Introduces The OK -EX -Total Tear Layer Control- Features. What is the OK-EX? Multi-Axis Toric Option.

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2 Features Optimum Control and Results for High Myopia Hyperbolic Treatment Zones for Maximum Flattening Dual Aspheric Reverse and Alignment Zones for Improved Lens Centering Topographical / Empirical / Inventory / Diagnostic Multi-Axis Toric / Astigmatism Option Introduces The OK -EX -Total Tear Layer Control- What is the OK-EX? The Contex OK-EX design is the result of years of research and development. With the advent of myopia control and the desire to quickly reduce larger amounts of myopia, Contex set out to create a lens that would offer the advantages of a controlled tear layer in the reverse zone and the ability to reduce higher amounts of myopia quicker and with more control. Multi-Axis Toric Option Unique Design Along Each Axis Toric Reverse and Alignment Zones Toric Treatment Zones Before After USA Phone: Fax: Color Fax: info@contexusa.com Contex OK-EX Promo US Rev-A

3 Why is the OK-EX Different? For years the standard optic zone for orthokeratology lenses has been 6.0mm. The OK-EX uses a variable optic zone diameter that is calculated to provide a consistent tear film depth at the edge of the optic zone. The higher the target power, the smaller the optic zone becomes. Hyper-Aspheric treatment zones create the ultimate flattening power. The OK-EX also features double aspheric reverse and alignment zones that help center the lens on even the most difficult corneas. Actual Patient Post Wear Diff Pre-Fit Easy E-System Nomenclature Example: CK: 43.00/44.00 Refraction: Eccentricity Value =.5 OK E-System Design Code: 43.00/-5.00 (.5EX) / 9.06 / 10.6 / If the Lens Is Tight: Raise the e-value OK E: 43.00/-5.00 (.55EX).05 loosens the fit by about 11 microns OK E: 43.00/-5.00 (.6EX).1 loosens the fit by about 22 microns If the Lens Is Loose: Lower the e-value OK E: 43.00/-5.00 (.45EX).05 tightens the fit by about 11 microns OK E: 43.00/-5.00 (.4EX).1 tightens the fit by about 22 microns Desired Map: Tight Map: Loose Map: USA Phone: Fax: Color Fax: info@contexusa.com Contex OK-EX Promo US Rev-A

4 FDA APPROVED for overnight wear! Contex OK E-System Simple Ortho-K, Expert Results Custom Designed to Each Individual Cornea Reduces 5 Diopters of Myopia up to 6 in some cases Proven Overnight Design Inventory Sets Recommended Inventory Sets with OK Lens Selection Software Available Sleep your way to better vision! Understanding Modern Ortho-K: The advanced OK E-System proportionate lens design allows you to custom build a lens that will reduce up to five diopters of myopia by gently and precisely molding the central epithelium while your patients sleep. Example: CK: 43.00/44.00 Refraction: Eccentricity Value =.5 OK E-System Design Code: 43.00/-5.00 (.5e) / 9.06 / 10.6 / If the Lens Is Tight: Raise the e-value OK E: 43.00/-5.00 (.55e).05 loosens the fit by about 11 microns OK E: 43.00/-5.00 (.6e).1 loosens the fit by about 22 microns If the Lens Is Loose: Lower the e-value OK E: 43.00/-5.00 (.45e).05 tightens the fit by about 11 microns OK E: 43.00/-5.00 (.4e).1 tightens the fit by about 22 microns Phone:

5 OK E-System Fitting Methods Choose the fitting method that best suits your practice. Topographical or keratometry based empirical fitting for the small Ortho-K practice, diagnostic fitting for the medium sized practice, or Inventory systems for the large Ortho-K practice. The Contex OK E-System is the only design that offers the versatility of 3 methods. 1. Take CK s, Rx, and Topography 2. Select lens closest to patient CK 3. Trial fit Indicated Lens 4. Order lens or Re-fit as Necessary 5. Follow-up 1st Morning Diagnostic Sets 1. Take CK s, Rx, and Topography 2. Enter into OK Lens Calculator 3. Trial Fit Indicated Lens 4. Dispense or Re-fit as Necessary 5. Follow-up 1st Morning Inventory Sets (diagnostic or dispensable) 1. Take CK s, Rx,(Topography if poss.) 2. Order OK Lens 3. Evaluate Lens Fit and dispense 4. Follow-Up 1st Morning 5. Follow-up or Re-fit as necessary Empirical Fitting (topography or CK s & Rx) Local:

