Astigmatic patients with unusual prescriptions can do well with Unilens’ C-VUE Advanced HydraVUE Custom Toric.

Specialty contact lenses can aid practitioners when they encounter atypical patient cases.

One of the most rewarding experiences for a contact lens fitter is watching the face of a difficult-to-fit patient light up, or even become teary-eyed when vision is corrected or restored with a contact lens. Today’s custom laboratories give us many options for even the most challenging patients. Here are a few that my practice has seen.

CASE #1: High Hyperopic Astigmatism.
A.A., a 14-year-old high school student, presented with a prescription from her pediatric ophthalmologist. She wanted desperately to see and be seen without glasses, which she had worn since age 2. Her prescription was: OD: +7.25 -4.25 x 180; OS: +8.50 -5.00 x 180.

Since she requested soft lenses, a quarterly replacement modality was favored, especially since she was a teenager. Her allergies required frequent use of antihistamines, so we needed a material that would maintain its wettability. Her lid configuration indicated that a “thin zones” or “double slab-off” design would be a good option. We ordered custom torics with this design in the hioxyfilcon D, 54% water material from Alden Optical, Inc. This material, which is available from most soft custom laboratories, has unique water-binding properties that enable it to retain its hydration throughout the entire wearing period. A.A. achieved 20/20 vision OU and 10 to 12 hours a day of good comfort. Most important to her, though, was her new image and the fact that her schoolmates no longer called her “google eyes.”

Our practice has also used custom soft torics from GP Specialists, Inc. (BioCurve), CooperVision, Inc. (Hydrasoft®), Kontur Kontact Lens, Co., Inc., SpecialEyes, Unilens Vision Inc., and Visionary Optics. Among these laboratories, practitioners can find a wide range of base curves and materials, sphere powers as high as +/-30.00D, cylinder powers up to -10.00D, and axes every degree around-the-clock.

Distributed by Advanced Vision Technologies, Eni-Eye SOFT K is ideal for patients with keratoconus.

CASE #2: Soft Lenses for Keratoconus.
Patient E.L., age 30, was unable to tolerate gas permeable (GP) lenses for keratoconus. We tried piggybacking his lenses over soft disposables, but he still had comfort issues and also complained about the necessity to clean and disinfect two sets of contacts. In January 2012, Bausch + Lomb announced the availability in the U.S. of KeraSoft® IC silicone hydrogel soft lenses for keratoconus, pellucid marginal degeneration, post laser refractive surgery, and other corneal irregularities. It’s currently available from Art Optical Contact Lens, Inc., Metro Optics, and a few other authorized laboratories. With KeraSoft IC lenses, E.L. was able to achieve 20/20 vision OD and 20/40 OS. He is now able to wear his lenses all waking hours and feels that with vision almost as good as he had with GP lenses and much improved comfort, he is able to function far better at work.

Other soft lens materials and designs for patients with keratoconus are available from X-Cel Contacts – A Walman Company (Flexlens®), Visionary Optics (HydroKone™), Advanced Vision Technologies and Accu Lens (Eni-Eye SOFT K), and Alden (NovaKone).

CASE #3: Natural-Looking Occluder Lens for Intractable Double Vision.
R.S., a 36-year-old female was injured in a surfing accident. Although her vision was not affected, an orbital floor fracture in her left eye socket left her with permanent diplopia despite six surgical procedures on the eye muscles. She presented wearing glasses with a frosted left lens and requested a prosthetic lens with an opaque pupil that would occlude her left eye, yet allow her to look normal. Prosthetic lenses are available with a variety of standard iris prints or custom handpainted designs, with clear or opaque pupils. We were able to achieve an almost-perfect match with a standard iris print from Medcorp International. The lens was made with a black underlayment and 4.5mm black pupil to match the pupil size of her right eye in ambient illumination. Prosthetic lenses with iris prints are also available from Custom Color Contacts and Adventures in Color.

