NOVEMBER 2012
AUSTRALIAN
contact
LENSES
15-page Product Guide SOFT AND RGP LENSES AND SOLUTIONS
Print Post Approved PP 328866 0047
Eye health isn’t one dimensional,
neither are your patients.
Choose a lens to support every
aspect of your patient’s busy life.
4 DIMENSIONS OF EYE HEALTH
HEALTH YOU CAN SEE
UV PROTECTIVE HEALTH
EVERYDAY HEALTH
HEALTH YOU CAN FEEL
1•DAY ACUVUE® TruEye™:
So healthy it feels like
wearing no lens at all*.
*JJVC, data on file 2010. Physiological response of neophytes with a daily disposable silicone hydrogellens. 1–year prospective randomised, double–masked, parallel group
study, results after 12 months, n=48. Measures included: Conjunctivaland limbalhyperaemia, conjunctivaland corneal staining, papillary conjunctivitis and subjective comfort.
Johnson & Johnson Vision Care. A division of Johnson & Johnson Pacific Pty Ltd., 45 Jones Street, Ultimo NSW 2007 Australia. Phone 1800 125 024. www.acuvue.com.au
NOVEMBER 2012
contact
LENSES
COVER: Bubbles under a reverse geometry
orthokeratology Contex RGP lens
Photo: Mark Hinds, Brunswick Optical
Editor JEFF MEGAHAN
National Publications Manager
SANDRA SHAW
Published by Optometrists Association Australia
ABN 17 004 622 431
204 Drummond Street, Carlton VIC 3053
Telephone 03 9668 8500
Facsimile 03 9663 7478
E-mailj.megahan@optometrists.asn.au
Copyright © 2012
Comments in CONTACT LENSES are of a general nature
and intended for guidance only. Optometrists Association Australia and the individual contributors expressly
disclaim all liability and responsibility to any person in
respect of, and for the consequences of, anything done or
omitted to be done in reliance wholly or partly on anything
in this publication. Acceptance of advertising does not
necessarily include endorsement of ­advertised products.
www.optometrists.asn.au/publications
2
Orthokeratology: option to correct presbyopia
3
Trends in Australian contact lens prescribing 2012
6
New lenses and technologies emerge
7
CASE REPORT Orthokeratology: myopia control for high myopes
9
CASE REPORT Unusual suspects in contact lens practice
11
Lens shape dynamics of materials during off-eye dehydration
14
CASE REPORT Will larger or smaller lenses work better for
keratoconus?
18
Update on orthokeratology, soft lenses and myopia progression
20
CASE REPORTS The story of mini-sclerals continues
22
Skills you don’t learn at uni
23
CASE REPORT Hybrids the talented child of soft and rigid parents
25
PRODUCT GUIDE: Materials
26
PRODUCT GUIDE: RGP contact lenses
27
PRODUCT GUIDE: Soft contact lenses
37
PRODUCT GUIDE: Solutions
40
Effects of ultraviolet-blocking contact lenses
41
CASE REPORT Mini-scleral for keratoconus and IOL subluxation
42
Three experienced prescribers share their views
44
CASE REPORTS Mini-sclerals vault and protect the cornea
46
Soft lens material choice could be wider
47
Drug eluting contact lenses
We acknowledge the editorial assistance of the
Cornea and Contact Lens Society of Australia
contact lenses orthokeratology
Here’s another option to correct presbyopia
W
Dr Paul Gifford
PhD MSc BSc(Hons)
MCOptom FIACLE FBCLA
FAAO
References are available
from j.megahan@optometrists.asn.au, subject: OK
for presbyopia 2012.
2 CONTACT LENSES 2012
ith the number of people worldwide aged 45
years and older predicted to increase from
1.8 billion in 2010 to over 2.8 billion by 2030,1
there is an ever-increasing number of presbyopes
entering the market. Generally more active and
image-conscious than their predecessors, emerging presbyopes have benefitted from technological
advances in contact lenses during their lives, leaving
many who do not want their vision compromised
as they enter presbyopia.
Soft contact lens manufacturers, keen to tap
into this already vast and growing market, are
continually developing new multifocal lens options. Although fitting surveys reveal an increase
in practitioner interest in fitting multifocal lenses,
the breakdown of lenses that are actually being
prescribed reveal that monovision fittings form a
similar proportion to multifocal contact lenses,2-5
and the majority of patients are still being fitted
with non-presbyopic lens options.6
Orthokeratology (OK) offers an alternative solution that is gaining interest through its overnight
wear modality and the opportunity this offers to
avoid having to wear spectacles or contact lenses
during the waking day. OK was first suggested as
a modality for correcting hyperopia, through what
was proposed to be a corneal bending effect induced
by steep-fitting rigid lenses.7 Lack of oxygen permeability through lens materials at the time led to a
poor refractive effect and the technique was soon
abandoned.8
It has since been shown in myopic OK that refractive effect is created from changes in epithelial
profile and not overall corneal bending,9,10 offering
further explanation of the reasons for the pioneering attempts at moulding corneal curvature into a
steeper shape not succeeding.
Recent studies have shown that if designed correctly, OK lenses manufactured in modern gas
permeable materials can be used to create a corneal
steepening effect.11–17 However, reliable outcomes
have been reported only for correction of up to
1.50 D,15-17 representing about one-third of the
refractive change that can be reliably achieved in
myopic OK.18
The time course of refractive and topographic effect is similar to myopic OK, with about 75 per cent
of effect achieved after the first night of lens wear,
and partial regression of effect during the day. Full
effect and greater retention of correction is achieved
after one week of lens wear.13 Similarities in time
course between hyperopic and myopic correction
have led to the suggestion that the same mechanisms
of corneal physiological changes are taking place.13
It has also been reported that changes to corneal profile are limited to para-central epithelial
thinning, without central epithelial thickening.17
This offers a possible explanation for the reduced
refractive effect in hyperopic OK when compared
to myopic OK, where changes to corneal thickness
have been reported at both central and para-central
locations.9,10
Given the growth of the number of people over
the age of 45 years, a natural progression was to
investigate whether hyperopic OK lenses could be
used to correct presbyopia. This led to a prospective analysis of hyperopic OK lenses fitted using a
monovision modality in emmetropic presbyopes.
Lenses were fitted only to the non-dominant eye,
with the fellow eye providing distance vision while
acting as a non lens-wearing control.
Outcomes revealed similar rates of change in
corneal curvature and refractive error to myopic
OK, with most change after the first night of lens
wear, and regression of effect during the day but
greater retention of effect by one week. Binocular
distance visual acuity was unaffected but reading
improved from 6/28 (14 pt equivalent) to 6/13 (6.5
pt equivalent) after one week of lens wear, exceeding visual requirements for normal newspaper print
which is in the region of 8 pt type.
When considering the retained distance vision
and improvement to near vision, this means that
presbyopic OK provides functional monovision
correction. There was a full return to pre-lens wearing refraction and corneal topography values after
ceasing lens wear for one week, indicating that,
like myopic OK, presbyopic OK is a temporary
procedure with effect retained only while overnight
lens wear is continued.
On the whole, patients fitted with these lenses
were delighted with the outcomes and enjoyed the
freedom from the need to wear vision correction
during the day. For the participants in the one-week
study outlined above, most wanted to continue with
wear and they are currently enrolled in a longerterm dispensing study.
Can I fit these lenses right now?
The lens used in this case presentation is being
developed into a commercial model. Several commercial hyperopic OK lens designs are currently
available, which could be fitted to provide monovision correction in emmetropic presbyopes in the
same manner as presented here.
trends contact lenses
Trends in contact lens prescribing 2012
Nathan Efron, Philip Morgan and Craig Woods report on their 13th annual survey of
Australian contact lens prescribing habits
T
he 13th annual survey of Australian contact
lens prescribing was conducted between January and April 2012. The same format as in previous years was employed. About 3,000 members
of Optometrists Association Australia were sent
an e-mail message with a link to a downloadable
questionnaire, and a request that this be accessed,
printed and completed to provide details of the first
10 patients fitted with contact lenses after receipt
of the questionnaire.
The questionnaire was specifically designed to
be straightforward to complete while capturing
key information about their patients. Practitioners
were asked general questions about themselves, and
for each contact lens fitting, they were requested to
complete the following details: date of fitting, new
fitting or refitting, age and sex of patient, lens material, lens design, frequency of replacement, times
per week of wear, modality (daily or extended wear)
and care system. Practitioners were asked to return
the questionnaire by facsimile or post.
Completed questionnaires relating to 592 contact
lens fittings were received. Each fitting was given a
weighting based on the number of lenses fitted per
year by the practitioner (based on the date information on the form). Data generated by practitioners
who conducted many contact lens fittings were
afforded a higher weighting than those performing
fewer fittings.
Demographics
Interesting demographic trends are apparent when
changes in the proportion of females fitted with
contact lenses and the mean age of lens wearers
are considered over the 13-year span of this annual
survey (Figure 1). During the first decade of this
century (2000 to 2010), between 61 and 68 per cent
of lens fittings were to females. This proportion has
shifted dramatically over the past two years, with
around 76 per cent of lens wearers being females.
The reason for this jump is unclear but may be
due to an accelerated promotion in recent times,
especially to females, of the cosmetic advantages
of contact lenses.
There has been a steady rise in the age of contact
lens wearers, from around 32 years in 2000 to 36
years in 2012. This could be due to two factors:
• a stagnation in the market, especially in respect
of fitting the younger generation of ametropes
with contact lenses, and/or
Nathan Efron PhD DSc
• an increasing proportion of ageing baby-­ Research Professor, Instiboomers being fitted with presbyopic forms of tute of Health and Biomedicontact lens correction (monovision or bifocal cal Innovation, and School
of Optometry, QUT
lenses, see discussion below).
Philip B Morgan PhD
Soft lenses
Unsurprisingly, soft lenses accounted for the majority of new fittings (94 per cent). Figure 2 is a
composite of pie charts detailing the key findings of
the 2012 survey in relation to soft lenses. Silicone
hydrogels represented 68 and 62 per cent of materials prescribed as new fittings and refittings, which is
a slight decrease over the 2011 data1 (70 and 77 per
cent). The balance of lens materials comprises midwater and high water content hydrogel materials.
There were no new fittings with low water content
hydrogel lenses this year, and these materials accounted for only one per cent of refittings.
The majority of soft lenses prescribed are spheres,
representing 39 and 60 per cent of new fittings and
refittings, respectively. There was a substantial
increase in the prescribing of soft lenses for the
correction of astigmatism in 2012, with 39 and 30
per cent of soft lens new fittings and refittings being
toric designs (25 per cent of both new fittings and
refittings were in toric designs in 2011). The current
level of toric lens prescribing in Australia suggests
that virtually all ‘clinically significant’ astigmatism
(> 0.75 D) is being corrected (the accepted target in
this regard is about 35 per cent of lenses).2
There has been a world-wide trend in recent
years favouring multifocal lenses over monovision
fittings for presbyopes.3 Australian practitioners
now appear to be gaining confidence in the ability of current bifocal designs to effectively deal
with the optical and psychophysical compromises
of presbyopic corrections, as indicated by 2012
prescribing figures. Specifically, there were more
presbyopic fittings with multifocal lenses (13 and
six per cent for new fittings and refittings) compared
with monovision (nine and three per cent for new
fittings and refittings). Currently, fitting of coloured
(tinted) soft lenses is negligible.
Director, Eurolens
­Research, The University of
Manchester,
Manchester, UK
Craig A Woods PhD
Associate Professor,
School of Medicine (Optometry), Deakin University
Continued page 4
3
CONTACT LENSES 2012
contact lenses trends
Trends in
contact lens
prescribing
2012
Trends in prescribing soft contact lenses according to replacement frequency are shown in Figure
3 for the years 2000 to 2012. This figure is derived
from a total database of 13,844 soft lens fittings
over this period. Figure 3 is characterised by a single
overarching positive trend in daily disposable lens
fitting; specifically, a slow and steady increase is
evident between 2000 and 2007, with a dramatic
increase since then, peaking at 42 per cent of all
soft lens fittings in 2012.
We surmise that this rise in popularity of daily
disposable lenses is being driven by an increasing
realisation by practitioners and lens wearers of the
convenience,4 health benefits4 and cost-effectiveness5 of this replacement modality. As well, the
contact lens industry seems to be responding to
this demand by introducing more daily disposable
lenses onto the market in an increasing range of
materials, parameters and designs.
From page 3
80%
38
Average age
75%
36
70%
34
65%
32
60%
30
00
01
02
03
04
05
06
07
08
09
10
11
12
Average age (years)
Proportion of females
Proportion of females
Year
Figure 1. Changes in the demographic of Australian contact lens wearers
between 2000 and 2012, in terms of the proportion of females fitted (left
vertical axis) and average age (right vertical axis)
New fittings
Materials
Designs
mid WC
21%
monovision
9%
multifocal
13%
high WC
11%
SiHy
68%
Replacements
annually
1%
sphere
39%
Refittings
SiHy
62%
mid WC
16%
high WC
21%
monovision
3%
anti-myopia
1%
multifocal
6%
toric
30%
daily
42%
1-2 weekly
24%
toric
39%
low WC
1%
monthly
32%
sphere
60%
3-6 monthly annually
1%
1%
monthly
33%
daily
45%
1-2 weekly
19 %
Figure 2. Detailed results for soft lens prescribing in the 2012 Australian
survey. SiHy: silicone hydrogel. WC: water content
4 CONTACT LENSES 2012
As can be seen from Figure 3, the rise in popularity of daily disposable lenses has been at the
‘expense’ of reusable lenses. Monthly replacement
lenses have been in steady decline since the middle
of the last decade, dropping from 54 per cent of soft
lens fittings in 2006 to 32 per cent in 2012. One to
two week replacement lenses remained around 30
per cent of soft lens fittings between 2006 and 2011,
but dropped to 21 per cent in 2012. The practice
of replacing lenses less frequently than monthly has
been in steady decline over the entire survey period
and now represents less than two per cent of all soft
lenses prescribed.
Multipurpose solutions account for 96 per cent
of prescribed care regimens, with peroxide systems
comprising the balance.
Rigid lenses
There was a slight decrease in rigid lens prescribing
in 2012, with non-orthokeratology and orthokeratology rigid contact lenses representing two and
four per cent of all contact lens fittings (down from
four and five per cent in 2011). As has been the case
in recent years, our data for non-orthokeratology
rigid lens fitting are so sparse that it is statistically untenable to break the data down into subcategories of materials, designs and replacement
frequencies. Overall, it appears from this data that
the primary indication for rigid lens fittings today
is orthokeratology.
Australia versus USA
We conduct contact lens prescribing surveys in
about 40 countries each year,6 which provides
an opportunity to benchmark Australian trends
against international colleagues. This year we
compare Australian contact lens prescribing with
that in the United States, which is the largest single
contact lens market in the world. The current pattern of contact lens fitting in these two countries is
shown in Figure 4. Six key categories of lens type
are represented. The outer and inner rings display
the Australian and US data, respectively.
The most noticeable disparity apparent in Figure
4 is that the extent of daily disposable lens fitting is
over 2.5 times higher in the Australia (42 per cent
of all lenses fitted) compared with that in the USA
(16 per cent).
The reason for this difference is unclear and is
perhaps surprising in view of the globalisation of
the contact lens market over the past decade, in
which the vast majority of soft lenses sold worldwide rests in the hands of a small group of companies that operate in virtually all countries.
Although there will undoubtedly be regional differences in marketing strategies employed by these
companies and some variation in product names,
the same general product ranges are available
worldwide. It is unlikely that pricing structures at
trends contact lenses
the point of retail sale differ significantly between
the two countries, and Australia and the USA are
similar in respect of general population demographics, national wealth, educational modes of
optometric training and professional practice, and
the commercial optical environment with a mix of
major practice chains and independent practices in
both countries.
The large disparity in daily disposable lens
prescribing between the two countries can largely
account for the other differences evident in Figure
4. An obvious trade-off is that the prescribing of
‘other’ replacement in Australia (eight per cent) is
lower than that in the United States (17 per cent).
The lower rate of silicone hydrogel lens prescribing in Australia may be attributed to the reduced
availability of daily disposable lenses made from
this material.
‘Increased convenience’ is a primary reason for
fitting extended wear lenses; perhaps the convenience benefits associated with daily disposable lenses
are perceived by Australian practitioners and lens
wearers as being greater than those associated with
extended wear lenses, thus accounting for the lower
rate of extended wear prescribing in Australia (six
per cent) versus the USA (14 per cent).
The rate of fitting of non-orthokeratology rigid
lenses is identical and very low in both countries
(two per cent). Orthokeratology is still being practised in Australia (four per cent) but is essentially
non-existent in the USA (0 per cent), perhaps reflecting the high level of enthusiasm among a niche
group of Australian orthokeratology enthusiasts.
Conclusion
The sudden and dramatic increase in daily disposable lens fitting in 2012 is the ‘headline’ finding
from our 2012 contact lens prescribing survey. As
we noted last year, this trend is likely to continue
as more daily disposable lenses become available
in a wider range of parameters, designs and materials, especially silicone hydrogels. Full correction of
astigmatism continues to be the norm, with high
levels of practitioner confidence in this lens design.
The recent trend is for more presbyopes to be fitted
with multifocal soft lenses than monovision. The
overall level of rigid lens prescribing remains low,
with orthokeratology being the main reason for
fitting this lens type. The contact lens demographic
is trending towards older age and a higher proportion of females.
1. Efron N, Morgan PB, Woods CA. Trends in Australian
contact lens prescribing 2011. Australian Optometry
(Contact Lenses Supplement) 2011; 32: 10: 4-7.
2. Holden BA. The principles and practice of correcting
astigmatism with soft contact lenses. Aust J Optom 1975;
58: 279-299.
3. Morgan PB, Efron N, Woods CA, The International Contact Lens Prescribing Survey Consortium. An international
survey of contact lens prescribing for presbyopia. Clin
Exp Optom 2011; 94: 87-92.
4. Efron N. Daily soft lens replacement. In: Contact Lens
Practice, 2nd ed. Edinburgh: Elsevier; 2010. P 209-216.
5. Efron N, Efron SE, Morgan PB, Morgan SL. A ‘cost-perwear’ model based on contact lens replacement frequency.
Clin Exp Optom 2010; 93: 253-260.
6. Morgan PB, Woods CA, Tranoudis IG, Helland M et al.
International contact lens prescribing in 2011. Contact
Lens Spectrum 2012; 27: 1: 26-31.
Rigid
OK
Daiy disposable
Other soft DW
SiHy DW (non-DD)
Soft EW
6%
2% 4%
70
Daily
1-2 weekly
Monthly
Other
Proportion of fittings %
2%
14%
60
16%
0%
50
Inner ring
United States
39%
40
Outer ring
Australia
17%
42%
30
51%
20
10
8%
0
00
01
02
03
04
05
06
07
08
09
10
11
Year
Figure 3. Percentage of soft lens fittings prescribed for daily, 1-2 weekly,
monthly and ‘other’ replacement frequencies in Australia between 2000
and 2012
12
Figure 4. Percentage of all contact lenses
prescribed in 2012 in Australia (outer ring)
compared with the United States (inner ring).
OK: orthokeratology. DW: daily wear.
SiHy: silicone hydrogel. EW: extended wear.
5
CONTACT LENSES 2012
contact lenses overview
New lenses and technologies emerge
T
Alan Saks
MCOptom(UK)
DipOptom(SA) FAAO(USA)
FCLS(NZ)
hose of us involved in soft lenses over the past
three or four decades have seen some massive
strides in technological development. In the 1970s,
’80s and ’90s, we were primarily concerned with
oxygen transmission and corneal hypoxia. Neovascularisation, oedema and related pathology were
common. Disinfection and infection was an issue, as
were lens deposits and giant papillary conjunctivitis.
Extended wear had its problems, too.
Today, many of these issues are resolved but a
few of them persist.
Oxygen flux (oxygen available to the cornea with
a contact lens in situ) is now close to a ‘no lens’
scenario: many silicone-hydrogel (SiHy) lenses provide close to 98 per cent of no-lens oxygen levels.
In most cases, we can beat solution complications and reduce infection risk with one-day lenses.
Although one-day users still suffer from a weakness of human nature (non-compliance), they tend
to be more compliant than other disposable and
conventional lens wearers. Infection, although very
rare, still occurs but is thought to be mostly due to
non-compliance: poor hygiene, reuse of lenses and
extended wear of single use lenses.
What’s new?
Alan Saks is an optometrist
who specialises in
keratoconus and complex
contact lens management
at an independent practice
in Auckland, New Zealand.
6 CONTACT LENSES 2012
Over the past few years, we have seen an increase
in prescribing of dailies and we now have SiHy
single-use lenses. In the recent past, we have also
seen new lenses become available for astigmats and
presbyopes.
We have seen the ASD design in Acuvue Oasys for
astigmatism and more recently, in a wide range of
parameters in 1 Day Moist for Astigmatism. Many
patients are impressed with their stability.
Bausch and Lomb has provided us with highdefinition optics in spheres and astigmatic lenses
such as PureVision2 HD for Astigmatism. Patients
notice the difference, especially in low light situations. We also hope soon to see Bausch and Lomb’s
new Biotrue ONEday Hypergel 78 per cent water
content hydrogel.
Although SiHy lenses have solved the hypoxia
problems, there are still too many cases of infiltrates
and giant papillary conjunctivitis among wearers.
The new 78 per cent water lens with a biomimetic
(mucomimetic) lens surface (and no silicone) promises to deliver enough oxygen for daily wear while
eliminating silicone-related complications.
Alcon and CIBA Vision joined forces in a recent
merger. They have launched a new lens, Focus Daily
Total 1, in Europe. The lens has a gradient water
content, with a low water 33 per cent high oxygen
silicone core that gradually changes to an 80 per
cent water, highly lubricious hydrophilic surface.
Preliminary reports regarding both Bausch and
Lomb’s and Alcon’s problem-solving interpretations
are very positive. It is likely we will be switching
patients to these and other new options in 2013
and beyond.
