CONTACT LENS OPTICS C. Fowler 7.4 INTRODUCTION A knowledge of the optics of contact lenses is essential for anyone involved in their fitting. This chapter attempts to give a straight- forward review of the basics of this subject, but for more comprehensive information, the references should be consulted. The sign convention for optical calcula- tions and diagrams is as follows: 1. In diagrams, incident light is considered to travel from left to right. Distances measured in the same direc- tion as incident light are considered to be positive, in the opposite direction to incident light negative. Distances are measured from the surface under consideration. 2. Unless otherwise specified, the ‘power’ of a contact lens is assumed to be the back vertex power (BVP) measured in air. Terminology is, as specified in BS 3521: Terms relating to ophthalmic eptics and spectacle frames. Part 3 1988: Glossary of terms and symbols relating to contact lenses. The author's interest in the optics of contact lenses was inspired by A.G. Ben- nett, to whom much gratitude must go for his assistance in the preparation of this chapter. 7.2. EFFECTIVITY OF CORRECTING LENS The effective power of a correcting lens will depend on its distance from the eye. As there is often a 10-15 mm difference between the position of the spectacle plane and the cor- nea, there will naturally be a difference between the power of a contact lens int situ and that cf 2 spectacle lens required to cor: Figure 7.1. Variables used in the calculation of effectivity of the correcting lens at the eye: Contact Lens Practice. Edited by Montague Ruben and Michel Guillon. Published in 1994 by Chapman & Hall, London. ISBN 0 412 35120 X124 Contact lens optics rect the same eye. In Figure 7.1, a correcting spectacle lens is shown positioned at a dis- tance ‘d’ from the corneal apex of a reduced eye. A focal length of f, will be required to image distant objects at the far point (My) of the eye. In other words, the focus F” of the lens should coincide with Mz ‘The distance of the eye from Mg is given by k, and the reciprocal of this value, K, is the ocular refraction. The relationship between the ocular and spectacle refraction is given by: K= (eqn 7.1) For example, if the spectacle refraction is -5.00 D at 13 mm from the comea, then the ocular refraction will be -4.70 D. Alterna- tively, a spectacle refraction of +5.00 D at 13 mm from the cornea indicates an ocular refraction of +5.35 D. Thus it is general good practice to record the distance from the eye at which a trial lens is used, and this is essential for tens powers cover 5.00 D if significant errors are to be avoid Note that the BVP of the contact lens in air is not necessarily the same as the ocular refraction. Any liquid lens formed by the tears beneath the contact lens also has to be taken in consideration. 7.3. CONTACT LENS POWER CALCULATION Because of their steep curves, and hence very short radii of curvature in relation to axial thickness, it is necessary to treat contact lenses as ‘thick’ lenses. This means that in determining the required surface powers for the lens, the thickness is taken into consider- ation, and not ignored, as in ‘thin’ lenses. The calculation to be performed by the manufacturer is this: the back optic zone radius (BOZR) of a contact lens is fixed by the fitting relationship required, and the BVP. The lens refractive index (n) is fixed by the lens material, and the axial thickness (1,) by the lens design. The problem then is to calculate the front optic zone radius (FOZR) required for the lens to give the correct BVP. This problem can be considered as the reverse of the effectivity problem described earlier. It is possible to solve this type of problem by reversing the light path through. the contact lens, so that the change of vergence at each surface is calculated with light incident at the rear surface. Allowance must be made Figure 7.2 Calculation of FOZR (¢,,) required to give a desired back vertex focal length (f,) for parallel ineident light (L; = 0) at the front surfacefor the ‘reduced thickness’ (t,/n) between the lens surfaces. The front surface power is calcu- lated so that light emerges parallel (zero ver- gence) under these conditions (Fig. 7.2). However, a simpler approach is to use the formula: Fg = 14 (in (eqn 7.2) Note that f is in metres. For example: Fv (BVP) = - 8.00 D; 1, (BOZR) = 8.00 mm; f= 0.30 mm; n= 149; Typ (FOZR) =? where r, is in millimetres, since: F, = 1000(1-m) thus F, = ~ 61.25 D. Substituting in the above expression Fig = (£8.00 + 61.25) 1+ (0.0003) (~ 8.00 + 61.25) 149 Fy = 52.69 Contact Lens / Tear Lens Liquid lens powers 125 ‘Therefore: FOZR (1,9) = 1000(n—1) Fag 130mm ‘The power of the front surface calculated here (+52.69 D) is seen to be weaker than the value of +53.25 D indicated by simply apply- ing thin lens theory. 