Slide 1. Slide 2. Slide 3. Richard Dorer NCLE

Transcription

1 Slide 1 Heart of America 2014 Richard Dorer NCLE richarddorer@gmail.com Slide 2 I am a paid representative and consultant of Blanchard Contact Lens. I represent Blanchard Contact Lens in the Mid-Western United States that includes the State of Kentucky. Slide 3 As an industry contact lenses started with firm (Glass, PMMA, RGP) materials. The industry then changed course going to a soft modality. Once again we are going back to our roots with the advancements of firm (GP, SiHi) materials and a better understanding of manufacturing and the mechanics of the overall eye. Richard Dorer, 2012

2 Slide LEONARDO DA VINCI Theory Put face in bowl of water alter corneal power da Vinci was the first to describe a principals of contact lenses. He had no plans on what we recognize as a contact lens. Slide 5 The first written description of a contact lens 1823 by Sir John Herschel Some transparent animal jelly contained in a spherical capsule of glass applied to the surface of the eye to correct for irregular astigmatism. Also suggested corneal molds for lenses. Slide 6 Late 1800 s to 1930 s Scleral shells made from glass and then PMMA were the lenses of the day William Feinbloom combined glass corneal sections with plastic scleral section contact lens 1950 Kevin Tuohy large flat lenses revolutionized the contact lens field. First corneal PMMA contact lens design. Received patent in 1950.

3 Slide 7 Tuohy corneal PMMA lenses 1946 sales 50,000 pair 1949 sales 200,000 pair 2011 US sales of contact lenses Soft 27.6 million wearers GP 5.6 million wearers World wide over 100 million wearers Slide 8 Bifocal Contact Lenses provide clear vision at various distances Colored Contact Lenses give your eyes a subtle or dramatic change Custom Contact Lenses could work for you if other options fail Disposable Contact Lenses enable a healthier lens-wearing experience Extended Wear Contact Lenses for safe overnight wear or naps Gas Permeable (GP) Contact Lenses for the ultimate in crisp vision Monovision might work for you if bifocal contact lenses don't Orthokeratology Lenses enable contact lens-free vision during the day Prosthetic Contact Lenses mask eye injury or disfigurements Scleral Contacts for irregular corneas Silicone Hydrogel Contacts transmit more oxygen to your eyes Special-Effect Contact Lenses: vampire, goth, monster and anime looks Toric Contact Lenses provide good vision if you have astigmatism Slide 9 Summary 1500 s to 1940 s Scleral lenses (Shell type) 1950 s to 2000 s Corneal lenses (Soft & GP) 2000 s to 2010 Scleral & Corneal (Soft & GP) Today and the Future Scleral lenses offer the comfort of soft lenses and the vision of GP s. Can correct for irregular cornea issues by not involving the cornea in the fit also great option for treatment of ocular dryness.

4 Slide 10 Not your mom s lenses Scleral lenses are back in a new and exciting way. They offer superior vision and the comfort you expect from soft lenses. Slide 11 When fitting we do not involve the cornea Land outside the limbus More specifically, land on the conjunctiva Vaulting the cornea and landing outside the limbus offers some great advantages and value to the fitter and the patient. Slide 12 Scleral Lens

5 Slide 13 Keratoconus / pmd Many practices are using the msd for all their keratoectasia fits Piggy-back fits and failures Post surgical corneas Poor comfort with traditional corneal designs Neovascularization with hybrid lens designs Stevens-Johnson Syndrome Keratitis Sicca / Dry Eye Syndrome Corneal Protection / HVGD Postpone or eliminate the need for further surgeries Slide 14 Better initial /long term comfort Centered optics /consistent visual acuity No foreign body complaints Healthy cornea Improved visual field vs. de-centered corneal lenses Slide 15 Corneal lenses : < 12.5 mm Corneo-scleral lenses : mm Semi-scleral lenses : mm Mini-scleral: mm Scleral lenses mm Many times these lenses are called - Scleral Devises