CooperVision has been making great strides
and winning significant market share. CooperVision’s rebranding has provided a fresh, modern
look while its Biofinity range of lenses provides an
industry-leading range of parameters. I have been
particularly impressed with the Biofinity Toric, even
on some tricky eyes, and have noted significant
improvements in vision and function.
CooperVision’s Biofinity Multifocal has also been
well received. It provides improved comfort in many
cases when compared to its successful forerunner
in the Proclear material, which was almost twice
as thick. I am having some promising initial results
with the One Day Proclear Multifocal, which is
also thinner than its monthly predecessor. On the
downside, CooperVision’s recent discontinuation
of a number of speciality lenses has made some
people unhappy.
Although not a big player in our part of the
world, expect to see Menicon make inroads with
its revolutionary flat pack lens packaging, known
as Magic. Menicon provides three-lens packs, about
the size and thickness of a credit card. One benefit
may be reduced contamination.
Time will tell if any of these new lenses and
technologies are long-term successes. We also
watch with interest to see if complication rates are
reduced.
Best care
By simplifying the number of steps involved in
lens care and avoiding cases and solutions, we
can enhance comfort and reduce problems. We
can focus our patient management and refine our
care through communicating ways to minimise the
remaining hurdles of lens care. Hygiene, lens handling, compliance with lens replacement—shorter is
better—and avoiding sleeping in lenses are some of
the final frontiers to which we must pay attention.
Not too far away, we are likely to see the appearance of microbe-resistant lens surfaces and
drug-releasing lenses. Currently, probable legislative
issues are holding back these technologies.
Further in the future, we are likely to see the first
electronic contact lenses for virtual reality and part
of the whole ‘wearable computer’ evolution. There
is already a microcircuit-containing lens available
that can wirelessly monitor IOP.
orthokeratology contact lenses
Myopia control for high myopes
A patient with high risk factors for myopia progression is ­advised of her options
CASE REPORT
A
17-year-old Caucasian female was referred to
our practice in July 2011 to explore treatment
options that could slow her myopia progression.
The patient is an avid reader and for the preceding
seven years, her myopic correction had progressed
by an average of -0.50 D each year (Table 1). At the
time, the patient was using single vision spectacles
and monthly disposable toric contact lenses with an
under-corrected prescription to correct her myopia.
The patient’s parents are also myopic.
At the initial examination, vision with the current
glasses was measured to be R 6/6 and L 6/6- and
subjective refraction results were R -7.25/-2.75 x 7
(6/6) and L -5.50/-1.50 x 170 (6/6+). Binocular vision assessment revealed a near esophoria (HowellDwyer test at distance measured ortho and at near
was 1D eso), reduced negative fusional reserves at
near (break at 10D and recovery at 8D) and a lag
of accommodation of +2.00 D at 40 cm.
Date
21 Apr 2004
14 Jul 2005
12 Jul 2006
26 Nov 2007
22 Aug 2008
3 Dec 2009
27 Jul 2010
16 Jun 2011
R refractive
error (D)
-4.25/-1.50
-5.00/-1.75
-6.25/-2.00
-6.75/-2.00
-7.00/-2.00
-7.00/-2.00
-6.75/-2.75
-7.25/-2.75
x
x
x
x
x
x
x
x
R spherical
equivalent (D)
UA
UA
UA
UA
UA
UA
5
5
-5.00
-5.88
-7.25
-7.75
-8.00
-8.00
-8.13
-8.63
Studies have shown that multiple risk factors
can increase the rate of myopia progression. These
include: parental history of myopia,1 environmental
factors including increased duration performing
near tasks,2 ethnicity3 and a relative esophoria or
significant lag of accommodation at near.4 There
is also evidence to support the theory of relative
peripheral hyperopia compared to central refraction
in myopes assisting in driving myopia progression.5
Given the patient met most of these risk factors,
she was advised of the options available to slow the
rate of myopia progression, including progressive
addition spectacle lenses, multifocal contact lenses
and orthokeratology.
Orthokeratology lenses have been shown to
induce a myopic shift in peripheral refraction to
equal the central myopic refractive error thus reducing myopia progression.6 The patient chose to try
partial correction by orthokeratology with use of
disposable toric contact lenses throughout the day
to correct any residual refractive error.
Marissa Conomos
BAppSci(Optom)
P/GCertOcTher CASA CO
Continued page 8
L refractive
error (D)
-2.25/-1.00
-2.50/-1.25
-3.25/-1.50
-4.00/-1.50
-4.25/-1.50
-4.25/-1.50
-5.00/-1.25
-5.00/-1.75
x
x
x
x
x
x
x
x
L spherical
equivalent (D)
UA
UA
UA
UA
UA
UA
170
165
-2.75
-3.13
-4.00
-4.75
-5.00
-5.00
-5.63
-5.88
UA: unknown axis, information unable to be supplied by referring practice
Table 1. Former spectacle prescriptions
Date
21 Jul 2011
22 Jul 2011
4 Aug 2011
25 Aug 2011
30 Sep 2011
16 Dec 2011
14 Mar 2012
8 May 2012
14 Aug 2012
R refractive
error (D)
-7.25/-2.75
-4.75/-2.75
-3.25/-2.75
-2.50/-3.25
-2.25/-3.50
-1.75/-2.50
-1.75/-1.75
-1.00/-1.75
-1.00/-1.25
x
x
x
x
x
x
x
x
x
R spherical R VA
equivalent (D)
7
7
7
10
7
10
5
8
18
-8.63
-6.13
-4.63
-4.13
-4.00
-3.00
-2.63
-1.88
-1.63
6/6
6/6++
6/6
6/4.5
6/4.5
6/4.5
6/4.5
6/4.5
6/4.5-
L refractive
error (D)
L spherical
equivalent (D)
-5.50/-1.50 x 170
-2.25/-1.75 x 173
-0.50/-2.00 x 165
-0.75/-1.25 x 170
+0.25/-0.75 x 160
+0.75/-1.75 x 170
+0.25/-1.25 x 170
plano/-1.25 x 170
+0.25/-1.25 x 170
-6.25
-3.13
-1.50
-1.38
-0.13
-0.13
-0.38
-0.63
-0.38
L VA
6/6+
6/4.56/6
6/4.5
6/4.5
6/4.5
6/4.5
6/4.5
6/4.5-
Table 2. Vision and refraction results at periodic reviews over the past 12 months
7
CONTACT LENSES 2012
contact lenses orthokeratology
Myopia control for
high myopes
From page 7
Contex E-series orthokeratology lenses of the
prescription R 41.75/-4.75(0.5e)/9.31/10.6/+1.00
and L 42.00/-5.00(0.5e)/9.31/10.6/+1.00 were fitted
with the prescribed methodology using a Medmont
E300 corneal topographer. Two months after the
initial fitting, the patient’s vision had stabilised and
unaided vision was R 6/45 and L 6/6+2. The patient
was given a new prescription for the Biofinity Toric
lens for the R eye of -2.75/-2.25 x 10 and decided
she did not want a disposable lens for the left eye
given her excellent unaided vision.
The patient was most recently reviewed in August 2012. She currently wears the disposable lens
in her right eye three or four days a week when
she needs to drive or attend lectures at university.
Unaided vision was measured to be R 6/9 and
L 6/6+2. Her near lag of accommodation was
+1.25 D and phorias were measured to be 0.5D exo
in the distance and 2D exo at near. Her positive and
negative fusional reserves at near were measured
within normal limits. Ocular health assessment
was unremarkable with no ocular surfaces changes
observed.
As shown in Table 2, the patient’s subjective
refraction results have generally improved at each
review over the past year, showing her myopia has
not progressed. This case study demonstrates that
partial correction of myopia is effective at reducing
or even stopping myopia progression and should be
considered as a treatment option for high myopes
in combination with spectacles or contact lenses
for daily use.
In future, toric orthokeratology lenses may be
explored for this patient but she is happy with her
current vision and contact lenses.
8 CONTACT LENSES 2012
Figure 1. Corneal topography before using orthokeratology lenses, July 2011
Figure 2. Corneal topography after using orthokeratology lenses, August
2012
1. Jones-Jordan LA, Sinnott LT et al. Early childhood refractive error and parental history of myopia as predictors of
myopia. Invest Ophthalmol Vis Sci 2010; 51: 1: 115-121.
2. Ip JM, Saw SM et al. Role of near work in myopia: findings in a sample of Australian school children. Invest
Ophthalmol Vis Sci 2008; 49: 7: 2903-2910.
3. Ip JM, Huynh SC et al. Ethnic differences in refraction
and ocular biometry in a population-based sample of
11-15-year-old Australian children. Eye 2008; 22: 5:
649-656.
4. Gwiazda J, Grice K et al. Response AC/A ratios are elevated in myopic children. Ophthalmic Physiolog Optics
1999; 19: 2: 173-179.
5. Sng CCA, Lin XY et al. Peripheral refraction and refractive error in Singapore Chinese children. Invest Ophthalmol Vis Sci 2011; 52; 2: 1181-1190.
6. Charman WN, Mountford J et al. Peripheral refraction
in orthokeratology patients. Optom Vis Sci 2006; 83: 9:
641-648.
shared care contact lenses
Unusual suspects in contact lens practice
T
he 2012 International Cornea and Contact Lens
Congress presented a fascinating and diverse
range of case reports illustrating that every case is
different and can be successfully managed with more
than one approach. This vast pool of knowledge of
speciality contact lens practitioners provided the
perfect platform to highlight these cases.
Practising in a speciality contact lens clinic provides a frequent reminder that usual and unusual
complications arise unrelated to the contact lens
wearing. Patients who require advanced contact
lens correction are just as likely to develop ocular
complications and disease as the general population, but the subgroups within this demographic
carry added complexities, which can often complicate clinical management.
If you had to guess, which illness would you say
is most prevalent in a developed country such as
ours—cancer or maybe heart disease?
Believe it or not, it is mental illness. Almost half
of all Australians will suffer from a mental illness at
some time in their lives. For this reason, counselling
and communication skills have to be a solid part of
our clinical practice and more so at the forefront of
speciality contact lens fitting.
Commonly, by the time patients end up sitting
in our practice they have ‘done the rounds’ for
some time with refittings and the rocky road of
practitioner and specialist hopping. Although our
patients deal with grief and (vision) loss in a general
pattern, they move through and possibly cycle back
through similar stages. For more on this, google
‘Kubler-Ross model’.
Often the initial consultations with post-graft
patients or those with advanced keratoconus have a
significantly large counselling element. It is imperative to establish where they have come from, where
they would like to be and most importantly, where
they are now. Once this is established, determine
whether the patient’s goals and expectations are
realistic and attainable. If they are not, are they
modifiable—or are they in a place of anger, denial
and bargaining? In that case, other health professionals may need to be engaged.
My conference presentation at the ICCLC included
a succinct series of case reports highlighting both
related conditions to corneal ectasias such as Marfan
Syndrome (Figure 1) and unrelated conditions such
as cystoid macular oedema secondary to Xalatan gtt
use in a primary open-angle glaucoma contact lens
patient. Again, my goal was to highlight the potential pitfalls of concentrating our efforts only on the
contact lens side of patient management and always
thinking: ‘It must be the contact lens’.
CASE REPORT
Mental health issues
WW, a 41-year-old male engineer, has bilateral advanced keratoconus (apical power of > 65 D) and
more than 15 years of smaller diameter, diminishing
contact lens-wear success with uncorrected vision
of R 6/60 and L 6/120. WW was refitted in our
practice with Gelflex mini-scleral RGPs ensuring
a minimum apical corneal clearance of 200 µm.
Right eye has two large temporal leading corneal
vessels into an area of posterior stromal scarring
secondary to hydrops mismanaged with Chlorsig
circa 2008 (Figure 2). Left eye had herpes simplex
keratitis circa 2005 with a large geographic nasal
area of neovascularisation (Figure 3) with the eye
remaining stable and quiet after 4/24 refitted RGP
contact lens wear (Figure 4).
He has visited all three leading corneal specialists
in Brisbane and each presented different care plans
to him. Compounding his vision difficulties, he
has anxiety and depression problems, which have
exacerbated vocational and marital stress.
In addition to standard optometric care, a conservative and measured care plan with positive
and calculated comment, neovascularisation photo
documentation, OCT RGP clearance and central
corneal thickness measurement, ± 4/24 CL wearing time then remove and insert with fresh saline,
and 1/12 reviews. This feedback was coupled with
extensive counselling and support.
WW has come to terms with his condition. With
WW accepting his keratonocus, we can move forward with the support of this calculated, tangible
care plan. He has also engaged ongoing psychological support from other allied health professionals.
Although obvious at the initial consultation,
WW’s situation is not unique and we find that we
have to be acutely aware of such needs in those
with ocular disease. His contact lenses are now a
part of his positive care plan and have increased
his quality of life.
The final fitting parameters of his Gelflex miniscleral lenses in Harmony Plus material were:
Mark Hinds
BScApp(Optom)
P/GCertOcTher
BScApp(HMS) P/G
BScHons
R 7.30/14.50/12.50/18.50/-8.75 (Sag 5960 µm)
(CT 200 µm) (VA 6/12)
L 7.70/14.50/12.50/18.50/-3.75 (Sag 5774 µm)
(CT 200 µm) (VA 6/9+)
Continued page 10
9
CONTACT LENSES 2012
contact lenses shared care
Unusual
suspects in
contact lens
practice
Cases such as WW’s give us the opportunity
to expand and challenge our clinical boundaries,
enhancing our clinical satisfaction and the patient’s lifestyle. They also allow us to fully use our
investment in the advanced diagnostic tools and
contact lenses that are now available from the
global market.
Successful management of complex cases like
WW’s demand that we engage with each patient
for a long-term holistic care plan.
From page 9
Figure 1. A subluxed IOL in a patient with Marfan
Syndrome and corneal irregularity fitted with
custom SiHy toric contact lenses
Figure 3. Left eye with extensive area of neovascularisation with ghost vessels in the presence of
new mini-scleral RGP contact lens wear
10 CONTACT LENSES 2012
Figure 2. Right eye wearing mini-scleral RGP
illustrating posterior stromal scarring and
two leading vessels from the temporal limbus
secondary to old hydrops
Figure 4. Left eye quiet at 4/24 wear of miniscleral RGP contact lens
materials contact lenses
Lens shape dynamics
during off-eye
dehydration of contact
lens materials with
varying water content
Rosa Lee MS
Alexis Vogt PhD
Vision care product design
engineer, Design Group,
Bausch + Lomb
Manager, medical affairs
global vision care and
­optical physicist,
Bausch + Lomb
NEW
LIFE DOESN’T STAND STILL
BUT A TORIC LENS SHOULD
A new generation of toric lenses, designed to
keep up with your patients’ every move.
P
atient insights are important when designing and fitting
contact lenses. In a study of contact lens patient insights,
two-thirds of contact lens wearers reported blurry vision or
comfort issues; however, only one in three of those patients
who experienced blurry vision was talking to their eye-care
professional about their dissatisfaction.1 About 60 per cent
of those who experienced blurry vision felt that the symptom
had a negative impact on their contact lens comfort.1
One culprit may be lens dehydration. During the course of
lens wear, contact lenses lose water content. This may lead
to discomfort and potentially reduces retinal image quality
through lens surface instability.
A unique bio-inspired hydrogel contact lens material,
nesofilcon A, was designed in response to patient insights.
This new lens was designed with an outer surface that mimics
the lipid layer of the tear film to prevent dehydration and to
maintain consistent optics. The lens material has the same
water content as the cornea (78 per cent) to provide a more
natural balance of oxygen and water, and to deliver the
oxygen transmission level (Dk/t = 42) the open eye needs to
maintain healthy, white eyes.
■
■
■
Auto-Align Design™ – delivers stability for
consistently clear vision all day.1
High Definition™ Optics – for crisp, clear
vision even in low light. 2
Comfort Moist ™ – improves comfort on
insertion and throughout the day.3
www.bausch.com.au
Lens shape dynamics
The shape of a soft contact lens can change as the lens dries
over the course of the day. This shape change can negatively
impact visual quality and comfort. To understand the lens
shape dynamics of soft contact lenses during off-eye dehydration, Cox and Lee evaluated nesofilcon A along with
Continued page 12
References 1-3: Data on File, Bausch & Lomb Inc. (Results from a 20-investigator, multi-site cross-over study of
PureVision®2 For Astigmatism and PureVision® Toric lenses. A total of 292 subjects completed the study. After
7 days of wear for each lens, subjects completed an online survey regarding lens performance. Consumers
rated performance attributes using a 6-point scale (1 = strongly disagree and 6 = strongly agree) and using a
5-point scale (excellent, very good, good, fair, poor). At the final visit, investigators rated the extent to which
they agreed or disagreed with performance attributes also using a 6-point scale.)
© 2012 Bausch & Lomb Incorporated. ®/TM denote trademarks of Bausch & Lomb Incorporated.
Bausch & Lomb (Australia) Pty. Ltd. ABN 34 000 650 251. Ground Floor, 16 Giffnock Avenue, Macquarie
Park NSW 2113 Australia.
contact lenses materials
Lens shape
dynamics
during
off-eye
dehydration
From page 11
three commercially-available daily disposable
contact lenses in a controlled laboratory environment (average indoor temperature was 22° C with
a relative humidity of 30 per cent).2 Four -3.00 D
power lenses of each product type (etafilcon A, 58
per cent; narafilcon B, 48 per cent; nelfilcon A, 69
per cent; nesofilcon A, 78 per cent) were allowed
to dehydrate in the controlled environment for 20
minutes to observe the physical shape changes in
the lenses over a 20-minute period. All 16 lenses
were allowed to dehydrate at the same time.
Each lens was taken from the package and blotted
to remove excess packaging solution. A photograph
was taken every two minutes over the 20-minute
period (Figure 1).
Four pair of photos for each lens type, at zero
minutes and 20 minutes, were presented to 12
subjects who were then asked: ‘Consider for a
moment that the first image presented to you (Image A) represents the intended contact lens shape.
When presented with a second image (Image B),
please rate your response to the following question:
Purely considering the shape (not size) of the lens,
how similar or different is Image A as compared
to Image B?’
The subjects then rated whether the lens shapes
shown in the two images were similar or different,
using a 10 point rating scale where 1 corresponded
to ‘Extremely Similar’ and 10 corresponded to
‘Extremely Different’. A one-way ANOVA showed
a statistically significant difference (p < 0.0001)
between the nesofilcon A (test) (A) compared to
nelfilcon A (D), narafilcon B (C) and etafilcon A
A
B
C
D
Figure 1. Photographs of lenses taken in four-minute increments from time
zero to 20 minutes for (A) nesofilcon A, (B) etafilcon A, (C) narafilcon B, (D)
nelfilcon A
12 CONTACT LENSES 2012
(B), where the mean rating scores were 1.9, 8.8, 8.4
and 6.8, respectively, indicating that the nesofilcon
A lens, after 20 minutes looked ‘Extremely Similar’
to the time zero image (Figure 2).
It has been reported that higher water content
lenses dehydrate more than lower water content
lenses.3 However, in this study, the highest water
content lens material demonstrated a more consistent lens shape over the 20-minute dehydration period compared to etafilcon A, 58 per cent; narafilcon
B, 48 per cent and nelfilcon A, 69 per cent lenses.
Understanding dehydration blur
In addition to changes in lens shape, the stability of
the lens surface may be affected by both the magnitude and rate of water loss across the lens diameter.
Inconsistent optical stability of a contact lens as the
lens dehydrates may degrade the patient’s visual
outcome. Slow, consistent and minimised water
loss across a lens may help to maintain the shape
characteristics that impact lens fit and the optical
surface of the lens, which may provide greater visual
stability with typical blink rates.
To evaluate the image quality as lenses dehydrated, Lee and colleagues compared the new nesofilcon
A lens to etafilcon A, narafilcon Band nelfilcon A
lenses using a novel optical bench technique. This
novel in vitro method quantitates the predicted
logMAR retinal image resolution based on the
measured optical image quality as lenses dehydrate.4
Using an optical imaging bench fitted with a
7.8 mm radius polymethylmethacrylate (PMMA)
model cornea and a US Air Force target, the image
quality of 20 -3.00 D lenses of each of the four
commercially-available daily disposable contact
lens brands was analysed. The US Air Force target
contains a series of horizontal and vertical lines that
represent specific spatial frequencies expressed as
line pairs per millimetre. The model cornea mimics
the optics and physical dimensions of an average
human eye and relays the retinal image plane of the
US Air Force target to a CCD camera.
Each lens was initially blotted to remove excess
packaging solution and was conformed to the
PMMA model cornea. Two drops of a rewetting
solution were used to simulate a fresh tear film after
a blink. As the lens naturally dehydrated, images
were acquired every 10 seconds, up to a total of 180
seconds (19 images total per lens) with the US Air
Force target at optical infinity (Figure 3).
After acquiring the images, a pattern-matching
algorithm, which takes into account the contrast
and resolution of each image, was used to calculate
the predicted logMAR score of the images for each
lens. To ensure consistency, the logMAR score for
each image was normalised against the specific
lens’s initial time zero image.
A one-way ANOVA showed that there was a
statistically significant difference for the time zero
materials contact lenses
Boxplot of ranking
10
0.4
8.8
8
Ranking
images between nesofilcon A and nelfilcon A (p <
0.03) with mean predicted logMAR scores of -0.11
and -0.05, respectively. For images taken at 10
seconds (shorter than blink rates associated with
reading or computer use), there was a statistically
significant difference (p < 0.001) between nesofilcon
A compared to nelfilcon A and etafilcon A, with
mean predicted logMAR scores of -0.10, -0.02 and
-0.03, respectively. When considering the overall
time-frame of three minutes, a one-way ANOVA
showed a statistically significant difference (p <
0.001) between nesofilcon A compared to nelfilcon
A, narafilcon B and etafilcon A, where the overall
predicted mean logMAR scores were -0.009, 0.116,
0.136 and 0.182, respectively.
6
6.8
4
2
1.9
0
Etafilcon A
Conclusions
Water content loss in a lens material may result in
shape changes that may affect the physical parameters and the optical performance of a lens. A lens
material that resists moisture loss may maintain
more consistent shape and optics to provide a better
lens wearing experience.
