Article Date: 1/1/2013

Contact Lens Focus
contact lens focus

Going Above and Beyond

Monthly replacement lens a solution for high-refractive error patients.


Ben Larson, O.D.

Finding monthly replacement contact lenses that offer a consistent fit and good degree of comfort for my high myopic, hyperopic and astigmatic patients can be challenging.

When I found out that X-Cel would be offering its Flexlens Toric contact lenses as a monthly replacement option, I appreciated the chance to make this available to my patients. This is because the product is a custom lens that allows me to go above and beyond typical parameters in a commercialized toric lens, fitting anyone regardless of cornea size and steepness.


The X-Cel Flexlens Toric Monthly Replacement lens is indicated for daily wear for the correction of visual acuity in aphakic and non-aphakic persons who have non-diseased eyes with myopia or hyperopia and refractive astigmatism not exceeding 10.00D, according to the company.

The lens uses a back surface toric design, with 1.50D of prism ballast to stabilize rotation. Also, it can fit standard parameter base curves of 8.0mm to 9.2mm in 0.1mm steps but offers parameters of 6.8mm to 10.0mm in 0.1mm steps.

The optic zone (OZ) is a standard 8.0mm diameter and not customizable, which I have found to be pretty typical among all toric lenses. I personally would like the customizing ability of a larger OZ, as I do have some patients with large, visible iris diameters and large overall pupil sizes who see a little flare. However, I have yet to find a lens that has a larger OZ for my higher refractive error patients.

X-Cel Flexlens Toric Monthly Replacement

MATERIAL: Hioxifilcon B 49% (Dk 17), Hioxifilcon A 59% (Dk 26), Methafilcon A 55% (Dk 18.8), Hydrogel Definitive 74% (Dk 60), Hefilcon A 45% (Dk 13.4)

DK/T: 17

WEARING SCHEDULE: Daily use (six and 12 packs available)


DIAMETER: 10.0mm to 16.0mm in 0.1mm steps

SPHERE POWER: +30.00D to −30.00D in 0.25D steps

CYLINDER POWER: −0.50D to −10.00D in 0.25D steps

AXIS: 1° increments up to 180°

The lens provides comfort and stability for the patient, giving my high-refractive error patients who cannot tolerate hard lenses in the X-Cel Flexlens Toric great results. For example, I successfully fit a patient with a 5.50 cyl O.S. into this lens after he was unsuccessful wearing a hard RGP lens. In the soft lens, I provided him with almost the same vision he had in the hard lens (20/30+ vs. 20/25), but the patients said the difference in comfort level was night and day for him.

Fitting & chair time

Fitting patients with the X-Cel Flexlens Toric lens is very easy due to the reproducibility of the lens. When I put a lens on a patient, it does not rotate 20° one way while the other lens rotates 20° the other way — it is very stable and repeatable. Additionally, because the parameters are available in .01° increments, I find fitting my low myopic and hyperopic patients quite easy.

When it comes to my patients with high refractive errors and parameters (e.g. −6.00D sphere or +6.00D or higher) then it becomes critical that you really nail the over-refraction so the reorder can be exact.

How do I do that? By using a method I have picked up through the years. I take the over-refraction and the prescription in their contact lenses, combine them in a trial frame and then read the trial frame in a lensometer. That gives me an exact reorder. To give me a little extra time to perfect that trick, I typically schedule an additional visit for my more myopic, hyperopic astigmatic patients to ensure their fit is perfect. However, my traditional patients require no additional chair time when fitting these lenses.

Marketing & ROI

The over-refraction method also gives me a marketing tool to use while my high-refractive error patients are in the chair. Using the trial lens and their current lenses, I can show them what their next order of contact lenses will be like with the over-refraction, which makes them very happy.

In addition, I show the patient what to do to fine tune the lens right there in the exam room — I can order any axis power to achieve the exact degree and power that the patient needs.

I have also been happy with this product in regards to fitting fees, patient retention and referrals, as well as product sales. We keep the pricing based on annual supply and make it competitive with commercial toric options. Also, since patients cannot purchase the X-Cel Flexlens Toric lens online, they return to my practice for their purchase.

Private practices that want to give their patients a custom prescription should consider the X-Cel Flexlens Toric lens. Patients come to a private practice for a high level of service and expertise, and this product gives them that. OM


Optometric Management, Volume: 48 , Issue: January 2013, page(s): 42 43