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7 OK E-System TAC Toric Reverse Geometry Lenses TAC Multi-Axis Technology Actual Patient Any Combination of Spherical and Toric Zones Works on Limbal Astigmatism Trial Sets Available Works with Any Brand of Topographer Actual Pattern 1 Month Post-Wear Phone: Standard reverse geometry lenses have proven to work well on corneas with up to about 1½ diopters of central or limbal astigmatism. Once the cylinder exceeds 1½ diopters, a toric lens may be indicated. Corneal astigmatism causes sagittal height differences between the flat and steep meridians. A toric design is needed when the lens fits well along the flat meridian, but rocks and/or tilts along the steep meridian. This can be detected during fluorescein evaluation. The Contex TAC Multi-Axis lenses incorporate a toric/aspheric treatment zone that adds flattening power to the steep meridian resulting in a greater reduction in the cylinder power. Contex TAC Toric lenses can be toric or spherical in any zone. You can combine a toric alignment zone with a spherical optic zone and reverse zone or any combination of toric and spherical zones. Toric alignment zones follow the peripheral shape of the cornea, creating a more uniform edgelift. Central vs. Limbal Astigmatism The flat meridian in both central and limbal astigmatism corneas are quite normal. The steep meridian is what varies in theses cases. Central astigmatism corneas have greater height differences in the center 5 or 6mm, whereas limbal corneas have height differences all the way out to 8 to 10mm. The peripheral area on these corneas is usually just slightly steeper than the peripheral area of the flat meridian. This shape causes the corneal eccentricity to be higher along the steep meridian than the flat meridian. Limbus to limbus corneas have greater height differences in the peripheral area which causes lower e-values. While it s important to have a desired fit along each meridian, it s more important to evaluate the flat meridian first. OK E-System TAC Info Sheet Rev-C

8 OK E-System TAC Quick Fit Guide Supply the following data to order OK lenses: 1. Central keratometry readings 2. Type and Brand of keratometer used to obtain the readings 3. Corneal Eccentricity (if available) 4. Brand of topographer used to obtain the corneal eccentricity 5. Refraction Diameter & Optic Zone: 10.0 to 10.6 diameters center best. 6.0mm optic zones are standard. For larger pupils we can increase the optic zone to a 6.5 or 7.0mm to reduce flare & glare. Base Curve: The base curve should display 2-4mm of central bearing and should cover the pupil for best results. Reverse Curve: The secondary fluorescein pattern should display a narrow but brilliant 360-degree ring of pooling. Alignment Curve: The steeper mid-peripheral curve or alignment curve forces the lens to center. The mid-peripheral fluorescein pattern should display medium to heavy bearing. Peripheral Curve: The OK E-System lenses utilize a true aspheric peripheral curve for a perfect fit. If more or less edgelift is required the alignment or reverse curves may need to be adjusted. Lens Dispensing Procedure: 1. Insert lenses and wait 10 to 15 minutes. 2. Observe the lenses with the slit lamp to check lens position and movement. 3. Insert fluorescein and observe the pattern, comparing it to the grading scale. Fluorescein Pattern Check List: A well centered lens 3-5mm of central bearing Narrow but brilliant secondary pooling ring Wide heavy mid-peripheral bearing ring 1mm movement on the blink Desired Fit: 4. Over-Refract with the lens on to make sure vision is acceptable with the lens on. 5. If all is acceptable, dispense the lenses to be worn at night only, unless the daytime vision is unacceptable, in which case they should see you within 48 hours to inspect the fit and cornea. If the lenses are worn as daily wear lenses, in some cases they will overtighten. 6. Check the patient the following morning if possible. Do not allow the patient to wear the lens for more than three nights without a check-up after the initial dispensing. Advise the patient to contact you immediately if they experience red, swollen, painful eyes and/or distorted vision. CAUTION: Edema, microcysts and even abrasions can occur if the lens over-tightens! A poorly centered lens can induce double vision, and astigmatism. Follow-Up Check List: 1. Examine the patient as early as possible. 2. Check lens position & movement with the slit lamp. 3. Over-refract with the lenses on. 4. Check the fluorescein pattern. If the fit is too tight or too loose, refer to the troubleshooting chart in the professional fitting guide or contact one of our consultants for assistance. 5. Remove lenses and check the Central K Reading. Check the unaided visual acuities and scope the remaining refraction to verify the amount of myopia left to reduce. Note: Do not use an Auto-Refractor. Manually over-refract to obtain the unaided vision with out lenses on. 6. Re-check the patient again in 1 week, 2 weeks and then one month if the lens fit and results are acceptable. Tight Fit: Loose Fit: OK E-System TAC Info Sheet Rev-C Local:

9 The Importance of Eccentricity and Temporal K while Performing Orthokeratology Corneal Eccentricity Corneal Eccentricity is defined as the rate at which the cornea flattens from the center to the periphery. Shape Factor, CEI (Corneal Eccentricity Index) and Delta-K all represent the corneal eccentricity. The Shape Factor is the square root of the corneal eccentricity value and is from the Humphrey, Atlas topographer. The CEI is the Corneal Eccentricity Value from the Tomey, TMS-3 topographer. The Delta-K is the difference between central & temporal K readings. This data is vital to the consistent success of Ortho-K. Accurate Data - Equals Accurate Lenses Two corneas could have the exact same Central K readings but have totally different peripheral shapes. This means no two corneas can be assumed to be identical. Lens designers and manufacturers who don t require a Corneal Eccentricity Value to design an Orthokeratology lens are designing their lenses under the assumption that each particular patients cornea is average shaped. Of course, with averages, rarely is something an average. The figure above shows how corneas with the same CK s can have different peripheral shapes. The figure above left demonstrates how corneas with different Central K readings and different corneal eccentricities can have similar peripheral shapes. Temporal K Readings The Temporal K reading allows us to estimate a patient s corneal eccentricity. It helps determine the correct radius that aligns the midperipheral cornea. Using a manual Keratometer take both the Central and Temporal K readings. The difference between the Central and Temporal K readings is called the Delta-K. The Delta-K is then converted into an estimated corneal eccentricity using the Contex Delta-K, Eccentricity and Shape Factor conversion chart. Note: Once a GP contact lens is worn, the Temporal K reading is influenced by the lens and therefore may be inaccurate. Phone: Measuring the Horizontal Temporal K reading: After recording the central K reading, have the patient fixate nasally along the horizontal axis at the cross hair at the edge of the last mires. It may be helpful to use a red dot or some other mark to assure consistency of the fixation point. Simply jog or slide the Keratometer over to the peripheral area rather than pulling it back and setting it up again as this may provide more consistent readings as well. Record only the horizontal value and convert the Delta-K to an estimated corneal eccentricity. Importance of Ecc and TK to Ortho-K Rev-C

10 OP Lens Ortho-Plus Hyperopic Ortho-K System Call for More Information! Simple and Accurate Hyperopic Ortho-K Reduces 2 Diopters of Hyperopia and up to 3 in Some Cases Custom Designed to Each Individual Cornea Standard 10.6mm Diameter Understanding Hyperopic Ortho-K: The advanced OP Lens molds a steeper cornea by gently squeezing the mid-peripheral cornea. By calculating the correct base curve and lens shape for the desired amount of correction we can predict the correct fit as well as the amount of reduction. Patient Selection: Patients who will be satisfied with up to three diopters of Hyperopic reduction are candidates. Most Hyperopic Presbyopes can also benefit from the OP Lens. Pre-fit Map: Post-Fit Map: Local: OP Info Sheet and Quick Fit Guide Rev-E Example: CK: 43.00/44.00 Refraction: Eccentricity Value =.5 Ortho-Plus Code: 43.00/+3.00(.5e) / B.C.: 7.11 / Dia: 10.6 / Lens Power: If the Lens Is Tight: Raise the e-value 43.00/+3.00(.55e).05e loosens the fit by about 8 microns 43.00/+3.00(.6e).1e loosens the fit by about 16 microns If the Lens Is Loose: Lower the e-value 43.00/+3.00(.45e).05e tightens the fit by about 8 microns 43.00/+3.00(.45e).1e tightens the fit by about 16 microns We obtained the first FDA clearance on Ortho-K lenses! For use outside the U.S.A.