The literature suggests that higher water content
lenses dehydrate more than lower water content
lenses.3 However, this new high water content lens
material, nesofilcon A (78 per cent) demonstrated
a more consistent lens shape over the 20-minute
dehydration period compared to narafilcon B (48
per cent), nelfilcon A (69 per cent), and etafilcon
A (58 per cent) lenses, suggesting that this novel
material may have unique properties relative to
moisture retention.
In addition, the above research demonstrates that
nesofilcon A exhibited better optical image quality
as well as a more consistent and slower reduction in
predicted retinal image quality over time compared
to etafilcon A, narafilcon B, and nelfilcon A. Further
research will help provide additional insight related
to the clinical impact and optical stability associated
with lens dehydration.
Narafilcon B
Nelfilcon A
Nesofilcon A (test)
Product
Figure 2. Boxplot of rankings on 1 to 10 scale with 1 = extremely similar
and 10 = extremely different. In a boxplot, the top of the box defines the
third quartile (where 75 per cent of the data values are less than or equal to
this value), the bottom of the box defines the first quartile. The upper and
lower whiskers extend to the highest and lowest data values and the outliers
are represented by asterisks. The values displayed represent the means.
1. Exploring blurry, changing or fluctuating vision associated
with contact lens wear. Kadence International. January
2012.
2. Cox IG, Lee RH. Understanding lens shape dynamics
during off-eye dehydration of contact lens materials with
varying water content. Invest Ophthalmol Vis Sci 2012;
53: E-abstract: 6104.
3. Efron N, Brennan NA, Bruce AS, Duldig DI, Russo NJ.
Dehydration of hydrogel lenses under normal wearing
conditions. CLAO J 1987; 13: 3: 152-156.
4. Lee RH, Kingston A, Richardson G. Evaluation of contact
lens image stability and predicted logMAR image resolution as lenses dehydrate. Invest Ophthalmol Vis Sci 2012;
53: E-abstract: 6110.
A
B
C
D
Figure 3. Time elapsed (180 sec) US Air Force target images of nesofilcon A (A),
etafilcon A (B), narafilcon B (C) and nelfilcon A (D)
13
CONTACT LENSES 2012
contact lenses RGP
Keratoconus: will larger or smaller lenses work better?
W
Associate Professor
Richard Vojlay
BScOptom LOSc FACO
PGCertOcTher
Dip Human (Music)
hen I examine a new patient who has keratoconus, we spend some time discussing the
options that are available. A spectacle correction is
an option that is not often discussed or offered by
optometrists. For some patients, a binocular acuity
of 6/10 – 6/12 is good enough to allow them to drive
and function effectively, albeit without excellent
vision. Often, their correction has high astigmatism and usually they adapt to the high levels of
associated aniseikonia that most ‘normal’ patients
would find unacceptable. A spectacle correction can
also be a very useful back-up for patients following
removal of their lenses.
Once a spectacle correction has been excluded as
a possibility, the discussion becomes more complicated. I reassure patients that in 2012, optometrists
have the best range of contact lens options ever
available, and with perseverance and patience, we
should be able to find a lens design that works for
them. I split the lens options into RGP designs of
varying diameters (small traditional designs to miniscleral) and hybrid lenses. The RGP options are:
1
Small traditional RGP lenses, overall diameter
8.0–9.0 mm (Figure 1).
These lenses are well away from the lids and so
may be more easily displaced with lid interaction.
This design may also be uncomfortable initially
due to lid interaction with the edge of the lens at
each blink. Unfortunately for some patients, this
discomfort does not diminish over time. A small
overall diameter results in a small optic size that
Figure 1
Figure 2
Figure 3
Figure 4
Figure 5A
Figure 5B
14 CONTACT LENSES 2012
RGP contact lenses
can generate significant flaring, especially at night.
2
Medium ‘within the limbus’ RGP lenses,
overall diameter 9.5–11.0 mm (Figure 2).
A larger diameter often allows attachment of the
lens under the upper lid, which improves comfort
and stability. The lower edge can often be tucked
behind the lower lid, depending on the lid position.
A larger overall diameter increases the possible optic size, reducing the potential for flaring at night.
3
Moderately large ‘over the limbus’ RGP
lenses, overall diameter 12.00–13.5 mm (Figure 3).
Centration and superior lid attachment are
guaranteed with this diameter. Minimal or no lid
interaction with the edges of the lens results in
substantially improved comfort.
4
Extra-large ‘landing on the conjunctiva’ and
miniscleral RGP lenses, overall diameter 14.0–16.5
mm (Figure 4).
The extra large diameter guarantees centration
and as the lids are well within the overall diameter,
comfort is usually excellent.
Find the best lens
All experienced contact lens fitters who work in
this area have a very high success rate in providing
Figure 6A
Figure 6B
Figure 7
Figure 8
Figure 9
Figure 10
Continued page 16
15
CONTACT LENSES 2012
contact lenses RGP
Keratoconus:
larger or
smaller?
From page 15
patients with effective lenses but it may be difficult
to find that one design that is going to tick all the
important criteria for success: a stable lens, reliable
vision, clear eyes after all-day wear, comfort, regular
all-day wear and no significant corneal staining. The
final successful design may not seem to be ‘perfect’
and may require some compromise to accommodate
a highly asymmetrical cornea.
Where do you start? Topography identifies the
area and location of the cone. The Medmont topographer generates contact lens designs and tear
film profiles from different manufacturers.
5
Small central nipple cone (Figures 5A and 5B).
Contact lens parameters: BCOR: 6.20 mm, OD:
8.0 mm BCOZ: 5.8 mm.
Australian Contact Lenses, Keratoconus design
A small nipple cone usually requires a small optic zone; a larger cone requires a large optic zone.
Small central cones usually naturally locate an
RGP lens over the cone and centration is usually
not an issue. For a small nipple central cone fitting,
traditional RGP-fitting philosophy would indicate
a small diameter lens (8.0–9.0 mm) with a small
optic zone (5.0–6.8 mm). This may require a steep
central curve and a higher rate of peripheral flattening to prevent tight edges. Ideally, we aim for
central clearance over the cone of 20–30 µm with
90 µm of edge clearance at 9/3 o’clock. Fluorescein
becomes visible underneath an RGP lens only at a
depth of 20 µm, so what may appears to be central
bearing may be feather clearance.
6
Large inferior cone (Figure 6A and 6B).
Contact lens parameters: BCOR: 7.25 mm, OD:
10.10 mm BCOZ: 6.8 mm.
Contact Lens Centre, Centra PGA Quad Sym
Design
Small and larger cones that are displaced inferiorly naturally drag the RGP towards the centre of
the cone, away from the pupil and over the lower
limbus. Lenses that displace inferiorly are often
uncomfortable due to upper lid and lens edge
interaction, as well as significant inferior conjunctival staining. Vision is often compromised as the
superior edge of the optic can cut across the pupil.
Large variations in edge clearance may be very difficult to correct due to the significant variation in
peripheral corneal flattening in various meridians.
CASE REPORT
Patient AH, 19 years old, was diagnosed with right
keratoconus when he was 18 years. Corneal crosslinking was performed 12 months prior to the visit;
visual acuity was unaffected by the cross-linking.
His left eye had slightly irregular astigmatism.
Refraction: R -4.50/-1.00x60 VA 6/6+ L -4.00/1.00x10 VA 6/5+
16 CONTACT LENSES 2012
Despite his better than normal acuity, the patient
was aware of poor quality vision when driving at
night and on the computer, and wanted to try RGP
lenses (Figure 7). 7
Right axial map: inferior central nipple cone
(Figure 8).
8
Right tangential map: inferior nipple cone
displayed as a larger area (Figure 9).
9
Right elevation map: darker blue areas below
the midline indicate a decreasing corneal height
below a best-fit sphere. A lens without lid attachment will tend to fall down to this area.
Medmont default contact lens designs:
10Australian
Contact Lenses, Keratoconus
­design (Figure 10)
Contact lens parameters: BCOR: 7.85 mm, OD:
9.00 mm BCOZ: 6.8 mm.
11 Contact Lens Centre, Centra PGA (Figure 11).
Contact lens parameters: BCOR: 7.77 mm, OD:
10.10 mm BCOZ: 7.0 mm.
The cone was on the small side and located only
slightly inferior central. The Medmont default
contact lens designs located centrally but I was
concerned about the possibility of the lens dropping, especially considering the significant decrease
in elevation below the midline. I decided to try a
Contact Lens Centre Centra PGA—overall diameter
10.10 mm.
Trial lens fitting:
12Contact Lens Centre Centra PGA: BCOR:
8.20 mm, OD: 10.10 mm BCOZ: 7.0 mm (Figure
12).
Slight central clearance, 9/3 edges okay, good
lid attachment, excessive inferior edge clearance,
overall stable.
13 To try and reduce the excessive inferior edge
clearance, I used a trial lens with a 0.4 steeper inferior peripheral curve, Contact Lens Centre Centra
PGA, Bi-sym design.
BCOR: 8.20 mm, OD: 10.10 mm BCOZ: 7.0 mm
Bi-Sym 0.4, inferior quadrant steepening—location
indicated by dot (Figure 13).
Superior bearing, lens sits slightly lower, Bi-sym
mislocates to 8 o’clock, still excessive inferior edge
clearance.
Lens ordered:
14 I ordered a steeper base curve with a tighter
mid periphery.
Centra PGA, BCOR: 7.90 mm, OD: 10.10 mm
BCOZ: 7.0 mm, mid periphery paracentral zone:
7.70 mm, Visual acuity: 6/5-
RGP contact lenses
Before blinking: excessive central clearance, 9/3
edges okay and excessive inferior clearance (Figure
14).
15 After blinking: lens drops, upper lid hits the
upper edge of the lens, lens sits over lower limbus
(Figure 15).
The patient was reasonably tolerant of this lens
but he was very aware of the variation in vision
after blinking and found prolonged computer work
impossible. The options were to try a smaller diameter lens (an interpalpaebral fit) and remove the
interaction of lids or to try a much larger diameter.
We swapped to a larger diameter design, to
­improve centration.
16 Contact Lens Centre, SSMax overall diameter
13.50 mm, BCOR: 8.20 mm, OD: 13.50 mm Visual
acuity: 6/6+2 (Figure 16).
Excellent centration and comfort, slightly excessive central clearance, edges okay, excellent stability.
17 Slitlamp after three hours wear, no significant
­ rescribed and may still need to be flattened slightly
p
to decrease the superior clearance and eliminate the
small area superior dimple veiling.
Small diameter RGP lenses with small optic diameters have a place for fitting small central cones.
Many patients have successfully worn small diameter designs for decades and do not wish to have
their contact lenses upgraded to a larger design by
a well-intentioned optometrist.
As RGP designs become
more sophisticated in solving the problems of peripheral asymmetry and lathes
are now able to manufacture these designs, large
diameter lenses are another
option for our patients.
More patients will be fitted
successfully with largediameter lenses with the
benefits of better comfort,
better stability and better
quality vision.
corneal staining, small area of superior dimple veiling (Figure 17).
Overall, the patient felt this lens was very comfortable with excellent acuity and could achieve
all day wear. This lens has only recently been
Figure 11
Figure 12
Figure 13
Figure 14
Figure 15
Figure 16
Figure 17
17
CONTACT LENSES 2012
contact lenses myopia control
Update on orthokeratology, anti-myopia soft contact
lenses and their effect on myopia progression
Novel approaches to myopia control show
promising results in children
Dr Pauline Kang
PhD BOptom(Hons)
Post-doctoral fellow,
­Research in Orthokeratology Group, School of
Optometry and Vision
­Science, UNSW
T
he prevalence of myopia varies between different regions and ethnicities. The trend is an
increase in myopia prevalence worldwide, particularly over the past generation. Interestingly,
Australia has produced one of the lowest myopia
prevalence rates reported from a developed country.
The Sydney Myopia Study estimated an overall
myopia prevalence rate of 11.9 per cent in 11to 15-year-old Australian school children1 and
hyperopia was the most common refractive error.
Significantly higher prevalence rates have been
documented in Asia.2-5 Myopia was estimated to
affect 81 per cent of 15-year-old Taiwanese school
children in 2000 compared to 64.2 per cent in 1983.
A more recent report by Jung et al6 estimated the
prevalence of myopia in 19-year-old Korean male
conscripts to be an astounding 96.5 per cent in
2010.
The age of onset of myopia is becoming younger7
and faster myopia progression rates have been associated with earlier age of myopia onset.8 Excessive
eye elongation, evident particularly in high myopes
(greater than -6 D), increases the risk of development of numerous sight-threatening conditions.
This, coupled with an increase in myopia prevalence worldwide, creates a demand for methods to
potentially slow or stop the progression of myopia.
Figure 1A. Simple schematic of peripheral hyperopic defocus
with traditional myopic correction
18 CONTACT LENSES 2012
Typically, myopes have been found to have relative peripheral hyperopia (Figure 1A) and it has
been proposed that the human eye grows in axial
length to bring the peripheral retina in focus with
the peripheral image despite central axial length
elongation or myopia development (Figure 1B).
Therefore, it is hypothesised that inducing myopic
defocus onto the peripheral retina may slow or stop
axial length elongation.9,10 This has led to the development of novel spectacle lenses11 and soft contact
lenses (SCLs)12,13 with the aim of inducing myopia
on to the peripheral retina. Orthokeratology (OK)
was found to inadvertently achieve this effect.14-16
Orthokeratology
OK is a procedure that involves the overnight wear
of reverse geometry design rigid lenses. The lensinduced changes in corneal topography (flattening
of central and steepening of mid-peripheral cornea)
corrects mild to moderate degrees of myopia.17
Prospective studies have demonstrated reduced
myopia progression in children fitted with OK
lenses compared to single vision contact lenses18
or spectacles.19-21 It is believed that the myopic
shift in peripheral refraction induced by OK lenses
may be the mechanism behind the reduced myopia
progression.
Figure 1B. The eye responds by increasing in axial length
(increase in central myopia) to focus the peripheral defocus
onto the retina
myopia control contact lenses
The Longitudinal Orthokeratology Research
in Children (LORIC) study conducted in Hong
Kong was a landmark study that measured axial
length and therefore myopia progression in sevento 12-year-old children fitted with OK lenses over a
two-year period.19 Axial length increased 0.25 mm
more in the single vision spectacle historical control
group compared to the OK group. This study was
followed by three other prospective studies, the
results of which are shown in the Table (right).
All studies18,20,21 measured reduction in axial
length elongation in eyes treated with OK compared to control groups but results from these
studies must be treated with caution. There was
significant variability in axial length measurements.
Although there was an overall mean reduction in
axial elongation in the OK compared to the control
groups, some children were found to respond to OK
treatment and had either slowed or stopped myopia
progression while others continued to progress at
rates similar to those of children in control groups.
Not all myopic children fitted with OK will benefit
from the myopia control effect.
Hiraoka et al22 followed 22 of the 42 Japanese
children treated with OK and 21 of 60 children in
the control group involved in the study described
by Kakita et al.20 They found that there were significant differences in myopia progression rates for
the first three years. OK treated eyes elongated at a
slower rate but during subsequent years (fourth and
fifth years), myopia progression rates were similar
between OK and control groups. It appears that the
therapeutic effect of OK may not last and there is
a potential for a rebound or catch-up effect after
discontinuation of OK. However, this is the only
study that has investigated long-term effects of OK
and myopia progression, and further investigation
is required.
Anti-myopia soft contact lenses
Novel SCLs have been developed with the aim of
inducing a myopic defocus onto the peripheral
retina, which is believed to be the mechanism behind reduced myopia progression achieved with
OK therapy.
The Anti-Myopia Contact Lens (AMCL; CIBA
Vision) is a silicone hydrogel SCL with an 8.6 mm
base curve and 14.2 mm diameter. The central zone
(3 mm diameter) is dedicated to central refractive
error correction. Outside this zone, the refracting
power of the lens progressively increases to a relative positive power of +2.00 D at the edge of the
treatment zone, (9 mm total treatment zone diameter). In a group of seven- to 14-year-old Chinese
children, axial length increase after 12 months
of AMCL wear was about 33 per cent less in the
AMCL compared to the control group. This lens
is not commercially available.
The dual-focus lens, commercially known as the
Study
Difference in axial
length between control
and OK group (mm)
Walline et al18 (CRAYON study)
0.32
Kakita et al 0.22
20
Santodomingo-Rubido et al210.22
(MCOS study)
Difference in axial length elongation between
control and OK groups over two years
MiSight lens (CooperVision), consists of a central
distance correction surrounded by two concentric
+2.00 myopic treatment zones and another two
concentric distance correction zones.13 This multifocal lens was designed to induce myopic defocus
onto the retina during both distance and near
viewing subsequent to a monovision study23 that
found that children who apparently experienced
sustained myopic defocus over the entire retina
during both distance and near viewing had reduced
myopia progression compared to the fully corrected
contra-lateral eye.
Subjects were randomised to wear the dual-focus
lens in one eye and a single vision SCL in the contralateral eye for 10 months (period 1) after which
lens assignment was swapped (period 2). During
period 1, axial length elongation was about 49 per
cent less in the eye wearing the dual-focus lens.
After the cross-over period, eyes now wearing the
dual-focus lens experienced 80 per cent less axial
elongation compared to eyes now wearing single
vision SCLs. This lens is currently available only
in Asia.
No long-term studies have been conducted with
these multifocal SCLs and therefore the long-term
therapeutic effects are unknown. Similar to OK, it
is unknown when treatment with multifocal SCLs
should start or how long it should continue. There
is great variability in peripheral refraction in humans and these anti-myopia SCLs may not induce
enough myopic shift onto the peripheral retina in
all myopic children.
Although more research is required to shed light
on the use of OK and multifocal SCLs in myopia
control, compared to other available modalities,
OK and multifocal SCLs provide promising results
and are some of the most effective interventions
available for slowing the progression of myopia.
OK has the advantage of providing clear, unaided
vision throughout the day regardless of where
fixation is and greater amounts of myopic defocus
imposed on the peripheral retina compared to
multifocal SCLs.
As not all children may be suitable for OK, multifocal SCLs provides a safe and effective therapy
option for myopia control.
References are available
from j.megahan@optometrists.asn.au, subject:
­Update on OK, 2012.
19
CONTACT LENSES 2012
contact lenses mini-scleral
The story continues
I
n the previous article in this series on mini-scleral
lenses, published in the 2011 issue of Contact
Lenses, I alluded to the interest ophthalmology was
taking in the lens as a means of ‘treating’ various
ocular surface disease conditions. In practice, we
have now fitted over 450 patients with the lens,
most of whom have keratoconus, pellucid marginal degeneration, post-graft or high myopia and
astigmatism. Of this group of patients, 28 were
specifically fitted to overcome discomfort and vision
John Mountford
problems due to ocular surface disease.
FAAO FCCLSA FBCLA
The patients suffered from a range of problems,
including aqueous deficient dry eye (13), Salzmann’s
nodular degeneration (6), cicatrical phemphigoid
(2), uniocular corneal scarring secondary to penetrating eye injury (3), severe corneal scarring secondary to corneal anaesthesia (2), Stevens-Johnson/
toxic epidermal necrolysis (2), limbal stem cell
deficiency (1), an emergency post-graft fitting and
an extreme case of keratoglobus.
In all of these cases, mini-scleral lenses were used
not only to provide relief from pain or discomfort,
but also to act as a protective shell for the cornea
and correct vision.
The scleral lens vaults the cornea and limbus and
has a deep reservoir of saline trapped behind it, usually 150-200 µm deep.
This acts as a barrier to
corneal exposure and
dryness, as the cornea
remains constantly wet.
There is no movement
of the lens and this,
combined with the overall clearance, eliminates
any risk of frictional
damage. Cicatrical
disease and StevensJohnson syndrome are
commonly associated
with lid conjunctival
Figure 1. Salzmanns nodular degeneration
scarring, entropion and
trichiasis, which in turn
only aggravates the existing corneal trauma and
pain. A mini-scleral lens acts as a bandage in these
cases to protect the cornea from the lids.
Of all the benefits associated with fitting patients
who are suffering from these various conditions, the
most clinically rewarding is the pain relief that they
happily report. The following brief case histories
are examples.
20 CONTACT LENSES 2012
CASE REPORT
Corneal scarring secondary to cicatrical
phemphigoid
The patient had moved to Queensland from Sydney and been referred by my colleague David Pye
from UNSW. She was wearing RGP lenses with
disposable soft piggyback lenses and BCVA of
R 6/18, L 6/12.
The patient suffered from chronic ocular pain,
photophobia and conjunctival injection. She was
relatively happy with the left lens. David had
advised her that the right lens would require
refitting and that she should have this done once
the move north had been completed. The wearing
time ranged from eight to 10 hours a day, none
of which was comfortable. Slitlamp showed irregular, raised areas of corneal scarring and lenses
that decentred infero-temporally OU. Corneal
topography was impossible due to the distortion
caused by the scarring.
After discussing the benefits and disadvantages,
we decided to trial fit a mini-scleral to the right eye.
As is usual practice, trial fitting was carried out until
a lens with about 300 µm of apical clearance and
good limbal clearance was achieved. The patient
was then sent out for an hour to allow the lens
to settle. Coincidentally, the trial lens was within
+0.50 of the final refraction and gave VA of 6/9-2.
Three hours later she returned. Her first comment was: ‘I’m not leaving here until you do one
for the left eye.’
The lenses were dispensed and have been worn
successfully for two years for an average of 16
hours a day with BCVA of 6/9 OU. There has been
a total resolution of the pain, photophobia and
conjunctival injection, which in turn, according to
the patient’s husband, led to a return of the bright,
happy and confident woman who had previously
retreated into her shell because of her fear of photophobia.
CASE REPORT
Toxic epidermal necrolysis (Stevens-­
Johnson Syndrome)
The patient is a highly trained member of the Police Emergency Response Team who suffered toxic
epidermal necrolysis as a result of an adverse reaction to penicillin. He had a photo taken in hospital
mini-scleral contact lenses
that showed his entire body ‘burned black’ by the
disease.
