The lens must have movement in order to properly exchange tears. Too much movement is uncomfortable for the patient and not enough is uncomfortable for the cornea. WORKBOOK #9If the lens is moving all over and is not stable, the vision will be poor and the comfort will be compromised. In order to achieve the up and down motion without the side to side movement that is described here, the lens must grab more of the flatter horizontal meridian. This is most easily achieved by making the lens larger. Be careful not to confuse the attendees with a lot of various scenarios. We are striving to give them easy, simple tools to use. If this first scenario doesnt work, it may be best to have them evaluate what is going on and call the lab for consultation. If, however, there are attendees who are more insistent on a number of scenarios and you dont feel the message of simplicity will be lost, you may go through a few other choices: steepen the base curve, evaluate the peripheral cornea to make certain that it is truly with-the-rule, etc.WORKBOOK #9Describe the photo reminding the attendees that this is a static photo and we are trying to describe movement. However, when the lens comes to its final resting place, this may be what the lens looks like if there is not enough stability in the horizontal meridian.WORKBOOK #9Admit that this one always confuses lens fitters. It would seem that if you follow the soft lens rules, if the lens drops down, it is too loose. However, the opposite seems to be the case when you are evaluating RGP fits. WORKBOOK #9These graphics illustrate the relationship between the flatter superior cornea and a lens that is fit too steeply for that area and a lens that is fit to align that area. Explain that the lens must not be too steep for that area or gravity and the force of the lids will allow it to slip down into the inferior position. By flattening this lens to cornea relationship, the lens will have more stable movement and will be more comfortable for the patient. Ask the attendees to describe how to flatten the lens to cornea relationship.WORKBOOK #9This may be how the lens comes to rest when it is too steep for the superior cornea. The quicker the drop, the steeper the relationship.WORKBOOK #9Patients love tight lenses. Make certain that the attendees do not use this as a criteria for success, however. Explain how vital movement of the lens is to the overall health of the cornea. Explain the important role of tear exchange in keeping the eye healthy and able to wear contact lenses. Discuss how this lens might feel during the day for the patient and how the patient may complain at the end of the day about burning or stinging when the lens is finally removed. These patients may also complain of a struggle in trying to take the lens out. WORKBOOK #9While the patient may not feel anything wrong with this lens, they will certainly become uncomfortable by the end of the day and this will get worse as time passes.In order to eliminate this inferiorly positioned adhered lens, the lens fitter would most likely flatten the base curve, reduce the size of a large lens or do both if the lens is really stuck.WORKBOOK #9The RGP lens is fit for the patient to serve one purpose--to provide vision. Because of this, it must position so that the optics are over the pupil.WORKBOOK #10Since the optics of the lens comprise 80-85% of the total lens, it isnt necessary for the lens to center directly over the pupil. While one position of the lens could be completely centered, another acceptable lens position is slightly superior. Some attendees may have questions about a lens being positioned too high. Discuss what the patient symptoms may be in those instances.Point out the upper edge of one lens pictured as being tucked underneath the upper lid while the other is positioned below the upper lid. Describe and briefly discuss the various philosophies that are involved in each of these different lens positions bearing in mind that the entire message is designed to convey an aura of simplicity. You may wish to mention that if the lens is tucked underneath the upper lid there may be less sensation as the lid passes over the lens on a blink. This will require a slightly larger lens design for some patients.You may also chose to discuss briefly, the role of edge designs when the lens is positioned either centrally (I.e. thinner lens edge to reduce sensation) or upper lid (I.e. creating a thicker edge on thin edged lenses to increase lid interaction). Keep these comments appropriate for the level of the group.WORKBOOK #10This is the only position that can be potentially harmful for the patient. While other positions may not be perfectly centered, this is the only one that can create havoc on the cornea because of its potential for adhesion. Remind the attendees that this is the same as a lens dropping too quickly into the inferior cornea. At some point, it may become too difficult for the upper lid to pull back up into position and then tear exchange wont occur leaving the cornea in a less than healthy position. Discuss the choices in correcting this lens position. Since the discussion earlier regarding a lens that drops focused on the steep aspects of the lens design, it should be mentioned here as well. Let the attendees know that a lens can only ride over an area of the cornea that it fits. If it doesnt fit superiorly or centrally, gravity will force it to drop down. WORKBOOK #10While this lens has not adhered to the cornea, this positioning is the first step in allowing that to happen.WORKBOOK #10While soft lenses also can be evaluated with the aid of movement and positioning clues, the real message comes through the loudest with the aid of fluorescein. This tool enables the contact lens professional to determine whether the lens is properly fit for the patient and, more importantly, enables them to determine how to improve a fit that needs improvement.WORKBOOK #11Fluorescein dye is the first tool used in this evaluation process. Wet the tip of the strip with irrigating solution or a saline solution (do not use tap water). Place the moistened strip on the inferior or superior sclera. It may be valuable to mention that only a little amount of fluorescein goes a long way and not a lot of dye needs to be used. WORKBOOK #11These photos go even one step further and use the yellow Wratten filter in front of the eye piece on the slit lamp. Now it is even easier to determine the different areas of tear volume. Point out to the attendees the areas in which there are a lot of tears and areas where tears are less abundant. Describe to them the need for different volumes of tears beneath the lens:the center should be aligned, the mid-periphery should be closer to aid in positioning of the lens and the edge should be brighter since it is a tear reservoir. Let the attendees know that this is understood by the manufacturers who have designed the lenses to meet these needs. ***THERE SHOULD BE A WRATTEN FILTER FOR EVERY ATTENDEE IN THEIR WORKBOOKSWORKBOOK #11It is perhaps easiest to split the lenses into three areas for evaluation. We will begin with the center of the lens. This area of the lens needs to gently align the center or apex of the cornea. It should have about the same color of tear film beneath it as the cornea does where there is no lens. Explain that this is the color of the normal thickness of tear film.While this is a good guideline, make sure that the attendees dont get too hung up on the colors. Remember, this is a simple fitting process! If the green is a little brighter or a little darker, assure them that this is fine as long as the needs of the lens are met: does provide vision, doesnt stain the cornea; goes up and down, doesnt go side to side.WORKBOOK #11In this photo, it should be obvious that the area in the center of the lens is very bright. This indicates that there is a great deal of distance between the back of the lens and the front of the cornea.Point out to the attendees that if there is a bright green area in the center of the lens that is surrounded by a tighter mid-periphery, then it would indicate that this area is too far from the cornea and needs to be flattened. Discuss how to solve a situation in which the sagittal depth of the lens is too great.WORKBOOK #11In this photo, the center of the lens is too close to the surface of the cornea and doesnt allow tears to collect there. While the patient may not have problems with this initially, it is important that the contact lens professional guards against this for their patients. This is one of the areas that we want to avoid--potential staining. In the long run, this patient would have problems if they continued to wear these lenses.Discuss how this situation can be remedied: increasing the sagittal depth of the lens to cornea relationship.WORKBOOK #11While the center of the lens needs to provide vision, the mid-periphery of the lens needs to provide the positioning. Point out the area in the photo that shows the lens coming closest to the cornea (along the horizontal meridian). Remind the attendees that it is the horizontal meridian that is flattest in with-the-rule corneas and we expect that the lens will touch here most closely. This allows the lens to move up and down, but keeps it from moving side to side. WORKBOOK #12

