Contact Lens Practice

  • Melanie Corbett
  • Nicholas Maycock
  • Emanuel Rosen
  • David O’Brart


Topography is useful for the fitting of contact lenses, particularly in irregular corneas and for rigid lenses. By identifying the curvature of the steepest and flattest areas of the cornea and generating a simulated fluorescein pattern, it can direct the selection of the initial back surface curvature to be tried, thereby reducing the number of trial lenses required. It can also inform the design of custom design lenses.

Corneal irregularity can cause visual loss which is correctable by rigid contact lenses, but not by glasses. Topography is valuable in identifying such cases. In severe cases, such information can be sent to contact lens manufacturers to inform custom lens designs.

Monitoring post-fitting can detect contact lens-induced corneal warpage, due to sustained pressure from the lens in areas of touch. Various patterns can occur, including changes of astigmatism, irregular astigmatism, oblate pattern (flattening centrally and steepening towards the periphery) and a steep-flat pattern with flattening under an eccentric lens with corresponding steepening elsewhere. If the steepening is inferior, this may mimic keratoconus. Warpage tends to reverse after several weeks without lens wear, but if lenses have been worn for many years, the corneal shape may never return to normal. Warpage should have reversed as fully as possible prior to taking measurements for biometry or refractive surgery.


Corneal topography Contact lens Contact lens fitting Rigid gas permeable Irregular cornea Corneal irregularity Keratoconus Corneal warpage Simulated fluorescein pattern Back surface curvature Trial contact lens Custom contact lens 


