Lens Use

Background

This case reveals a novel presentation of Kc management with the latest and high-end technology contact lens for keratconus management and PKP with high irregularity of the cornea. This corneal irregularity is present with poor vision, which most patients with Kc complain from.

Many patients suffer from small diameter design lenses as foreign body awareness, friction, sometimes lens dislocation and discomfort, which can also induce many mechanical complications like corneal staining.

Case Description

A 51 Year old female complain from unilateral anterior irregularity with PKP.

OD: Kc history with PKP management for the past 12 years,

       VA: 0.10

OS: -0.75, managed with glasses

       VA: 1.0

The patient was referred to my clinic practice on Jun 15/2022 by Key Ophthalmology Eye Care Center for possible right eye management with contact lenses to improve vision and reduce the headache.

I started over evaluating patient ocular health by objective test with my slit lamp observation and found OD with PKP as a clear and healthy cornea.

Figure 1

During the fitting session to evaluate a scleral lens on a patient who has keratoconus, various amounts of fluorescein can be used between the lens and cornea to understand the proper fitting and fluid amount.

Figure 2

Ideal fitting we achieved after the proper adjustment done.

Figure 3

Diffuse light examination using cobalt blue filter to evaluate the general fitting.

I started with a trial lens with a diameter of 15.5, Sag of 3800, Bc of 8.04, toric edge design, PWR: +2.00 Ds. Initially, the lens was stable and comfortable as the patient expressed and my observations reflected.

During slit lamp evaluation I found the central apical zone was flat with low Sag as 3800 @100 microns after 30 minutes, and I found the mid peripheral settled by 200 microns. The limbal part was appropriate with an average of 75 microns, and the landing part was well aligned horizontally flatter than vertically to meet the scleral shape with no impingements.

Made changes to the lens in the central part by increasing the sag with 150 microns, as shown in figure 2, and I over-refract the case with the lens as the following final Rx: -4.75 Ds.

VA improved up to 0.9

I ordered the final lens with the following: Sag: 3800, BC: 8.04 Dia: 15.50 toric edge design, Total PWR: (-4.75Ds).

The lens material selected was Optimum extreme to have good oxygen fluxing to the cornea and be away from any expected mechanical complications like hypoxia. I exceeded patient expectations in terms of vision and comfort, which she had lost in the past 12 years.

I received the original lens and we scheduled for the patient an appointment to receive and evaluate the lens required in term of vision, comfort and practice.

All objective and subjective tests were done and satisfied.

“You changed my life” said the Patient."

Conclusion

The case demonstrates how much we can help and improve PKP, Kc, and irregular corneal position with large-diameter scleral lenses made of high-quality materials. 

It is vital to ensure that the patient uses the lenses in accordance with eye care professional instructors in terms of hygiene care, insertion solution such as using saline, and so on.

Recommendation

To achieve great performance, eye care professionals should be updated with knowledge and information needed to improve skills and meet patient needs.

They should also prepare the necessary practice units and materials as trial lens sets. I would advise having different trial sets to have different designs to achieve the best fitting consultant and result.

Dr. Nezar Damati

Jordan

SAPHIR RX

Saphir RX es una lente de contacto de hidrogel de silicona con un alto contenido de agua y baja deshidratación, con superficie de alta lubricidad, (CoF = 0,02). Su bajo módulo de elasticidad (0.33 Mpa) mejora el confort del lente y garantiza simultáneamente calidad visual y facilidad de uso durante todo el ciclo de vida del lente.

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MULTIFOCAL TÓRICO

GENTLE 80

Gentle 80 is a bio-inspired hydrogel lens designed to imitate the natural properties of the cornea. Its material combines high water content, low dehydration, and the lowest modulus on the market (0.13 MPa) with oxygen transmissiblity that reaches silicone hydrogel levels (Dk = 60), achieving award-winning comfort and health.

ORI:GEN TECHNOLOGY

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Saphir representa una familia de lentes blandos mensuales y trimestrales fabricados individualmente con hidrogel de silicona, el material más avanzado del mercado, que maximiza el flujo de oxígeno al ojo. Su combinación única de comodidad, transpirabilidad y calidad de visión se adapta incluso al usuario de lentes de contacto más exigente.

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GENTLE 59

Gentle 59 es un lente de hidrogel biomimética diseñada para imitar las propiedades naturales de la córnea. Su material combina una elevada lubricidad de la superficie (CoF = 0.05) con una baja deshidratación (<1%) para un confort excelente. Su módulo de elasticidad (0.36 Mpa) ha sido calibrado cuidadosamente para obtener una óptima manipulación y una excelente calidad visual durante todo el ciclo de vida del lente sin comprometer salud ni comodidad.

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BLU:GEN

Blu:gen es un lente de contacto de hidrogel de silicona que combina un filtro UV de Clase 1 con un filtro selectivo de la luz azul para proteger el ojo en un 99% contra los rayos UVB, el 93% de los rayos UVA y el 14% de la luz azul-violeta nociva. El material cuenta con un alto contenido en agua y baja deshidratación, con el módulo de elasticidad más bajo (0.25 Mpa) entre todos los hidrogeles de silicona disponibles en el mercado. Todo esto ofrece a tus pacientes lentes saludables y cómodas para usar durante todo el día.

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BLU:KIDZ

Blu:kidz es un lente de contacto de hidrogel de silicona que combina un filtro UV de Clase 1 con un filtro selectivo de la luz azul para proteger el ojo en un 99% contra los rayos UVB, el 93% de los rayos UVA y el 14% de la luz azul-violeta nociva. La gama de diámetros enfocada a los niños favorece su adaptación también en los ojos más pequeños, mientras que el tinte de manipulación verde, el alto contenido en agua y el material de baja deshidratación garantizan una mejor facilidad de uso y confort: perfecta para los nuevos usuarios.

