Contact Lens Complications E-Book
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Effectively manage even the most challenging contact lens complications with help from Contact Lens Complications, 3rd Edition! Award-winning author, clinician, and researcher Professor Nathan Efron presents a thoroughly up-to-date, clinician-friendly guide to identifying, understanding, and managing ocular response to contact lens wear.

  • Evaluate and manage patients efficiently with an organization that parallels your clinical decision making, arranging complications logically by tissue pathologies.
  • Turn to the lavish illustrations and full-color schematic diagrams for a quick visual understanding of the causes and remedies for contact lens complications.
  • Stay up to date with the latest advances and concepts in contact-lens-related ocular pathology, including findings from the Dry Eye Workshop (DEWS), the International Workshop on Meibomian Gland Dysfunction, a new approach to corneal inflammatory events and microbial keratitis, and new instrumentation and techniques for anterior eye examination.
  • Consult the most comprehensive and widely-used grading system available, as well as 350 new references that reflect an evidence-based approach, and dozens of superb new illustrations that help you instantly recognize clinical signs.



Publié par
Date de parution 19 juin 2012
Nombre de lectures 3
EAN13 9781455737741
Langue English
Poids de l'ouvrage 5 Mo

Informations légales : prix de location à la page 0,0399€. Cette information est donnée uniquement à titre indicatif conformément à la législation en vigueur.


Contact Lens Complications
Third Edition

Nathan Efron, BScOptom PhD (Melbourne) DSc (Manchester) FAAO (Dip CCLRT) FIACLE FCCLSA FBCLA FACO
Research Professor, School of Optometry and Vision Science, Queensland University of Technology, Brisbane, Australia

Table of Contents
Cover image
Title page
Contact lens complications quick-find index
Part I: Examination and grading
Chapter 1: Anterior eye examination
Chapter 2: Grading scales
Chapter 3: Grading morphs
Part II: Eyelids
Chapter 4: Blinking abnormalities
Chapter 5: Eyelid ptosis
Chapter 6: Meibomian gland dysfunction
Chapter 7: Eyelash disorders
Part III: Tear film
Chapter 8: Dry eye
Chapter 9: Mucin balls
Part IV: Conjunctiva
Chapter 10: Conjunctival staining
Chapter 11: Conjunctival redness
Chapter 12: Papillary conjunctivitis
Part V: Limbus
Chapter 13: Limbal redness
Chapter 14: Vascularized limbal keratitis
Chapter 15: Superior limbic keratoconjunctivitis
Part VI: Corneal Epithelium
Chapter 16: Corneal staining
Chapter 17: Epithelial microcysts
Chapter 18: Epithelial oedema
Chapter 19: Epithelial wrinkling
Part VII: Corneal Stroma
Chapter 20: Stromal oedema
Chapter 21: Stromal thinning
Chapter 22: Deep stromal opacities
Chapter 23: Corneal neovascularization
Chapter 24: Corneal infiltrative events
Chapter 25: Microbial keratitis
Chapter 26: Corneal warpage
Part VIII: Corneal Endothelium
Chapter 27: Endothelial bedewing
Chapter 28: Endothelial blebs
Chapter 29: Endothelial cell redistribution
Chapter 30: Endothelial polymegethism
Grading scales for contact lens complications
Guillon tear film classification system

an imprint of Elsevier Limited
© 2012 Elsevier Limited. All rights reserved.
© 2004 Elsevier Limited
© 1994 Reed Educational and Professional Publishing Ltd
© Tear Film Classifications from J.P. Guillon
Grading Morphs and Tutor © 2004, Elsevier Limited; 2001 Reed Educational and Professional Publishing Ltd, Professor Nathan Efron & Dr Philip Morgan
The right of Nathan Efron to be identified as author of this work has been asserted by him in accordance with the Copyright, Designs and Patents Act 1988.
No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from the publisher. Details on how to seek permission, further information about the Publisher’s permissions policies and our arrangements with organizations such as the Copyright Clearance Center and the Copyright Licensing Agency, can be found at our website: .
This book and the individual contributions contained in it are protected under copyright by the Publisher (other than as may be noted herein).