7.4 LIQUID LENS POWERS In the case of hard contact lenses, it will be apparent that the total power effect of the contact lens on the eye is a combination of the refractive power of the lens plus any lens effect from the layer of tear fluid between the contact lens and the cornea, shown diagram matically in Figure 7.3. In the case of a lens with BOZR shorter than the corneal radius this will result in a positive liquid lens and, as shown in Figure 7.3, a lens with BOZR longer than the corneal radius will result in a negative power liquid lens. ‘The effective power of this liquid lens can be calculated by assuming that the contact lens and the liquid lens are both surrounded Figure 7.3. Schematic illustration of the formation of a liquid tear lens between contact lens and cornea.126 Contact lens optics by a very thin film of air. Thus the total power of the system is then simply the sum of each of the individual components, mea- sured in air Example A hard contact lens with BOZR 8.0 mm, is fitted on an eye with a central keratometry reading of 7.8 mm. What is the power of the liquid lens? We first have to assume a value for the mean refractive index of tears. This is gener lly taken as 1.336, Hence in air: Front surface power = 1000(n-1)/ rap = 336/8.0 = +42.00D Rear surface power = 1000(1-n)/r, = 336/7.8 = = 43.08 D Total thin lens power = -1.08 D This gave rise to the approximate relation- ship that was used extensively in fitting of hard (PMMA) contact lenses: A difference of 0.05 mm between BOZR of a hard contact lens and keratometry reading is equivalent to 0.25 D of liquid lens power. This rule should be used carefully, particu- larly with very steep or very flat corneas. For example, a lens with BOZR of 6.8 mm fitted ‘on a comea of radius 7.0 mm will have a liquid lens power in air of +1.41 D, and not + 1.00 D as the approximate rule would suggest. Another example, using much flat- ter curves would be of a lens with BOZR of 9.0 mm fitted on a cornea with radius 9.2 mm. This would give a liquid lens power of +0.81 D, as opposed to +1.00 D if the approximate rule is used. 7.5 CORRECTION OF ASTIGMATISM AND. ‘TORIC LENSES ‘The use of a spherical hard contact lens on an astigmatic cornea gives very effective correction of corneal astigmatism. This might seem surprising, as the corneal refractive index is 1.376, compared with 1.336 for tears. From this relationship, it might be assumed that a spherical lens would only neutralise 336/376 X 100 or 90% of the corneal astigmatism. However, it is generally assumed that the rear surface of a typical cornea neutralizes some 10% of the astigmatism introduced by the front sur- face of the cornea. Example ‘A spherical rear surface hard contact lens has a BOZR of 8.00 mm, and is used on an eye with keratometry readings of 7.50 and 8.00 The rear surface of the contact lens and the front surface of the tear lens are both spheri- cal, and hence can be ignored in the calcula- tion of astigmatism: Index Astigmatism Corea 1.376 (50.13- 47.00) = 3.13D Rear surface tearlens 1.336 ~(44.80-42.00) = -2.80 D It is assumed that 10% of the corneal astig- matism (~ 0.31 D) will be corrected by the rear surface of the cornea ‘Any astigmatism not corrected by the con- tact lens in this case would be known as residual astigmatism. However, it is extremely unlikely that a spherical lens would give an adequate fit in this case, therefore a rear toroidal surface might be used instead. If this is fitted in alignment, the powers of the liquid lens can be ignored, as this simply becomes an afocal layer sandwiched between the contact lens and the cornea: Index 1.376 Astigmatism Cornea (60.13 - 47.00) = 3.13 D Rear surface contact lens 1.490 4.08 (65.33 - 61.25) D an increase of ~1.28 D Thus in this case, the higher refractive indexof the hard contact lens over-corrects