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RGP Fitting
Why?
GP pts are loyal: successful GP wearers love their CLs.
serious complications are rare: chemicals going into eyes
great vision
significant profit in material & fits: some pts lose their
lenses & have to replace them freqly. Charge more for
fitting.
All powers, parameters available in numerous high Dk
materials: can virtually get anything you want.

The best multi-focal lenses are GPs: b/c GPs move a lot w/
the eye.
GPs may slow myopia progression
Keratoconics see best with GPs
Post surgical often best with GPs
GPs are easy & fun to fit. The hardest thing about fitting GP
is selling the idea to the pt. Presentation is the key dont
say hurt, roll your edges, use anesthetic.

To start:
st
1 : verify that your Ks and refaction are accurate
nd
2 : Choose diagnostic lens avg dia (~9.0), BC close to pts FLATTEST K. (Go bet. The Ks if high cyl)
rd
3 : place on eye, evaluate movement, centration, fluorescein pattern and decide next step (consider OR).
st
o Clean lens 1 . Have pt look down while you apply the lens. This is the most comfortable gaze. Eval after 10min.
If totally clueless, you can always call the lab.
2 different ways of fitting GPs:
1) Diagnostic lens fitting parameters to be ordered determined by applying in-office dx lenses, eval fit, OR
o May give greater success rate and requires fewer reorder.
o Provides pt familiarity w/ lens type b/c you allow adaptation to begin during fit visit (even w/ instillation of anesthetic)
o Drawback: more time consuming, and sometimes you dont have parameters close to pts rx.
o Steps:
Verify:
parameters (BC, F) of dx lens and record them in pts file in this order:
BC/OAD/Power + name of lens/material
Ex. 7.4/9.0/-2.50D Boston ES
Verify that the edge is smooth, if not polish them.
Application:
Wash hands in pts presence. Clean, rinse, and apply wetting solution to dx lens.
Seat pt in exam chair w/ headrest in place for greater control.
If desired, instill anesthetic: time saver, less tearing, definitely use it w/ kids (myopic control) and opt II students
Advise pt what to expect and to fixate. And fixate downward after application for a few mins.
Firmly grasp lids and apply lens directly onto central cornea. NOT onto conj.
Do not release lids until lens has settled into place or else lens will pop out.
When tearing as subsided, use SLE to observe lens positioning, movement, and fluorescein pattern.
If the fit appears acceptable, perform OR.
Evaluate after tearing has subsided.
2) Empirical fitting order from data WITHOUT diagnostic lens application.
o CL received is not a trial. Need to be paid in advanced. Only way to modify parameters is by purchasing exchange warranty.
o ~50% of practitioners use this method. Parameters determined by OD or by lab.
For the lazy/incompetents: Virtual design using topographer: calculates tear lens thickness for you w/ or w/o dx CLs machine
designs lens for you.
The GOAL of GP fitting:
Good vision; pupil in OZ most of the time; comfortable
Good movement and centration
Acceptable fluorescein patterns
o Peripheral clearance for tear exchange and debris removal 0.2 0.6mm wide
o Centrally & mid-periphery light pooling or light bearing. No heavy or harsh pooling/bearing/junctions.