The right eye retained perfect vision but the left
was blind (PL only) due to dense corneal scarring.
The left eye was chronically red, watery and painful.
Frustration with the only treatment offered (one
drop of Celluvisc every two minutes) led him to do
internet research to see if anything else was available. Scleral lenses seemed to work, so he requested
a referral from his ophthalmologist for fitting.
Again, a routine fitting was performed, while he
happily discarded used unit dose lubricant containers on the floor—I picked up 12 of them after
he left. He returned after an hour and advised the
receptionist that he was not giving the trial lens
back, as the pain had gone and he did not need to
use the lubricating drops. The lens’s fit was ideal
and because no refractive correction was required,
we taught him insertion and removal and let him
keep the trial lens until his own arrived. The lens
achieved what he wanted: relief of pain and less
dependence on the constant use of lubricants.
CASE REPORT
Keratoglobus
Figure 2. OCT scan of a nodule being compressed by the lens; the fit was
steepened to give clearance between the lens and the nodule
The patient had been fitted with PMMA moulded
scleral lenses by the legendary John Strachan more
than 40 years ago. The patient had undergone PK
in the right eye but was losing tolerance to his left
scleral lens. Fluorescein pattern showed a lens with
heavy apical bearing and a huge 360-degree bubble. I advised him that we would need to prescribe
another lens as his current lens did not have enough
thickness to allow for further grinding out, or we
could proceed with a mini-scleral fitting.
He did not believe that the fitting would be
relatively straightforward. As those who have
done moulded eye scleral lens fitting know, it is
time-consuming and can take months of visits and
grinding to get the ideal fit. He decided to return
to Melbourne and see John and his son Greg for
a second opinion. Greg is a successful irregular
corneal design (ICD)* wearer and encouraged the
patient to try the new design.
The final fit was achieved with two exchanges and
gives VA of 6/9. The photo was taken at the first visit.
By the end of the first 3 months, the eye was white
and the lens ‘exceptionally’ comfortable.
Figure 3. Irregular corneal design lens on an
advanced case of keratoglobus
* The development of the KATT lens, now called the irregular
corneal design or ICD, would not have been possible
without the formidable mathematical and computer design
capabilities of Don Noack, who died after a short illness in
July. I had the great pleasure of working and arguing with
Don for over 20 years; he taught me the mathematics and
concepts required to design RGP lenses, and for that, as
well as his friendship, I will be eternally grateful. I dedicate
this ‘continuing story’ to his memory.
21
CONTACT LENSES 2012
contact lenses experience
Skills you don’t learn at uni
U
niversity is a place for learning. We leave with
all the knowledge we think we will need to be
optometrists and then, after joining a practice we
find there is a host of practical things we still need to
learn. New graduates have identified areas in which
they needed to gain more experience when they
made the transition from student to practitioner.
Gaining efficiency
Helen Gleave
BScOpt(Hons) MCOptom
Professional training
­manager, Alcon
Going from a 90-minute examination to a
30-minute examination is one of the first challenges.
How can you create enough time to discuss all the
vision correction options, including contact lenses?
One way is to incorporate throughout the examination questions and tests that are conducive
to contact lenses. By asking about the patient’s
lifestyle and the visual tasks they undertake, you
will be better able to include contact lenses as part
of your vision correction recommendation.
A slitlamp examination that looks at the cornea,
tear film and lids will support your ability to select
a contact lens product appropriate for each patient.
Same-day fitting
Narelle Hine
MScOptom DCLP FAAO
Clinical student supervisor,
UNSW
Fitting the patient with contact lenses the same day
is ideal but if the appointment book is full, then
making an appointment on the day of the spectacle
collection is a time-efficient option for the patient.
Can the contact lens teaching session be delegated? Front-of-house staff members can be a
valuable resource, not only to discuss contact lens
options with patients but also to help with teaching
patients insertion and removal. An investment in
time for staff training can save the optometrist up
to one hour with every new patient fitted.
Discussing fees
References are available
from j.megahan@optometrists.asn.au, subject: Skills,
2012.
22 CONTACT LENSES 2012
Discussing fees and the cost of contact lenses is an
area in which many new graduates find they have
very little experience. They may feel awkward, as
though they have to justify the cost of their clinical
expertise. One way for an optometrist to approach
this situation is to discuss what will be involved in
the contact lens examination and the technology
behind the contact lenses before discussing price.
In other words, if patients are simply told that their
contact lens consultations cost $150, they have no
point of reference to determine if this represents
good value for money.
By informing the patient of all the steps involved,
such as confirming the spectacle prescription, assessing the health of the eyes, corneal topography
and trial lens assessment, the optometrist can help
them understand all the work involved before talk-
ing about the cost. This enables the patient to make
an informed decision and be impressed by the scope
of your clinical skill.
Fitting high-technology lenses
While many graduates feel confident fitting a spherical soft disposable contact lens, many feel they are
not experienced when it comes to fitting astigmatic
or presbyopic patients. It is common for graduates
to have fitted only a few astigmatic patients and
maybe no presbyopic patients. Fortunately, today’s
toric and multifocal contact lenses have high firstfitting success rates,1,2,3 allowing less-experienced
optometrists to fit these lenses with confidence.
There is a wealth of very practical clinical articles
available on the internet. Tom Quinn has written
many articles on the art of toric and multifocal
fitting. In his 2008 Contact Lens Spectrum article
on fitting torics, Quinn suggests making a small
investment in time with a three-step approach to
assessing rotational stability, rather than a one-step
approach.4 He says this will help identify potential
problems early and allow you to make changes at the
outset to expedite success with astigmatic wearers.
Step 1. Assess stability in straight-ahead gaze.
Step 2. Assess stability with gaze change with the patient looking from left to right then up and down.
Step 3. Assess stability with digital displacement by
rotating the lens out of position with your finger.
New technology in multifocal lens designs is making them more successful than ever before. Here
are some practical pearls from the Association of
Contact Lens Educators5 to enhance success rates:
• Ask patients about visual tasks, hobbies, sports
and so on, and explain the limitations of the
lenses with these tasks if necessary.
• Let the lenses settle for at least 20 minutes before
evaluating.
• Use normal room illumination.
• Over-refract monocularly with both eyes open.
• Use hand-held flippers or trial lenses to overrefract.
• Change the sphere power before changing the
ADD power.
• Discuss positively and enthusiastically the limitations of a simultaneous design.
Learning is a lifelong experience that does not
end with the awarding of a degree. Practical aspects of optometry can be learned in the workplace
in conjunction with attending conferences and
manufacturers’ events. Optometrists who take this
lifelong approach to increasing their knowledge and
skills are likely to be successful, especially in their
contact lens practice.
hybrid contact lenses
Talented child of soft and rigid parents
A teenager with keratoconus who
has undergone corneal collagen
cross-linking treatment is delighted
with his hybrid lenses
A
chieving a successful contact lens fitting for an
irregular cornea can be challenging. Importantly, the word ‘successful’ alludes to a combination of features that include the delivery of clear
vision, consistent on-eye lens performance—that
is, a lens that is comfortable, can be worn for extended periods, delivers stable acuity and does not
mislocate with eye movements—and the absence of
any adverse ocular physiological response.
Traditionally, optometric management of irregular astigmatism for conditions such as keratoconus
has involved rigid gas permeable (RGP) lenses because their ability to mask the asymmetric corneal
curvature provides acuity superior to that of soft
contact lenses. Success with this lens modality can
be limited by inferior initial comfort in unadapted
eyes. Soft lenses offer the advantage of improved
centration, enhanced comfort, reduced foreign body
entrapment and greater on-eye stability.
In light of these attributes, the concept of combining rigid lens optics with the comfort profile
of a soft lens has been harnessed in the modality
known as hybrid lenses. Physically comprising
a rigid central portion that is bonded to a soft
peripheral surround or ‘skirt’, the first generation
of these lenses was introduced in the early 1980s.
These early lens products were restricted in their
application due to their low oxygen permeability
and limited underlying tear exchange, which posed
a significant risk for hypoxic-induced corneal
neovascularisation.
SynergEyes represents the contemporary hybrid
lens platform; the latest generation of hybrid
contact lenses that consist of a high-Dk central
gas permeable material (Paragon HDS 100,
Paragon Vision Sciences) and either a hydrogel
or silicone-hydrogel skirt portion, depending
on the specific lens design. The enhanced design
parameters, improved lens materials and presence
of a ‘hyperbond’ junction between the rigid and
soft lens portions have renewed hybrid lenses as
a viable modality for many patients. This case
report describes the successful application of the
SynergEyes ClearKone design for the management
of keratoconus in a teenager.
CASE REPORT
In June 2011, patient LS, a 17-year-old male of
Caucasian descent was referred to me by his corneal
specialist for contact lens management. LS had been
diagnosed with progressive keratoconus the year
prior and had undergone corneal collagen crosslinking (CXL) in both eyes within the six months
prior to his attendance.
Ocular history was significant for seasonal allergic conjunctivitis and mild dry eye. General health
was reported to be excellent. There was no established family history of ocular disease. LS advised
that prior to undergoing CXL he had attended for
an in-practice trial of rigid gas permeable (RGP)
lenses with his previous optometrist. The experience
had motivated him to seek an alternative solution
to RGP lenses. He had researched the SynergEyes
products and was keen to discuss his potential
suitability for this lens modality. In particular, he
hoped such a lens would enable him to participate
in sporting activities, including basketball, tennis
and hockey.
Unaided vision of R 6/38-, L 6/12+ corrected
to R 6/24-, L 6/7.5- with a spectacle correction of
R +1.00/-1.75x60, L +1.50/-1.25x120. Minimal
subjective improvement in acuity was noted by the
patient compared with his unaided vision.
Slitlamp examination revealed characteristic biomicroscopic signs of keratoconus that were more
prominent in the right eye. Approximately 20 fine
striae were evident in the paracentral inferior region
of the right cornea. Stromal corneal thinning was
present at a location one millimetre inferior to the
visual axis (R > L). Both eyes demonstrated mild
anterior stromal corneal haze overlying the region
of the cone. This is a common observation following CXL treatment.
Baseline videokeratography (axial power maps,
Medmont E300 corneal topographer) revealed
inferiorly displaced cones in each eye (Figure 1).
Consistent with the more advanced biomicroscopic signs, the maximal apical curvature was
significantly greater in the right than the left eye.
Intraocular pressures and posterior ocular health
were within normal limits.
Given the requirement for maximal lens stability
due to the patient’s active participation in sporting activities and the motivation for a hybrid lens
design, LS was fitted with SynergEyes ClearKone
lenses. Fitting of the ClearKone design involves the
consideration of lens sagittal depth (sag) rather than
Dr Laura Downie
BOptom PhD(Melb)
PGCertOcTher FACO
DipMus(Prac) AMusA
Head of Cornea and
Contact Lens Services, the
University of Melbourne
Continued page 24
23
CONTACT LENSES 2012
contact lenses hybrid
Talented
child of soft
and rigid
parents
From page 23
corneal curvature (keratometric values). Diagnostic
fitting is essential as topographical findings do not
necessarily correlate with the final vault values.
The final lens order incorporated the following
parameters:
R central vault: 350 µm, total diameter: 14.5 mm,
back vertex power: -1.75 D, skirt curve: steep
L central vault: 200 µm, total diameter: 14.5 mm,
back vertex power: +2.00 D, skirt curve: steep
High-molecular weight fluorescein photographs
of the lens-eye relationship are shown in Figure
2. The main features of the hybrid lens fittings in
each eye are:
• central fit: apical clearance over the entire rigid
portion of the lens
• peripheral fit: skirt curvature that lands inside
the limbus and extends onto the sclera with an
absence of any fluting
• rigid/soft junction fit: inner landing zone demonstrates graded fluorescein thinning when approaching from the junction to the centre of the
lens; outer landing zone demonstrates alignment
as extending out from the junction to the lens
periphery.
The lenses demonstrated a degree of movement
Figure 1
Figure 2
24 CONTACT LENSES 2012
similar to that of a standard soft contact lens.
For this design, lens movement is essential for allowing adequate tear exchange beneath the lens.
Compromising this aspect of the fitting increases
the likelihood of lens adherence, which may result
in an ocular inflammatory response.
The daily cleaning regime involved AOSept hydrogen peroxide solution. Each lens was filled with
a non-preserved ocular lubricant (Systane Ultra,
Alcon) prior to being applied to the eye.
Best corrected visual acuities with the lenses in
situ were R 6/6-2, L 6/6-. Lens wearing time was
increased gradually over the first seven days of
wear. After one week, LS advised that he could
comfortably wear his lenses for up to six hours a
day without any apparent ocular hyperaemia or
discomfort. At after-care, there was no significant
corneal staining in either eye following four hours
of lens wear. LS was encouraged to continue to
increase his maximal daily wearing period; within
two weeks he was achieving up to 12 hours of lens
wear per day.
LS has now been successfully wearing ClearKone
lenses for over 12 months and one scheduled lens
duplication has occurred during this time. He has
been delighted with the quality of vision that he
achieves as well as the wearability of the lenses for
his school and extracurricular activities.
SynergEyes ClearKone hybrid lenses are indicated
for oval, centred and decentred cones, and can
be applied to a range of irregular corneas from
emerging to relatively advanced keratoconus.
The lens design may also be suitable for pellucid
marginal degeneration and other forms of corneal
irregularity, for example, LASIK-induced ectasia or
post-trauma. The ClearKone lens continues to be a
valuable addition to my lens repertoire for fitting
the irregular cornea. In particular, it has allowed
the successful correction of some of my patients
requiring monocular lens prescriptions or part-time
contact lens wear, or who have a strong history of
RGP intolerance.
Hybrid contact lenses continue to be an evolving
technology. At present, the hydrophilic skirt of the
ClearKone design is a non-ionic, low-water content
material with a Dk of nine. While the material
is dimensionally stable with a relatively low rate
of deposition, the acknowledged limitation is its
low oxygen permeability. SynergEyes is currently
undertaking a clinical study to evaluate various
designs of the ClearKone lens with a new silicone
hydrogel skirt. The release of this new high-Dk lens
is highly anticipated and will no doubt expand the
range of patients who can be effectively fitted with
this unique lens modality.
materials contact lenses
These tables are current at 1 October 2012. While all care has been taken in preparing the information,
it is subject to change and should be confirmed with relevant companies.
Brand name/design
Material
AUSTRALIAN CONTACT LENSES
Boston IV
Boston ES
Boston EO (UV)
Boston XO (UV)
Fluorex 300
Fluorex 500
Fluorex 700
HDS
HDS 100
Optacryl 18
Optacryl 32
RXD
Quantum II
Innovation 80
(hydrophilic soft surface)
PMMA
Spherical any design
Keratoconus - ACL & Rose K
designs
Toric - back surface, front surface,
bitoric & toric periphery
Graft & Reverse Geometry
Bifocal - Concentric Design &
Tangent Streak (spheres & torics).
Multifocal - Concentric Design
(sphs & torics)
Emerald Ortho-K
Limbal Lift (E&K Series)
PMMA
Paragon HDS
Paragon HDS 100
Paragon Thin
FluoroPerm 30
FluoroPerm 60
Fluorex 500
Boston IV
Boston ES
Boston XO
Boston XO2
Boston EO
Equalens
Menicon Z
Menicon Z-alpha
Menifocal Z
Z CRT for ortho-K
Centra PGA Quad-Sym
Centra PGA Keratoconus
Centra PGA FST & TSP
Centra PGA BST
Centra PGA Bi-toric
Centra PGA Post Graft
Centra PGA Bi-Sym
Centra Bifocal
Centra Aspheric
Conax 11, 12, 13
Conoid M2
Conocoid (Aspheric)
Custom Multi Curve (V Contour,
Tricurve, Ski, etc)
Essential Multifocal
Essential Xtra Multifocal
Paragon NormalEyes
SSMax (12.0 to 14.5)
SSMax Toric (12.00 to 14.5)
Tangent Streak
ORTHOKERATOLOGY
Paragon CRT for ortho-K
Paragon CRT Dual Axis for ortho-K
HYBRID LENSES
SynergEyes Duette HD
SynergEyes Multifocal
SynergEyes ClearKone
Any material, including
Boston, Paragon,
Contamac, Menicon
material etc
Boston ES, XO
Boston ES, XO
Boston XO
Boston ES, XO
TBA
Boston XO
Boston XO
F500
Paragon HDS 100
Paragon HDS 100
84 Dk SiH Skirt 130 DK
Centre
84 Dk SiH Skirt 130 DK
Centre
TBA
GELFLEX LABORATORIES
MENICON
Menicon EX
Material
CONTACT LENS CENTRE AUSTRALIA
Mini Scleral (16 mm)
Pericon
CAPRICORNIA CONTACT LENS
All spherical, aspherical,
keratoconus, asymmetric and toric
designs made to order and
proprietary designs including
Conoid
ModCon
MA
SA Multifocal
Capricornia Keratoconus
KBA (keratoconus bi-aspheric)
KATT mini scleral (16.5 mm
Keratoconus)
Epicon LC (keratoconus)
BE (orthokeratology)
PCS (post-corneal surgery)
Rose K & Rose K2 range:
(Irregular Cornea, Post Graft &
Toric Periphery)
Marconus (Keratoconus)
Marconus Graft
Bifocal—concentric centre
distance std
Eycon
Sphere—Eycon Tricurve. Any
custom
Aspheric—Astrocon aspheric
Toric—front surface, back
surface, bitoric and toric
periphery
Bi-Focal
Mini Scleral
Brand name/design
Co-polymer of
Fluoromethacrylate,
Siloxanylmethacrylate &
Methylmethacrylate
Co-polymer of
Fluoromethacrylate,
Siloxanylstyrene &
Benzotriazol
Spheres, aspherics, front surface
torics, back surface torics,
bitorics, Linear Plus Translating
Bifocal
Tabb Series of Reverse Geometry
Lenses:
NoMove
Orthokeratology NightMove,
HyperMove, AstigMove
Tabb ReHabMove (post graft,
post laser)
Tabb ConeMove (Keratoconus)
Keracon, Korb (Keratoconus)
Post Graft
Hartzog (post laser)
Gas Permeable Scleral lenses
Harmony Plus
Harmony for Sclerals
Boston XO
Boston EO
Boston Equalens
Paragon HDS
Fluorex 300, 700
FSA 30, 60, 90
Soft and RGP lenses and solutions
ONLINE at
www.optometrists.asn.au
25
CONTACT LENSES 2012
26 CONTACT LENSES 2012
24
Oprifocon A
Itabisfluorofocon A
Itafocon B
Hexafocon B
Boston IV
Boston XO2
101
22
30
Paflufocon D
Pahrifocon A
Paflufocon C
Paragon HDS
100
Paragon HDS
HI 1.54
FluoroPerm
30
64
99
38
52
50
Paflufocon A
Paflufocon D
Paflufocon E
Migafocon A
Pasifocon C
Pasifocon A
Kolfocon A
Paraperm O2
Optacryl 60
14
16
43
Paflufocon B
FluoroPerm
60
FluoroPerm
92
FluoroPerm
151
FSA 38
FSA 52
Paraperm EW
23
Paflufocon C
Paragon Thin
40
Paflufocon B
Not available
Not available
Not available
Not available
Not available
Available option
Available option
Available option
Available option
Not available
Not available
Available option
Available option
Yes
163
51
Not available
With/without UV
absorber
No
With/without UV
absorber
Only available with
UV absorber
Only available with
UV absorber
Available as option
Available as option
Available as option
UV absorber
(with/without)
19
141
100
Paragon HDS
Menicon Z,
Menicon Zalpha
Menifocal Z
Dyna Cone Z
Intra-Limbal
Z-CRT
Co-polymer of
Fluoromethacrylate,
Siloxanylmethacrylate
& Methylmethacrylate
Co-polymer of:
Fluoromethacrylate,
Siloxanylstyrene
& Benzotriazol
85
Itafluorofocon A
Boston
Equalens
Boston
Equalens II
Boston RXD
Menicon EX
47
Hexafocon A
Boston XO
18
Enflufocon A
Boston ES
58
Dk*
Enflufocon B
Material
Boston EO
Brand name
Blue, green, electric blue,
cool green, clear
Blue, grey, green
Blue, green, violet, clear
Blue, green
Blue, green, clear
Blue, crystal blue
Blue, green, grey, crystal
blue, majestic blue, brown,
clear
Blue, green, crystal blue,
brown, clear
Blue, green, clear
Sapphire blue, emerald
green, crystal blue, forest
green, violet
Sapphire blue, emerald
green, clear
Sapphire blue, emerald
green, yellow
Blue, green
Blue
Blue
Ice blue, violet, blue, green,
clear
Blue
Blue, ice blue
Blue, green
Blue, ice blue, green, brown,
grey, ice green, ice grey
Blue, ice blue, green, brown,
grey, clear
Ice blue, violet, blue & green,
clear
Blue
Colour
* Dk measurements use the ISO method. There are several different ways to measure Dk, some of which will give higher numbers than in this table.
Paragon Vision
Sciences
Menicon
Bausch + Lomb
Boston GP
Manufacturer
A reliable low Dk material with structural integrity
Seven day continuous wear. Superior stability with increased
oxygen delivery.
Seven day continuous wear. Excellent material to promote corneal
health.
A reliable low Dk material with structural integrity
A reliable mid-range Dk material with structural integrity
Seven day continuous wear: the only silicone acrylate with this
extended wear approval.
A reliable low Dk material with structural integrity
Seven day continuous wear.
Seven day continuous wear. High oxygen delivery and the same
material used in Paragon CRT.
The highest refractive index (1.54) available worldwide. Excellent for
presbyopic lens designs
Exceptional material for upgrading first generation GP wearers.
Superior stability and wettability.
Exceptional durability for ultra-thin lens designs
Seven day continuous wear. Mid-range Dk with superior stability
and wettability.
30 days continuous wear. Superior stability & wettability, excellent
deposit resistance.
Material hardness rivals that of PMMA. Excellent optical surfaces.
Excellent wetting and deposit resistance due to low silicone content.
Fitting characteristics similar to Boston II.
Hyper-transmissibility & stability equalling
High oxygen delivery.