11 OP Lens Quick Fit Guide Supply the following data to order OP Lenses: 1. Central keratometry readings 2. Type and Brand of keratometer used to obtain the readings 3. Corneal Eccentricity if available 4. Brand of topographer used to obtain the corneal eccentricity 5. Auto-Refraction Base Curve and Optic Zone: Upon dispensing the base curve or optic zone should display 2-5mm of central clearance or vaulting that progresses to an area of touch. The clearance area may display small bubbles that may dissipate after the lens is worn. Secondary Zone: The secondary zone should display a narrow and shallow 360-degree ring of clearance. Mid-Peripheral Zone: The steeper mid-peripheral curve or alignment curve forces the lens to center and causes the central cornea to become steeper. The mid-peripheral fluorescein pattern should display medium to heavy bearing. Peripheral Zone: The OP lenses utilize a true aspheric peripheral curve for a perfect fit. If more or less edgelift is required the eccentricity in the optic zone or secondary zone may need to be adjusted. Diameter: 10.6 diameters perform best. Lens Dispensing Procedure: 1. Insert lenses and wait 10 to 15 minutes for them to settle. 2. Observe the lenses with the slit lamp to check lens position and movement. Lenses should center well. 3. Insert fluorescein and observe the pattern, comparing it to the desired photo on the Intro Sheet. Fluorescein Pattern Check List: 3-5mm of central clearance that may display small bubbles upon dispensing 1-2 mm of touch in the 4 to 8mm central area Shallow and Narrow secondary clearance ring.8 to 1mm wide heavy mid-peripheral bearing ring Adequate Peripheral Edgelift 1mm movement on the blink 4. Over-Refract with the lens on to make sure vision is acceptable with the lens on. 5. If all is acceptable, dispense the lenses. 6. Check the patient the following morning if possible. Do not allow the patient to wear the lens for more than three days without a check-up after the initial dispensing. Advise the patient to contact you immediately if they experience red, swollen, painful eyes and/or distorted vision. CAUTION: Edema, microcysts and even abrasions can occur if the lens over-tightens! A poorly centered lens can induce double vision, and astigmatism. Follow-Up Check List: 1. Examine the patient as soon as possible once the lenses are removed. 2. Check lens position & movement with the slit lamp. 3. Over-refract with the lenses on. 4. Check the fluorescein pattern. 5. Remove the lenses and measure the central K readings 6. Check the unaided visual acuities and scope the remaining refraction to verify the amount of hyperopic correction left to reduce. 7. Take Topography maps. 8. If results are acceptable re-check the patient again in 1 week, 2 weeks and then one month. 9. If results are unacceptable send a completed Troubleshooting Form along with axial and tangential topography maps (or the data below) to Contex for assistance. Pre and Post-wear K Readings Pre and Post-wear Refraction Over-refraction with lenses on Pre and Post Axial and tangential maps Lens Position (central, superior, inferior, temporal, nasal and how many mm s) Description of Fluorescein pattern Wearing schedule NOTE: Do not use an Auto-Refractor. Manually over-refract to obtain the unaided vision without lenses on. OP Info Sheet and Quick Fit Guide Rev-E Local:

12 OP Lens Fitting Info and Case Study Necessary Data: Central K Readings, Refraction and Topography (if available). NOTE: See the OP Lens Quick Fit Guide for further details. Presbyopes: If the patient is a Presbyope, determine the Non-dominant eye. By using the same technique and lens design used on hyperopes, a "natural monovision" effect for emmetropic presbyopes can be obtained. By inducing a small amount of myopia, we can obtain a similar result as an aspheric bifocal. NOTE: If the patient wishes to wear the lens as a bifocal, you may boost the add power if you over-plus the dominant eye by +.25, and the non-dominant eye by For more advanced Presbyopes, add up to If yet more add power is needed, order an E-.6 aspheric front surface to boost the add power by an additional Fluorescein: The following photos demonstrate a desired fit and a loose fit. Desired Fit: Loose Fit: Case Study Beginning : Right Eye (pre-fit): Manual K s: 44.00/44.50 Refraction: x050 Eccentricity Value =.28 This patient is a Presbyope and desires to be slightly myopic after removal of the lenses. In this case the right eye is the non-dominant and the target reduction is 3 diopters because the desired post wear refraction is R: OP 100A1.2 B.C. = 7.03 Lens Power: (over-plus d by +1.25) Diameter: 10.6 Right Eye (1 month post-wear): Manual K s: 45.50/46.25 Refraction: Eccentricity Value =.40 NOTE: Manual K readings were used instead of the Sim K s from the topographer Pre-map Post-map For use outside the U.S.A. OP Lens Fitting Info and Case Study w Dr White Case Study Rev-D Local:

13 Hyperopic Ortho-K and the Contex OP TM Lens Gary C. White O.D. OP Lens Fitting Info and Case Study w Dr White Case Study Rev-D