RGP Fitting
Evaluation of fluorescein patterns:
Make sure the CL is in most centered position (may center lens manually)
Note how pattern appears most of the time w/ normal blink.
Avoid excessive fluorescein b/c too much dye will fluoresce the entire cornea and you cant see real pooling/bearing. Allow them to
drain before eval.
Use fluorescein, cobalt filter, Wratten yellow filter & slit lamp, or Burton lamp to examine and describe the following:
1) Pooling: green, clearance
o Heavy pooling or heavy bearing generally undesirable, but usually okay to have more pooling in periphery curve area than
in mid-periphery or center. B/C good periphery pooling is necessary for debris removal and tear exchange.
o Note location, degree and extent of pooling and bearing.
o Describe all portions of pattern: central, mid-periphery, & periphery
2) Alignment: thin even film fluor, may barely be visible.
o Lens parallels corneal contour resulting in a thin even tear film over central and mid-peripheral regions: light green. This
means that the curve of the lens is equal to the curve of the cornea.
o Does NOT have to be in alignment to be an acceptable fit, but alignment does avoid corneal molding.
o In some cases, you may need to fit slightly steep, or slightly flat to achieve best centration.
Ex. High + lenses tends to drop down when you blink, fit slightly steep.
o BC may not be exactly same as flattest K (depending on OAD, OZW, ect)
o Pooling : PC area slightly > central & mid-periphery.
3) Bearing: black, ie absence of fluorescein.
o Where CL touches eye.
o Heavy bearing is not good. Can cause edema, corneal molding and disruption of debris removal/tear exchange.
Types of fit:
o Flat fit: central bearing, mid- peripheral & peripheral pooling flat fit
flatness harshness of central bearing central bearing area periphery & mid periphery pooling
o Steep fit: central pooling, bearing in the mid-periphery and periphery
steepness density of central pooling central pooling area width of bearing in mid-periphery
Bubbles may be trapped centrally
o Interpalpebral fit
Centers between the lids. Edge of lens can be tucked slightly under upper lid.
Best for pts w/ wider palpebral fissures.
There should be a lag of 1-3mm, and the CL should be recenter rapidly after blinking.
OAD: large, medium, or small
Desired fluor pattern: alignment, slightly steeper or slightly flatter than K depending on OAD, toricity, &lens design.
o Lid attachment fit
Lens remains in contact w/ upper lid at all times (1/4 of the lens). Works best on low positioned upper lids.
Movement: no lag (lid does NOT release the lens.) Lens moves w/ upper lid as if it were part of the tear film.
Lens awareness initially but after adaptation some doctors feel this is the most comfortable GP design.
OAD: generally 9.5mm, but depends on cornea/fissure size.
Thin lens with anteriorly placed apex
Select BC ~ 0.1mm to 0.2mm (0.5D 1.00D) flatter than interpalpebral fit allow adequate movement.
Desired Pattern
Preferred: light bearing centrally w/ moderate pooling in the mid-pheriph and periph. Alignment pattern may be
acceptable if good movement, centration is present.
If lens is not being held by the upper lid or is riding too low, try a flatter BC. Dont go overboard! Dont want
harsh/excessive bearing/pooling anywhere.
Ex. Korb 9.5 OAD design (polycon II & Fluorocon)
Lid attachment design
Very thin RGP design as thin as 0.07mm ct
Can request similar design in newer materials

RGP Fitting

RGP Parameter selections

OAD
o Ranges:
Avg = 9.0 9.2mm
Unusual: can fit < 8.5mm or > 10.0mm.
Semi-scleral specialty: 13.5 15.0mm. This is about the size of a soft CL, therefore its more comfortable. Used in some
sports to prevent CL popping out.
Sclera: 22 24mm. use for pts w/ pathologically dry eyes b/c it works as a barrier to take away pain. They also work as a
tear reservoir.
o Selection:
Consider HVID (horizontal visible iris diameter), Palpebral aperature height, lid position, and pupil size.
Best comfort Avoid CLs w/ upper edge at upper lid margin. Go larger or smaller.
Consider activity large OAD is less likely to pop out
Consider larger OAD: wide palp fissure (>10.5), larger HVID (>11.5mm), lens edge at upper lid margin, sph corneas, flat
corneas (<41.00D), sports, loose upper lids, Ortho-K
Consider smaller OAD: narrow palp fissure (<9.0mm), small HVID (<11.5mm), lens edge at upper lid, high corneal
astigmatism (2.00D), steep corneas (>45D)
OZW optical zone width
o Varies between pts, but generally 65 80% of lens OAD
o Typically needs to be 1-2mm larger than pupil in dim illumination.
o Can be varied to alter fit by changing sag. OZ steepness b/c sag. Or you can leave it up to the lab!
o Common methods:
OZW = OAD 1.4
Used by lab: 0.4 secondary curve, 0.3 periphery curve.
OZW = OAD 1.6
Used by some fitting sets: 0.5 SC/0.3PC
OZW = BC
Used in clinic! If the lens has a BC of 41.75D or 8.09mm BC, use 8.1mm for OZW.
BC base curve
o Based on desired relationship to central to mid-central cornea.
o Depends on: corneal curvature/toricity, OAD/OZW, desired lens position (lid attachment/interpalp), fluorescein pattern.
o Conversion: (KNOW for test!)
Bennetts Guidelines for Initial DX BC
0.1mm = 0.5D, 0.05mm = 0.25D
for 9.0 OAD/7.4 OZW GP
Not exact, but close enough for dx lens fitting purposes.
Corneal cyl BC
o MM vs D
Pl 0.50
0.25D flat on K
D = dioptors. D = steeper
0.75 1.50 On K 0.25D steep
Mm = radius in mm, mm = flatter
1.75 2.50 0.25 0.50D steep

, or r =

2.75

bitoric

Another way: add 0.1mm to the avg K 0.5D flatter.