the comeal astigmatism, giving rise to induced astigmatism. This may well require the use of a toroidal front surface in order to correct the unwanted astigmatism. Occasionally, scleral lenses are used with rear toroidal surfaces for the correction of astigmatism. In air, the back surface power of an acrylic contact lens is ~ 490/r, dioptres (r, in millimetres), but in contact with tears fluid it is: = (490 ~ 336) or. r r The power of the rear surface is hence reduced by a factor of 490/154 or 3.18. Thus io produce a desired cylinder power of C dioptres when in situ, the back surface should be made 3.18 C dioptres when mea- sured in air. A general expression for this ratio, for any contact lens material of refrac- tive index 1 is: 1000 (= 1) 1000 (n ~ 1) = 336 In the case of soft contact lenses, a spherical lens will mould itself to a toric cornea, trans~ mitting the corneal astigmatism. Designs are produced commercially with either a front surface toric or a rear surface toric, the other surface being spherical. However with these designs itis likely that the lens will end up as bi-toric on an astigmatic eye as it moulds to the shape of the cornea. One advantage of a front surface toric is that lens designs of this type can also be used to correct for lenticular astigmatism, as well as corneal astigmatism. Front and back surface torics are stabilized by using techniques such as truncation and prism ballasting. The theoretical ideal for a soft lens with a rear surface toric would be one with a high water content, as here the refractive indices, of the contact lens and cornea would be the closest. Magnification effects of contact lenses 127 7.6 BIFOCAL CONTACT LENSES Contact lens bifocals of conventional (refrac- tive) designs are manufactured in both fused and solid varieties. Because of the neutraliz- ing effects of tears, a front and rear surface solid hard bifocal contact lenses require dif- ferent treatment. For example, if a front surface addition of +2.00 D is required on a 1.490 refractive index lens with a FOZR of 7.90, then this will require a radius of 7.65 mm for the segment, as these radii are equivalent to +62.03 D and +64.06 D,respectively. However, if a rear surface bifocal with an addition of +2.00 D is made from the same refractive index material and a BOZR of 7.45 mm, then account must be taken of the refractive index of tears. Thus addition required in air is 2.00 X 3.18 = 6.36 D. A BOZR of 7.45 mm gives a power in air of - 490/745 =65.77 D. Hence near vision area must have a power in air of = -59.41 D. Required radius = ~ 490 = 8.25 mm 59.41 7.7 MAGNIFICATION EFFECTS OF CONTACT LENSES The differences in retinal image magnifica tion with spectacle and contact lenses have important clinical considerations. Two types of magnification related to a correcting lens on an eye are conventionally described — spectacle magnification’ and relative spec tacle magnification, 7.7.1 SPECTACLE MAGNIFICATION This is the ratio of the image size in the corrected eye to the image size in the uncor- rected eye. The retinal image in the uncor- rected eye may be blurred, as in myopia, or sharp, as in hypermetropia neutralized by accommodation. To cover both possibilities, the size is defined by rays from the object's128 Contact lens optics extenities, passing through the centre of the eye's entrance pupil. These measure the dis- tance between the centres of the limiting blur circles, whatever their size. In Figure 7.4, a spectacle lens is shown correcting a hyper- metropic eye. The angular subtense of a distant object at the entrance pupil centre is given by 1 Oblate ellipsoid, P=1 Spherical 11 THEN a(i)=r(i-1)-SQR((i-1)*2- yli-2)"2}-(rli)-SQR(r(i)"2-y(i-1)"2)) 105 PRINT a(i) 110 120 220 IF L<=y(i) THEN 300 250 NEXT i 300 s=1-SQR(2-1"2)-+k 301 IF L>r(1) THEN 305 302 t=r(1)-SQR((1)2-L"2) 303 g=t-s 304 PRINT “Edge Lift L 305 PRINT “y: 306 PRINT “Sag, 310 END REFERENCES Atkinson, T.C.O. (1989) Towards a new gas per meable lens geometry. The Optician, 197 (5158), 13-45, 17. Baker, T.Y. (1943) Ray tracing through non- spherical surfaces. Proc. Phys. Soc., LV, 361-4 Bennett, A.G. (1976) Power changes in soft contact Tenses due to bending. Ophthalmic Optician, 16 (22), 939-47, Brennan, N.A., Lowe, R., Efron, N., Ungerer, J.L. and Camey, L.G. 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