Download Contact Lens Registry Examination: Questions and Answers for NCLE CLRE Exam and more Exams Optics in PDF only on Docsity!
National Certification Organization
for Opticians
The National Contact Lens Examiners
(NCLE) ABO American Board of Opticianry
CLRE Contact Lens Registry Examination
Course Title and Number: ABO NOCE Competency Exam Exam Title: Registry Exam Exam Date: Exam 2025- 2026 Instructor: [Insert Instructor’s Name] Student Name: [Insert Student’s Name] Student ID: [Insert Student ID]
Examination
180 minutes
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NCLE - CLRE Contact Lens Exam 2 Review Questions and Answers | 100% Pass Guaranteed | Graded A+ | 2025- The National Contact Lens Examiners NCLE ABO American Board of Opticianry CLRE Contact Lens Registry Examination
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What are some things you must consider when chosing a material that lower vs. higher dk? - =Answer>> must consider power, fitting circumstances, overnight wear, etc What are some characteristics of lower dk? - =Answer>> More stable, durable, less oxygen transmission, less deposits Keep in mind that tears also provide oxygen! What are some characteristics of higher dk? - =Answer>> Greater oxygen transmission BUT more deposits, fragile, flexure, warpage When ordering spherical GPs, what MUST you state/specify? - =Answer>> BC, power (F), OAD, tint, material** What are some optional things you might order for a Spherical GP? - =Answer>> Optional: dot the OD, make OD and OS different tints, plasma treatment, Tangible hydra-peg
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🤔 Hybridgrades101@gmail.com For peripheral clearance/edge life, what will the clinician see? Versus what the lab sees/does? - =Answer>> What the clinician sees: pooling at lens edge, peripheral clearance What the lab sees: calculating axial edge lift (AEL) How the lab thinks about clearance What is axial edge lift? - =Answer>> Axial edge lift (AEL): geometrical calculation of vertical distance between lens edge and extension of the BC radius of the lens -Distance between where edge of lens is with SC and PC, and where it would have been without them -Constant axial edge lift designs keep sag constant at edge of lens regarding power and OAD Changing peripheral clearance Rule of thumb What is the minimum change for clinical difference, and what would you do it adequate on/too little clearance for SCR or PCR, and SCW or PCW? - =Answer>> SCR or PCR: at least 1.0mm, Ex) 11.0 mm PCR à flatten in-office to 12 mm or reorder SCW or PCW: at least 0.20mm, ex) With 0.40 PCW à widen in-office to 0.60 mm or reorder Example #1: The best BC is on but the PCR = 11 mm and shows inadequate clearance. What will the new radius be? A. 11.2 mm B. 11.5 mm C. 12 mm - =Answer>> ANSWER: C. 12 mm. Must change at least 1 mm to see a difference. Either flatten in office with diamond tool or send back to lab. When changing the peripheral curve, first be sure that: - =Answer>> the fluorescein pattern is optimal
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🤔 Hybridgrades101@gmail.com Increasing the peripheral clearance: - =Answer>> -Flatten and/or widen peripheral curves, keeping all other parameters constant: Can be done as in-office modification using techniques shown in lab for applying SC and PC -Increase blend: can be done in-office (increases tear exchange and movement) Decreasing peripheral clearance - =Answer>> -Steepen and/or narrow peripheral curves -Requires reorder Selection of Toric lens depends on: - =Answer>> 1) ocular health and exam findings
- agreement with patient on which best fits their needs frequency of replacement depends on tendency for coatings, wearing schedule, etc Other things to keep in mind for toric follow ups and ordering - =Answer>> Order trial lens and perform f/u before ordering multipacks -Power should be close enough to be functional and allow adaption -VAs with trials can be 20/15 to 20/25 if exact power is not available Demonstrate OR to patient and add it to the CL trial order Do not have to trial every single adjustment made -Follow-ups are meant for making tweaks to the lens parameters, if needed -NEVER finalize and order on the dispense visit Fit may be different esp. if CLs have never been worn before Types of torics - =Answer>> Which type of SCL torics are particularily expensive? - =Answer>> SiHy Daily Disposables (DD)