Ex. Pt Ks 42.50(7.94) @ 180/43.50(7.75)@90; avg K is 7.84, add 0.1mm = 7.94mm. RX 7.94mm K.
CT center thickness
o Greatest factors are F & OAD
o Too thick
rides inferiorly (due to gravity and lens mass
may O2 transmission.
o Too thin: flexure, instability, easily damaged
High Dk lens and corneal cyl usually flexure. So you need to the CT to stabilize the lens.
Rule of thumb: starting from standard ct for a specific F and OAD, then ct by 0.02mm for DK >50. Additional
0.02mm/dioptor of cyl.
o Varies between materials, lens designs, manufacturers, and labs
o Generally, Dr. does not specify on order unless for a particular reason. Mostly an attempt to duplicate previous lens.
o TAP = thin as possible
o

Calculate rounding to nearest quarter or eighth: D =

RGP Fitting

Remember: 1 dx lens is only a starting point.

o Evalulate movement, centration, fluor pattern, and then decide what to do next.
st
o 1 dx lens is only a logical ballpark starting place.

Fit adjustments
o General:
movement and improve centration: steep/ BC
movement/decentration: flatten/ BC
Only consider these when they dont cause unacceptable fluors pattern changes.
o To steepen/tighten fit
sag by BC by 0.1mm while keeping OAD/OZQ constant, or
sag by OZW by 0.4 or 0.5mm while keeping BC constant.
Summary: sag = BC = OZW
Ex. A 9.0/7.4 -1.50RGP w/ a OR is pl.
BC method: Order 43.50/9.0/7.4/-2.00D Remember that you have to compensate for the change in F by the change
in BC. steepness = more plus, so add more minus to RX. (FAP SAM)
OZW method: Order 43.00/9.4/7.8/-1.50D
No effect in power by or OZW.
o To flatten/loosen fit
Opposite of steeping
Flatten BC() by 0.1mm while keeping OAD/OZW constant
OZW by 0.4mm while keeping BC constant
Flatten = BC or OZW
o To change OAD/OZW w/o altering BC/cornea relationship
A change in OAD will alter the seg and therefore the tear film power. Need to alter BC to compensate.
For OZW by 0.4 or 0.5mm, need to BC by 0.05mm (0.25D). And vice versa for OZW
Ex. Lens is 43.25/9.0/7.4/-3.00D. OR is pl. You like the fluorescein pattern, but need a larger OZW. To maintain the same
fluorescein pattern, you should order43.00BC/9.4OAD/7.8OZW/-2.75D

st

- To OZW: add 0.4mm to OAD/OZW 9.4/7.8. This the seg, and tightens the lens. To compensate: make BC flatter.
- conversion is 0.4mm OZW to 0.25D BC. Flatten the 43.25D BC by 0.25D 43.00D BC.
-Remember: when you flatten the BC by 0.25D, you also need to adjust the power of the lens order to compensate for the change in overall power.
(FAPSAM!) Last step is to change the power ordered by 0.25D. -2.75D.

Give it time
On initial insertion, lens awareness typically causes excessive movement, decentration. This lessens as adaptation occurs.
Rough edges also cause same sxs. Always make sure the edges are smooth before you give them to the patients.
Decentration:
Before trying to correct decentration of any kind, first figure out why the lens is decentering and manually center to see BC
to cornea relationship! It may be due to
Decentered apex, ART cyl, or lid influence
To alleviate, consider:
Steeper BC - 0.1mm if fluor pattern still OK.
Change to aspheric design such as the Boston Envision
Larger OAD - 0.4 0.5mm and leave BC
Soft lens
unchanged.
Small amt maybe acceptable if pupil coverage is OK.
To lower a superiorly positioned lens
ct or change to thinner edge design (Ex. Plus lenticular) or consider bitoric if high corneal cyl
Change to material with high specific gravity (mass)
Steepen BC by 0.1mm or OAD to move it away from upper lid.
To raise an inferior lens
CT or consider bitoric if high cyl (>2.50D) or consider minus lenticular (all + and low -) or plus lenticular (>-5.00)
change to material with lower specific gravity
flatten BC by 0.1mm keeping OAD/OZW the same or OAD/OZW by 0.4mm
change to lid attachment fit