Contact Lens Management of the Challenging Patient Disclosures: Alcon Bausch + Lomb SpecialEyes Valley Contax Vistakon Contact Lens Challenges Matthew J. Lampa, OD, FAAO lampa@pacificu.edu Challenge: Getting the Most out of Soft Contact Lens Multifocals the Contact Lens Possible Options? Air Optix Aqua 8.6/14.2-3.00 (High Add) Purevision MF 8.6/14.0-3.00 (High Add) 1
Acuvue Oasys MF 8.4/14.3-3.00 (High Add) Proclear MF 8.7/14.4-3.00 (+2.50 Add) Proclear MF 8.7/14.4-3.00 (+2.50 Add) Proclear MF 8.4/14.4-3.00 (+2.50 Add) Proclear MF 8.4/14.4-3.00 (+2.50 Add) Further Investigation 2
Angle Lambda and Multifocals Fovea is decentered temporal Visual axis passes through the lens 1 to 9 degrees nasal to center Air Optix Aqua 8.6/14.2-3.00 (High Add) Purevision MF 8.6/14.0-3.00 (High Add) Acuvue Oasys MF 8.4/14.3-3.00 (High Add) Biofinity MF 8.7/14.4-3.00 (+2.50 Add) D 3
Biofinity MF 8.7/14.4-3.00 (+2.50 Add) N Study What is Normal? Subjects = 18 Enrolled based on: Central K 43.00 D <1.00 D corneal toricity Visible Iris Diameter 11.8mm +/- 0.2mm 5 Commercially available multifocals chosen Lenses allowed to settle centration verified Over topography performed Study Mismatch always temporal Mismatch range = 0 1.25mm Mismatch average = 0.50mm Line of Sight + CL Optic Decenter the Optics Decenter the Lens Subject 1 OD Standard MF + Robert B. Mandel 4
Subject 1 OD 0.5mm Offset MF Subject 2 OD Standard MF Subject 2 OD 1.0mm Offset MF Multifocals Centration is critical (over line of sight) Alter base curve or diameter Consider other lens design Consider custom multifocal Consider monovision Challenge: Low Myope Frustrated with CLs &/or Spectacles Possible Options? Some Topographical changes Associated with Silicone Hydrogel Contact Lenses May be Due to Everted Lenses Williams, Westburge, Popowski, Popowski, Bergenske, Caroline, Smythe Presented at AAO, Tampa, FL 12/2004 5
Orthokeratology Controlled reshaping of the cornea with reverse geometry GP CL Correct myopia Centration is the primary goal Central applanation (3-4mm) Soft Lens Orthokeratology Silicone Hydrogel Centration Improved initial comfort Traditionally soft contact lens wearers Patient LE -9.00 Everted Night & Day Patient: JS Age: 24 Male History: Right Eye: -0.75 DS 20/20 Left Eye: -0.75 DS 20/20 Interested in orthokeratology Right Eye Uncorrected VA 20/20 Everted -10.00 Night & Day Left Eye Uncorrected VA 20/20 Actual Profile view -10.00 Night & Day Right Side In Actual Profile View -10.00 Night & Day Inside Out 6
Summary Prescribing Material High Modulus (Night & Day) Base Curve Steep (Night & Day Aqua 8.4mm) CL Power -8.50 D to -10.00 D Treatment Range -0.50 D to -1.25 D Off Label Challenge: Getting the Most out of RGP Multifocals Possible Options? Presbyopia GP contact lenses Alternating / Translating Segmented Annular Simultaneous Annular Aspheric Anterior Aspheric Multifocal Pros Large Diameter Centration Comfort Less Spectacle Blur Alignment corneal relationship Cons Centration Optics Large Diameter Front Aspheric POSTERIOR Aspheric Multifocal GP Lens Design ANTERIOR Aspheric Multifocal GP Lens Design Aspheric Multifocals Add Effect Back vs. Front Surface Asphericity Front surface asphericity yields higher add effect than back surface asphericity Base Curve Steeper BC yield higher add effect Index of Refraction Higher indices of refraction yield higher add effect 7
Contamac HR Index of Refraction: 1.505 Dk: 50 10~11 @ 35deg Specific Gravity: 1.045 Current FDA Status: FDA approved Paragon HDS HI 1.54 Refractive Index: 1.544 DK: 22 x 10-11 @ 35C Specific Gravity: 1.12 Current FDA Status: FDA Approved Anterior Aspheric Multifocal Prescribing Large diameter 10.0 mm to 11.0 mm overall diameter Centration Base Curve: On-K to 0.50 D steeper-than-k Higher index of refraction i.e. SGP 2 (n = 1.48), Optimum HR (n = 1.55), HDS 154 (n = 1.54) Asphericity 0.30 back surface -0.30 to -0.50 front surface, depending on base curve and material Pupil Size and Age Age Daylight Nighttime (Years) Diameter Diameter 20 5.0 8.0 40 4.0 6.0 50 3.5 5.5 60 3.0 4.25 70 2.5 3.0 80 2.0 2.5 2.6 mm Pupil Add powers with 3.0 and 5.0 mm pupils N D 4.5 mm Pupil 5.6 mm Pupil Pacific University College of Optometry 8
Ant. Aspheric Multifocal Powers Pupil Diameter Add Power 3.0mm 5.0mm +1.30 D. +3.50 D.. Pacific University College of Optometry Ant. Aspheric Multifocal Powers Anterior Asphere Plano 3.0 pupil 1.00 (Normal) +1.30 Ant. Aspheric Multifocal Powers Distance Power +4.00 Plano -4.00 3.0 5.0 3.0 5.0 3.0 5.0 +1.50 +4.00 +1.30 +3.50 +1.10 +3.00 1.20 (High) +1.60 1.40 (Very High) +1.90 Pacific University College of Optometry Anterior Aspheric Optics Challenge: Astigmatic Patient Interested in Orthokeratology Radial Astigmatism Possible Options? Vertical Coma Spherical Aberration 9
CRT 8.6 525 33 Paragon Dual Axis Design Corneal Cylinder 2.87 D Dual Axis CRT 8.6.525 / 6.00 33 Dual Axis CRT 8.4.525 /.600 33 Dual Axis Design Dual Axis Design Traditional CRT Traditional CRT Traditional Design 10
JL Dual Axis 2 Weeks Spherical CRT Dual Axis CRT 11
CRT Simulated Fluorescein Pattern Actual On-Eye Fluorescein Pattern Dual Axis Simulated Fluorescein Pattern Actual On-Eye Fluorescein Pattern 12