Custom soft lenses can correct irregular corneas and improve the appearance of disfigured eyes.
A 43-year-old male with keratoconus presented to our clinic following a motor vehicle accident that left him with limited motility and limited dexterity of his extremities. The patient was unable to properly insert scleral lenses, which presented a challenge in correcting his irregular corneas.
How would you correct this patient’s vision, keeping in mind the new limitations from the accident?
As contact lens technology continues to evolve, we are better able to fit challenging patients. Consider: Scleral lenses allow us to vault an irregular cornea and allow us to treat such conditions as dry eye, post-trauma, keratoconus, keratoplasties, and neurotrophic keratitis. (To learn about a new scleral lens and expanded indications for an existing one, go to “New Product Gallery,” page 30.) Furthermore, hybrid lenses, such as UltraHealth, SynergEyes KC and ClearKone from SynergEyes, combine a highly oxygen-permeable rigid center with a soft peripheral skirt, with the central GP zone of the lens vaulting over the cone-shaped cornea for increased comfort.
And, we now have a variety of custom soft contact lenses that have become available for individuals with keratoconus and to improve the appearance of individuals with disfiguring ocular disorders. We’ll look at some of these custom soft lenses here.
The patient above elected to switch from his existing scleral lenses to a soft contact lens in the hopes of reducing the insert and removal struggle. We obtained the NovaKone fitting set and fit the patient with equally good visual success.
NovaKone from Alden Optical, a division of Bausch & Lomb, is an option for varying stages of keratoconus and is an alternative option for patients who cannot tolerate gas permeable, scleral or hybrid lenses. Online certification and an 18-lens diagnostic fit set are required to successfully fit this product.
NovaKone is comprised of hioxifilcon D with a 54% water content and a Dk value of 21. The key novel features of the NovaKone include: Dual Elliptical Stabilization for rotational stability of the front-surface toric, variable center thickness (IT Factor) to help neutralize the irregular astigmatism, base curve parameters aligning with the steep central cornea, and an independent para-central fitting curve to help lens movement and stability.
NovaKone comes in a standard diameter of 15.0mm but can be custom made to larger diameter designs. The sphere power availability is from +30.00D to -30.00D in 0.25D steps. Cylinder power availability is up to -10.00D (0.25D steps), and axis powers are from 1° to 180°. Additionally, the lens features variable center thickness (index of thickness, or IT factors) to neutralize corneal irregularities.
KeraSoft IC is a lathe-cut silicone hydrogel soft lens design that can be customized for irregular corneas.
Recommended fitting for this lens includes all stages of keratoconus, pellucid marginal degeneration, post-refractive surgery and post-LASIK ectasia.
This lens originates from UltraVision in the U.K. and is manufactured and distributed in the U.S. by ABB Concise, Art Optical and Metro Optics.
KeraSoft IC is made from efrofilcon A, a 74% water content material with a Dk value of 60, and it is recommended for quarterly replacement.
The fit set for KeraSoft IC consists of an eight-lens diagnostic set with standard 14.5mm diameter lenses, plano power and a range of base curves from 7.8mm to 8.6mm. The standard base curves utilize a standard periphery, while the flatter base curves include flat and steep peripheries for special fitting circumstances. Spherical powers are available from +30.00D to -30.00D, cylinder power from -0.50D to -15.00D (0.25D steps) and axis of 1° to 180°.
You must complete an online certification to fit KeraSoft IC and purchase the fit set. You cannot fit these lenses empirically, as there are numerous variables you must assess prior to ordering.
The manufacturer recommends using the MoRoCCo VA technique to assess the lens behavior on eye: movement, rotation, centration, comfort and visual acuity. Treat all characteristics equally when assessing the fit on an irregular cornea. Live consultants are available for troubleshooting if you need assistance.
MedCorp International offers Cantor Prosthetic Lenses and Nissel Naturals to improve the appearance of eyes that were disfigured due to congenital abnormalities, traumatic injuries and scarring secondary to eye diseases.
MedCorp International offers these patients lenses via computer-generated colors that are hand-painted for an exact match. You can order lenses that have an open or closed pupil of varying pupil size, a clear back surface or a black back surface to eliminate photophobia.
Even severe forms of congenital coloboma, corneal scarring, strabismus, aniridia and traumatic iridoplegia are disguised with the remarkable hand-painted iris detail that MedCorp International can provide.
The best way to obtain a successful color match is to digitally photograph the healthy eye in natural lighting. Lighter iris colors are generally more difficult to match than darker iris colors due to reflections of light. Hand-painted prosthetics are the best option for light colored eyes along with considering matching the healthy eye with the same color prosthetic.
The Cantor Prosthetic and Nissel Naturals contact lenses are available in sphere power of -30.00D to +30.00D, cylinder power of -0.75D to -6.00D, and an axis of 1° degree to 180° degrees in 5° steps. Base curves range from 6.60mm to 10.40mm. Available diameters are 11.00mm to 20.00mm (0.50mm steps), and closed pupils are 2.5mm to 5.0mm (0.50mm steps). The ability to custom-design the prosthetic lenses provides practitioners with successful products for patient loyalty and retention.
SpecialEyes designs custom soft spherical, toric, bifocal and multifocal contact lenses for patients who have large amounts of astigmatism, hyperopia and/or myopia. The wide parameter ranges offer the ability to design a lens to the patient’s exact refractive error for precise visual acuity. These lenses are an alternative for those individuals who have difficulty adapting to scleral and gas permeable lenses and when an in-office stock contact lens doesn’t work.
Custom lenses can be made with the following parameters: spherical lenses from +25.00D to -25.00D and cylinder powers up to -8.00D (0.10D steps), with 1° axis increments. Multifocal products are available in toric or sphere parameters with add powers up to +4.00 diopters and completely customizable optics via the SpecialEyes Multifocal Simulator. Lens modalities include SpecialEyes 54% and 59% with quarterly replacement or SpecialEyes 49% with yearly replacement.
SpecialEyes delivers the lenses to your office in two to four business days and offers a Guaranteed Fit Program. This program will remake or exchange lenses at no additional cost until optimal fit and vision are obtained. If the trial is unsuccessful or the patient is unable to adapt to the lenses, SpecialEyes will provide full credit for the trial lens cost. Live consultants are available to help fine-tune adjustments along with extensive online training.
Anar Maurya, OD, received her doctorate from UAB School of Optometry in 2004. She currently specializes in ocular disease, post surgical management and fitting specialty contact lenses at Woodhams Eye Clinic in Atlanta.
WHERE TO FIND IT:
Alden Optical, Inc.
800.253.3669 | AldenOptical.com
Art Optical Contact Lens, Inc.
800.253.9364 | ArtOptical.com
949.582.0313 | MedcorpInt.com
866.404.1060 | SpecialEyesQC.com
877.733.2012 | SynergEyes.com