6 Slide 16 Eef van der Worp classification Slide 17 Slide 18 Keratoconus Early through Advanced Pellucid marginal degeneration Post Surgical Corneas (Penetrating and Lamellar Keratoplasty) Poor Refractive Surgery Outcomes (RK & LASIK) Corneal Protection / Dry Eye Syndrome Any compromised and/or irregular cornea

7 Slide 19 The measurement from the flat plane at a given diameter to the highest point of the concave surface of the contact lens Slide 20 Once the ideal sag depth is determined, evaluate the midperipheral/limbal zone clearance Slide 21

8 Slide 22 Slide 23 1 st - Determine the best sagittal depth value 2 nd - Evaluate the mid-peripheral/limbal zone 3 rd Determine / evaluate Peripheral Edge Zone 4 th - Over-refract final lens power 5 th Order Slide 24 PRACTITIONER TO PATIENT PATIENT

9 Slide 25 Insertion bubbles are not acceptable! Remove lens and re-fill with solution then re-insert msd lens. Fill the lens with solution prior to lens insertion to reduce bubbles Slide Your eye must be open wide -the lid spread is everything! 2. The approaching device and plunger must be centered within that opening. Use the center hole in the plunger as your reference point. 3. The plunger must be vertical. Your device must retain the Unisol 4 in the device to avoid bubbles. 4. Overfill your device to improve your chances of a bubble-free insertion. Slide 27 Incorrect! Fingertips are not centered. Lid spread is not a perfect circle. Incorrect! Lids slipped from fingertips. Lids are not open wide enough. Perfect!! A perfectly round opening with plenty of clearance for the device.

10 Slide Lubricate your eye thoroughly with preservative free artificial tears or Unisol Wet a removal plunger. 3. Execute proper lid spread. 4. Place a towel on your work surface and lay a small mirror on top of the towel. While squeezing, attach the small plunger towards the lower edge of the lens. 5. Hold the plunger at a 45 degree angle, aimed at the 6 o clock position on the device. 6. Gently press the plunger against the device and rotate the plunger away. When the lower edge of the lens has broken suction, you can then remove the device slowly in a downward arc. DO NOT release your lids until the device is out of your eye. 7. Remove device from plunger by twisting and maneuvering it towards the edge of the device. Slide 29 Slide 30 Bubbles will also form when there is too much clearance between the lens and the cornea and/or sclera. Remove, re-fill & reinsert. Ideal tear thickness is 250um to 300um

11 Slide 31 Good Clearance Slide 32 Bubbles in the Central Zone Reduce the sag depth value Slide 33 Bubbles in the Mid-peripheral/Limbal Zone 4.20 S

12 Slide 34 Bubbles in the Mid-peripheral/Limbal Zone 4.20 S 4.20 D Change to a 4.20 D (Decreased) option Slide 35 Touch in the Mid-peripheral/Limbal Zone 4.20 S Slide 36 Bubbles on the Scleral Area

13 Slide 37 Slide 38 Fill the Bowl Unisol or Non-Preserved Drops Use NaFL in bowl for evaluation Follow-up Place NaFL on front surface of lens to check tear exchange. Change edge if needed. No Bubbles No Blanching No Corneal Touch 200 to 300um clearance White Light Optic Section for Evaluation (OCT) Lenses are very comfortable Slide 39

14 Slide 40 The OneFit P+A semi-scleral lens is designed to vault over corneas with a normal prolate profile, corneas with astigmatism, post grafts (prolate pattern) or moderately irregular corneas such as emergent or fruste keratoconus cases. The only semi-scleral lens designed for the normal eye on the market. Slide 41 Defining the needs Eliminate initial comfort issues with GP lenses. Eliminate the burden of two different lens systems with piggy back lenses. Increase fitting GP lenses on a daily basis. Helping practitioners keep patients in their practice Slide 42 Defining the goal Introduce a GP lens that s easy to fit and as comfortable as a soft lens. Ultimate goal: Keep all the benefits of GP lenses (visual acuity, reduced aberrations) without their limitations (initial discomfort, movement, foriegn body issues, etc).