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🤔 Hybridgrades101@gmail.com A CW lens _________ (cannot/can) be worn on a DW wearing schedule - =Answer>> can Most doctors advise against habitually sleeping in torics due to ____________ ________, UNLESS: - =Answer>> lens thickness SiHy and approved for overnight Greatest risk for microbial keratitis is in _____ use - =Answer>> EW Patient management of toric SCLs What are symptoms and recommendations for someone with allergies? - =Answer>> Patient management for toric SCLs What are the symptoms and recommendations for someone with intense near work? - =Answer>> -more problematic with torics b/c they are larger and tend to do under the lid -lid interaction affects lens position What are the important things we need to do in a toric CL dispense/follow up? - =Answer>> 1) Obtain history
- check acuity
- check compliance
- note any mislocation
- determine any other problems How does mislocation change over time? Why is this so detrimental to CL - =Answer>> Mislocation may occur at dispense but less movement occurs over time with adaption -Potentially causes decreased VA (use 20/40-20/15 chart) -Always verify mislocation in both eyes first in primary gaze -If good VA with spherical OR, STOP here (Spherocylindrical OR only if indicated)
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🤔 Hybridgrades101@gmail.com What should you consider in the follow up appointment when you perform the tear film and lid evaluation? - =Answer>> -artificial tears -allergy meds -PF solutions -more frequent replacement Case #1:Acuity decreased from last visit and Rx has -2.25 cyl. You see 0 mislocation now. You saw 10° R last week. Trial lens axis is 160. Spectacle axis is 170.What axis do you try next? What other test could you do to see what axis is needed? - =Answer>> try axis 170. if necessary, check axis with SCOR when acuity is reduced What does a Spherocylindrical ORx (SCOR) indicate when doing a contact lens follow up? - =Answer>> It indicates the cyl axis was off SCOR + toric lens sphere and axis gives a _______________ __________ ______________ effect - =Answer>> oblique cross cyl effect What are the steps of the spherocylindrical ORx (SCOR)??? - =Answer>> Basically the JCC portion of the manifest refraction
- Do spherical OR first
- Next fish for cyl using .50D cylin parallel positionin all major meridians (45, 90, 135, 180)
- If accepted, go back and refine axis in straddle position then recheck cyl power
- See if acuity improves
- If acuity improves, calculate resultant (ORx in -cyl format + trial Rx) and order anew trial After performing a spherocylindrical ORx (SCOR), how do you determine the resultant axis? - =Answer>> As the lab to calculatre the resultant or use online CL manufacturing resources Case #2: New fit with spec Rx cyl vertexed is -1.25 axis 020. Closest lens in stock is axis 010but it does have the same sphere and cyl amount as specs. The VA with the lens is an easy 20/15. Zero
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🤔 Hybridgrades101@gmail.com 4.Determine 2 major meridians:a.Getone merdian in focus first by turning the stage to rotate the lens and moving the power knobb. Turn the power knob until the other axis is clear and in focus 5.Read off the powers 6.Axis can be estimated (difficult to determine exactly) a.At least ensure correct power and cyl amount i.More common problem with custom lenses ii.Also used to verify if CLs were switched b/w the two eyes What are the 3 things we need to communicate to the patient in terms of GP lens care and handling to help the patient be successful?