Fluorinated polymer for improved oxygen delivery.
Excellent wetting & deposit resistance. Fitting & manufacturing
characteristics similar to Boston ES.
Exceptional durability & modulus. Exceptional wetting & deposit
resistance.
High oxygen delivery. Stability equalling that of lower Dk materials.
Special attributes
contact lenses RGP
soft contact lenses
DISPOSABLE SPHERICAL MONTHLY
Lens type
Power range (D)
(Lenses are in 0.25 steps between
-6.00 & +4.00 & 0.50 steps outside
this range, except where noted)
-0.25 to -6.00 (0.25 steps)
-6.50 to -12.00 (0.50 steps)
+0.25 to +6.00(0.25 steps)
+6.50 to +8.00 (0.50 steps)
-0.25 to -6.00 (0.25 steps)
-6.50 to -10.00 (0.50 steps)
+0.25 to +5.00 (0.25 steps)
+5.50 to +8.00 (0.50 steps)
% H20
Group
Thickness
at -3.00
48
Gp 1
0.08
Silicone hydrogel. Dk/t 160, Visitint, daily wear,
flexible wear, 29 nights continuous wear.
55
0.07
UV Blocker. Blue handling tint. Mid blue, mid
green & mid aqua tints available.
14.2
-0.25 to -6.00 (0.25 steps)
-6.50 to -20.00 (0.50 steps)
+0.50 to +6.00 (0.25 steps)
+6.50 to +20.00 (0.50 steps)
62
Gp 2
0.065
Low dehydration. All day comfort. Blue handling
tint.
Mid blue, mid green & mid aqua tints available.
8.40,
8.70
14.4
+20.50 to +30.00 (0.50 steps)
62
Gp 2
0.065
Low dehydration. All day comfort. Blue handling
tint. Mid blue, mid green & mid aqua tints
available.
8.6
14.2
+6.00 to -8.00 (0.25 steps)
-8.50 to -10.00 (0.50 steps)
33
Gp 1
0.08
Silicone hydrogel, plasma polymerisation surface
treated for wettability and low deposits.
Advanced aspheric lens design for optics, fit and
comfort.
AQUA Moisture System.
Light blue handling tint.
Daily wear or up to 6 nights extended wear.
BOZR
Diameter
Australian Contact
Lenses
Breeze
8.6
14.0
Australian Contact
Lenses
Practitioner’s Own Brand
8.6
14.2
ACL Private Label
MonthlyPro
8.6
ACL Private Label
MonthlyPro Extended
Range
Alcon
AIR OPTIX AQUA
8.8
Dk/t 138
Bausch + Lomb
PureVision
Notes
8.6 & 8.3
14.0
8.6BC: -0.50 to -6.00 (0.25 steps)
-6.50 to -12.00 (0.50 steps)
Plano to +6.00 (0.25 steps)
8.3BC: Plano to -6.00 (0.25 steps)
36
Dk/t 101
(edge
corrected)
Gp 3
112
(non-edge
corrected)
0.09
Silicone hydrogel.
Suitable for daily wear or up to 30 days
continuous wear.
Light blue visibility tint.
Front surface aspheric design.
Bausch + Lomb
PureVision 2 with High
Definition Optics
8.6
14.0
-0.50 to –6.00 (0.25 steps)
-6.50 to -12.00 in 0.50 steps
+0.25 to +6.00 in 0.25 steps
36, Gp 3
Dk/t 130
(edge
corrected)
144
(non-edge
corrected)
0.07
Silicone hydrogel.
Daily wear or flexible wear as recommended by
the optometrist.
High Definition Optics provide clear, crisp vision
– all day and all night.
Comfort Moist Technology for overall comfort
Light blue visibility tint.
Bausch + Lomb
SofLens 38
8.7
14.0
-0.25 to -5.00 (0.25 steps)
-5.50 to -9.00 (0.50 steps)
+0.25 to +4.00 (0.25 steps)
38
Gp 1
0.035
Blue handling tint.
Capricornia Contact Lens
Clear All-Day
Biocompatible Sphere
8.6
14.2
-12.00 to -6.50 (0.50 steps)
-6.00 to -0.25 (0.25 steps)
+0.25 to +4.00 (0.25 steps)
+4.50 to +6.00 (0.50 steps)
57
Gp 3
0.08
UV absorber. Blue handling tint.
Capricornia Contact Lens
Encore 56
8.6
14.2
-0.50 to -8.00 (0.25 steps)
-8.50 to -10.00 (0.50 steps)
56
Gp 2
0.08
UV absorber. Blue handling tint.
Contact Lens Centre
Australia
Onyx 55 UV
8.4
8.8
14.2
>+4.00 to -6.00 (0.50 steps)
<+4.00 to -6.00 (0.25 steps)
Power range +8.00 to -12.00
55
Gp 4
0.08
Blue handling tint and UV filter standard.
Contact Lens Centre
Australia
Definition AC
Pk of 6 lenses
8.6
14.2
>+4.00 to -6.00 (0.50 steps)
<+4.00 to -6.00 (0.25 steps)
Power range +8.00 to -12.00
55
Gp 4
0.08
Blue handling tint and UV filter standard.
CooperVision
Biofinity
8.6
14.0
+6.00 to -6.00 (0.25 steps)
-6.50 to -12.00 (0.50 steps)
+6.50 to +8.00 (0.50 steps)
48
Gp 1
0.08
160 Dk/t, Comfilcon A material suitable for daily
wear, flexible wear, 29 nights continuous wear.
CooperVision
Proclear
8.6
14.2
-0.25 to -6.00 (0.25 steps)
-6.50 to -20.00 (0.50 steps)
+0.50 to +6.00 (0.25 steps)
+6.50 to +20.00 (0.50 steps)
62
Gp 2
0.065
Low dehydration. All day comfort.
Gelflex Extreme H2O
monthly 3-pack
8.6
14.2
-0.50 to -6.00 (0.25 steps)
-6.00 to -8.00 (0.50 steps)
+0.50 to +6.00 (0.50 steps)
59
Gp 2
0.08
Low dehydration: consider for dry eye. Blue
handling tint.
DISPOSABLE SPHERICAL TWO-WEEKLY
BOZR
Diameter
Power range (D)
(Lenses are in 0.25 steps between
-6.00 & +4.00 & 0.50 steps outside
this range, except where noted)
% H20
Group
Thickness
at -3.00
Alcon
FreshLook Handling Tint
Median
(8.6)
14.5
+6.00 to -8.00 (0.25 steps)
Excludes plano
55
0.08
Gp 4
Light green handling tint.
Australian Contact Lenses
Aura
8.5
14.2
-0.25 to -6.00 (0.25 steps)
-6.50 to -12.00 (0.50 steps)
+0.25 to +6.00 (0.25 steps)
+6.50 to +8.00 (0.50 steps)
46
0.08
125 Dk/t Silicone hydrogel. UV blocker.
Naturally wettable, soft, low modulus. Visibility
tint.
Lens type
8.4
Notes
27
CONTACT LENSES 2012
contact lenses soft
DISPOSABLE SPHERICAL TWO-WEEKLY (continued)
Australian Contact
Lenses Switch 60
8.5
14.2
Bausch + Lomb
SofLens 59
8.6
14.2
8.30, 8.60
14.0
8.4
Contact Lens Centre
Australia
-0.25 to -6.00 (0.25 steps)
-6.50 to -10.00 (0.50 steps)
+0.25 to +6.00 (0.25 steps)
-0.50 to -6.00 (0.25 steps)
-6.50 to -9.00 (0.50 steps)
+0.50 to +4.00 (0.25 steps)
+4.50 to +6.00 (0.50 steps)
60
0.075
Low dehydration. All day comfort. Blue handling
tint.
59
Gp 2
0.14
Blue handling tint, previously named SofLens
Comfort.
-0.25 to -6.50 (0.25 steps)
-7.00 to -13.00 (0.50 steps)
+0.25 to +6.00 (0.25 steps)
40
Gp 1
0.08
Dk/t: 161
Nanogloss Technology for superior comfort,
improved wettability & lipid resistance.
14.2
+0.25 to +6.00 (0.25 steps)
+6.50 to +8.00 (0.50 steps)
-0.25 to -6.00 (0.25 steps)
-6.50 to -12.00 (0.50 steps)
46
0.08
125 Dk/t, Enfilcon A material with UV blocker,
Modulus 0.50 MPa.
Naturally wettable, soft, low modulus.
14.2
-0.50 to -6.00 (0.25 steps)
+0.50 to +6.00 (0.25 steps)
-6.00 to -8.00 (0.50 steps)
-0.50 to -6.00 (0.25 steps)
-6.00 to -8.00 (0.50 steps)
-0.50 to -6.00 (0.25 steps)
-6.50 to -10.00 (0.5 steps)
+0.50 to +6.00 (0.50 steps)
59
Gp 2
Menicon PremiO
6 lenses per pack
CooperVision
Avaira
8.5
Medium
Gelflex Extreme H2O
2-weekly 6 pack
8.60
Steep
8.30
8.6
Gelflex Sofclear
6 Pack
0.08
14.2
14.3
59
Gp 2
55%
GP 4
Low dehydration: consider for dry eye. Blue
handling tint.
0.08
0.08
Made in Australia. Ultra comfort design. Blue
handling tint. UV filter.
Silicone hydrogel, no surface coating. Superior
comfort in environments that make eyes feel tired
& dry, 14-days daily wear or 6-nights/7-days
continuous wear. Class 1 UV blocking (FDA)
>96% UVA, >99% UVB, ‘123’ inside-out mark,
Blue visibility tint.
‘123’ inside-out mark.
Class 2 UV blocking (FDA) 82% UVA, 97% UVB.
Visibility tint.
Johnson & Johnson
Acuvue Oasys with
Hydraclear Plus
8.4, 8.8
14.0
-0.50 to -6.00 (0.25 steps)
-6.50 to -12.00 (0.50 steps)
+0.50 to +6.00 (0.25 steps)
+6.50 to +8.00 (0.50 steps)
plano
38
Gp 1
0.07
Johnson & Johnson
Acuvue 2
8.3, 8.7
14.0
58
Gp 4
0.084
8.30, 8.60
14.0
-0.50 to -6.00 (0.25 steps)
-6.50 to -12.00 (0.50 steps)
+0.50 to +6.00 (0.25 steps)
+6.50 to +8.00 (0.50 steps)
-0.25 to -6.50 (0.25 steps)
-7.00 to -13.00 (0.50 steps)
+0.25 to +6.00 (0.25 steps)
40
Gp 1
0.08
Menicon PremiO
6 lenses per pack
Dk/t: 161
Nanogloss Technology for superior comfort,
improved wettability & lipid resistance.
DISPOSABLE SPHERICAL DAILY
BOZR
Diameter
Power range (D)
(Lenses are in 0.25 steps between
-6.00 & +4.00 & 0.50 steps outside
this range, except where noted)
% H20
Group
Thickness
at -3.00
Alcon
DAILIES AquaComfort
Plus
8.7
14.0
+0.50 to +6.00 (0.25 steps)
-0.50 to -6.00 (0.25 steps)
-6.50 to -10.00 (0.50 steps)
69
Gp 2
0.10
Nelfilcon A material with Triple Action
Moisture System. Light blue handling tint.
Alcon
Focus DAILIES All Day
Comfort
8.6
13.8
+0.50 to +6.00 (0.25 steps)
-0.50 to -6.00 (0.25 steps)
-6.50 to -10.00 (0.50 steps)
69
Gp 2
0.10
Nelfilcon A material with AquaRelease PVA
technology. Light blue handling tint.
Alcon
Freshlook One-Day
8.6
13.8
-0.50 to -6.00 (0.25 steps) and plano
69
Gp 2
0.10
Available in blue, green, pure hazel and grey.
Australian Contact
Lenses Clear Day
30 & 90 Pack
8.7
14.2
-0.25 to -6.00 (0.25 steps)
-6.50 to -12.00 (0.50 steps)
+0.25 to +5.00 (0.25 steps)
+5.50 to +8.00 (0.50 steps)
60
0.09
Low dehydration. All day comfort. Visibility
tint.
Australian Contact
Lenses Day by Day
30 & 90 Pack
8.7
14.2
52
Gp 4
0.07
Blue handling tint. UV filter.
Bausch + Lomb
SofLens Daily Disposable
30 Pack
Bausch + Lomb
SofLens Daily Disposable
90 Pack
Capricornia Contact Lens
Clear 1-Day
Biocompatible Sphere
8.6
14.2
59
Gp 2
0.09
Visibility tinted contact lenses for daily wear.
Hilafilcon B. Blister pack with poloxamine.
8.6
14.2
59
Gp 2
0.09
Visibility tinted contact lenses for daily wear.
Hilafilcon B. Blister pack with poloxamine.
8.7
14.2
-0.25 to -6.00 (0.25 steps)
-6.50 to -10.00 (0.50 steps)
+0.25 to +5.00 (0.25 steps)
+5.50 to +6.00 (0.50 steps)
-0.25 to -6.50 (0.25 steps)
-7.00 to -9.00 (0.50 steps)
+0.25 to +6.50 (0.25 steps)
-0.25 to -6.50 (0.25 steps)
-7.00 to -9.00 (0.50 steps)
+0.25 to +6.50 (0.25 steps)
-10.00 to -6.50 (0.50 steps)
-6.00 to -0.50 (0.25 steps)
+0.50 to +4.00 (0.25 steps)
57
Gp 3
0.08
UV inhibitor. Handling tint.
Contact Lens Centre
Australia
Definition AC Everyday
30 Pack
Contact Lens Centre
Australia
Definition AC Everyday
90 Pack
8.6
14.2
+6.00 to -8.00
58
Gp 4
0.09
Blue handling tint and UV filter standard.
8.6
14.2
+6.00 to -8.00
58
Gp 4
0.09
Blue handling tint and UV filter standard.
Lens type
28 CONTACT LENSES 2012
Notes
soft contact lenses
DISPOSABLE SPHERICAL DAILY (continued)
CooperVision
Biomedics 1-Day Extra
30 and 90 pack
8.6 (-)
14.2
-0.25 to -6.00 (0.25 steps)
-6.50 to -10.00 (0.50 steps)
+0.25 to +5.00 (0.25 steps)
+5.50 to +6.00 (0.50 steps)
55
Gp 4
0.07
Easy handling.
8.8 (+)
CooperVision
Proclear 1-Day
30 and 90 pack
8.7
14.2
-0.25 to -6.00 (0.25 steps)
-6.50 to -12.00 (0.50 steps)
+0.25 to +5.00 (0.25 steps)
+5.50 to +8.00 (0.50 steps)
60
0.09
Low dehydration. All day comfort.
Gelflex Sofclear Dailies
30 and 90 pack
8.6
14.3
-0.50 to -6.00 (0.25 steps)
-6.50 to -10.00 (0.50 steps)
+0.50 to +6.00 (0.50 steps)
57
Gp 4
0.09
Blue handling tint and UV filter standard.
Innovative Contacts
Sage-Gel 1 Day
8.6
13.8, 14.1
6.00 to +4.00 (0.25 steps)
-6.00 to -10.00 (0.50 steps)
-6.00 to +4.00 (0.25 steps)
-6.00 to -10.00 (0.50 steps)
+4.50 to +7.00 (0.50 steps)
60
0.08, 0.11
8.5, 9.0
14.2
-0.50 to -6.00 (0.25 steps)
-6.50 to -12.00 (0.50 steps)
+0.50 to +6.00 (0.25 steps)
46
Gp 1
0.085
Highest oxygen transmissibility of any daily
disposable. Class 1 UV blocking (FDA) >96%
UVA, >99% UVB. ‘123’ inside-out mark. Blue
visibility tint. Available in 30 and 90 packs.
8.5
14.2
-0.50 to -6.00 (0.25 steps)
-6.50 to -12.00 (0.50 steps)
+0.50 to +6.00 (0.25 steps)
58
Gp 4
0.084
Contains Lacreon technology, all day moisture.
‘123’ inside-out mark. Class 2 UV blocking
(FDA) 82% UVA, 97% UVB. Blue visibility
tint. Available in 30 pks and 90 pks.
14.2
Plano
-0.50 to -6.00 (0.25 steps)
-6.50 to -12.00 (0.50 steps)
0.084
Accent and Vivid styles.
Dark limbal ring that enlarges iris diameter.
Class 2 UV blocking (FDA) 82% UVA, 97%
UVB.
Johnson & Johnson
1-Day Acuvue TruEye
(Silicone hydrogel)
Johnson & Johnson
1-Day Acuvue Moist
9.0
Johnson & Johnson
1-Day Acuvue Define
8.5
58
Gp 4
World’s only hyaluronate gel contact lens.
Front curve aspheric, UV and blue handling
tint. Available in 30 Pack and slim compact
pack.
CONTINUOUS WEAR / FLEXIBLE WEAR
Frequency
BOZR
Diameter
Power range (D)
(Lenses are in 0.25 steps between
-6.00 & +4.00 & 0.50 steps outside this
range, except where noted)
% H20
Thickness
at -3.00
Alcon
AIR OPTIX
Night & Day AQUA
Monthly
(up to
30 days)
8.4, 8.6
13.8
+6.00 to -8.00 (0.25 steps)
-8.50 to -10.00 (0.50 steps)
Plano (for therapeutic use in 8.6)
24
Dk/t 175
Gp 1
0.08
Silicone hydrogel. Plasma
polymerisation surface treatment
for wettability and low deposits.
Advanced aspheric lens design for
clear vision fit and comfort.
AQUA Moisture System.
Daily wear or up to 30 days
continuous wear.
Light blue handling tint.
Australian Contact
Lenses
Breeze Spheres
Monthly
8.6
14.0
+6.00 to -6.00 (0.25 steps)
-6.50 to -12.00 (0.50 steps)
+6.50 to +8.00 (0.50 steps)
48
Dk/t 160
Gp 1
0.08
Silicone hydrogel. Suitable for
daily wear, flexible wear or 29
nights continuous wear. Visibility
tint.
Australian Contact
Lenses
Breeze Toric
Monthly
8.7
14.5
Sph: +6.00 to -6.00 (0.25 steps)
-6.50 to -10.00 (0.50 steps)
+6.50 to +8.00 (0.50 steps)
Cyl: -0.75, -1.25, -1.75, -2.25
Axis: 10° to 180° (10° steps)
48
Dk/t 116
Gp 1
0.11
Silicone hydrogel. Suitable for
daily wear, flexible wear or 29
nights continuous wear. Visibility
tint.
Bausch + Lomb
PureVision
Monthly
8.6 & 8.3
14.0
-0.50 to -6.00 (0.25 steps)
-6.50 to -12.00 (0.50 steps)
Plano to +6.00 (0.25 steps)
36
Dk/t 101
(edge
corrected)
Gp 3
112
(non-edge
corrected)
0.09
Silicone hydrogel.
Suitable for daily wear or up to 30
days continuous wear. Light blue
visibility tint.
Front surface aspheric design.
Bausch + Lomb
PureVision 2 with
High Definition Optics
Monthly
8.6
14.0
-0.50 to -6.00 (0.25 steps)
-6.50 to -12.00 in 0.50 steps
+0.25 to +6.00 in 0.25 steps
36, Gp 3
Dk/t 130
(non-edge
corrected)
123 (edge
corrected)
0.07
Silicone hydrogel.
Daily wear or flexible wear up to
30 days as recommended by the
optometrist.
High Definition Optics provide
clear, crisp vision – all day and all
night
Comfort Moist Technology for
overall comfort
Light blue visibility tint.
Bausch + Lomb
PureVision Toric
for Astigmatism
Monthly
8.6
14.0
Plano to -6.00 (0.25 steps)
-6.50 to -9.00 (0.50 steps)
+0.25 to +6.00 (0.25 steps)
Cyl: -0.75, -1.25, -1.75, -2.25
Axis: 10° to 180° in 10° steps
36
Dk/t 91
(edge
corrected)
101 (nonedge
corrected)
Gp 3
0.10
Silicone hydrogel. Suitable for
daily wear or up to 30 days
continuous wear. Visibility tint.
Quick alignment system toric
design.
Guide marks at 5, 6 and 7 o’clock.
0
(30 apart)
Lens type
Notes
29
CONTACT LENSES 2012
contact lenses soft
CONTINUOUS WEAR / FLEXIBLE WEAR (continued)
Bausch + Lomb
PureVision 2 with
High Definition
Optics for
Astigmatism
Monthly
8.9
14.5
+6.00 D to -6.00 D (0.25 D steps)
-6.50 D to -9.00 D (0.50 D steps)
Cyl: -0.75 D, 1.25 D, -1.75 D,-2.25 D
36
Dk/t 91
(edge
corrected)
0.10
Silicone hydrogel.
Daily wear or flexible wear up to 30
days as recommended by the
optometrist.
Auto Align Design (hybrid ballasting)
High Definition Optics
Comfort Moist Technology
Orientation mark at 6 o’clock
Light blue visibility tint
Axis: 10° to 180° in 10° steps
Bausch + Lomb
PureVision
Multi-Focal
Monthly
8.6
14.0
Plano to -10.00 (0.25 steps)
+0.25 to +6.00 (0.25 steps)
Low ADD: Progressive up to +1.50
High ADD: Progressive +1.75 to +2.50
36
Dk/t 101
(edge
corrected)
112
(non-edge
corrected)
Gp 3
0.09
Silicone hydrogel.
Suitable for daily wear or up to 30
days continuous wear. Visibility tint.
CooperVision
Biofinity
Monthly
8.6
14.0
+6.00 to -6.00 (0.25 steps)
-6.50 to -12.00 (0.50 steps)
+6.50 to +8.00 (0.50 steps)
48
Dk/t 160
Gp 1
0.08
Comfilcon A material suitable for
daily wear, flexible wear or 29 nights
continuous wear.
Fortnightly
8.3,8.6
14.0
-0.25 to -6.00 (0.25 steps)
-6.50 to -13.00 (0.50 steps)
+6.00 to +0.25 (0.25 steps)
40
Dk/t 161
Gp 1
0.08
Silicone hydrogel. Suitable for daily
wear, flexible wear or 1 week of
continuous wear. Visitint.
