By Ronald K. Watanabe OD FAAO

This medical instruction manual offers universal touch lens issues of step by step remedy ideas. 40 case experiences hide more than a few difficulties from easy becoming dilemmas to adversarial results of touch lens put on. every one case starts off with a presentation of signs and symptoms, together with a case background and goal try findings and ends with the author's prognosis and dialogue.

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Contemporary RGP bifocals: Fitting and follow-up. Eyequest. 1992;2(5):34–46. 4. Watanabe RK. Presbyopia: Contact lenses 2000. Contact Lens Spectrum. 2000;15(5):41–47. Visual Flare, Part 2 55 5. Schatz S. Improve visual performance with an aspheric multifocal. Contact Lens Spectrum. 2000;15(8):37–39. 6. Hodur NR, Gandolfi B, Wojciechowski S. Flare with rigid contact lenses. Contact Lens Forum. 1986;11(3):48–49. CASE 2-3 Sudden Onset Blur in One Eye Figure 2-3 History A 19-year-old Caucasian male presents at his first rigid gas-permeable (RGP) contact lens (CL) follow-up visit with complaints of suddenonset blurry vision in his right eye only that began 2 days earlier.

The patient is compliant with the care of her lenses. 25 × 010, 20/15–1/6 • Biomicroscopy: OU central cornea clear, no staining, mild (<1/2 mm) perilimbal vascularization Based on the clinical data, develop your list of differential diagnoses. Then, determine your final diagnosis and develop your treatment plan. Differential Diagnoses • Flat soft contact lens causing cylinder misalignment due to excessive rotation during or after a blink • Cylinder misalignment due to prescribing wrong axis • Crisp vision not afforded by toric soft contact lens due to cylinder component in excess of sphere component Diagnosis The vision afforded JS is not acceptable with toric soft contact lenses.

Clinical Pearls • Visual flare can be caused by a large pupil, small optic zone, or lens decentration. • Visual flare is common early in RGP adaptation. • Patient education prior to fitting RGP lenses helps reduce complaints of visual flare after initial dispensing. References 1. Hodur NR, Gandolfi B, Wojciechowski S. Flare with rigid contact lenses. Contact Lens Forum. 1986;11(3):48–49. 2. Hom MM. Rigid lens design and fitting. In: Hom MM (ed). Manual of Contact Lens Prescribing and Fitting with CD-ROM, 2nd ed.

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