CASE #4 AND #5: Custom Silicone Hydrogels.
Case #4
S.G., age 26, presented with corneal ectasias O.U. following unsuccessful LASIK surgery. His Post-LASIK refraction was: OD: -7.25 -2.75 x 30; OS: -9.00 -1.00 x 160. He had tried, but could not tolerate GP lenses. We ordered custom torics in the new Definitive 74% water, latheable silicone hydrogel material from X-Cel. The lenses moved and centered well, yielded 20/20 vision OD; 20/30 vision OS; and could be worn all his waking hours.

Case #5
Patients who are fit with piggyback lenses must wear the highest Dk soft and GP lenses possible in order to prevent corneal edema. C.T., a 73-year-old female with severe keratoconus, had been piggybacked with a custom silicone hydrogel in her left eye for several years. Unfortunately,

SynergEyes’ hybrid lenses are good options for patients who need the acuity of a rigid lens and the comfort of a soft lens.

this particular lens was discontinued. All disposable silicone hydrogels demonstrated inferior standoff on her incredibly steep 4.90mm cornea. We obtained a very steep plano quarterly replacement custom silicone hydrogel in the Definitive material from X-Cel, which enabled her to maximize the limited acuity in that eye. Custom lenses in the Definitive material are available through Art Optical, X-Cel, Metro Optics, and ABB CONCISE, with almost limitless parameter options.

CASE #6: Hybrid Lenses.
S.C., a 60-year-old female, presented with pseudophakia and irregular astigmatism OS resulting from an injury. She was a rigid lens dropout and was currently wearing a soft toric lens but complained of starbursts around oncoming headlights at night that made driving difficult and dangerous. We refit S.C. with a Synerg- Eyes, Inc. hybrid lens that provided excellent comfort and eliminated the aberrations around headlights, permitting S.C. to drive again at night. Hybrid lenses, with their rigid central core surrounded by a soft skirt are available in standard, multifocal, keratoconus, and post-refractive surgery designs. They are a good option for patients who need the acuity of a rigid lens and the comfort of a soft lens but are unable to achieve good comfort, good vision, or good centration with either of those modalities.

CASE #7: Soft Toric Multifocals.
A 72-year-old pianist, P.L. had worn toric soft lenses for years but disliked wearing reading glasses over her contacts during piano recitals. She had tried monovision but found that it limited her range of vision significantly, allowing either intermediate or near vision in her “reading” eye, but not both. We ordered Proclear® Multifocal Toric monthly replacement lenses from CooperVision: OD: 8.8 -2.25 -0.75 x 80 add +1.50 N; OS: 8.8 -2.25 -0.75 x 80 add +2.00 N. These lenses yielded 20/25+ vision for distance, J1+ at near, and excellent vision in the intermediate range so she could see her piano music without the need for reading glasses. Planned replacement multifocal torics are also available from Unilens and other custom soft lens laboratories.

Every practice has seen cases similar to these. In order to obtain success for these special patients, it’s essential to make sure you add specialty contact lenses to your conventional product supply.

Phyllis L. Rakow is Director of Contact Lens Services for The Princeton Eye Group in Princeton, NJ.


ABB CONCISE • 800-929-1431 ext. 1001 •
Accu Lens • 800-929-1431 ext. 1002 •
Advanced Vision Technologies • 800-929-1431 ext. 1044 •
Adventures in Color • 800-929-1431 ext. 1043 •
Alden Optical, Inc. • 800-929-1431 ext. 1003 •
Art Optical Contact Lens, Inc. • 800-929-1431 ext. 1004 •
Bausch + Lomb • 800-929-1431 ext. 1005 •
CooperVision, Inc. • 800-929-1431 ext. 1010 •
Custom Color Contacts • 800-929-1431 ext. 1011 •
GP Specialists, Inc. • 800-929-1431 ext. 1015 •
Kontur Kontact Lens, Co., Inc. • 800-929-1431 ext. 1018 •
Medcorp International • 800-929-1431 ext. 1023 •
Metro Optics • 800-929-1431 ext. 1025 •
SpecialEyes • 800-929-1431 ext. 1031 •
SynergEyes, Inc. • 800-929-1431 ext. 1032 •
Unilens Vision Inc. • 800-929-1431 ext. 1035 •
Visionary Optics • 800-929-1431 ext. 1036 •
X-Cel Contacts – A Walman Company • 800-929-1431 ext. 1039


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