14 Multifocal-19 Fitting and Information Guide Base Curve Table Flat K Base Curve to to to to to to to to to to to to to to to to See Near, Far, and In-Between ADD Power Up to ADD with Front Aspheric Crisp, Sharp Distance Vision Excellent for Previous Gas Perm Wearers Patient Selection: Select patients with a or less ADD power. Take central K readings, refraction, and topography if available. Determine which is the non-dominant eye. To increase the ADD power, over-plus the dominant eye by +.25 and the non-dominant eye by +.50 on early presbyopes, and up to or more for advanced presbyopes. If More ADD Power Is Needed: Assuming you have achieved a good fit that translates well and you have pushed the plus as much as possible in both eyes, then you may need to add a front reverse aspheric curve to boost the ADD power. Order an e-.5 front surface to boost the ADD power by about Desired Fit: Tight Fit: Loose Fit: If Indicated Lens is Too Tight: Flatten the Base Curve by ½ diopter If Indicated Lens is Too Loose: Steepen the Base Curve by ½ diopter Local: info@contexusa.com Example: CK s: R: 43.00/44.00 (Dom) Spectacle-Rx: Eccentricity Value =.52 L: 44.00/46.00 (Non-Dom) Spectacle-Rx: Eccentricity Value =.48 R: Suggested Base Curve: 7.38 Dominant Distance Power: L: Suggested Base Curve: 7.22 Non-Dom Distance Power: For further fitting details refer to the MF-19 Quick Fit Guide or contact one of our knowledgeable consultants. MF-19 Fit and Info Sheet Rev-F

15 Multifocal-19 Quick Fit Guide Supply the following data to order MF-19 Lenses: 1. Central keratometry readings (manual/auto) 2. Corneal eccentricity (if available) and brand of topographer 3. Refraction 4. ADD power 5. Dominant and non-dominant eye Base Curve and Optic Zone: Upon dispensing, the base curve or optic zone should display 2-4mm of central clearance that progresses to a 2mm band of touch at around 8 mm s. Mid-Peripheral Zone: The mid-peripheral band of touch is a result of fitting the lens steeper than flat central K. Though the central base curve is steeper than the central cornea the overall sagittal depth of the lens is equal to that of the cornea. Peripheral Zone: Aspheric and multifocal lenses utilize a true aspheric peripheral curve for perfect lift. If more or less edgelift is required, the base curve may need to be flatter or steeper. If you feel the central base curve is fit correctly then you may order a high or extra high edgelfit. Diameter: 10.0 diameter performs best. Over Plus Non-Dominant Eye: To assure maximum ADD power we suggest to over-plus the non-dominant eye based on the ADD power required. Add Power: Over Plus Amount: to to to to to to Lens Dispensing Procedure: 1. Insert the lenses and wait 10 to 15 minutes for them to settle down or until the patient stops tearing. 2. Observe the lenses with the slit lamp to check lens position and movement. Lenses should center and move well. 3. Insert fluorescein and observe the pattern comparing it to the description below: Fluorescein Pattern Check List: 2-4mm central clearance 1-2mm of touch that becomes progressively darker in the 8mm central area.8 to 1mm wide mid-peripheral alignment ring Adequate peripheral edgelift 2-3mm movement on the blink 4. Over-refract the distance vision in the dominant eye. To enhance the near vision an over-refraction of -.25 is preferred. 5. Over-refract the distance vision in the non-dominant eye. To enhance the near vision an over-refraction of at least -.50 in the is preferred. Note: Any plus over refraction for distance will decrease the ADD power by the same amount or more. 6. To over-refract near vision have the patient gradually look down to read while trying to keep their chin up. Stand by their side to be sure the lens translates up to the near or ADD portion of the lens. 7. If acceptable, dispense the lenses. 8. If more ADD power is needed, make sure the lens is not riding inferior. The lens must position central to superior. If the lenses ride low, when the patient looks down to read, the lens moves further up into the distance zone instead of the near zone. 9. If possible, a follow-up should be done within one week. Schedule it towards the end of the wearing schedule. CAUTION: Advise the patient to contact you immediately if they experience red, swollen eyes and/or distorted vision. Follow-Up Check List: 1. Check lens position & movement with the slit lamp. 2. Over-refract with the lenses on. 3. Check the fluorescein pattern. 4. Remove the lenses and measure the central K readings. 5. Check the refraction to see if it is stable. 6. Take topography maps if available. 7. If results are acceptable, schedule the patient for an annual follow-up. 8. If results are unacceptable, send a completed Contex Troubleshooting Form along with axial and tangential topography maps (or the data below) to Contex for assistance. Supply the following data to re-order MF-19 lenses: Pre and post-wear K readings Pre and post-wear refraction Over-refraction with lenses on Pre and post axial and tangential maps Lens position (central, superior, inferior, temporal, nasal and how many mm s) Description of fluorescein pattern Wearing schedule MF-19 Fit and Info Sheet Rev-F Local:

16 AS-20H Fitting and Information Guide Base Curve Table Flat K Base Curve to to to to to to to to to to to to to to to to Fits All Types of Keratoconus Aspheric Design 3 Point Touch Fit The AS-20H lens utilizes a high eccentricity value. This allows us to fit a steep base curve so the lens will rest lightly on the cone but it also gives us a light touch in the periphery to balance the pressures. The first lens should be fit about five diopters steeper than flat K. These tips should help you achieve a successful fit: 1. Light touch on cone. 2. The lens should center between the apex of the cornea and the cone. 3. Peripheral clearance is a must to promote tear exchange to the cone. 4. The lens must display adequate movement on the blink. 5. The best starting overall diameters are mm. 6. Trial fitting is a must for best success. Desired Fit: Tight Fit: Loose Fit: Local: info@contexusa.com If Indicated Lens Is Too Tight: Flatten the Base Curve by ½ diopter Example: If Indicated Lens Is Too Loose: Steepen the Base Curve by ½ diopter CK s: R: 48.00/52.00 Refraction: Eccentricity Value =.72 L: 49.50/53.00 Refraction: Eccentricity Value =.79 R: Base Curve: 6.37 Lens Power: (w/vertex) L: Base Curve: 6.19 Lens Power: (w/vertex) For further fitting details refer to the Aspheric Fitting and Information Sheet or contact one of our knowledgeable consultants. AS-20H Fit and Info Sheet Rev-F

17 AS-20H Fit and Info Sheet Rev-F

18 Aspheric & Multifocal Lens Designs True Aspheric Central & Peripheral Curves Custom design any aspheric or multifocal lens imaginable All Contex aspheric and multifocal lenses are 100% reproducible Local: True Aspheric Curves & Optics Highest Resolution Optics Crisp Distance and Near Vision Aspheric and Multifocal Fitting Theory If all corneas are aspheric, why are spherical lenses fit on aspheric corneas? The only way to equal the quality of optics that the natural lens of the eye produces is to match the aspheric shape of the eye with the lens. The eccentricity value is used to adjust the aspheric value of the lens to match that of the cornea. Aspheric and multifocal lens designs fit looser than spherical lens designs because the eccentricity value creates an elliptical shape within the central optic zone. The higher the eccentricity value, the quicker the radius flattens, and the steeper the base curve will need to be fit. The eccentricity value also produces the ADD Power in aspheric and multifocal lenses. Though the base curve needs to be fit steeper than the central cornea, the overall shape of the lens matches the overall shape of the cornea when fit correctly. Two Zone Aspherics Ecc. Add Approximate Fit Aspheric-15 (formerly K-10).5e steeper Aspheric-16.6e steeper Aspheric-17.7e steeper Aspheric-18 (reduces WTR cyl.).8e steeper Aspheric e steeper Three Zone Multi-Focals Ecc. Add Power Approximate Fit Multifocal-19 (Our #1 Multifocal) 1.0e steeper Multifocal e steeper Front Aspherics Ecc. Add Power Approximate Fit Aspheric-96 e on flat CK Back/Front Aspherics Ecc. Add Power Approximate Fit Aspheric-17e-.6.7e/e steeper Aspheric-18e-.5.8e/e steeper Aspheric-19 e e/e steeper Front Aspherics: By adding an e-.5 or e-.6 to the front surface of any aspheric or multifocal lens design, the ADD power is increased by +.50 to By adding an e+.5 or e+.6 to any aspheric lens design the ADD power is reduced. Example: By ordering a MF-19 e-.6, the ADD power is increased from to Diameters: Aspheric designs are available from 8.0 to 12.2mm and multifocal designs available from 9.2 to 12.2mm. For further fitting details contact us or refer to the True Aspheric Quick Fit Guide or the MF-19 and AS-20H Fitting and Information Guides. Aspheric and Multifocal Info Sheet Rev-F