- =Answer>> 1) provide several methods of insertion and removal patient must demonstrate proficiency before leaving office
- educate the patients on solutions in recommended care regimen function and importance of performing properly
- educate the patient on limitations and complication: do's and don'ts, inlcuding overnight wear and troubleshooting issues What are the GP lens care components/products? - =Answer>> Can be individual or combination products -cleaner -rinsing agent -disinfectant -conditioner/wetting agent -periodic cleaner -lens case Daily cleaners are _______________ (less/more) important in GP wear than with soft contact lenses because:
- lenses need to last longer
- surfaces of CL readily attracts oil from eye, face, and eye creams, oily soaps, make up remover
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🤔 Hybridgrades101@gmail.com in daily cleaners, the purpose of the surfactant/detergent plus friction is: - =Answer>> to remove environmental and tear film debris make-up, mucoprotein, lipids Use a daily cleaner for GPs in the __________________ to:
- enhance disinfection 2)debris is more easily removed when the lens is warm after being worn
- improves wettability: artificial biofilm and molecular reversal In daily cleaners of GP lenses, ______________ is necessary, becuase... - =Answer>> rub is necessary digital pressure/friction helps remove deposits (however, excessiveness leads to warpage and breakage) rub 2-3 drops daily cleaner in palm of hand for 15-30 seconds clean with L-r or up-down motion, NOT between fingers NOT circular motion What are some examples of abrasive daily cleaners? - =Answer>> Boston Cleaner, Boston Advanced Cleaner, Opti-Free daily cleaner What is an abrasive daily cleaner? - =Answer>> uses a surfactant plus small polymer particles to increase friction during lens scrubing -newer products have smaller particle size What are the disadvantages of abrasive daily cleaners? - =Answer>> May hasten removal of plasma treatment and may be contraindicated in hyper DK lenses
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🤔 Hybridgrades101@gmail.com What functions do they do? What is the advantage? How long do you need to soak? List 4 examples - =Answer>> -What functions do they do? Cleaning, soaking, wetting/conditioning -What is the advantage? easiest for patients to comply, especially when begginer in GP lenses -How long do you need to soak? 6 hours
- Boston Simplus multi-action solution
- menicon unique pH
- alcon clear care
- Equate Sterile CL conditioning solution: or other store brands In general, if label says _____________, ________________, and ______________ then its OK for lens application, no need to rinse before applying to eye - =Answer>> conditioner wetting rinsing agent What is a clear warning NOT to apply something directly to your eye in GP solutions? - =Answer>> a RED cap! optimum CDS or ESC Doesn't apply to Clear care if its neutral What are the 4 purposes of rewetting/re-lubricating drops? - =Answer>>
- rewet lens surface
- stabilize tear film
- rinse away trapped debris (especially for those with allergies)
- breakup loosely attached deposits (with blinking) When/how do you instill rewetting/relubricating drops? - =Answer>> instill directly into eye during lens wear use as necessary, since not all patients need them not necessary for all patients
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🤔 Hybridgrades101@gmail.com What type of drops should you use for rewetting? Should we be concerned about safety with rewetting drops? - =Answer>> almost any artifical tear is okay safe to use unless patient is sensitive to preservative Artificial tears vary in composition including preservatives and viscosity What 3 things might artifical tears contain? And how does each one function? - =Answer>> 1) PVA: increases length of contact time 2)celllulose derivatives: increases viscosity and aid in surface wetting. remind patient they might experience slight blur initially
- mild, non-ionic detergent: oosens and solubizes mucus and debris Rewetting/Insertion: Now-a-days we prefer ____________ (more/less) viscous solutions. Why is this? and for what type of lenses is this most important? - =Answer>> less viscous especially for large diameter GP lenses (sclerals). avoid thickeners e.g. methyl cellulose, which gets trapped under lens and causes longer contact time. Instead use a preservative free or saline solution for insertion Periodic cleaners: What is the purpose of an enzymatic cleaner? - =Answer>> weekly cleaner to remove accumulation of deposits beneficial adjunct to daily cleaner What is the lens care sequence for non-red cap solutions? - =Answer>> wash hands, rub lens with cleaner in palm of hand, rinse with saline or MPS, soak overnight with MPS or disinfectant, apply to eye from case (can use rewetting drops) rewetting/lubricating drops PRN enzymatic cleaner PRN What is the lens care sequence for red cap solutions (optimum and menicare)? - =Answer>> wash hands, clean by rubbign at night with CDS
