FlexLens Product Guide Year

Transcription

This is a supplement to the main Flexlens fitting guide and does not contain all the warnings, precautions and directions for
use found in the main fitting guide. Please refer to the main fitting guide for additional important information.
CAUTION: fEDERAL LAW REStricts this device to sale by or on the order of a licensed practitioner
D ES I G N E D
Flexlens® Spherical • Flexlens® Aphakic • Flexlens® Toric • Flexlens® Multifocal
F O R
S U CC ESS . . .G UA R A N T E E D
TO
F I T
Flexlens® Tri-Curve Keratoconus • Flexlens® PRS • Flexlens® Piggyback
2775 Premiere Parkway, Suite 600, Duluth, GA 30097 | 800.241.9312 | www.walman.com | www.xcelcontacts.com
FLEX082011
FLEXLENS PRODUCT & FITTING GUIDE
We Fit Your Practice.™
Our commitment to you.
With over 30 years of experience in the custom optical industry,
X-Cel Contacts Group is a leading manufacturer of custom soft and gas
permeable contact lenses. In this product and fitting guide you will
find detailed information on our custom soft lens design, Flexlens®.
We are committed to providing you with high quality specialty soft
“Virtually Unlimited Parameter Combinations”
contact lenses. That is why Flexlens® lenses are made to order and offer
designs and parameters not available in other soft contact lens
product lines. X-Cel’s order fulfillment time (whether standard or special
parameters) on any Flexlens design is from 2 to 3 working days.
To learn more about Flexlens Specialty Soft Lens designs, please call
your local branch. Flexlens are manufactured under a 13485 ISO
Multifocal, Keratoconus,
Post Refractive Surgical, Irregular Corneal,
Post Corneal Graft, High Astigmatism,
Pellucid Marginal Degeneration.
registered quality management system.
Scan this QR Code to learn more about Definitive
tM
About X-Cel contacts group
Products
Material
Lenses are available in hioxifilcon B 49%, hefilcon A 45%, hioxifilcon A 59%,
methafilcon A 55% and Definitive Silicone Hydrogel 74% (efrofilcon A) water content
materials. All materials are available in a visitint, with the exception of methafilcon A
55% and Definitive Silicone Hydrogel 74% only being available in clear.
*Flexlens Multifocal soft contact lenses for Daily Wear are available only in hioxifilcon A
59% and hioxifilcon B 49% material.
**We recommend OptiFree contact lens solution for use with Flexlens designs.
Hours of Operation: 8:30 a.m. to 8:30 p.m. EST
Flexlens® Spherical
Flexlens® Aphakic
Flexlens® Toric
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Flexlens® Multifocal
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2
3-5
6-8
9-11
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12-14
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15-17
Flexlens® Tri-Curve Keratoconus
Flexlens® PRS
Flexlens® PiggybacK
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Flexlens® Diagnostic Sets
Flexlens® Pricing
18-21
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24
Manufacturer’s Warranty
Initial Lens Fit: Flexlens products are warranted for unlimited exchanges or cancellation provided the
Consultation Services: For professional assistance in designing or fitting Flexlens products you may
contact a Flexlens Fitting Consultant at any branch.
Policies are subject to change without prior notice.
2775 Premiere Parkway, Suite 600 • Duluth, GA 30097 • 800-241-9312 • Fax 800.822.9235
TABLE OF CONTENTS
exchanges and/or cancellations occur within 90 days of the original invoice date. Exchanged lenses will be
billed at full price. Credit will be issued via paperless credits ([email protected]) or when the lenses
are returned. All paperless returns will incur a $3 material recovery fee per lens. All physical returns will
incur a $5 material recovery fee per lens, and original invoice must accompany lenses. Warranties do
not cover lost or damaged lenses.
Spherical Lens
Aphakic Lens
For an exact fit every time
The Flexlens Spherical Lens is indicated for daily wear use for the
correction of higher degrees of ametropia. The lens is available in a
large diameter with or without a thick edge and also with 1.50D or 2.00D
of prism.
Adult & Pediatric
The Aphakic Lens is indicated for daily wear use for the correction of refractive
ametropia and specialized use such as atypical ametropia. The lens is available
for those patients who have undergone cataract removal either as a child or
an adult. The range of available lens parameters makes it an ideal lens for any
patient who cannot tolerate a GP lens after surgery.
Standard Design & Fitting
Parameter Availability
Standard soft lens fitting principles apply to the Flexlens Spherical Lens. Lens selection should be 4.00D flatter
than the patient’s flattest keratometric value. There should be lens centration with 1.0 to 1.5mm of limbal
draping and lens movement should be minimal, 0.25 to 0.50mm in primary position with normal blink.
BASE CURVE DIAMETER
POWER
Standard Parameters
Available as a Monthly in 6 and 12 packs.
BASE CURVE
DIAMETER
POWER
5.0 to 11.0mm in 0.1mm steps
+00.00D to +50.00D in 0.25D steps
13.5 to 15.0mm in 0.1m steps
+10.00D to –10.00D in 0.25D steps
BASE CURVE
DIAMETER
POWER
+50.00D to –50.00D in 0.25D steps
A custom multi-packaged lens available for
monthly or quarterly wear schedules.
2
A custom multi-packaged lens available for
monthly or quarterly wear schedules.
ADULT & PEDIATRIC
3
Front View FLEXLENS® APHAKIC LENS
Sectional View
FLEXLENS APHAKIC LENS - TROUBLESHOOTING
Patient Symptoms
Poor visual acuity on
delivery or first follow-up
Objective Findings
Possible Cause
Unacceptable vision on
eye chart
Lens not centered
Scleral indentation
Corneal edema
Vision decreases
during the day
Fluctuating vision
Deposits
Basic Fitting Information
Initial discomfort
BASE CURVE
Select a diagnostic lens whose base
EXAMPLE:
“K’s”
Flat “K”
Diagnostic Lens
curve is 4.00D flatter than the patient’s flattest keratometer value.
45.00D @ 180 / 47.00D @ 090
45.00D – 4.00D = 41.00D
8.2mm
Excessive movement
Discomfort at day’s end
Too little or no movement
A FLAT fitting relationship may exhibit:
Lens decentration
Edge lift when the lens is manually pushed up to the lower limbus
Clear “K” mires that become irregular after the blink
Scleral indentation
Lens dislodges during wear
Superior or inferior edge lift
If the initial lens exhibits any of the above, choose the next steeper base curve and re-evaluate.
A STEEP fitting relationship may exhibit:
Bubble beneath the periphery of the lens
Scleral indentation or conjunctival drag
Irregular “K” mires that clear upon blink
If the initial lens exhibits any of the above, choose the next flatter base curve and re-evaluate.
Push Up Test
If the lens decenters up, down, left or right, the base curve is most likely too flat and the next steeper base curve
should be evaluated. If the lens centers well, a simple “push up” test will verify if the base curve is appropriate for
the patient. Place your index finger on the patient’s lower lid margin and manually push the lower lens edge up to
the lower limbus. Release your finger pressure from the lower lid and evaluate the lens movement. If the
decentered lens slowly drops into a center position, the lens to cornea relationship is appropriate. If the lens
remains in a superior decentered position, or if edge stand off is noted as the lens reaches the lower limbus, the
base curve relationship is too flat. In this situation, the next steeper base curve/diameter should be evaluated. A
steep fitting lens will exhibit resistance to the manual manipulation of the lens with the lower lid. In this situation,
the next flatter base curve can be evaluated.
4
5
Plan
Incorrect refraction or
over-refraction
Order new lens based on new
refraction
Base curve too flat
Steepen base curve by 0.3mm
Diameter too small
Increase diameter 0.5mm
Lens is too steep
Flatten base curve by 0.3mm
Lens is too large
Decrease diameter by 0.5mm
Lens is too thick, material
does not provide enough
oxygen
Increase water content of lens
material
Lens is too steep
Lens is too large
Lens displaces occasionally
Increase lens diameter
by 0.5mm
Care system not followed
or not adequate
Discuss care system with
patient and change as
necessary
Incompatibility with material
Change to lower water
content material
Improper fit
Evaluate fit
Incompatibility with solutions
Change patient’s care system
Base curve too flat
Diameter too small
Increase diameter by 0.5mm
Base curve too steep
Diameter too large
Lens dehydrating on eye
Decrease water content
of lens
Diameter too large
Base curve too flat
Diameter too large
Toric Lens
Designed for success. Guaranteed to fit.
Front View FLEXLENS® TORIC LENS
Sectional View
The Flexlens Toric Lens is indicated for daily wear use for the correction of visual
acuity in aphakic and non aphakic persons with non-diseased eyes with myopia
or hyperopia and possesses refractive astigmatism not exceeding 10.00D.
Lens Design
The Flexlens Toric Lens utilizes a back surface toric
design, with 1.50D of prism ballast to stabilize
rotation. There is a laser mark (V) at 6 o’clock to
mark the location of the prism ballast. For those
patients with high degrees of irregular astigmatism
that cannot achieve optimal visual acuity can try a
rigid gas permeable lens or the Piggyback design.
The Flexlens Toric Lens is fit using a nomogram method which utilizes the Flat keratometry value.
Standard Parameters
Flexlens Toric
Base Curve
Diameter
Sphere Power
+10.00D to –10.00D
(in 0.25D steps)
Cyl Power
–0.50D to –10.00D
(in 0.25D steps)
Axis
1º increments up to 180º
Center Thickness .16mm at –3.00D
Base Curve
Diameter
Sphere Power
Cylinder Power
Axis
+30.00D to –30.00D in 0.25D steps
–0.50D to –10.00D in 0.25D steps
1º increments up to 180º
6
Flat “K” Reading
Suggested Base Curve
Suggested Diameter
45.00D and steeper
43.25D to 44.75D
41.50D to 43.00D
41.00D and flatter
8.0mm to 8.3mm
8.3mm to 8.6mm
8.6mm to 8.9mm
8.9mm to 9.2mm
14.0
14.0 or 14.5
14.5 or 15.0
15.0
The chosen lens should be placed on the eye and allowed to equilibrate for a minimum of 20 minutes before
evaluating the fit for movement, rotation, and centration. The ideal lens fit should exhibit good centration with
approximately 0.25 to 0.50mm of lens movement in primary position. Clinical experience with the Flexlens Toric
has shown that it is not necessary to measure the lens rotation and calculate the traditional LARS compensation.
The sphero-cylindrical over-refraction alone can correct for the lens rotation. If upon evaluation, the lens rotates
more than 10 degrees and your over-refraction does not yield good visual results, consider a change in base curve
and/or diameter prior to ordering a new lens that incorporates the cross cylinder as determined by your
over-refraction.
7
Multifocal Lens
FLEXLENS TORIC LENS - TROUBLESHOOTING
Patient Symptoms
Objective Findings
Possible Cause
Lens rotates 10° or less
Scleral indentation
Corneal edema
Vision decreases
during the day
Diameter too small
Base curve too flat
and incorporate over
refraction. Re-order new
lens.
Diameter too small
and incorporate over
refraction. Re-order new
lens.
Diameter too small
Base curve too flat
Lens is too steep
Lens is too large
Material does not provide
enough oxygen
Change to a higher water
content material
Lens rotates out of position at Lens is too steep
day’s end
Lens is too large
Deposits
Unstable vision
Sphere/cylinder off axis
If over-refract yields good
results, reorder new powers
indicated
Lens rotates more than 10°
Lens does not rotate but is
decentered
Slight edge lift
Initial discomfort
Excessive movement
Plan
For emerging to mature presbyopia
The Flexlens Multifocal is indicated for daily wear use for the correction of
refractive ametropia and specialized use such as presbyopia. The lens will
cover all ranges of patients from emerging to mature presbyopia.
Lens Design
The Flexlens Multifocal is a Daily Wear soft lens multifocal with an aspheric front surface and a spherical base
curve. The progressive optics utilize the simultaneous vision concept which offers functional vision from distance to
near throughout the viewing range. The Flexlens Multifocal is fit only on the Non-Dominant eye, while a Spherical
design is fit on the Dominant eye. The design is recommended in hioxifilcon B 49% and also available in
hioxifilcon A 59% BENZ-G lens materials. The Pupil Zone on the front surface varies with the size of the patient’s
pupil at normal room illumination.
Decrease diameter 0.5mm
Standard Parameters
content material
Care system not followed or
not adequate
necessary
Occasional rotation of lens
BASE CURVE
DIAMETER DISTANCE POWER
ADD POWER
PUPIL ZONE
Base curve too flat
Improper fit
Evaluate fit
Base curve too flat
Diameter too small
Diameter too large
Decrease water content of
material
8.3, 8.6
14.0
+4.00D to -6.00D in .25D steps*
+1.00, +1.50, +2.00, +2.50
1, 2, 3
*PLANO, +0.25, and -0.25 distance powers are available as a custom parameter
BASE CURVE DIAMETER DISTANCE POWER
ADD POWER
PUPIL ZONE
8.0 to 9.2mm (.1 steps)
13.5 to 15.0mm (.1 steps)
+10.00D to -10.00D (.25D steps)
+1.00D to +3.00D (.25 steps)
1, 2, 3
The Flexlens Multifocal is fit using a nomogram system that is based
on the patient’s flattest keratometry reading, spectacle refraction for
distance and near, and the pupil diameter. The base curve and diameter
recommendation are as follows:
Flat K reading
45.00 and Steeper
44.75 and Flatter
Suggested Base Curve
8.3
8.6
* The diameter should be at least 2.0mm larger than the patient’s HVID
8
9
Push Up Test
FLEXLENS® MULTIFOCAL LENS
Front View
Sectional View
When fitting the Flexlens Multifocal the lens needs to fit slightly steeper to minimize lens movement. If the lens
decenters up or down, left or right, the base curve is most likely too flat and the next steeper base curve should
be considered. If the lens centers well, a simple “push up” test will verify if the base curve is appropriate for the
patient. Place your index finger on the patient’s lower lid margin and manually push the lower lens edge up to the
lower limbus. Release your finger pressure from the lower lid and evaluate the lens movement. If the lens remains
in the superior decentered position or shows evidence of edge standoff as the edge reaches the lower limbus, the
base curve relationship is too flat. A steep fitting lens will exhibit resistance to the manual manipulation of the lens
with the lower lid.
FLEXLENS MULTIFOCAL LENS - TROUBLESHOOTING
Patient Symptoms
Objective Findings
Poor distance acuity
Fitting Considerations
When fitting the Flexlens Multifocal the following recommendations should be followed:
• Record patient’s full Add correction (Do not adjust)
• When determining the pupil diameter of the patient, measure in normal room illumination
• Allow lens to settle for 20 minutes before evaluation
Poor near acuity
• The lens needs to fit as tight as possible to minimize lens movement; use push up test to evaluate (see following page for Push Up Test)
• Over-refract near vision using trial frames
(use of the Phoropter may affect pupil diameter and acuity results)
• Recheck pupil size (very important) at normal room illumination
Scleral indentation
Corneal edema
Vision decreases
during the day
Pupil Zone
Pupil Sizes
3.0 to 3.5
4.0 to 4.5
5.0 to 5.5
Deposits
Pupil Zone
PZ 1
PZ 2
PZ 3
Initial discomfort
10
Plan
over-refraction
refraction for Dominant eye
Multifocal on Dominant eye
Multifocal must be on
Non-Dominant eye; Spherical
lens on Dominant eye
Lens decentered
Order steeper base curve or
larger diameter
over-refraction
refraction for Non-Dominant
eye
Lens decentered
larger diameter
Incorrect pupil zone
Decrease pupil zone on
Flexlens Multifocal
Pupil zone too small
Increase pupil zone on
Flexlens Multifocal
Lens decentered
larger diameter
Lens is too steep
Lens is too large
Decrease diameter 0.5mm
Lens is too steep
Flare, Haze, or doubling
• The Flexlens Multifocal is fit in the Non-Dominant eye with a Spherical lens fit on the Dominant eye. The visual acuity must be evaluated binocularly at all times.
NOTE: Patients who wear aspheric contact lenses to correct presbyopia may not achieve the
best corrected visual acuity for far or near vision. Visual requirements vary with the individual
and should be considered when selecting the most appropriate type of lens for each patient.
Possible Cause
Lens does not provide enough Change lens materials and
oxygen
increase water content
content material
not adequate
necessary
Improper fit
Evaluate fit
Torn or damaged lens edge
Reorder new lens
Patient adaptation
Allow lens to settle for
20 minutes; ensure lens is
not inverted
11
Tri-Curve Keratoconus Lens
For moderate to advanced keratoconus
The Tri-Curve Keratoconus Lens is indicated for daily wear use for the
correction of refractive ametropia and specialized use such as atypical
ametropia.
Indications
Examples include, but are not limited to: irregular astigmatism created by keratoconus, trauma, or
post/penetrating keratoplasty. The lens is for patients with moderate to advanced keratoconus and
is ideal for those:
•Who cannot adapt to a rigid lens material
•With monocular keratoconus who wish to wear a soft lens in the fellow eye
•Who experience decentered optics with a rigid lens material
Lens Design
The Tri-Curve Keratoconus Lens is based on a tricurve posterior design. The optical success of the design is based
on the standard center thickness that ranges from .45 to .65mm which is often thicker than the keratoconus
cornea itself. The design incorporates a flat secondary curve of 1.2mm to 1.8mm flatter, depending on the base
curve. A scleral curve with a radius of 2.2mm to 2.8mm flatter, depending on the base curve, is added peripherally
to align with the scleral curve of the eye. For those patients who exhibit high degrees of irregular astigmatism,
they may be better served with the Piggyback Lens design.
BASE CURVE
DIAMETER
POWERS
CENTER THICKNESS
+50.00D to –50.00D in 0.25D steps
.45mm to .65mm
Available as a Monthly in 6 & 12 packs.
Front View
FLEXLENS® TRI-CURVE KERATOCONUS LENS Sectional View
Other patients who may benefit from the increased central thickness and rigidity of the Tri-Curve Keratoconus
Lens for vision correction include those with:
•
•
Pellucid marginal degeneration
Refractive surgery
The Flexlens Tri-Curve Keratoconus lens can correct up to 6.00 diopters of astigmatism, but may need
a .65 center thickness to do so.
Below are cases where the Tri-curve Keratoconus should be considered:
PMD
RK
RK
TRAUMA
A diagnostic set is recommended foremost in successfully fitting this lens design.
BASE CURVE
Select a diagnostic lens using the averaged keratometer value.
EXAMPLE:
“K’s”
52.00D @ 180 / 57.00D @ 090
Flat “K”
(52.00D + 57.00D) 42 = 54.50D
Diagnostic Lens 6.2mm Base Curve on flat k
POST PK
CENTRAL NIPPLE
CONE
CONE
LARGE SAGGING
CONE
Lens Evaluation
When evaluating the fit of the Tri-Curve Keratoconus Lens, the lens should exhibit:
•
•
•
12
Lens centration with 1.0 to 1.5mm of limbal draping
Lens movement of 0.25 to 0.50mm in primary position with normal blink, maintaining stable vision
Visual acuity within two lines of best corrected vision
13
Post Refractive Lens
Push Up Test
If the lens decenters up, down, left, or right, the base curve is most likely too flat and the next steeper base curve
should be evaluated. If the lens centers well, a simple “push-up” test will verify if the base curve is appropriate for
the patient. Place your index finger on the patient’s lower lid margin and manually push the lower lid and evaluate
the lens movement. If the decentered lens slowly drops into a centered position, the lens to cornea relationship is
appropriate. If the lens remains in a superior decentered position, or if edge stand off is noted as the lens reaches
the lower limbus, the base curve relationship is too flat. In this situation, the next steeper base curve/diameter
should be evaluated. A steep fitting lens will exhibit resistance to the manual manipulation of the lens with the
lower lid. In this situation, the next flatter base curve can be evaluated.
The first approved soft contact lens for vision correction
following corneal refractive surgery
The Post Refractive Lens is indicated for daily wear use for the correction of
refractive ametropia and specialized use such as atypical ametropia
following corneal refractive surgery.
Lens Power
If the visual acuity is less than expected, an additional over-refraction should be performed. The most accurate
results will be obtained after the lens is worn for three to seven days of daily wear, with the lens being worn at
least four hours on examination day. Residual astigmatism will be best managed in a pair of spectacles worn over
the contact lenses.
FLEXLENS TRI-CURVE KERATOCONUS LENS - TROUBLESHOOTING
Patient Symptoms
Objective Findings
Unacceptable vision on eye
chart
Lens not centered
Fluctuating vision
Sphero-cylindrical
over-refraction provides
good vision
Scleral indentation
Vision decreases
during the day
Corneal edema
Initial discomfort
Excessive movement
Scleral indentation
Lens dislodges during wear
Superior to inferior edge lift
Possible Cause
Plan
over-refraction
refraction
Base curve too flat
Diameter too small
Base curve too flat
Flat Fit = patient will
exhibit “clear, blur, clear”
when blinking
Steep Fit = patient will
exhibit “blur, clear, blur”
when blinking
Cylinder over-refraction 2.00
diopters and under; Center
thickness too thin
Increase center thickness to
.65mm
Cylinder over-refraction over
2.00 diopters
Change to Flexlens Piggyback
design or utilize spectacles
over the lenses
Lens is too steep
Lens is too large
Lens is too thick; material
oxygen
material, or decrease center
thickness
The Post Refractive Lens function allows the central optical portion of the lens to be flatter than the mid-periphery.
The optical zone has a thickness of approximately .28mm at –1.00D, which provides stable optics over the central
cornea. The peripheral lens carrier is as thin as, or thinner than, any standard soft lens to ensure maximum oxygen
permeability to the peripheral cornea, limbus and conjunctiva.
BASE CURVE
DIAMETER
POWER
+50.00D to –50.00D in 0.25D steps
Lens is too steep
Improper fit
Evaluate fit
Base curve too flat
Diameter too small
Diameter too large
Decrease water content of
lens
Diameter too large
Base curve too flat
Diameter too large
14
Lens Design
Below are cases where the Flexlens Post Refractive lens should be considered:
POST LASIK
RK
RK
15
FLEXLENS® POST REFRACTIVE LENS
Front View
Sectional View
FLEXLENS POST REFRACTIVE LENS - TROUBLESHOOTING
Patient Symptoms
Objective Findings
refraction
Lens not centered
Base curve too flat
Fluctuating vision
Center thickness too thin
.45mm
Cylinder over-refraction 2.00
diopters and under; center
thickness too thin
.45mm
Cylinder over-refraction over
2.00 diopters
Change to Piggyback lens
design or utilize spectacles
over lenses
Lens is too steep
Lens is too large
Lens is too thick; material
oxygen
material, or decrease center
thickness
Lens is too steep
Lens is too large
content
not adequate
necessary
Improper fit
Evaluate fit
Sphero-cylindrical
over-refraction
provides good vision
Scleral indentation
Corneal edema
Vision decreases during the
day
Central keratometric readings are of little value in fitting the Post Refractive Lens. A diagnostic set is recommended
for most successful fitting of this lens. Select a lens from the diagnostic set with a base curve of 8.7mm and a
diameter of 15.0mm. Allow the lens to equilibrate a few minutes before performing the initial evaluation. If the
diagnostic lens does not exhibit obvious edge lift, allow the lens to equilibrate an additional 30 minutes. If the lens
does exhibit edge lift or decenters in any direction, this indicates a flat fitting relationship and the next steeper
base curve should be tried.
Deposits
Initial discomfort
Push Up Test
If the lens centers well, a simple “push-up” test will verify if the base curve is appropriate for the patient. Place
your index finger on the patient’s lower lid margin and manually push the lower lens edge up to the lower limbus.
Release your finger pressure from the lower lid and evaluate the lens movement. If the decentered lens slowly
drops into a centered position, the lens to cornea relationship is appropriate. If the lens remains in a superior
decentered position, or if edge stand off is noted as the lens reaches the lower limbus, the base curve
relationship is too flat. In this situation, the next steeper base curve/diameter should be evaluated. A steep fitting
lens will exhibit resistance to the manual manipulation of the lens with the lower lid. In this situation, the next
flatter base curve can be evaluated.
Lens Fitting Evaluation
When evaluating the fit of the Post Refractive Lens, the lens should exhibit:
•
•
•
Lens movement of 0.25 to 0.50mm in primary position with normal blink
Visual acuity within two lines of best corrected vision
NOTE: If pre-operative keratometric readings are available, fit as follows:
Post-Op K’s Range
Base Curve
Diameter Pre-Op K’s Range
37.75 - FLATTER
38.00 - 41.00
9.0
8.7
15.0
15.0
41.25 - STEEPER
8.4
15.0
Base Curve
Diameter
41.75 or FLATTER
42.00 - 45.00
9.0
8.7
15.0
15.0
45.25 - STEEPER
8.4
15.0
16
Plan
over-refraction
Possible Cause
chart
17
Piggyback Lens
For advanced keratoconus
Front View
FLEXLENS® PIGGYBACK LENS
Sectional View
The Piggyback Lens design is ideal for the patient who requires the optics
of a rigid lens but has difficulty with the initial comfort of that material.
This lens is indicated where centration is difficult to achieve due to an irregular corneal surface.
Patients who would benefit from this design could have:
•
•
•
•
Beginning to advanced keratoconus Pellucid marginal degeneration
Terrien’s marginal degeneration
Penetrating Keratoplasty
Refractive corneal surgery
Corneal trauma
Corneal surface disease
•
•
•
Lens Design
The Piggyback Lens incorporates a central circular depression into the anterior surface of the soft lens carrier.
The design recesses the GP lens within the soft lens eliminating upper lid dislodgement and maintaining
centration of the GP optics over the pupil.
SOFT LENS BASE CURVE
Below are cases where the Flexlens Piggyback lens should be considered:
The Piggyback Lens fitting criteria is identical to any soft lens, with movement and centration the primary
factors. The initial lens selection should be 1.0mm flatter than the patient’s flattest keratometric value (in mm).
There should be lens centration with 1.0 to 1.5mm of limbal draping and lens movement should be minimal,
0.25 to 0.50mm in primary position with normal blink.
EXAMPLE:
“K’s”
52.00D @ 180 / 57.00D @ 090
Flat “K”
52.00D = 6.49mm
Diagnostic lens7.5mm Base Curve
Recommended lens: 7.5mm Base Curve, 14.5mm Diameter, Plano Power, 10.2mm Anterior Cut-out Diameter
PMD
LASIK
RK
RK
TRAUMA
Diagnostic fitting of the soft lens is enhanced by inserting a GP lens that is 1.0mm smaller than
the recessed cut-out diameter. GP Insert Lens: Take the keratometric reading for the insert
lens over the piggyback carrier. For example, if the anterior cut-out is 10.2mm, the largest
GP lens diameter would be 9.2mm. This will mimic the final weight and lid to lens
interaction, allowing for a better evaluation.
NOTE: The soft lens skirt should be inserted first, followed by the GP lens
being inserted on top of the soft lens.
POST PK
CENTRAL NIPPLE
CONE
CONE
LARGE SAGGING
CONE
Lens Evaluation
When evaluating the fit of the Piggyback lens, the soft lens should exhibit:
BASE CURVE
DIAMETER
ANTERIOR CUT-OUT DIAMETER
POWERPlano
•
•
Lens movement of 0.25 to 0.50mm in primary position with normal blink
18
19
Push Up Test
FLEXLENS PIGGYBACK LENS - TROUBLESHOOTING
If the soft lens decenters up, down, left or right, the base curve is most likely too flat and the next steeper base
curve should be evaluated. If the soft lens centers well, a simple “push-up” test will verify if the base curve is
appropriate for the patient. Place your index finger on the patient’s lower lid margin and manually push the lower
lens edge up to the lower limbus. Release your finger pressure from the lower lid and evaluate the lens movement.
If the decentered lens slowly drops into a centered position, the lens to cornea relationship is appropriate. If the
lens remains in a superior decentered position, or if edge stand off is noted as the lens reaches the lower limbus,
the base curve relationship is too flat. In this situation the next steeper base curve/diameter should be evaluated.
A steep fitting lens will exhibit resistance to the manual manipulation of the lens with the lower lid. In this
situation, the next flatter base curve can be evaluated.
Gas Permeable Insert
Patient Symptoms
Objective Findings
chart
Possible Cause
Order new GP lens based on
new refraction
Base curve too flat
Steepen base curve by 0.50D
and adjust power
Anterior cut-out too large
Order new soft lens with
smaller anterior cut-out
Lens too small
Increase soft lens diameter by
0.5mm
Lens too loose
Steepen soft lens base curve
by 0.3mm
Bubble between posterior
surface of GP and anterior
surface of soft lens
Incorrect GP base curve
Flatten GP base curve by
0.50D and adjust power
GP lens too large for anterior
cut-out
Incorrect GP diameter
Reduce GP diameter to fit
into cut-out
GP base curve too flat
Steepen GP base curve by
0.50D and adjust power
Excessive edge lift of GP lens
Reduce edge lift of GP lens
Base curve of soft lens too
steep
Flatten base curve of soft lens
by 0.3mm
Diameter of soft lens too
large
Reduce soft lens diameter by
0.5mm
GP base curve too steep
Flatten GP base curve 0.50D
and adjust power
Water content of soft lens
too low
Increase water content of soft
lens material
Dk of GP lens too low
Increase Dk of GP lens
material
GP base curve too flat
Steepen GP base curve 0.50D
and adjust power
Soft lens base curve too steep
Flatten soft lens base curve by
0.3mm
Edge of GP lens too thick
Reduce edge profile of GP
lens
GP diameter too large
into cut-out
Call Consultation for best
material recommendation
not adequate
necessary
GP lens too large trapping
debris in cut-out
into cut-out
flat
Steepen soft lens base curve
by 0.3mm
small
Increase soft lens diameter by
0.5mm
steep
Flatten soft lens base curve by
0.3mm
GP Lens not centered
Once the appropriate soft lens has been designed, the GP lens is removed from the central cut-out with a
standard GP suction device. Keratometry is performed over the central depression of the soft contact lens and a
standard GP lens is designed as if it were being fitted onto the cornea. A base curve is selected on “K” or .10mm
steeper than the flat “K”. The GP lens diameter should be selected at least 1.0mm smaller than the anterior
cut-out boundaries to facilitate lens movement and tear exchange.
Soft lens not centered
Build up of foreign matter
between lenses
Corneal edema
Vision decreases
during the day
GP lens dislodges
Ensures centration of the rigid
lens over the central cornea
maintaining a comfort level
similar to a soft lens, allowing
freedom of day to day activities
without discomfort.
Plan
over-refraction
Deposits
Excessive movement
Initial discomfort
Too little movement
Reduce soft lens diameter by
large
0.5mm
NOTE: The gas permeable lens should be rinsed with saline or a multi-purpose soft lens solution prior to inserting it into the
soft lens.
20
21
Diagnostic Sets
To evaluate the fit.
Learn about X-Cel’s
In-Office Consultation for
Specialty Contact Lens Fits
Flexlens Specialty Soft Lens Designs
Flexlens Toric Diagnostic Set (30 blister pack lens set)
Base Curves
8.30
8.30
8.60
8.60
8.60
8.60
8.90
8.90
8.90
8.90
Spherical Power
-2.00
-2.00
-2.00
-2.00
-2.00
-2.00
-2.00
-2.00
-2.00
-2.00
Cylinder Power
-2.00
-2.00
-2.00
-2.00
-2.00
-2.00
-2.00
-2.00
-2.00
-2.00
90
180
135
45
90
180
135
45
90
180
14.0
14.0
14.5
14.5
14.5
14.5
15.0
15.0
15.0
15.0
Axis
Diameter
Flexlens Tri-Curve Keratoconus Diagnostic Set (30 blister pack lens set)
Base Curves
6.0, 6.3, 6.6, 6.9, 7.2mm
7.5, 7.8, 8.1, 8.4, 8.7mm
Diameter
14.0mm
14.5mm
Power
-3.00
-3.00
Center Thickness
.45mm
.45mm
Flexlens Pediatric Aphakic Diagnostic Set (21 blister pack lens set)
Base Curves
7.20
7.20
7.50
7.50
7.50
7.50
7.80
Spherical Power
+20.00
+25.00
+25.00
+20.00
+25.00
+25.00
+25.00
Diameter
11.5
11.5
11.5
12.0
12.0
12.5
13.0
Flexlens PRS Diagnostic Set (21 blister pack lens set)
Base Curves
7.8, 8.1, 8.4, 8.7, 9.0, 9.3, 9.6mm
Diameter
15.0mm
Power
-1.00
Center Thickness
.28mm
Flange Thickness
.10mm
Flexlens Piggyback Diagnostic Set (30 blister pack lens set)
Base Curves
6.6, 6.9, 7.2, 7.5, 7.8, 8.1, 8.4, 8.7, 9.0, 9.3mm
Diameter
14.5mm
Power
Plano
Center Thickness
.12mm
Anterior Cutout
10.2mm
In today’s optical business, time is the most valuable commodity. The initial specialty lens fitting process
averages multiple office visits per patient, but with the help of our in-office assistance, the visits can be
reduced in most cases. We believe the patient in your chair is our patient too. If you are fitting one of our
designs for the first time, fitting a new patient, or have a difficult fit, we would like to provide you with not
only multiple lens options for your patient, but also an “in-office” consultant. During the consult, we are
there to assist in the fitting process and to ensure a successful fit with one of our custom soft or GP lens
designs.
How we can help assist you:
• Identify 2 or more patients with any of the following conditions: Keratoconus, Astigmatism, Presbyopia,
or any Irregular Cornea.
• Call an X-Cel Consultant or Account Manager with any/all pertinent information such as K’s, refraction,
patient history, topography and current lens Rx.
• Our Consultation team will use the information and design multiple lenses for each patient, which may
consist of multiple designs and/or materials (GP and Soft), as well as applicable diagnostic sets.
• Once the lenses are completed, the Consultant or Account Manager will call your office to coordinate the
in-office consult.
*Other diagnostic sets available upon request.
• On the day of the fitting, we will arrive early to discuss with you a plan for the fitting procedure and
assist with the evaluation of the patient fit and recommendations from that point.
22
22
We Fit Your Practice™

FlexLens Product Guide Year

Transcription

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