Article Date: 5/1/2004

contact lens management
Taking a Softer Approach

This new soft contact lens was designed for the keratoconic patient.
CHAD NICHOLSON, O.D.

When fitting keratoconic patients, we don't often use the words "easy" and "well-tolerated." The usual fitting choices range from spectacle correction, soft toric lenses, special design GP contact lenses, or piggyback fitting with soft and GP contact lenses. Each presents challenges.

► With spectacle correction, adaptation to the often large amounts of cylinder required to provide acceptable acuity is frequently a source of aggravation.

► While traditional soft contact lens options often provide increased comfort, poor or unstable acuity is frequently a problem; it's also associated with an increased likelihood of failure.

► GP contact lenses may result in discomfort or difficulty in obtaining an acceptable fit -- both reasons a practitioner or patient may shy away from using these options.

Meeting clinical demands

When I first heard about a soft contact lens that was specifically designed for keratoconic patients, I was intrigued, yet skeptical. In today's clinical setting of increasing costs and decreasing reimbursements, any lens that's simple-to-fit, well-tolerated and cost-effective is a welcome addition. Accu Lens's Eni-Eye Soft K contact lens is just that. It works on much the same principle that GP lenses do. By providing a firm optic zone that helps vault most corneal irregularity, a somewhat more regular refracting surface is produced and acuity is often greatly increased.

The lens has proven to be well-tolerated physiologically, as tear exchange is enhanced through pressure balancing holes (fenestrations) in the lens. I have yet to see edema caused by daily wear. Even first-time wearers seem to have little difficulty adapting.

The Soft K System uses a three-lens diagnostic fitting set for proper selection. 

A fitting set with three base curves

Fitting the Soft K lens is fairly simple and entails proper base curve selection. The Soft K System uses a three-lens diagnostic fitting set that includes 7.3, 7.6 and 7.9 base curves. Start with the 7.6 and if that exhibits too much movement, then move to the 7.3. If you don't see enough movement with the initial 7.6, move to the 7.9. Allow the best-fitting diagnostic lens to equilibrate, but first perform a spherical overrefraction.

Patients who have low to moderate keratoconus can usually obtain satisfactory acuity with minimal residual astigmatism. If residual astigmatism is degrading the patient's acuity to an unacceptable level, perform a sphero-cylinder overrefraction. If this helps restore acuity to an acceptable level, then order a custom toric Soft K lens incorporating the overrefraction results.

If you can't obtain acceptable acuity with overrefraction, then you may need to explore the traditional options.

Facilitate difficult fittings

I've found that overall, the Soft K lens System is a quick, in-office diagnostic fitting set that can greatly facilitate the fitting process of often difficult keratoconic patients. Possible future uses may include patients who have post-surgical corneal irregularities, trauma-induced scarring and other causes of corneal irregularities that are amenable to contact lens options.

For eye care practitioners who pride themselves in presenting options to their patients regardless of the corneal conditions present, Accu Lens's Soft K Fitting System may provide an excellent alternative for patients sensitive to GP lens wear.

DR. NICHOLSON IS A GRADUATE OF PACIFIC UNIVERSITY AND NOW PRACTICES IN AN INDEPENDENT MULTI-PRACTITIONER OFFICE IN THE DENVER, COL. AREA. CONTACT HIM AT (303) 649-9500.

 


Optometric Management, Issue: May 2004