15 Slide Optical zone Large as possible to eliminate halos, glare No significant changes from one base curve to another 2. Transition zone Create reverse curves that make a smooth transition between the base curve and peripheral curves Reverse curves varied according to the radius of the central base curve Slide 44 The Landing Zone Should align with the conjunctiva in all meridians Without compression or blanching Tear exchange Modify edge without influencing the rest of the parameters Standard, Flat, Steep 1 or Steep 2 Slide 45 The lens will not be supported by the cornea but from the fluid layer under the lens as well as the conjunctiva. The goal is to achieve a clearance of 100µm to 150µm at the apex of the cornea. Based on clinical trials, every 0.10 mm change in the base curve value will lead on average to a variation in clearance of 30 to 35 microns

16 Slide µm clearance Slide To evaluate eye parameters Central K readings / sim K s Corneal diameter Optional: topography 2. To determine the initial lens fit For Regular Corneas (Prolate), Toric Corneas, 0.2 mm steeper than flat K Slide 48 This information is on the OneFit P+A handout.

17 Slide 49 Slide 50 Allow minutes for the lens to settle Use the Inside-Out approach: Evaluate central clearance at the thinnest point first Goal: µm (= half lens or 1/5 corneal thickness) Do not tolerate any touch on the cornea Evaluate the limbal clearance You should see NaFl at the limbus in the OneFit P+A Evaluate the peripheral profile No edge stand-off or compression or blanching Perform a push-up test No resistance Up to 1mm of movement Slide 51 Lens is too steep. 360 µm of clearance

18 Slide 52 Every change of 0.1 mm (or 0.5D in BC induces a change of 30 µm In this case we need a decrease of 210µm = Go flatter 0.7 mm BC: µm clearance BC: µm clearance Slide µm clearance Slide 54 B.C. 6,9; 359 um B.C. 7.6 = 116 um Objective vs.subjective Clearance Evaluation

19 Slide 55 -To maintain healthy stem cells, the limbus should always be bathed in fluid. -Excessive limbal clearance will exhibit bubbles. -Fluorescein should extend from just outside the limbal region onto the cornea, covering the limbus completely. Slide 56 Optimal landing Slide 57

20 Slide 58 Optimal edge profile Slide 59 Slide 60 SMALL LENS (14.3) LENS EXCEEDS THE LIMBUS BY AT LEAST 1 MM ON EACH SIDE (14.3)

21 Slide 61 Slide 62 Clinical Pearls Time for the lens to settle (15 min) Comfort of the patient: key of a good fit Fluorescein observation Under low to med magnification Under WHITE light- never use blue light Slide 63 Benefits of the OneFit It is a semi-scleral vs. a corneo-scleral Healthier and less stressful for the cornea Easiest semi-scleral to fit /troubleshoot Practitioner friendly Intuitive Inside-out 3 steps approach GP as comfortable as a soft lens Visual acuity as crisp as with other GP lenses

22 Slide 64 Handling/Insertion Difficulty handling lenses Insertion bubbles Answer: Use devices to help to insert/remove lenses (DMV or rubber ring), fill the lens (saline) and add a drop of more viscous solution. (Non-Preserved Optive / Systane Ultra) Slide 65 Visual acuity is not optimal Most of the time due to the presence of induced cylinders Increase the clearance Order a lens with increased central thickness (.05 thicker) Initial or long-term discomfort Differentiateinitial awareness vs true discomfort Discomfort is always a sign of a bad lens to cornea/relationship Fix the fit Slide 66 Lens Care Boston Solutions Insertion Non preserved saline solution (Unisol 4) 0.9% sodium chloride inhalation solution Fill contact lenses as directed Dispense 3ml vials X 100

23 Slide 67 This is the Future of GP s Complete fitting guide online at Slide 68 Thanks for your time and if you wish to contact me: richarddorer@msn.com x 131