19 True Aspheric Quick Fit Guide Supply the following data to order Aspheric Multifocal Lenses: 1. Central keratometry readings (manual/auto) 2. Corneal eccentricity (if available) and brand of topographer 3. Refraction 4. Add power 5. Dominant and non-dominant eye or 4. Over-refract the distance vision in the dominant eye. To enhance the near vision an over-refraction of.25 is preferred. 5. Over-refract the distance vision in the non-dominant eye. To enhance the near vision an over-refraction of at least.50 in the is preferred. Note: Any plus over refraction for distance will decrease the add power by the same amount or more. Base Curve and Optic Zone: Upon dispensing, the base curve or optic zone should display alignment or slight clearance. The higher the eccentricity, the more clearance there will be because the base curve will need to be steeper to allow for the more elliptical shape within the optic zone. This is caused by the need to fit a steeper base curve for higher eccentricity lenses. For example: A.7 eccentricity lens may only need to be fit one diopter steeper than the flat central K reading, while a 1.0 eccentricity lens may need to be fit up to three diopters steep than the flat CK. Peripheral Zone: Aspheric and multifocal lenses utilize a true aspheric peripheral curve for perfect lift. If more or less edgelift is required the eccentricity in the optic zone or secondary zone may need to be adjusted. If you feel the central area is fit correctly then a high or extra high edgelfit may be ordered. Diameter: 9.8 to 10.6mm diameters perform best. Note: Multifocal diameters are typically 10.0mm. Lens Dispensing Procedure: 1. Insert lenses and wait 10 to 15 minutes for them to settle. 2. Observe the lenses with the slit lamp to check lens position and movement. Lenses should center well. 3. Insert fluorescein and observe the pattern, comparing it to the description below. Fluorescein Pattern Check List: Central alignment to clearance for low eccentricity aspheric designs and central clearance for high eccentricity aspheric and multifocal designs 1-2mm of touch that becomes progressively darker in the 4 to 8mm central area.8 to 1mm wide mid-peripheral alignment ring Adequate peripheral edgelift 2-3mm movement on the blink 6. To over-refract near vision have the patient gradually look down to read while trying to keep their chin up. Stand by their side to be sure the lens translates up to the near or add portion of the lens. 7. If acceptable dispense the lenses. 8. If more add power is needed, make sure the lens is not riding inferior. All aspheric and multifocal lenses must ride central to superior. If the lenses ride low, when the patient looks down to read the lens moves up into the distance zone instead of the near zone. 9. If possible a follow-up should be done within one week. Schedule it towards the end of the wearing schedule. CAUTION: Advise the patient to contact you immediately if they experience red, swollen eyes and/or distorted vision. Follow-Up Check List: 1. Check lens position & movement with the slit lamp. 2. Over-refract with the lenses on. 3. Check the fluorescein pattern. 4. Remove the lenses and measure the central K readings. 5. Check the refraction to see if it is stable. 6. Take topography maps if available. 7. If results are acceptable schedule the patient for an annual follow-up. 8. If results are unacceptable send a completed Troubleshooting Form along with axial and tangential topography maps (or the data below) to Contex for assistance. Supply the Following Data to Re-Order Aspheric or Multifocal Lenses: Pre and post-wear K readings Pre and post-wear refraction Over-refraction with lenses on Pre and post axial and tangential maps Lens position (central, superior, inferior, temporal, nasal and how many mm s) Description of fluorescein pattern Wearing schedule Aspheric and Multifocal Info Sheet Rev-F Local:

20 AirCurve AC Lens Fitting and Information Guide Base Curve Selection Table Flat K Base Curve to to to to to to to to to to to to to to to to The Standard of standard GP lenses! Easy to Fit Crisp Optics Super Comfortable 100% Reproducible Perfect Machined Edges The AC Lens provides your single vision GP patients with the best possible comfort, optics, and durability available. The aspheric peripheral edge lift system gives the right amount of edge lift on every fit. Simple Base Curve Selection Table lets you determine the best base curve for your patients. Give your patients the best! Patient Selection: Select patients with 2 diopters or less of astigmatism. Always take central K readings, refraction, and topography whenever possible. Example: CK s: R: 43.00/44.00 Spectacle-Rx: Eccentricity Value =.52 L: 44.00/46.00 Spectacle-Rx: Eccentricity Value =.48 Order: R: AC Base Curve 7.80 Lens Power: L: AC Base Curve 7.60 Lens Power: Desired Fit: Tight Fit: Loose Fit: Intl: info@contexusa.com If Indicated Lens is Too Tight: Flatten the Base Curve by ½ diopter If Indicated Lens is Too Loose: Steepen the Base Curve by ½ diopter Early Presbyopes: For emerging presbyopes a front surface ADD may be used. Assuming a good fit is achieved, by adding a front reverse aspheric curve a ADD power can be obtained. Order an E-.6 front surface. For further fitting details refer to the AirCurve Quick Fit Guide or contact one of our knowledgeable consultants. AC Fitting Info and Quick Fit Guide Rev-B