Menicon Contact
Lens Centre
Australia
PremiO
DISPOSABLE TORIC & REGULAR REPLACEMENT TORICS
Frequency
BOZR
Diameter
Power range (D)
(Spherical powers are in 0.25 steps
between -6.00 & +4.00 & 0.50 steps
outside this range, exc. where noted)
% H2O
Group
Thickness
at -3.00
ACL Private Label
Monthly Pro Toric
Monthly
8.8
14.4
Sph: +6.00 to -6.00 (0.25 steps)
-6.50 to -8.00 (0.50 steps)
Cyl: -0.75, -1.25, -1.75, -2.25
Axis: 10° to 180° (10° steps)
62
Gp 2
0.11
Low dehydration. All day
comfort. Blue handling tint.
Mid blue, mid green & mid aqua
tints available.
ACL Private Label
Monthly Pro Toric
Monthly
8.4
8.8
14.4
Sph: +6.00 to -8.00 (0.25 steps)
Cyl: -2.75, -3.25, -3.75, -4.25, -4.75,
-5.25, -5.75
Axis: 5° to 180° (5° steps)
59
0.13
For high astigmats. Low
dehydration. All day comfort.
Blue handling tint.
Mid blue, mid green & mid aqua
tints available.
Monthly
8.4
8.8
14.4
59
0.13
Lens type
ACL Private Label
Monthly Pro Toric
Extended Range
Sph: +6.00 to -8.00 (0.25 steps)
Cyl: -2.75, -3.25, -3.75, -4.25, -4.75,
-5.25, -5.75
Axis: 5° to 180° (5° steps)
Notes
For high astigmats. Low
dehydration. All day comfort.
Blue handling tint.
Mid blue, mid green & mid aqua
tints available.
Silcone hydrogel. 91 Dk/t.
Naturally wettable material with
low modulus. UV blocker.
Handling tint.
Australian Contact Lenses
Aura Toric - 2 Weekly
2-weekly
8.5
14.5
Sph: Plano to -6.00 (0.25 steps)
-Cyl: -0.75, -1.25, -1.75
Axis: 10° to 180° (10° steps)
46
0.11
Australian Contact Lenses
Breeze Toric - Monthly
Monthly
8.7
14.5
Sph: +6.00 to -6.00 (0.25 steps)
-6.50 to -10.00 (0.50 steps)
+6.50 to +8.00 (0.50 steps)
Cyl: -0.75, -1.25, -1.75, -2.25
Axis: 10° to 180° (10° steps)
48
0.11
Silcone hydrogel. 116 Dk/t.
Suitable for daily wear, flexible
wear or 29 nights continuous
wear. Visibility tint.
Australian Contact Lenses
Practitioner’s Own Brand
Toric
Monthly
8.7
14.4
Sph: +6.00 to -8.00 (0.25 steps)
Cyl: -0.75, -1.25, -1.75, -2.25
Axis: 10° to 180° (10° steps)
55
Gp 4
0.105
Light blue handling tint. Location
mark at 6 o’clock. Mid blue, mid
green & mid aqua tints available.
Australian Contact Lenses
Practitioner’s Own Brand
Toric
Extended Range
Monthly
8.7
14.4
Sph: +8.50 to -11.00 (0.25 steps)
Cyl: -0.75, -1.25, -1.75, -2.25, -2.75,
-3.25, -3.75
Axis: 10° to 180° (5° steps)
55
Bausch + Lomb
PureVision Toric
for Astigmatism
Monthly
8.6
14.0
Plano to -6.00 (0.25 steps)
-6.50 to -9.00 (0.50 steps)
+0.25 to +6.00 (0.25 steps)
Cyl: -0.75, -1.25, -1.75, -2.25
Axis: 10° to 180° in 10° steps
36
Dk/t 91
(edge
corrected)
101
(non-edge
corrected)
Gp 3
0.10
Silicone hydrogel.
Suitable for daily wear or up to 30
days continuous wear. Visibility
tint.
Quick alignment system toric
design. Guide marks at 5, 6 and 7
0
o’clock (30 apart).
Bausch + Lomb PureVision
2 with High Definition
Optics for Astigmatism
Monthly
8.9
14.5
+6.00 to -6.00 (0.25 steps)
-6.50 to -9.00 (0.50 steps)
36
Dk/t 91
(edge
corrected)
0.10
Silicone hydrogel.
Daily wear or flexible wear up to
30 days as recommended by the
optometrist.
Auto Align Design (hybrid
ballasting).
High Definition Optics.
ComfortMoist Technology.
Orientation mark at 6 o’clock
Light blue visibility tint.
Cyl: -0.75, -1.25, -1.75, -2.25
Axis: 10° to 180° in 10° steps
30 CONTACT LENSES 2012
Light blue handling tint. Location
mark at 6 o’clock. Mid blue, mid
green & mid aqua tints available.
soft contact lenses
DISPOSABLE TORIC & REGULAR REPLACEMENT TORICS (continued)
Alcon
AIR OPTIX
for Astigmatism
Monthly
8.7
14.5
Daily
8.6
14.2
2-weekly
8.5
14.5
Bausch + Lomb
SofLens Daily Disposable for
Astigmatism
Daily
8.6
14.2
Capricornia Contact Lens
Clear All-Day Biocompatible
Toric
Monthly
8.7
3-monthly
Sph: 0.00 to -6.00 (0.25 steps)
Cyl: -0.75, -1.25, -1.75 and -2.25
Axis: 10° to 180° in 10 steps
Sph: -6.50 to -9.00 (0.50 steps)
Cyl: -1.25, -1.75
Axis: 10/20/70/80/90/100/110/
160/170/180°
Sph: -6.50 to -9.00 (0.50 steps)
Cyl: -0.75, -2.25
Axis: 20/90/160/180°
Sph: -9.50 to -10.00 (0.50 steps)
Cyl: -1.25, -1.75
Axis: 20, 90, 160, 180
Sph: +0.25 to +6.00 (0.25 steps)
Cyl: -0.75, -1.25 and -1.75
Axis: 10/20/70/80/90/100/110/
160/170/180°
+4.00 to -6.00 (0.25 steps)
-6.50 to -8.00 (0.50 steps)
Cyl: -0.75 and -1.50
Axis: 20°, 70°, 90°, 110°, 160° and
180°
Plano to -6.00 (0.25 steps)
-6.50 to -9.00 (0.50 steps)
Cyl: -0.75, -1.25, -1.75, -2.25, -2.75
Axis -10 to 180 (in 10° steps)
+0.25 to +6.00 (0.25 steps)
Cyl: -0.75,-1.25,-1.75, -2.25
Axis: 10° steps
33
0.10
Silicone hydrogel, Dk/t 138.
Plasma polymerisation surface
treated for wettability and low
deposits.
Precision balance 8|4 design for
optics, fit and comfort.
Daily wear or up to 6 nights
extended wear.
Light blue handling tint.
69
Gp 2
0.10
Nelfilcon A material with
AquaRelease PVA technology
and handling tint. Double thin
zone, back surface toric design.
66
Gp 2
0.195
Previously named SofLens 66
Toric. Guide marks at 5, 6 and 7
o’clock. Quick alignment system
toric design.
Visibility tinted contact lenses
for daily wear.
Plano to -10.00 (in 0.25 steps)
-6.50 to -9.00 (in 0.50 steps)
Cyl: -0.75, -1.25, -1.75
Axis: 90 & 180, 20 & 160 degrees
59
Gp 2
0.125
Visibility tinted contact lenses
for daily wear.
Hilafilcon B. Blister pack with
poloxamine. 1 guide mark at
6’oclock.
Quick alignment system toric
design.
14.5
Sph: -8.00 to -6.50 (0.50 steps)
-6.00 to +4.00 (0.25 steps)
Cyl: -1.00, -1.75
Axes: 10/20/80/90/100/160/170/180°
57
Gp 3
0.09
UV inhibitor. Blue handling tint.
Any
Any
Sph: +25.00 to -25.00
Cyl: -0.50 to -6.00
Axis: Any
38 Gp 1
48 Gp 1
58 Gp 2
0.13
0.13
0.14
Also available in increased
prism design & thin design. Flat
K +10%. Laser markings at 6
o’clock std. Ink dot markings std
at 12 o’clock on request. R-1 dot,
L-2 dots.
Daily
8.7
14.5
Sph: 0.00 to -6.00 (0.25 steps)
-6.50 to -10.00 (0.50 steps)
Cyl: -0.75 and -1.25, -1.75
Axis: 20°, 90°, 160°, 180°
90° & 180° axes only available for
-7.50 to -10.00 sphere powers
-1.75 cyl only available in
90 and 180 axes
55
0.11
Smooth continuous surface.
Uniform edge design. Wide
ballast band.
CooperVision
Biomedics Toric
2-weekly
8.7
14.5
Sph: +5.00 to -6.00 (0.25 steps)
-6.50 to -9.00 (0.50 steps)
+5.50 to +6.00 (0.50 steps)
Cyl: -0.75, -1.25, -1.75, -2.25
Axis: 10° to 180° (10° steps)
55
Gp 4
0.11
Smooth continuous surface.
Wide ballast band.
CooperVision
Avaira Toric
2-weekly
8.5
14.5
Sph: Plano to -6.00 (0.25 steps)
Cyl: -0.75, -1.25, -1.75
Axis: 10° to 180° (10° steps)
46
0.11
Dk 100, Enfilcon A material with
UV blocker, naturally wettable,
low modulus 0.50 MPa.
Smooth continuous surface,
wide ballast band.
CooperVision
Biofinity Toric
Monthly
8.7
14.5
Sph: +6.00 to -6.00 (0.25 steps)
-6.50 to -10.00 (0.50 steps)
+6.50 to +8.00 (0.50 steps)
Cyl: -0.75, -1.25, -1.75, -2.25
Axis: 10° to 180° (10° steps)
48
0.11
Comfilcon A, smooth
continuous surface, wide ballast
band. Suitable for daily, flexible
or 29 nights continuous wear.
CooperVision
Frequency XCEL Toric
Monthly
8.7
14.4
Sph: +6.00 to -8.00 (0.25 steps)
Cyl: -0.75, -1.25, -1.75, -2.25
Axis: 10° to 180° (10° steps)
55
Gp 4
0.105
Marks at 6 o’clock.
Blue handling tint.
CooperVision
Frequency XCEL Toric XR
Monthly
8.7
14.4
Sph: +8.50 to -11.00 (0.25 steps)
Cyl: -2.75, -3.25, -3.75
Axis: 5° to 180° (5° steps)
55
Gp 4
0.105
For high astigmats.
CooperVision
Proclear
Toric
Monthly
8.8
14.4
Sph: +6.00 to -6.00 (0.25 steps)
-6.50 to -8.00 (0.50 steps)
Cyl: -0.75, -1.25, -1.75, -2.25
Axis: 10° to 180° (10° steps)
62
Gp 2
0.11
Low dehydration.
All day comfort.
CooperVision
Proclear Toric XR
Monthly
8.4
8.8
14.4
Sph: +6.00 to -8.00 (0.25 steps)
Cyl: -2.75, -3.25, -3.75, -4.25, -4.75,
-5.25, -5.75
59
Alcon
Focus DAILIES All Day
Comfort Toric
Bausch + Lomb
SofLens Toric
for Astigmatism
Capricornia Contact Lens Eycon Prescription Toric
Prism Ballast
E38
E48
E58
CooperVision
Biomedics 1 Day Extra Toric
For high astigmats.
31
CONTACT LENSES 2012
contact lenses soft
DISPOSABLE TORIC & REGULAR REPLACEMENT TORICS (continued)
CooperVision
3 Monthly FRP
Custom Toric
3-monthly
7.2 to
9.6
(0.3
steps)
10.0 to
16.5 (0.5
steps)
Unlimited
38, 58, 59
PC
0.07
Unlimited parameters.
3 monthly replacement option.
3 or 4 lens pack Frequent
Replacement Program, free trial
available.
Available in Proclear material. RP
or CV design.
Gelflex Synergy Toric
3-monthly
8.3,
8.6,
8.9,
9.2
14.3, 14.8
15.0 15.3
Sph: Plano to ±10.00 (0.25 steps)
±10.50 to ±12.00 (0.50 steps)
Cyl: range to 5.00
Axis: Any
55, 49
0.11
Blue handling tint.
Bi-prism stabilisation.
2-weekly
8.6
14.5
Sph: Plano to -6.00 (0.25 steps)
Cyl: -0.75, -1.25, -1.75
Axis: 10° to 180° in 10° steps
Cyl: -2.25
Axis: 90 ±20°, 180 ±20° (10° steps)
Sph: -6.50 to -9.00 (0.50 steps)
Cyl: -0.75, -1.25, -1.75
Axis: 10° to 180° in 10° steps
Cyl: -2.25
Axis: 90; 180 ±20° (10° steps)
Sph: +0.25 to +6.00 (0.25 steps)
Cyl: -0.75, -1.25, -1.75
Axis: 90 ±20°, 180 ±20° (10° steps)
38%
Gp 1
0.08
Silicone hydrogel.
Hydraclear Plus technology—no
surface coating required.
Accelerated Stabilisation design
for stable vision.
Class 1 UV blocking (FDA) >96%
UVA, >99% UVB.
Blue visibility tint, and orientation
marks at 6 & 12 o’clock.
Daily
8.5
14.5
Sph: Plano to -6.00 (0.25 steps)
Cyl: -0.75, -1.25, -1.75
Axis: 10,20,60,70,80,90,100,
110,120,160,170,180,
Cyl: -2.25
Axis: 20,90,160,180
Sph: -6.50 to -9.00 (0.50 steps)
Cyl:-0.75, -1.25, -1.75
Axis: 10,20,60,70,80,90,100,
110,120,160,170,180,
Cyl: -2.25
Axis: 20,90,160,180
Sph: +0.25 to +4.00 (0.25 steps)
Cyl: -0.75,-1.25,-1.75
Axis: 20,70,90,110,160,180
58%
Gp 4
0.09
Accelerated Stabilisation design
for stable vision.
Class 2 UV blocking (FDA) 82%
UVA, 97% UVB.
Blue visibility tint, and orientation
marks at 6 & 12 o’clock.
Johnson & Johnson
Acuvue Oasys for
Astigmatism
Johnson & Johnson
1 Day Acuvue MOIST for
Astigmatism
MULTIFOCAL SOFT (Also consider monovision with single-vision lenses)
Frequency
BOZR
Diameter & type
Power range (D)
(Lenses are in 0.25 steps between
-6.00 & +4.00 & 0.50 steps outside
this range, except where noted)
% H2O
Thickness
at -3.00
Alcon
AIR OPTIX AQUA
MULTIFOCAL
Monthly
8.6
14.2
+6.00 to -10.00 in 0.25 steps
Add powers: LO, MED, HI
33
Gp 1
0.102
Silicone hydrogel, Dk/t 138. Centre near
Precision Transition lens design. AQUA
Moisture System. Daily wear or up to 6
nights extended wear. Blue handling
tint.
Alcon
Focus DAILIES All
Day Comfort
Progressives
Daily
8.6
13.8
69
Gp 2
0.11
Nelfilcon A material with AquaRelease
PVA technology and handling tint.
Trial lens power = BVS+half Add, or
use fitting table.
Australian Contact
Lenses
ControlPro Sph
multifocal
Monthly
8.7
14.4
+5.00 to -6.00 (0.25 steps)
Single progressive Add up to +3.00
Aspheric multifocal centre near
design
Sph: +6.00 to -6.00 (0.25 steps)
-6.50 to -8.00 (0.50 steps)
Add Power: +1.00, +1.50, +2.00,
+2.50
Design: D & N
62
0.16
Balanced Progressive Technology. All
day comfort. Centre distance & centre
near design. Blue handling tint. Mid
blue, mid green & mid aqua tints
available.
Australian Contact
Lenses
ControlPro Sph
multifocal
extended range
Monthly
8.4
8.7
14.4
Sph: +6.50 to +15.00 (0.50 steps)
-8.50 to -15.00 (0.50 steps)
Add Power: +1.00, +1.50, +2.00,
+2.50, +3.00, +3.50
Design: D & N
59
Australian Contact
Lenses
ControlPro Early
Sph
multifocal
Monthly
8.7
14.4
Sph: +6.00 to -6.00 (0.25 steps)
-6.50 to -8.00 (0.50 steps)
Add Power: Suitable for up to +1.25
60
0.16
Bausch + Lomb
PureVision
Multi-Focal
Monthly
8.6
14.0
36
Gp 3
0.09
Bausch + Lomb
SofLens Multi-Focal
Monthly
8.5,
8.8
14.5
Plano to –10.00 (0.25 steps)
+0.25 to +6.00 (0.25 steps)
Low Add: Progressive up to +1.50
High Add: Progressive +1.75 to +2.50
+6.00 to -10.00 (0.25 steps)
Low: Progressive up to +1.50
High: Progressive +1.75 to +2.50
38
Gp 1
0.10
8.2 to
9.2
(0.2
steps)
Aspheric
multifocal
centre near
design
Made to order. Spherical and toric
powers available.
BVP deduced empirically based on
patient's ocular Rx
38
49 G
0.08
74
0.08
Lens type
Capricornia Contact
Lens
SA lens*
Conventional
32 CONTACT LENSES 2012
Notes
Balanced Progressive Technology. All
day comfort. Centre distance & centre
near design. Blue handling tint. Mid
blue, mid green & mid aqua tints
available.
Centre spherical distance zone with
progressive aspheric zone for excellent
intermediate & near vision.
Blue handling tint.
Mid blue, mid green & mid aqua tints
available.
Silicone hydrogel.
Suitable for daily wear or up to 30 days
continuous wear. Advanced aspheric
centre near design. Visibility tint.
Advanced aspheric centre near design.
Daily wear.
Must provide K readings and spec Rx
with order. Note: vials show apical
(near) power.
Available in non-plasma coated silicone
hydrogel material.
soft contact lenses
MULTIFOCAL SOFT (continued)
Capricornia Contact
Lens - Eycon
Prescription Bifocal
E-38
E-48
E-58
Made
to
order
Made to order.
Concentric
distance centre
+25.00 to -25.00
Up to +3.00 Add
Contact Lens Centre
Australia
Bifocal
Conventional
Made
to
order
Made to order
Made to order sphere and toric
powers
38
45 G
60
70
0.08
Supply spec Rx and K readings.
Tinting available.
CooperVision
Bifocal
Conventional
Made
to
order
Made to order
Multifocal
distance centre
Made to order sphere and toric
(any power, cyl, axis and add)
38
58
59
0.06
Available in Proclear material.
Daily
8.7
14.2
Sph: +6.00 to -6.00 (0.25 steps)
-6.50 to -10.00 (0.50 steps)
Add Power: Up to +2.50
60
0.09
Centre near aspheric design, single
power profile, near boost in the nondominant eye. Naturally resists
dehydration – beneficial for agerelated dryness.
CooperVision
Proclear Multifocal
Monthly
8.7
14.4
62
Gp 2
0.16
Balanced. Progressive tech. All day
comfort. Centre distance and centre
near design.
CooperVision
Proclear Multifocal XR
Monthly
8.4
8.7
14.4
Made
to
order
Made to order
Multifocal
distance centre
Sph: +6.00 to -6.00 (0.25 steps)
-6.50 to -8.00 (0.50 steps)
Add Power: +1.00, +1.50, +2.00,
+2.50
Design: D, N
Sph: +6.50 to +15.00 (0.50 steps)
-8.50 to -15.00 (0.50 steps)
Add Power: +1.00, +1.50, +2.00,
+2.50, +3.00, +3.50
Design: D, N
Made to order sphere and toric
(any power, cyl, axis and add)
Made
to
order
Made to order
Multifocal
distance centre
8.0 to
9.2
(0.03
steps)
8.5
CooperVision Proclear
1 day multifocal
Yearly
CooperVision
Proclear Multifocal
Conventional
CooperVision
Proclear Multifocal
3-monthly
Gelflex Triton
Translating Bifocal
Conventional
Johnson & Johnson
Acuvue Bifocal
Disposable 2-Weekly
38 Gp 1
48 Gp 1
58 Gp 2
0.11
0.11
0.15
59
Balanced. Progressive tech. All day
comfort. Centre distance and centre
near design.
59
0.16
Balanced. Progressive tech. All day
comfort. Centre distance and centre
near design.
Made to order sphere and toric
(any power, cyl, axis and add)
59
0.16
Balanced. Progressive tech. All day
comfort. Centre distance and centre
near design.
15.0/13.4
14.5/13.4
Made to order
Power ±10.00 (0.25 steps)
±10.50 to ±10.00 (0.50 steps)
Cyls: to 4.00
Axis: Any
Reading: Add to +4.00
55, 49
0.10
Fitting using Triton fitting set to
obtain correct seg position.
14.2
Multiconcentric
centre distance
+6.00 to -9.00 (0.25 steps)
Add: +1.00 to +2.50 (0.50 steps)
58
Gp 4
0.075
‘123’ inside-out mark. Visibility tint.
Class 2 UV blocking (FDA) 82%
UVA, 97% UVB.
*Contact Lens Centre Australia tints: blue, green, aqua, brown, amber and violet. Specify density and HVID.
*Capricornia Contact Lens tints: blue, green, aqua, brown, violet, amber and grey. Ultralight, light, medium or dark. Stipulate HVID.
CONVENTIONAL SPHERICAL SOFT (12 month replacement interval recommended)
BOZR
Diameter
Power range (D)
(Lenses are in 0.25 steps between
-6.00 & +4.00 & 0.50 steps outside this
range, except where noted)
% H2O
Thickness
at -3.00
Australian Contact
Lenses ST*
Made to
order
(0.2 steps)
Made to
order
(0.5 steps)
Made to order
38/55/
45G/55G
0.07
Mean K +0.6. Tints available.
Australian Contact
Lenses HM*
Made to
order
(0.2 steps)
Made to
order
(0.5 steps)
Made to order
38
0.12
Mean K +0.8. Tints available.