Knowledge and best practice in this field are constantly changing. As new research and experience broaden our understanding, changes in research methods, professional practices, or medical treatment may become necessary.
Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using any information, methods, compounds, or experiments described herein. In using such information or methods they should be mindful of their own safety and the safety of others, including parties for whom they have a professional responsibility.
With respect to any drug or pharmaceutical products identified, readers are advised to check the most current information provided (i) on procedures featured or (ii) by the manufacturer of each product to be administered, to verify the recommended dose or formula, the method and duration of administration, and contraindications. It is the responsibility of practitioners, relying on their own experience and knowledge of their patients, to make diagnoses, to determine dosages and the best treatment for each individual patient, and to take all appropriate safety precautions.
To the fullest extent of the law, neither the Publisher nor the authors, contributors, or editors, assume any liability for any injury and/or damage to persons or property as a matter of products liability, negligence or otherwise, or from any use or operation of any methods, products, instructions, or ideas contained in the material herein.
ISBN: 978-0-7020-4269-0
British Library Cataloguing in Publication Data
Efron, Nathan
  Contact lens complications. — 3rd ed.
  1. Contact lenses—Complications
  I. Title

Ebook ISBN : 978-1-4557-3774-1
Printed in China
Last digit is the print number: 9 8 7 6 5 4 3 2 1
Back in the days of rigid lenses, contact lens practice was largely concerned with the physical fit of a contact lens on the eyeball. Contact lens surfaces were generated using complex geometric principles, and the precise relationship between the cornea and lens was assessed with fluorescein. New lenses were ordered if the fitting relationship was judged to be unsatisfactory.
When soft lenses were introduced in the 1970s, practitioners initially tried to fit them like rigid lenses. The original soft lenses, made of low water content hydroxyethyl methacrylate (HEMA), were thick and unforgiving. Fitting was achieved by choosing a lens from a range of perhaps 12 different base curves which were available in increments of 0.3 mm. The emphasis in lens fitting was to match the curve of the lens to the eye.
Time has certainly moved on, as they say. Here we are in the second decade of the 21st century, and the general approach to contact lens fitting bears little resemblance to the approaches described above – save the relatively few instances where rigid lens lenses are still required. At the present time, about 96% of all new contact lens fits are with soft lenses. Modern soft lenses are thin and flexible, and as such are very forgiving on the eye. Most lenses are only available in one or two base curves and a single diameter. The emphasis has shifted away from physically matching the fit of the lens to the eyeball, and more towards fitting by physiological (or pathological) response. We now choose lenses that provide physiological conditions for maintaining optimum ocular health. When assessing contact lens performance, we carefully inspect the eye and lens under high magnification and look for factors such as the quality of the tear film, limbal redness, impact of the lens edge on the conjunctiva, corneal integrity etc.
With the advent of highly oxygenated silicone hydrogel contact lenses, we have largely eradicated hypoxia-related complications. And with second and third generation low modulus silicone hydrogel materials, we are alleviating complications that have a mechanical aetiology. In recent times when lecturing on the topic of contact lens complications, I have joked with my audience that, in view of these developments, the next edition of Contact Lens Complications will only need to be half the size of previous editions. However, about 40% of soft lenses prescribed today are made from conventional, low oxygen performance hydrogel materials, which means that virtually all of the complications described in this book are still relevant to modern-day practice. As well, some new complications have become apparent, that are only seen among those wearing silicone hydrogel lenses – such as mucin balls. Many of the complications that occurred in response to hydrogel lens wear also occur with silicone hydrogel lenses, such as corneal infiltrative events and keratitis. Overall, therefore, all previous complications need to be considered in addition to newly observed complications … so rather than getting smaller, this edition is actually slightly larger.
It is for the reasons outlined above that, more than ever, the current generation of contact lens practitioners needs to keep abreast of clinical information relating to the ocular response to contact lens wear, the theories underpinning these responses, implications for assessing suitability for lens wear and ways of managing adverse reactions. That is where this book can be of assistance. I have striven to assemble a comprehensive, evidence-based account of this topic, drawing extensively from the current literature, and moderated from my personal experience as a clinician and researcher spanning 35 years. The evidence base that I provide is in the form of literature references that can be found at the end of each chapter – over 1000 in total. I make no apologies for this evidence-based approach; it is the only valid approach to considering any aspect of health care.
Although the title Contact Lens Complications implies unwelcome adverse reactions to lens wear, this book is really about much more than that. It deals with the full range of ocular responses, from the most subtle of innocuous and largely harmless tissue reactions – such as endothelial blebs – to the most severe of reactions, such as microbial keratitis.
Much has changed in our understanding of contact lens complications since the second edition of this title was published in 2004. Every chapter of this new edition has been revised and updated, but here are some highl

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