*References Particularly Worth Reading

  1. 1.
    ACLM Industry Statistics – contact lens market. Today; March 28th 1994; 23.Google Scholar
  2. 2.
    Dart JKG. Predisposing factors in microbial keratitis: the significance of contact lens wear. Br J Ophthalmol. 1988;72:926–30.CrossRefGoogle Scholar
  3. 3.
    Dart JKG, Stapleton F, Minassian D. Contact lenses and other risk factors in microbial keratitis. Lancet. 1991;338:650–3.CrossRefGoogle Scholar
  4. 4.
    Schein OD, Glynn RJ, Poggio EC, Seddon JM, Kenyon KR. The relative risk of ulcerative keratitis among users of daily-wear and extended-wear soft contact lenses: a case-control study. Microbial Keratitis Study Group. N Engl J Med. 1989;321(12):773–8.CrossRefGoogle Scholar
  5. 5.
    Poggio EC, Glynn RJ, Schein OD, Seddon JM, Shannon MJ, Scardino VA, Kenyon KR. The incidence of ulcerative keratitis among users of daily-wear and extended-wear soft contact lenses. N Engl J Med. 1989;321:779–83.CrossRefGoogle Scholar
  6. 6.
    Stern GA. Contact lens associated bacterial keratitis: past, present, and future. CLAO J. 1998;24(1):52–6.PubMedGoogle Scholar
  7. 7.
    Keay L, Stapleton F, Schein O. Epidemiology of contact lens-related inflammation and microbial keratitis: a 20-year perspective. Eye Contact Lens. 2007;33:346–53.CrossRefGoogle Scholar
  8. 8.
    Stone J, Phillips AJ. Contact lenses. London: Butterworths; 1989.Google Scholar
  9. 9.
    Douthwaite WA. Contact lens optics. London: Butterworths; 1987.Google Scholar
  10. 10.
    *Stevenson RWW, Corbett MC, O’Brart DPS, Rosen ES. Corneal topography in contact lens fitting. Eur J Implant Ref Surg. 1995;7(5):305–317.CrossRefGoogle Scholar
  11. 11.
    Fredrick S, Wilson G. The relation between eyelid tension, corneal toricity, and age. Invest Ophthalmol Vis Sci. 1983;24:1367–73.Google Scholar
  12. 12.
    Schnider CM, Kennedy L, Mintle L, Carr C, Hnatko T. Comparison of computerised corneal topography device nomogram and topographical fits to trial lens fitting. Invest Ophthalmol Vis Sci. 1995;36(Suppl):1458.Google Scholar
  13. 13.
    Szcotka LB, Capretta DM, Lass JH. Effect of computerised titration on videokeratoscope contact lens fitting. Invest Ophthalmol Vis Sci. 1995;36(Suppl):1458.Google Scholar
  14. 14.
    *Szczota LB, Capretta DM, Lass JH. Clinical evaluation of a computerised topography software method for fitting rigid gas permeable contact lenses. CLAO J. 1995;20:231–235.Google Scholar
  15. 15.
    Szczotka LB. Evaluation of a topographically based contact lens fitting software. Optom Vis Sci. 1997;74:14–9.CrossRefGoogle Scholar
  16. 16.
    *Astin CLK, Gartry DS, Steele ADMcG. Contact lens fitting after photorefractive keratectomy. Br J Ophthalmol. 1996;80:597–603.CrossRefGoogle Scholar
  17. 17.
    McCarey B, Zurawski C, O’Shea D. Practical aspects of a corneal topography system. CLAO J. 1992;18:248–54.PubMedGoogle Scholar
  18. 18.
    Wang X, McCulley JP, Bowman RW, et al. Time to resolution of contact lens-induced corneal warpage prior to refractive surgery. CLAO J. 2002;28(4):169–71.PubMedGoogle Scholar
  19. 19.
    Ruiz-Montenegro J, Mafra CH, Wilson SE, Jumper JM, Klyce SD, Mendelson EN. Corneal topographic alterations in normal contact lens wearers. Ophthalmology. 1993;100:128–34.CrossRefGoogle Scholar
  20. 20.
    *Wilson SE, Lin DTC, Klyce SD, Reidy JJ, Insler MS. Topographic changes in contact lens-induced warpage. Ophthalmology. 1990;97:734–744.CrossRefGoogle Scholar
  21. 21.
    *Wilson SE, Klyce SD. Screening for corneal topographic abnormalities before refractive surgery. Ophthalmology. 1994;101:147–152.CrossRefGoogle Scholar
  22. 22.
    Corbett MC, O’Brart DPS, Marshall J. Biological and environmental risk factors for regression after photorefractive keratectomy. Ophthalmology. 1996;103:1381–91.CrossRefGoogle Scholar
  23. 23.
    Phillips AJ. Orthokeratology – an alternative to excimer laser. J BCLA. 1995;18:65–71.Google Scholar
  24. 24.
    Hsiao CH, Lin HC, Chen YF, Ma DHK, Yeh LK, Tan HY, Huang SCM, Lin KK. Infectious keratitis related to overnight orthokeratology. Cornea. 2005;24:783–8.CrossRefGoogle Scholar
  25. 25.
    Tseng CH, Fong CF, Chen WL, Hou YC, Wang IJ, Hu FR. Overnight orthokeratology-associated microbial keratitis. Cornea. 2005;24(7):778–82.CrossRefGoogle Scholar
  26. 26.
    Yepes N, Lee SB, Hill V, Ashenhurst M, Saunders PP, Slomovic AR. Infectious keratitis after overnight orthokeratology in Canada. Cornea. 2005;24(7):857–60.CrossRefGoogle Scholar
  27. 27.
    Nesburn AB, Bahri S, Salz J, Rabinowitz YS, Maguen E, Hofbauer J, Belin M, Macy JI. Keratoconus detected by videokeratography in candidates for photorefractive keratectomy. J Refract Surg. 1995;11:194–201.PubMedGoogle Scholar
  28. 28.
    Stevenson RWW. Analysis of post-PRK topography maps. Invest Ophthalmol Vis Sci. 1995;36(Suppl):1792.Google Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Melanie Corbett
    • 1
  • Nicholas Maycock
    • 2
  • Emanuel Rosen
    • 3
  • David O’Brart
    • 4
  1. 1.Imperial College Healthcare NHS TrustLondonUK
  2. 2.University Hospital Coventry and WarwickshireCoventryUK
  3. 3.ManchesterUK
  4. 4.Department of OphthalmologySt. Thomas HospitalLondonUK

Personalised recommendations