21 AirCurve AC Lens Quick Fit Guide Supply the following data to order AirCurve Lenses 1. Central keratometry readings (manual/auto) 2. Spectacle Refraction 3. Corneal eccentricity (if available) and brand of topographer Fluorescein Pattern Check List Central alignment Adequate peripheral edge lift 2-3mm movement on the blink Base Curve and Optic Zone Upon dispensing, the base curve or optic zone should display alignment. Peripheral Zone AirCurve lenses utilize a true aspheric peripheral curve for perfect lift. If more or less edge lift is required, the base curve may need to be flatter or steeper. If you feel the central base curve is fit correctly then you may order a X-Low, Low, High or X-High edge lift. Base Curve and Diameter Flat K Base Curve to to to to to to to to to to to to to to to to Diameter Lens Dispensing Procedure 1. Insert the lenses and wait 10 to 15 minutes for them to settle down or until the patient stops tearing. 2. Observe the lenses with the slit lamp to check lens position and movement. Lenses should center and move well. 3. Insert fluorescein and observe the pattern comparing it to the description in #4. 4. Over-refract and adjust power as necessary. 5. If acceptable, dispense the lenses. 6. If possible, a follow-up should be done within one week. Schedule it towards the end of the wearing schedule. CAUTION: Advise the patient to contact you immediately if they experience red, swollen eyes and/or distorted vision. Follow-Up Check List 1. Check lens position & movement with the slit lamp. 2. Over-refract with the lenses on. 3. Check the fluorescein pattern. 4. Remove the lenses and measure the central K readings. 5. Check the refraction to see if it is stable. 6. Take topography maps if available. 7. If results are acceptable, schedule the patient for an annual follow-up. 8. If results are unacceptable, send a completed Contex Troubleshooting Form along with axial and tangential topography maps (or the data below) to Contex for assistance. Supply the following data to re-order AirCurve lenses Pre and post-wear K readings Pre and post-wear refraction Over-refraction with lenses on Pre and post axial and tangential maps Lens position (central, superior, inferior, temporal, nasal and how many mm s) Description of fluorescein pattern Wearing schedule AC Fitting Info and Quick Fit Guide Rev-B Intl:

22 Care and Handling of High DK Gas Permeable Contact Lenses Ask about our Clear Clean and Polish Brite! Clean lenses are the key to success. Some patients have problems with blurred vision or warped and flattened lenses due to improper care and handling. Here are some suggestions: 1. Stress to your patients the importance of washing their hands thoroughly with soap and water every time before insertion and removal of their lenses. Lotions, make-up and skin oil leave residue on hands and lenses, which can blur the patient s vision. SPECIAL Buy 20 Clear Clean Get 4 Free 2. We find that many patients apply too much pressure to their lenses when cleaning. They should be as gentle as possible when cleaning their lenses. Today s High DK materials are more fragile and too much pressure can warp and flatten them. 3. Patients should always clean and rinse their lenses after use to avoid the accumulation of mucous. Once mucous dries it is extremely hard to remove. Sterile Saline is preferred for rinsing lenses. Do not use hot water to clean lenses. 4. Lenses should be stored in soaking solution. Contact lens cases should be cleaned and the solution changed frequently to prevent the growth of bacteria. Dirty cases are often the cause of dirty lenses which can cause sudden discomfort or uncomfortable wear. For long term storage, lenses should be stored dry. 5. When closing cases, patients should be sure that the lenses are well away from the edge of the case to avoid chipping or breaking their lens. Local: We hope these suggestions will be helpful to your contact lens patients. Care and Handling of High DK GP Lenses Rev-E

23 FLUORESCEIN GRADING SCALE AND INSTRUCTIONS Use the fluorescein grading scale to standardize evaluation of OK E-System lenses. Use with the OK E-System Troubleshooting Form #1 Evaluate the alignment zone to determine the degree of alignment bearing #2 Evaluate the amount of central bearing #3 Evaluate the depth of the reverse zone OK E-System FLUORESCEIN GRADING SCALE Alignment Zone Bearing Grade 1 Grade 2 Grade 3 Grade 4 Grade 5 No Bearing Light Bearing Desired Bearing Heavy Touch X-Heavy Touch Lens Not Centered Seal Broken With Tear Exchange Sealing Off Sealed Off Optic Zone Bearing Grade 1 Grade 2 Grade 3 Grade 4 Grade 5 Central Pooling Minimal Touch Desired Touch Heavy Touch X-Heavy Touch Reverse Zone Clearance Grade 1 Grade 2 Grade 3 Grade 4 Grade 5 Alignment Minimal Pool Brilliant Pool Small Bubbles Large Bubbles info@contexusa.com

24 Diopter to Millimeter Conversion Table Laminated Diopter to mm Conversion Table-2dig Rev-C Local: