LENS DYNAMICS, INC.
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Transcript of LENS DYNAMICS, INC.
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LENS DYNAMICS, INC.
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SCLERAL HISTORY
• Original contact lens• Hand ground glass lenses• Fit by casting a mold of the cornea
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EARLY SCLERAL PERFORMANCE
• Difficult to fit• Hard to manufacture and reproduce• Corneal hypoxia• Very short wearing times• Corneal molding – The negative kind
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SCLERAL DEFINED
• Mini-Sclerals – 12.5mm to 14.5mm• Medium Range Sclerals – 15.0mm to
18.0mm• Full Sclerals – 18.5mm to 28.0mm
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SCLERALS – FIRST OR LAST RESORT?
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WHY FIT A SCLERAL LENS?
THE PRO:• To vault highly irregular corneas• To provide better visual acuity than soft
lenses• To prevent lost lenses• New Oxygen permeable materials
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WHY FIT A SCLERAL LENS?
THE CON:• Harder to fit• Harder to insert and remove• Can reduce metabolic waste removal• Potential for hypoxia• Harder to fit
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THE PRACTICAL:
• First or Last Resort as a design?• Who fits sclerals at all?• Who fits sclerals as the design of First
choice?• Who fits sclerals as a design of Last
resort?
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THE DESIGN:
• 13.0mm, 13.5mm, 14.0mm• Lathe cut on DAC ALM lathes• Spherical back and front surfaces• Normally NOT fenestrated
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HOW TO FIT
• Start with a base curve close to average Ks
• Trial for best alignment pattern as possible• Be sure there is NO conjunctival drag• Do spherical over-refraction• Need 0.5mm of movement
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FITTING TIPS
• Fill concave side with saline/wetting drops into posterior of trial lens
• Dip fluorescein strip into solution• Insert using 2 fingers to handle the trial
lens with patient looking at floor• Low riding lens – select flatter base curve• Flatten base curve to solve edge
tightening
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CASE HISTORIES
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48 years old, Caucasian male, OD cornea
• Can’t use bi-toric• Quadrant Specific
base curve not indicated
• Temporal/superior area eliminates reverse curve design
• Select Semi-Scleral 13.5 design
CASE 1
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48 years old, Caucasian male, OD cornea
• Average K is 47.00 D. or 7.18mm
• Select 7.20mm BC from trial set, 13.5mm -4.00
• Acceptable fit with -2.25 over-refraction
CASE 1
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22 years old, African American male, OS cornea
CASE 2
• Superior, peripheral area too steep for Quadrant Specific base curve
• Bi-toric not indicated• Select Semi-Scleral
13.5 design
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22 years old, African American male, OS cornea
• Average K is 47.00 D. or 7.18mm
• Select 7.20 BC from trial set, 13.5mm
• Lens too tight at edge and too much vaulting
CASE 2
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22 years old, African American male, OS cornea
• Select trial lens 0.2mm flatter or 7.40mm
• Acceptable fit• Perform spherical
over-refraction
CASE 2
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31 year old Caucasion female, OD cornea
• Bi-toric not indicated• Flatter areas too
narrow for Quadrant Specific base curves
• Reverse curve design not indicated
• Select Semi-Scleral 13.5 design
CASE 3
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31 year old Caucasion female, OD cornea
• Average K is 46.25 D. or 7.30mm
• Select 7.30mm trial lens from trial set
• Low riding lens-select flatter base curve
CASE 3
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31 year old Caucasion female, OD cornea
• Select 7.50mm base curve from trial set
• Acceptable fit with lens properly positioned
• Perform spherical over-refraction
CASE 3
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Questions?