Capricornia Contact Lens
Omega*
Made to
order
(0.2 steps)
Made to
order
(0.5 steps)
Made to order
38/58/67
49G
0.06
Flat K +0.8
Capricornia Contact Lens
KeraSoft
Series: A
(steeper)
B (median)
C (flatter)
14.5
(std)
14.0
15.0
Made to order
58
Gp 2
Capricornia Contact Lens
-Eycon Prescription
Spherical
E-38
E-48
E-58
Any
Any
+25.00 to -25.00 (0.25 steps)
Capricornia Contact Lens
–Eycon
Visual Eyes
8.2, 8.4, 8.6
8.4, 8.7, 9.0
13.50
14.00
Contact Lens Centre
Australia
CLCA Custom Spheres*
SoftK Sph
Made to
order
CooperVision
Proclear Custom
CooperVision
Custom Sphere
Lens type
Notes
Fit with plano trial lenses.
Available in non-plasma coated
Silicone hydrogel material.
74
38 Gp 1
48 Gp 1
58 Gp 2
0.11
0.11
0.15
Also available in thin design, bifocal
and various tint colours.
Flat K +10%.
Custom tints available.
Available in non-plasma coated
Silicone hydrogel material.
74
0.11
-1.00 to -7.00 (0.25 steps)
-7.50 to -9.00 (0.50 steps)
38
0.11
Flat K +10%.
Various tint colours.
All tint colours available.
Made to
order
Made to order
Benz
38/45G/58
Biogel
60/70/80
Igel
67
0.06
Standard tinting available. Opaque
tinting also available.
Made to
order
Made to
order
Made to order
59
0.07
Available in Proclear material.
Made to
order
Made to
order
Made to order
38/58/67
0.07
33
CONTACT LENSES 2012
contact lenses soft
CONVENTIONAL SPHERICAL SOFT (continued)
CooperVision
Zero6 stock
8.1, 8.4, 8.7,
9.0
13.5, 14.0
-10.00 to +8.00 (0.25 steps)
38
0.06
Available in softints (stock).
Gelflex Alpha*
8.0 to 9.0
(0.2 steps)
14.0, 14.5,
15.0
Plano to ±10.00 (0.25 steps)
±10.50 to ±20.00 (0.50 steps)
38
0.07
Flat K +0.9
Capricornia Contact
Lens Omega*
Made to
order
(0.2 steps)
Made to
order
(0.5 steps)
Made to order
38/58/67
49G
0.06
Flat K +0.8
Gelflex Delta*
8.0 to 9.2
(0.3 steps)
14.3, 14.8,
15.3
Plano to ±10.00 (0.25 steps)
±10.50 to ±20.00 (0.50 steps)
55
0.11
Flat K +0.9
Gelflex EWII
8.2 to 8.8
(0.2 steps)
14.0, 14.5,
15.0
Plano to ±10.00 (0.25 steps)
±10.50 to ±20.00 (0.50 steps)
71
0.12
Flat K +0.8. Clear only.
Gelflex Gamma
8.0 to 9.2
(0.3 steps)
14.3, 14.8,
15.3
Plano to ±10.00 (0.25 steps)
±10.50 to ±20.00 (0.50 steps)
49
0.11
Flat K +0.9. Blue handling tint only.
Gelflex Definitive
Hygel
8.0 to 9.2
(0.3 steps)
14.3, 14.8,
15.3
Plano to ±10.00 (0.25 steps)
±10.50 to ±15.00 (0.50 steps)
53
0.07
Flat K +0.6. Clear or blue handling tint.
Menicon Australia
Menicon Soft 72
8.1, 8.4
8.4, 8.7, 9.0
13.5
14.0
+25.00 to -25.00
72
0.15
Mean K + 0.8. Try 8.4 first. Visibility tint.
* Tints
ACL: blue, green, aqua, violet, brown and amber. Light, medium or dark. Stipulate HVID.
Capricornia Contact Lens: blue, green, aqua, brown, violet, amber and grey. Ultralight, light, medium or dark. Custom tinting: brown, amber, aqua,
yellow, grey, blue, green, violet, red, prosthetics, opaques, clear and black pupils. (Good quality digital photographs are essential for matching). Stipulate HVID.
Contact Lens Centre Australia: blue, green, aqua, amber and brown. Stipulate density and HVID. Clear pupil, black pupil and opaque colours also available.
Gelflex: Sky blue, Ocean blue, Chocolate brown, Caramel brown, Emerald green, Jade, blue, brown, green and grey. Handling: light, medium or dark. Stipulate
HVID.
CONVENTIONAL TORIC SOFT
BOZR
Diameter
Power range (D)
(Lenses are in 0.25 steps between
-6.00 & +4.00 & 0.50 steps outside
this range, except where noted)
% H2O
Thickness
at -3.00
Australian Contact
Lenses Toric*
Made to
order
Made to
order
Made to order
38/55/
45G/55G
0.07
Capricornia Contact
Lens
KeraSoft Toric
Series: A
(steeper)
B (median)
C (flatter)
14.5
(std)
14.0
15.0
Made to order
58
Gp 2
Capricornia Contact
Lens
Nutoric*
Made to
order
Made to
order
Made to order
38 Gp 1
49G Gp 1
58 Gp 2
67 Gp 2
Yearly
8.2, 8.4, 8.6
8.4, 8.7
13.5
14
Yearly
Any
Any
Sph: +10.00 to -10.00 (0.25 steps)
Cyl: -0.75 to -2.75 (0.25 steps)
Axis: Any
Sph: +25.00 to -25.00
Cyl: -0.50 to -7.00
Axis: Any
Yearly
Any
Any
Yearly
Any
Lens type
Frequency
Notes
Use HM for 38%. ST for other
materials. Markings: R–2 dots,
L–1 dot. Tints available.
Fit with plano trial lenses.
Available in non-plasma coated
silicone hydrogel material.
0.08
74
38
Fit with Omega sphere (diam. 2.5
mm > HVID). 5 laser marks 10° apart,
left lens has gap in the central mark.
Available in non-plasma coated
silicone hydrogel material.
0.11
Prismballast.
Flat K +10%
38 Gp 1
48 Gp 1
58 Gp 2
0.13
0.13
0.14
Also available in thin design.
Flat K +10%. Laser engravings std at
6 o’clock. Ink dot markings R-2 dots,
L-1 dots at 12 o’clock on request.
Sph: +25.00 to -25.00
Cyl: -0.50 to -6.00
Axis: Any
38 Gp 1
48 Gp 1
58 Gp 2
0.13
0.13
0.14
Also available in increased prism
design & thin design. Flat K +10%.
Laser markings std at 6 o’clock. Ink
dot markings R-2 dots, L-1 dots at 12
o’clock on request.
Any
Sph: +25.00 to -25.00
Cyl: -0.50 to -6.00
Axis: Any
38 Gp 1
48 Gp 1
58 Gp 2
0.10
0.10
0.10
Also available in thin design. Flat K
+10%. Laser markings std at 6
o’clock. Ink dot markings
R-2 dots, L-1 dots at 12 o’clock on
request.
Made to
order
Made to
order
Made to order
Benz
38/45G/58
Biogel
60/70/80
Igel
67
Essential
M/focal
48% only
0.8
Standard tinting available. Opaque
tinting also available. Lenses marked
at
6 o’clock unless otherwise requested.
Fitting instructions supplied for
essential multifocal fitting.
CooperVision
Proclear Custom Toric
Made to
order
Made to
order
Made to order
59
0.10
Proclear material
RP or CV Toric design.
CooperVision
Custom Toric
Made to
order
Made to
order
Made to order
38/58/67
0.10
RP or CV Toric design.
Gelflex Alpha Toric*
8.0 to 9.2
(0.3 steps)
14.5, 15.0
Custom made to order
(any power, cyl & axis)
38
0.10
Mean K +0.8.
R marked with one dot,
L marked with two dots.
Gelflex Delta Toric*
8.0 to 9.2
(0.3 steps)
14.3, 14.8,
15.3
Custom made to order
(any power, cyl & axis)
55
0.11
Mean K +0.9.
R marked with one dot,
L marked with two dots.
Capricornia Contact
Lens - Eycon Fastrack
Toric Semi-stock toric
Capricornia Contact
Lens - Eycon Balance
Toric
E-38
E-48
E-58
Capricornia Contact
Lens - Eycon
Prescription Toric
Prism Ballast
E-38
E-48
E-58
Capricornia Contact
Lens - Eycon
Prescription Toric
Toroptic (slab off
design)
E-38
E-48
E-58
Contact Lens Centre
Australia
Centra ST Toric
Centra ST Q Toric
Back Surface Toric
Front Surface Toric
Essential Multifocal
Toric
SoftK Toric
34 CONTACT LENSES 2012
soft contact lenses
CONVENTIONAL TORIC SOFT (continued)
Gelflex Definitive Hygel
Toric
8.0 to 9.2
(0.3 steps)
14.3, 14.8,
15.3
Custom made to order
(any power, cyl & axis)
53
0.08
Mean K +0.9
R marked with one dot,
L marked with two dots.
Clear or blue handling tint.
Menicon Australia
Menicon Soft 72 Toric
8.1 to 9.3
(0.3 steps)
(8.1/14.0
n/a)
13.0–14.0
(0.5 steps)
Sph: -1.50 to -8.00
Cyl -0.75 to -2.75 (0.50 steps)
Axis 0° to 180° (10° steps)
72
0.12
Approx. mean K +0.8
* Tints ACL: blue, green, aqua, violet, brown and amber. Light, medium or dark. Must stipulate HVID.
Capricornia Contact Lens: blue, green, aqua, brown, violet, amber and grey. Ultralight, light, medium or dark. Custom tinting: brown, amber, aqua, yellow, grey,
blue, green, violet, red, prosthetics, opaques, clear and black pupils. (Good quality digital photographs are essential for matching). Stipulate HVID.
Contact Lens Centre Australia: blue, green, aqua, brown and amber. Stipulate density and HVID. Also available in opaque.
Alcon: Optifit Color Toric colours baby blue, emerald green, aqua, hazel, sapphire blue, jade green, violet, misty grey, chestnut brown and baby blue
enhancer.
Gelflex: sky blue, blue, Chocolate brown, Caramel brown, Emerald green, Jade, blue, brown, green and grey. Handling: light, medium or dark. Must stipulate HVID.
COSMETIC TINTED DISPOSABLE
Lens type
Power range (D)
(Lenses are in 0.25 steps between
-6.00 & +4.00 & 0.50 steps outside
this range, except where noted)
+2.50 to +6.00 (0.50 steps)
+2.00 to -6.00 (0.25 steps)
-6.50 to -8.00 (0.50 steps)
And plano
% H2O
Group
Thickness
at -3.00
55
Gp 4
0.08
+2.50 to +6.00 (0.50 steps)
+2.00 to -6.00 (0.25 steps)
-6.50 to -8.00 (0.50 steps)
And plano
+2.50 to +6.00 (0.50 steps)
+2.00 to -6.00 (0.25 steps)
-6.50 to -8.00 (0.50 steps)
And plano
-0.50 to -6.00 (0.25 steps)
Plano
-0.50 to -6.00 (0.25 steps)
Plano
55
Gp 4
0.08
55
Gp 4
0.08
Available in Pacific Blue,
Sea Green and Carribean
Aqua.
69
Gp 2
69
Gp 2
0.10
Blue, green, pure hazel,
grey.
0.10
-0.25 to -6.00 (0.25)
-6.50 to -10.00 (0.50)
+0.25 to +5.00 (0.25)
+5.50 to +8.00 (0.50)
Sph: +6.00 to -8.00 (0.25 steps)
Cyl: -0.75, -1.25, -1.75, -2.25
Axis: 10° to 180° in 10° steps
Sph: +8.50 to -11.00 (0.25 steps)
Cyl:-0.75, -1.25, -1.75, -2.25,
-2.75, -3.25, -3.75
Axis: 5° to 180° in 5° steps
55
Gp 4
0.07
Asian eyes are given an
exotic lift thanks to the
appearance of a
surrounding limbal ring
which darkens and enlarges
the iris.
Black limbal ring
Tints: mid blue, green,
aqua.
55
Gp 4
0.07
Tints: mid blue, green,
aqua.
55
Gp 4
0.07
Tints: mid blue, green,
aqua.
14.2
-0.25 to -6.00 (0.25 steps)
-6.50 to -20.00 (0.50 steps)
+0.50 to +6.00 (0.25 steps)
+6.50 to +20.00 (0.50 steps)
62
Gp2
8.4
8.7
14.4
+20.50 to +30.00 (0.50 steps)
Monthly
8.8
14.4
Monthly
8.4
8.8
14.4
Sph: +6.00 to -6.00 (0.25 steps)
-6.50 to -8.00 (0.50 steps)
Cyl: -0.75, -1.25, -1.75, -2.25
Axis: 10° to 180° (10° steps)
Sph: +6.00 to -8.00 (0.25 steps)
Cyl: -2.75, -3.25, -3.75, -4.25, -4.75,
-5.25, -5.75
Monthly
8.6
14.2
Frequency
BOZR
Diameter
Alcon
Freshlook Colorblends
2-weekly
Median
14.5
Alcon
Freshlook Colors
2-weekly
Median
14.5
Alcon
Freshlook Dimensions
2-weekly
Median
14.5
Alcon
FreshLook One-Day
Alcon
FreshLook Illuminate
Daily
8.6
13.8
Daily
8.6
13.8
Australian Contact Lenses
Practitioner’s Own Brand
Spheres
Monthly
8.6
14.2
Australian Contact Lenses
Practitioner’s Own Brand
Torics
Australian Contact Lenses
Practitioner’s Own Brand
Torics Extended Range
Monthly
8.7
14.4
Monthly
8.7
14.4
Monthly
8.6
Monthly
8.8
ACL Private Label
MonthlyPro Spheres
ACL Private Label
MonthlyPro Spheres
MonthlyPro Toric
ACL Private Label
MonthlyPro Toric
Extended Range
Capricornia Contact Lens
FreshKon Colors Fusion &
Alluring Eyes
Available in True Sapphire,
Blue, Green, Brown, Grey,
Pure Hazel, Honey,
Turquoise, Brilliant Blue,
Gemstone Green and
Sterling Grey.
Available in Blue, Green,
Violet and Sapphire Blue
0.065
Extended Range
ACL Private Label
Notes
Axis: 5° to 180° (5° steps)
-10.00 to -6.50 (0.50 steps)
-6.00 to -0.50 (0.25 steps)
0.00 (plano)
Tints: mid blue, green,
aqua.
62
Gp 2
0.065
62
Gp2
0.11
Tints: mid blue, green,
aqua.
59
0.13
Tints: mid blue, green,
aqua.
55
Gp 4
0.07
Available in Perky brown,
Groovy green, Sky blue,
Baby aqua, Hippie chestnut,
Warm hazel, Misty grey,
Romantic violet, Cool
green, Winsome brown &
Mystical black (Alluring
Eyes)
Tints: mid blue, green,
aqua.
35
CONTACT LENSES 2012
contact lenses soft
COSMETIC TINTED DISPOSABLE (continued)
Johnson & Johnson
1-Day Acuvue Define
Gelflex Ningaloo Coloured
Lenses
Daily
disposable
8.5
14.2
Plano
-0.50 to -6.00 (0.25 steps)
-6.50 to -12.00 (0.50 steps)
58
0.08
2-weekly
8.6
14.3
-0.50 to -6.00 (0.25 steps)
-6.50 to -10.00 (0.5 steps)
+0.50 to +6.00 (0.50 steps)
55%
Gp 4
0.08
Accent and Vivid styles
Dark limbal ring that enlarges
iris diameter
Class 2 UV blocking (FDA)
82% UVA, 97% UVB.
Made in Australia. Ultra
comfort design. UV filter.
Colours – 2 tone and 3 tone.
Bay blue, Summer hazel,
Pearly grey, Sea green, Beach
bronze.
Note that Bausch + Lomb’s Optima Colours are opaque tinted lenses, so special conditions and prices apply.
COSMETIC TINTED CONVENTIONAL
Frequency
BOZR
Diameter
Power range (D)
(Lenses are in 0.25 steps between
-6.00 & +4.00 & 0.50 steps outside
this range, except where noted)
% H20
Group
Thickness
at -3.00
Notes
Yearly
Any
Any
Sphere & toric
Torics also available in Balance
design.
38
Gp 1
0.11 (std)
0.06 (thin)
EyColours: green, blue, baby blue,
chestnut brown, emerald green, grey,
hazel, sapphire blue, violet, aqua,
jade green & misty grey.
EyColourBlends: blue, brown, grey,
green, amethyst, honey & turquoise.
Contact Lens
Centre Australia
CLCA Colours
Any
Any
Sphere and toric made to order
Benz
38/45G/58
Biogel
60/70/80
Igel
67
0.06
Opaque: blue, green. aqua, amber &
brown. Special prices and conditions
apply.
Also available in transparent colours.
Black pupil & iris also available.
Gelflex Opaque
Tints
Any
14.3, 14.8,
15.3
Plano to -8.00
38
55
0.12
Opaque tints. Special conditions and
prices apply.
Lens type
Capricornia
Contact Lens
Eycon
EyColours &
EyColourBlends
SPECIALITY
Lens type
Frequency
BOZR
Diameter
Capricornia Contact Lens
Eycon Prosthetic
EyColour and
EyColourBlends
Yearly
Any
(8.6 std)
Any
(14.3 std)
Capricornia Contact Lens
Eycon E-58 Therapeutic
Yearly
10.0
17.3
% H20
Thickness
at -3.00
Notes
+25.00 to -25.00
38
Gp 1
0.11
Colours: Jet black, black,
brown, hazel, grey.
ColourBlends: blue & green.
With or without black pupil (4
mm std).
Plano (therapeutic lens)
58
Gp 2
74
0.2
Bandage lens.
Available in non-plasma
coated silicone hydrogel
material.
Power range (D)
(Lenses are in 0.25 steps between
-6.00 & +4.00 & 0.50 steps outside
this range, except where noted)
HYDROGEL LENS MATERIALS SUMMARY
1. HEMA materials
• Benz 38, Igel 38. (ACL ST/HM, Capricornia Contact Lens Omega, NUTORIC
and SA, Gelflex Alpha,
Contamac 38—CooperVision, B+L Soflens 38, Alcon CibaSoft) 38%, Eycon
custom lenses 38%.
• Polymacon B (CooperVision ActiToric 43%)
2. Vinyl-pyrolidone materials
• Benz 55 (HEMA, NVP) ACL 55 sphere and toric.
• Igel 56. (HEMA, NVP).
• Alphafilcon A. (HEMA, NVP, 4-tertiary butyl-2-hydroxycyclohexyl
methacrylate) B&L Soflens 66/Toric. Toric is thicker.
• Hilafilcon-A. (HEMA, NVP) B+L Soflens one day 70%.
• Igel 58. (MMA, NVP) Capricornia Contact Lens Omega and NUTORIC,
CooperVision Contamac 258 & RP Toric.
• Hyper58 (NVP, MMA,) ACL—claimed as a water-retaining, deposit-resistant
material.
• Igel 67 (MMA, NVP) Capricornia Contact Lens Omega and NUTORIC,
CooperVision Contamac 267.
• CooperVision ActiFresh 400 (MMA, NVP) 73%, CooperVision ActiFresh 400
UV
• Vasurfilcon-A. (VP, MMA) Alcon Precision UV 74%.
• Menicon 72 (DMMA, NVP) Menicon Soft 72 and Toric 72. (DMMA =
N-dimethyl acrylamide).
3. Glyceryl Methacrylate materials
• Benz 45G (HEMA, GMA)- ACL, Eycon custom lenses.
Benz 49% (Hema-GMA) Gelflex. Capricornia Contact Lens Omega, NUTORIC
and SA
• Benz 55G (HEMA, GMA), Extreme H2O disposable lenses, Gelflex.
• Eycon E-58 (HEMA, GMA, MMA) - Eycon custom lenses.
Benz materials (45G, 55G) became available in custom lenses in the 1990s,
claiming lower dehydration.
4. HEMA and Methacrylic acid materials
• Ocufilcon D. ACL Practitioner own brand and Softview.
• Etafilcon A. Johnson and Johnson ACUVUE 1DAY MOIST, 1 DAY MOIST
FOR ASTIGMATISM, 1 DAY DEFINE, ACUVUE 2 and ACUVUE Bifocal
58% H2O
5. HEMA and Methyl Methacrylate
• Phemfilcon-A (HEMA, MMA) Alcon 55%, Freshlook ColorBlends ,
Freshlook Colors, and Freshlook Dimensions
36 CONTACT LENSES 2012
Gp II non-ionic material. Successful as an opaque tinted material.
Conventional and disposable lenses.
6. HEMA and phosphorylcholine
• Omafilcon A 62% and 59% —Proclear, CooperVision.
GP II Zwitterionic high water material. Low dehydration due to high
bound water.
7. Polyvinyl Alcohol materials
• Nelfilcon A. 69% Alcon Focus DAILIES, Freshlook One Day, and
Freshlook Illuminate.
Deposit resistant.
8. Silicone-hydrogel materials
• Lotrafilcon A. Alcon AIR OPTIX NIGHT & DAY AQUA. Non ionic. Plasma
surface treated. 24% H20, Dk/t 175 for -3.00 D
• Lotrafilcon B. Alcon Air Optix. Non ionic. Plasma surface treated. 33%
H20, Dk/t 138 for -3.00 D
• Balafilcon-A. (Silicone vinyl carbamate, NVP, siloxane crosslinker, vinyl
alanine wetting monomer) B+L PureVision. 36%.
• Senofilcon A. Johnson & Johnson ACUVUE Oasys with Hydraclear Plus
and ACUVUE Oasys for Astigmatism with Hydraclear Plus. 38% H2O
These are low water content and non-ionic or weakly ionic.
9. LWC Ionic (v. uncommon group of lenses)
• Bufilcon A.
Comment on MWC and HWC materials for custom lenses
ACL mainly Benz materials. 38/45G/55.
Contact Lens Centre Australia: Benz, Igel and Biogel materials.
CooperVision mainly Igel materials. 38/58/67.
Capricornia Contact Lens has both Contamac and Benz.
Gelflex MethafilconA and Polyhema materials made in Gelflex polymer
laboratory.