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EQUILIBRIA

Equilibria es la alternativa sin silicona, con excelentes propiedades de retención de agua y tensoras para los pacientes acostumbrados al reemplazo trimestral de los lentes de contacto.

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QUATTRO

Quattro nos permite corregir potencias esféricas, tóricas y multifocales en diferentes diámetros para aquellos pacientes acostumbrados al reemplazo anual.

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BLU:SSENTIALS

Blu:ssentials es un lente de contacto de hidrogel de silicona que combina un filtro UV de Clase 1 con un filtro selectivo de la luz azul para proteger el ojo contra más del 99% de rayos UVB, el 93% de rayos UVA y el 14% de la luz azul-violeta nociva. Su gama seleccionada de parámetros ofrece a los pacientes con prescripciones estándar la protección contra la luz ultravioleta y la luz azul del sol y de la iluminación LED en ámbito doméstico, en los espacios públicos y de los dispositivos móviles.

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XTENSA RX

Xtensa Rx es un lente de contacto de hidrogel desarrollado a partir del hidrogel convencional.

Se caracteriza por cilindros disponibles hasta -5.75D que añade una gama tórica personalizable a la gama de lentes moldeados.

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Quattro nos permite corregir potencias esféricas, tóricas y multifocales en diferentes diámetros para aquellos pacientes acostumbrados al reemplazo anual.

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BLU:GEN

Blu:gen is a silicone hydrogel lens, combining a Class 1 UV Filter with selective Blue Light Blocking to protect the eye from upwards of 99% of UVB, 93% of UVA, and 14% of harmful blue-violet light. Its high water content, low dehydration material featuring the lowest modulus of all silicone hydrogels on the market (0.25 Mpa) offers your patients a healthy, comfortable all-day wearing experience.

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MYLO

Mylo is an individually crafted silicone hydrogel contact lens specifically designed for Myopia Management. It is powered by the Brien Holden Vision Institute’s patented Extended Depth of Focus (EDOF) technology, which slows myopia progression and supports a comfortable adaptation to the lens, enhancing the overall wearing experience. A monthly disposable contact lens, MYLO features high water content, low coefficient of friction and low elastic modulus, which combine to improve comfort throughout the day. Its wide range of parameters ensure an excellent fit, especially for the youngest contact lens wearers.

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TORIC

BLU:KIDZ

Blu:kidz is a silicone hydrogel lens, combining a Class 1 UV Filter with selective Blue Light Blocking to protect the eye from upwards of 99% of UVB, 93% of UVA, and 14% of harmful blue-violet light. Its child-friendly range of diameters makes it possible to fit even the smallest of eyes, whilst its green handling tint and high water content, low dehydration material provide improved handling and comfort-perfect for first-time contact lens wearers!

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SAPHIR

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EQUILIBRIA

Equilibria provides a non-silicone option, featuring good water retention and tensile properties, for patients already accustomed to a 3-monthly lens replacement.

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QUATTRO

Quattro provides spherical, toric and multifocal correction in multiple diameters for patients already accustomed to a 3-monthly lens replacement.

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BLU:SSENTIALS

Blu:ssentials is a silicone hydrogel lens, combining a Class 1 UV Filter with selective Blue Light Blocking to protect the eye from upwards of 99% of UVB, 93% of UVA, and 14% of harmful blue-violet light. Its select range of parameters offers patients with standard prescriptions protection from UV and blue light originating from the sun, ambient LED lighting at home and in public spaces, and mobile devices.

SILICONE HYDROGEL

TORIC

MONTHLY

MULTIFOCAL

SPHERICAL

XTENSA RX

Xtensa Rx is a monthly contact lens lathed from our proven hydrogel material. It offers a wide range of parameters to meet virtually all prescriptions. Its blue visibility tint ensures an easy handling.

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MULTIFOCAL TORIC

QUATTRO

Quattro provides spherical, toric and multifocal correction in multiple diameters for patients already accustomed to a 1-year lens replacement.

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SAPHIR RX

Saphir RX is a silicone hydrogel lens, featuring a comfortable high water content, low dehydration material with a highly lubricious surface (CoF= 0.02).

Its low modulus (0.33 Mpa) adds to the comfort of the lens whilst ensuring vision quality and easy handling throughout the lens’ life cycle.

SILICONE HYDROGEL

MONTHLY

SPHERIC

TORIC

MULTIFOCAL

GENTLE 59

Gentle 59 is a bio-inspired hydrogel lens designed to imitate the natural properties of the cornea. It combines high surface lubricity (CoF = 0.05) with low dehydration (< 1%) for excellent comfort, and its modulus (0.36 Mpa) has been carefully calibrated to achieve optimal handling and vision quality throughout the lens’ lifecyle, without reducing comfort or health.

ORI:GEN TECHNOLOGY

MONTHLY

SPHERIC

TORIC

MULTIFOCAL

MULTIFOCAL TORIC

GENTLE 80

Gentle 80 es un lente de hidrogel biomimético diseñado para imitar las propiedades naturales de la córnea. Su material combina un alto contenido en agua, una baja deshidratación y el módulo de elasticidad más bajo del mercado (0.13 MPa), así como una transmisibilidad al oxígeno que alcanza los niveles del hidrogel de silicona (Dk = 60), para lograr una comodidad y salud visual inigualables.

ORI:GEN TECHNOLOGY

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