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🤔 Hybridgrades101@gmail.com How is chlorohexadine's efficacy improved? - =Answer>> by adding EDTA or thimerosal What is thimerosal? - =Answer>> an organic mercurial compound that used to be a common preservative (less common now due to sensitivity) What is the spectrum of activity for thimerosal? - =Answer>> bactericidal with a broad spectrum but very slow acting, but ineffective for pseudomonas in low concentrations What is EDTA? - =Answer>> Ethylenediamine Tetra Acetate; a chelating agent (not a true preservative) What is the purpose of using EDTA? - =Answer>> used in combination for synergistic effects, especially against pseudomonas How does EDTA work? - =Answer>> disrupts bacterial cell wall to give preservative better efficacy What is PAPB/Dymed? - =Answer>> Polyaminopropyl biguanide; a soft and GP contact solution preservative (30 - 50x higher concentration for GPs) What is the spectrum of activity for PAPB/Dymed? - =Answer>> effective against acanthamoeba and better against serratia than chlorohexadine What solutions is PAPB/Dymed used in? - =Answer>> Boston Advance Conditioner, Boston Simplus, and all Baush and Laumb products What solutions is chlorohexadine used in? - =Answer>> Boston simplus, Boston original conditioning
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🤔 Hybridgrades101@gmail.com What solutions is Polyquad found in? - =Answer>> uniquePh, Optifree, and most Alcon artificial tears Why is benzyl alcohol used in some solutions? - =Answer>> good disinfection capabilities and effective with lipid removal, negligible binding to BP surface What solutions use Benzyl alcohol? - =Answer>> Optimum CDS and Menicare CDS What preservatives are used in Boston original? - =Answer>> Chlorohexadine What preservatives are used in Boston Advance? - =Answer>> PAPB/Dymed What preservatives are used in Boston Simplus? - =Answer>> Chlorhexadine plus PAPB/Dymed What preservatives are used in Unique pH? - =Answer>> Polyquad What preservative is used in optimum extra strength cleaner by lobob? - =Answer>> trick! non-preserved Describe hydrogen peroxide solutions - =Answer>> non-preserved FDA approved with GPs rub required to prevent deposits some prefer to apply lens with artificial tears instead of neutralized saline Describe Boston Conditioning solution - =Answer>> -disinfects and cusions -wetting agent coats surface of lenses to make them smooth, wet, and comfortable -helps reduce friction between lens and eye
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🤔 Hybridgrades101@gmail.com oAlcohol based oFor soft lenses, but can be used on occasional basis for RGP lipid, mucous, and protein build-up oCould damage RGP surface if used routinely oDiscontinued in 2010, now available to purchase on website In office RGP disinfection In the Us versus europe? Most doctors... - =Answer>> In US: use system known to be effective against communicable diseases such as hepatitis and HIV oCVS Extra Strength Daily Cleaner (NOT a peroxide cleaner) oClear Care Hydrogen Peroxide In parts of Europe: reuse of diagnostic lenses not recommended due to fear of transmission of Mad Cow Disease •Most doctors: oClean with good cleaner (Optimum ESC), rinse, and store them dry oClean case with alcohol prep and wipe dry oRe-clean and condition before placing on patient's eye How should we clean our case? DAily and weekly - =Answer>> daily: allow to air dry, face down weekly: clean with daily cleaner to prevent biofilm formation rub with clean fingers for at least 5 seconds rinse with disinfection solution wipe clean with tissue How should we store spare lenses? - =Answer>> -recommended to store dry -long term storage in soaking solution without replacing solution on a regular basis may result in: evaporation of solution leaving adherent residue loss of efficacy, allowing microbial growth
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🤔 Hybridgrades101@gmail.com What should you recommend to patients in terms of cosmetics and CLs - =Answer>> -recommend water solube eye makeup -apply CLs before applying makeup, moisturizer, oily hair products, etc -Do not handle anything containing oils or fragrances prior to insertion What to know about compliance? - =Answer>> 1) most patients non- compliant with contact lenses in general: cleaning/rubbing is the most skipped step
- studies have shown that extra counseling/patient education improved compliance: educate why using specific solution
- at every office visit, ask patients to tell you what products they are using and how they are using them
- verbal and written instructions need to be documented Regarding compliance, what questions should you ask a patient? - =Answer>> What kind of hand soapare you washing your hands with prior to lens application? Do you put on make-up before applying lens? Lotions? Hair gels? Do you rub lenses in palm of hand after removal? What are the steps in a dispensing visit? - =Answer>> 1) Prior to visit, verify CL parameters, surface quality, edge smoothness with a radiuscope: Place in wetting/soaking solutionto remove impurities
- verify if any changes in history since last visit
- Record entering VAs(even with specs)
- SLE including staining: Assess baseline staining(any pre-existing dryness, dry eye components, SPK, etc.)
- Now for the lenses: -Apply lenses and allow to settle -Record VA with CLs -Perform ORx -Assess fit with slit lamp NaFlpattern, movement, centration
- Instruct application and removal, and re-centration: Reassurance is important, must educate how to rec-enter if lensesare offset•
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