When the middle of the lens is too tight, it will seal off the tear film in the center of the lens and inhibit the exchange of oxygen. A tight middle will also limit the movement of the lens and may cause rubbing of the cornea. In other words, its simply not the best situation! Discuss how flattening the center of the lens will loosen this area of the lens and allow greater movement.WORKBOOK #12When there is not enough interaction between the back side of the lens and the cornea, there will not be the opportunity to hold the lens in place. When this happens, the lens can slip from side to side and movement will not be consistent.WORKBOOK #12Edge lift is an area in which the lens manufacturers have spent considerable time and energy. They have developed comfortable, uniform, productive edge lifts. This is an area that is important to pay attention to, however, one which doesnt need to be altered much by the contact lens professional.Since the edge contains the tear reservoir, there should be an adequate amount of edge lift in order to keep the lens comfortable on the eye.WORKBOOK #12Work through the examples given in the workbook. The parameters should either be determined through the nomogram in the workbook or with the nomogram provided by the sponsoring lab. Or, both can be utilized to compare the results.WORKBOOK #13Work through the examples given in the workbook. The parameters should either be determined through the nomogram in the workbook or with the nomogram provided by the sponsoring lab. Or, both can be utilized to compare the results.WORKBOOK #13Work through the examples given in the workbook. The parameters should either be determined through the nomogram in the workbook or with the nomogram provided by the sponsoring lab. Or, both can be utilized to compare the results.WORKBOOK #13Work through the examples given in the workbook. The parameters should either be determined through the nomogram in the workbook or with the nomogram provided by the sponsoring lab. Or, both can be utilized to compare the results.WORKBOOK #13Work through the examples given in the workbook. The parameters should either be determined through the nomogram in the workbook or with the nomogram provided by the sponsoring lab. Or, both can be utilized to compare the results.WORKBOOK #13Work through the examples given in the workbook. The parameters should either be determined through the nomogram in the workbook or with the nomogram provided by the sponsoring lab. Or, both can be utilized to compare the results.WORKBOOK #13Evaluate the photos in the workbook and on the slides. Encourage the attendees to evaluate the fit based on fluorescein interpretation and then discuss the possible solutions. Make certain that the attendees are able to easily evaluate the lenses. If there are any questions, keep the answers simple and follow the easy rules that have been laid out in the previous pages.This lens has been fit too steeply in the center of the lens and needs to have the sagittal depth reduced.WORKBOOK #14The lens is fit too flat centrally and needs to have the sagittal depth increased.WORKBOOK #14The lens in this photo is fit too steeply and is riding too low. The sagittal depth needs to be reduced in order to allow the lens to ride on the superior cornea.WORKBOOK #14This lens is fit too flat and this is allows it to decenter laterally.WORKBOOK #14This lens has no edge lift. This has not been discussed earlier so it may be more difficult for the attendees to describe this. WORKBOOK #14This lens is a perfect fit. Even those who are new to RGP fitting can easily have results like this with the simple steps weve outlined.WORKBOOK #14Welcome the attendees! Let the attendees know that you are going to begin the hour long seminar with a few questions that will evaluate how they utilize RGP lenses in their own practice. Direct the attendees to the questionnaire in the workbook. Give them no more than five minutes to complete the survey. When they have finished, the discussion can begin! Stress that these answers are for their personal use only so they can be honest!

WORKBOOK PAGE #1

Aspect Os Fundamental Es

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