CooperVision 38 materials from Contamac.
CooperVision has Proclear material.
Polyquad
(polyquaternium-1
0.001%), Aldox
(myristamidopropyl
dimethlamine
0.0006%)
Citrate
Polyhexamethyle
ne biguanide
(.0001%)
Sodium
hyaluronate
Tetronic 904
Alcon
AQuify MPS
AMO
Blink Contacts
Eye Drops
AMO
RevitaLens
OcuTec MPDS
Tyloxapol,
Tromethamine
Sodium
hyaluronate
(lubricating
agent)
Alcon
AQuify
Comfort Drops
AMO
COMPLETE
Blink-N-Clean
Hydrogen
peroxide (3%)
Alcon
AOSEPT
PLUS
(Formerly
OPTI-FREE
EverMoist
MPDS)
Alcon
OPTI-FREE
PureMoist
MPDS
PHMB
( 0.0001%)
(Polyhexamethylene
biguanide)
Alexidine
dihydrochloride
0.00016%,
Polyquarternium-1
0.0003%
Ocupure (2%)
(oxychloro complex
sodium perborate)
Polyhexamethylene
biguanide
Preservative-free on
the eye (Sodium
perborate)
Preservative-free
Disodium edetate
(0.05%), Polyquad
(polyquaternium-1
0.001%)
Citrate
OPTI-FREE
Contacts
Rewetting
Drops
Alcon
Preservative(s)
Cleaning agent(s)
Solution type
CONTACT LENS SOLUTIONS
N/A
6 hours
N/A
Rub and rinse
with minimum
5 minutes soak or
4 hours/
overnight soak
N/A
Soak for a
minimum of
6 hours or
overnight
6 hours
N/A
Minimum
recommended
disinfection time
(MRDT)
30 days
30 days
N/A
14 days
30 days
Maximum
recommended
storage time
(MRST)
2 months
3 months
45 days
3 months
8 weeks
3 months
6 months
6 months
Shelf-life
once
opened
5 mL trial, 15 mL
2 x 300 mL+120 ml Value pack
with lens cases
300+120 mL Value Pack with
lens case
300 mL with lens case
120 mL with lens case
2 mL trial, 10 mL
Value Pack:2 x 360 mL, 90 mL
with 3 MicroBlock lens cases
Standard Size: 360 mL with
MicroBlock lens case,
Travel Size: 90 mL with
Microblock lens case,
10 mL
Value Pack: 2x 360 mL, 1x
90mL, 3x cup and disc
Standard Size: 360 mL (1 cup
and disc)
Starter Pack: 90 mL (1 cup and
disc).
Optometry Pack: 2 x 300 mL
plus 90 mL with 2 x lens case
Standard Pack: 300 mL with
lens case
Starter Kit: 60 mL trial with
lens case,
Travel Pack: 90 mL retail size
with lens case,
10 mL
Packaging
Abbott Medical Optics
Abbott Medical Optics
Abbott Medical Optics
Alcon/CIBA Vision
Alcon/CIBA Vision
Alcon/CIBA Vision
Alcon, Good Optical,
Jack Chapman
Alcon, Good Optical,
Jack Chapman
Supplier
Cleans and rewets contact lenses while you
wear them, built-in artificial tear lubricant,
suitable for soft contact lenses. Ideal for
extended wear lenses. Keep out of reach of
children; if irritation develops, discontinue use
and consult your eye care practitioner. Should
not replace normal contact lens cleaning regime
Cleans, rinses, disinfects, stores, removes lipids
and proteins and rewets
Suitable for all soft and hard contact lenses.
Lubricating eye-drop for fast relief of dry, tired
eyes associated with contact lens wear.
Advanced formulation, preservative-free in eye.
Unique MicroBlock anti-bacterial lens case,
specially formulated for silicone hydrogels.
Long-lasting comfort drops to relieve dryness.
Never place unneutralised AOSept Plus in the
eye; it will cause a burning sensation. Ideal for
patients who experience lens-related dryness or
irritation with other solutions or are sensitive to
added chemicals and preservatives.
Effective yet gentle formula that kills germs
Removes lipids and protein for clear vision
Provides 16 hours of moisture
Multipurpose disinfecting solution containing
HydraGlyde Moisture Matrix, a proprietary
formula that is specially designed to keep lenses
comfortable for the entire day.
Rewetting drop that refreshes lenses and helps
prevent protein build-up. For soft lenses,
including silicone hydrogel and gas permeable
contact lenses.
Special features and precautions
solutions contact lenses
CONTACT LENSES 2012
37
38 CONTACT LENSES 2012
Povidone
(lubricating
agent)
Silica gel
B+L ReNu
MultiPlus
Lubricating &
Rewetting
Drops
B+L Boston
Advance
Cleaning
Solution
30 mL
Proteolytic
enzyme &
glycerol
B+L Boston
Enzymatic
Cleaner
B+L Boston
Re-Wetting
Drops 10 mL
Polyaminopropyl
biguanide
(0.0005%),
Chlorhexidine
Glucomate
(0.003%0, EDTA
(0.05%)
B+L Boston
Advance
Conditioning
Solution
120 mL
Alkyl ether
sulphate
Poloxamine
(surfactant +
rewetting agent)
Poloxamine
(surfactant +
rewetting agent)
Hydranate
(for protein
removal)
B+L Renu
sensitive
B+L Renu
fresh
Poloxamine
(surfactant +
rewetting agent)
B+L Biotrue
Multipurpose
Solution
Sulfobetaine
(surfactant +
rewetting agent)
Tyloxapol,
Tromethamine
Hydrogen
peroxide
(3%)
AMO
Total Care 1
Formerly
Omnicare 1
Step
AMO
Oxysept
Edetate Disodium,
Chlorhexidine
gluconate
N/A
4 hours
4 hours
Polyaminopropyl
biguanide (0.0005%),
Chlorhexidine
glucomate (0.003%0,
EDTA (0.05%)
Preservative-free
Daily rub and
rinse
N/A
4 hours with a
gentle rub
formula
Rinse each side
of the lens for
5 seconds; soak
at least 4 hours
4 hours
4 hours
6 hours
Polyaminopropyl
biguanide (0.0005%),
Chlorhexidine
glucomate (0.003%0,
EDTA (0.05%)
Edetate disodium
(0.1%) and Sorbic
acid (0.1%)
Dymed (0.00005%)
(biguanide)
Dymed (0.0001%)
(biguanide)
Polyaminopropyl
biguanide (0.00013%)
and Polyquaternium
(0.0001%)
Polyhexamethylene
biguanide
(0.0001%)
Nil
CONTACT LENS SOLUTIONS (continued)
N/A
Overnight and
replaced daily
Overnight and
replaced daily
N/A
30 days
30 days
30 days
30 days
7 days
3 months
3 months
3 months
1 month
3 months
3 months
3 months
3 months
2 months
10 mL bottle/6 bottle pack,
Advance Comfort Formula
starter (see Advanced Cleaning
Solution)
2.4 mL bottle/6 bottle pack,
no starter pack
120 mL bottle/6 bottle pack,
Advance Comfort Formula
starter (see Advanced Cleaning
Solution)
30 mL bottle. Advance Comfort
Formula starter (5 mL ReWetting drops, 30 mL Advance
Conditioning Solution,
10 mL Advance Cleaning
Solution with lens case)
8 mL
Duo Pack with 120 ml, 355 ml
and lens case.
Starter kits (instructions, with
60ml with lens case)
Starter kit (instructions, 60 mL
with lens case),
120 mL, 355 mL, 500 mL, Value
Pack (2 x 355 mL, 120 mL with
lens case)
Value Pack (2 x 300 mL, 1 x
120 mL and 3 lens cases
Duo Pack (120 mL, 300 mL and
2 lens cases)
Starter kits (instructions with
120 mL and lens case)
120 mL with lens case
240 mL / 24 tabs with lens case,
3x240 mL / 72 tabs with lens
case
Bausch + Lomb, ACL,
Capricornia,
CooperVision, Gelflex,
Good Optical, Jack
Chapman
Bausch + Lomb, ACL,
Capricornia,
CooperVision, Gelflex,
Good Optical, Jack
Chapman
Bausch + Lomb, ACL,
Capricornia,
CooperVision, Gelflex,
Good Optical, Jack
Chapman
Bausch + Lomb, ACL,
Capricornia,
CooperVision, Gelflex,
Good Optical, Jack
Chapman
Bausch + Lomb
Bausch + Lomb
Bausch + Lomb, Good
Optical, Jack Chapman
Bausch + Lomb
Abbott Medical Optics
Abbott Medical Optics
Re-wets and lubricates RGP lenses in eye.
For weekly use with RGP contact lenses
For wetting, soaking & disinfecting RGP lenses,
do not use with tap water.
For cleaning of RGP lenses.
A lubricant that provides moisturising comfort
for optimal lens wear.
Cushion of moisture between your lenses and
your eyes. Exceptional disinfection.
Gentle formula for sensitive eyes.
PET clear bottle.
Fresh lens comfort all day long. Effectively
removes protein. Unsurpassed disinfection.
Previously known as Bausch + Lomb ReNu
MultiPlus MPS
PET Clear Bottle
Keeps certain beneficial tear proteins active
Uses a natural lubricant
Matches the pH of healthy tears
Multipurpose solution that works like the eyes
to make contact lens wearing easier, by
combining 3 bio-inspired innovations:
Multi purpose solution with built-in protein
remover and artificial tear lubricant, suitable for
all hard contact lenses.
Preservative free, built-in artificial tear
lubricant, neutralising tab with vitamin B12
colour indicator, patented lens case, suitable for
all soft contact lenses. Do not allow solution to
come in contact with eyes. Neutralise lenses and
rinse with saline prior to inserting them.
contact lenses solutions
Silica gel
Alkyl ether
sulphate
Polyhexmethylen
e biguanide
Polyhexmethylen
e biguanide
Sodium
hypochlorite
Active chlorine
B+L Boston
Advance
Cleaning
Solution
30 mL
Menicon
MeniCare Plus
Menicon
Menicare Soft
Menicon
Progent
Meni-LAB
Spray & Clean
Sodium olefine
Sufonate
Hydrogen
peroxide (3%)
B+L Renu
EasySept
0.5%
Poloxamine
B+L Boston
Simplus
Multi-Action
Solution
Preservative free
Preservative-free
Preservative-free
Polyhexmethylene
biguanide
Polyhexmethylene
biguanide
Polyaminopropyl
biguanide (0.0005%),
Chlorhexidine
glucomate (0.003%0,
EDTA (0.05%)
Preservative-free
Chlorhexidine
gluconate,
Polyaminopropyl
biguanide
CONTACT LENS SOLUTIONS (continued)
Rub clean daily
5 minutes
5 minutes
4 hours
5 minutes
Daily rub and
rinse
Soak for a
minimum of
6 hours or
overnight
4 hours
60 minutes
30 minutes
30 days
30 days
Overnight and
replaced daily
Overnight and
replaced daily
3 months
90 days
Single use
90 days
90 days
3 months
3 months
3 months
15ml
250 mL
7 treatments, starter includes 1
treatment and case for use
360 mL
250 mL with lens case, starter
50 mL with lens case
30 mL bottle/6 bottle pack,
Advance Comfort Formula
starter (5 mL Re-Wetting drops,
30 mL Advance Conditioning
Solution,
10 mL Advance Cleaning
Solution with lens case)
Optometry Pack (2 x 360 mL
with 2 lens cases)
Starter kit (120 ml & lens case)
120 mL bottle
Menicon
Menicon
Menicon
Menicon
Menicon
ACL, Bausch + Lomb,
Capricornia,
CooperVision, Gelflex,
Good Optical, Jack
Chapman
Bausch + Lomb
ACL, Bausch + Lomb,
Capricornia,
CooperVision, Gelflex,
Good Optical, Jack
Chapman
Daily surfactant cleaner for use with all RGP
lenses
Effective against: bacteria, yeasts and moulds,
viruses and amoeba
For disinfection of practitioner trial RGP lenses
including all ortho-K lenses.
Professional use only
For use with all RGP lenses, do not use with soft
lenses, rinse lenses well with MeniCare Plus or
saline prior to inserting in the eyes.
For use with all soft lenses. Do not use with
RGP lenses.
Do not use with soft lenses.
For cleaning of RGP lenses.
Powerful disinfection. Oxygen release action.
Preservative free.
Removes protein, cleans, disinfects, conditions,
cushions, rinses and wets RGP lenses. Do not
use with tap water.
solutions contact lenses
Soft and RGP lenses and solutions
ONLINE at
www.optometrists.asn.au
CONTACT LENSES 2012
39
contact lenses UV protection
Effects of ultraviolet-blocking contact lenses
M
Professor
James Wolffsohn
BSc PhD MCOptom
uch of the shorter wavelength UV light emitted
from the sun (UVC and UVB) is absorbed by
the atmosphere.1 Some UVB and UVA light makes it
to the ocular surface and is linked with anomalies,
the most familiar being pinguecula, pterygia and
carcinomas.2 The crystalline lens absorbs most of
the remaining UV light by adulthood and as a result,
UV is well recognised as a risk factor for cataract.3
Is the retina unaffected and what is the effect of
UV on presbyopia?
Little is known about the latter,4 although a
recent review highlighted the potential of UV light
to cause heat-induced denaturisation of proteins in
the crystalline lens, potentially reducing ability to
focus as well as cataract formation.5 In addition, a
high incidence of presbyopia has been reported to
occur at younger ages in countries with high levels
of UV.6 With respect to the retina, there are lots of
basic and epidemiological studies linking light and
in particular, short wavelength light, to the development of age-related macular degeneration.7,8,9
Macular pigment (MP, comprising lutein and
zeaxanthin) appears to have a density related
protective effect against AMD as it has a broadband absorbance spectra peaking at 460 nm.10,11
As an effective short wavelength filter, any reduction in macular pigment optical density (MPOD)
level is likely to increase the risk of AMD development.12,13,14 MPOD has been found to respond
within three to six months to vitamin supplements
and blue-blocking intraocular lenses,15,16 and is a
useful surrogate to AMD development.17 Although
only small amounts of UV reach the retina, it has
been shown that short wavelengths of light have
a far more damaging photochemical effect on the
retina than long wavelengths and the shorter the
wavelength, the greater the likelihood of retinal
damage.18
Sunglasses
References are available
from j.megahan@optometrists.asn.au, subject: UV
contact lenses, 2012.
40 CONTACT LENSES 2012
Australia has a great record in promoting sun protection but UV exposure to the eyes is more strongly
related to the solar angle in the sky than time of day
(with low angles being worst due to the protection
afforded to the eyes of the eyebrows and eyelids.19
Sunglasses often do not provide adequate protection
as they are usually worn for limited periods and
are often removed when it is cloudy, but UV can
penetrate cloud and there is a danger to the eyes for
most of the day, and sunglasses dilate the pupils.
Also, most sunglass designs allow light around
the periphery, which is focused by the optics of the
eye (termed the ‘peripheral light focusing effect’),
magnifying the effect on the nasal cornea/limbus
by about 22 times and the nasal crystalline lens
by about 8 times.20 Therefore, the publicised UV
index is misleading with respect to ocular damage.
Soft contact lenses with UV blocking help protect
from transmission of UV radiation to the covered
structures of the eyes.
Study of UV-blocking contact lenses
The aim of a recent retrospective study reported at
the British Contact Lens Association conference in
Birmingham, UK21 was to examine the long-term
(over about five or more years) protective effect of
UV-filtering contact lenses on macular pigment and
accommodative function.
Forty pre-presbyopic patients (18 to 43 years old)
who had worn contact lenses for at least about five
years were recruited. Twenty wore UV-blocking
contact lenses and the 20 controls wore a contact
lens material with minimal UV-blocking properties
over a similar period.
The patients were selected across the range of ages
from 18 to 42 years so that the cohorts of subjects
who had worn UV-blocking or non UV-blocking
contact lenses were matched for age, gender, race,
body mass index, diet, lifestyle, UV exposure,
­refractive error and visual acuity.
The results showed no statistical difference in
ocular health, amplitude of accommodation, range
of clear focus and objective stimulus response curve
in eyes that had worn UV-blocking contact lenses
compared to the controls. However, subjects who
had worn UV-blocking contact lenses consistently
showed a higher accommodative response (by a
quarter of a dioptre on average), a shorter accommodative latency and a faster accommodative
increase and relaxation.
MPOD was statistically significantly greater in
eyes that had worn UV-blocking contact lenses
compared to eyes that had worn non UV-blocking
contact lenses. It appears that blocking the transmission of UV through a contact lens is beneficial in
maintaining macular pigment density. There is also
an indication that accommodation may be affected.
Eye-care professionals have a public health obligation to warn patients about the risks of UV to the
eyes and how the risk does not occur just in clear
conditions in the middle of the day. UV-blocking contact lenses should be considered alongside sunglasses
and a wide-brimmed hat, especially if any sunglasses
worn are not wrap-around in design.
Professor James Wolffsohn is a former president of the
British Contact Lens Association and held a clinical and
research position at the Victorian College of Optometry in
1997-2000. He is now Deputy Executive Dean for Life and
Health Sciences at Aston University.
mini-scleral contact lenses
Concentric bifocal for keratoconus and IOL subluxation
Blunt trauma, IOL subluxation and glaucoma were some of the
factors to be considered in managing this patient
CASE REPORT
P
L is a 31-year-old Maori male security officer
who was referred for a contact lens fitting from
a tertiary eye hospital.
Previous ocular history includes long-standing
moderate central keratoconus (Figure 1); blunt
trauma to the left eye from a fireworks accident,
leading to cataract and subsequent IOL circa 1998;
enthusiastic eye rubbing, leading to subluxing
the intraocular lens (IOL) in the left eye in 2011;
glaucoma in the left eye (Travatan gtt nocte) with
RNFL loss, optic nerve head (ONH) cupping and
arcuate visual field loss, central corneal thickness
of R 376 µm and L 395 µm, and IOP 8 mmHg OU.
He is on the public waiting list for the IOL in the
left eye. He has been instructed to modify systemic
surgical risk factors and lose weight before being
considered for another IOL operation. He is 193
centimetres tall, has recently lost 50 kilograms and
now weighs 180 kilograms.
Horizontal visible iris diameter (HVID) is 12.35
mm and has a wide vertical aperture with significant
white at 6 am in both eyes. The patent was fitted
in New Zealand for contact lenses but he has not
worn them for several years as they kept falling out.
Best corrected visual acuity in spectacles does not
allow him to drive a car and is a vocational limiting
R 6/24 and L 6/38.
Due to the nature of his left eye and his security
work where he has to read ID cards at night, it was
decided to place a concentric bifocal on the front
surface on a well-centred mini-scleral RGP with a
+2.00 D Add. The final apical corneal clearance
after at least 4/24 of contact lens wear is R 170
µm and L 255 µm.
Final parameters in a Gelflex mini-scleral design
in Harmony Plus material and vision are:
Mark Hinds
BScApp(Optom)
P/GCertOcTher
BScApp(HMS) P/G
BScHons
R 8.40/14.50/12.50/18.50/-5.00 Add+2.00 (CT
200 µm)(Sag 5256 µm)
VA 6/12 & n5
L 8.00/13.75/12.50/18.50/-5.25 Add+2.00 (CT
200 µm)(Sag 5385 µm)
VA 6/12+ & n5.
Figure 1. Topography with chord of corneal ectasia diameter highlighted
Figure 2. Mislocated intraocular lens in the left
eye under mini-scleral RGP
41
CONTACT LENSES 2012
contact lenses multifocal
Three experienced prescribers share their views
F
Professional affairs
­manager, Alcon Australia
Overall
Australia
UK
75
% Fittings to females
Lauren Richard
BOptom(Hons) UNSW
inance journalist Alan Kohler often finishes
the ABC news comparing two sets of financial
figures to show a simple but powerful truth. In
Kohler style, here are two sets of data to show the
opportunity for multifocal contact lenses in Australia. Looking at the average age and gender of a
contact lens wearer, compared to other developed
markets, Australian optometrists fit older patients
(average 35.2 years) and more females.1
With those demographics, you would expect
a higher proportion of presbyopic contact lens
prescriptions, but compared to the USA market,
Australian optometrists fit fewer presbyopic contact
lenses overall, and for the majority of presbyopic
fittings, they choose monovision over multifocal
designs (Figures 1 and 2).1
Most of this is probably habit. It is easy to adjust
an early presbyope’s contact lens prescription to
monovision and for a long time we had few other
options, but with the multifocal contact lens technologies now available, easier fittings and higher
success rates, we can offer presbyopic patients a
more natural and fuller range of binocular vision. A
study by Woods and colleagues2 showed Air O
­ ptix
Aqua Multifocal outperforms monovision for intermediate and distance vision and for real-world
tasks like driving and viewing television.
The three Add powers of Air Optix Aqua Multifocal give practitioners a soft entry-level lens for
younger patients and options to retain patients as
they transition through presbyopia. Every day, we
see patients who are not yet ready psychologically
to use spectacles or over-specs, but need extra visual
clarity at near and relief from the eye strain they
are starting to experience, and for these patients
the low Add is ideal.
The prescribing data from the USA show the
potential for multifocal contact lenses and in the
practitioner perspectives below, you will see how
you can provide real world differences to your
patients.
USA
65
55
25
30
35
40
Mean age (years)
Figure 1. Average age and gender for patients
fitted with contact lenses in Australia, UK and
USA versus data from 29 countries, showing
Australian wearers are more likely to be older
females. Adapted from Morgan and co-authors, 2011.1
It is more important that with multifocals you give
presbyopes back their full range of vision, not just
the small print, but the newspaper, the computer,
the iPad, the blackboard specials, the car in front.
They don’t need 6/6. They need great functional
vision.
CLARK: Monovision is a quick fix. It’s very easy to
give +0.75 in the non-dominant eye and it works for
a while, but as the Add goes up, the non-dominant
eye becomes blurry in the distance and it leads to
drop-out. Long term, a multifocal is much better.
With a choice of Adds you can tailor the prescription to match the natural transition of the eye.
SANDLER: I’d rather not fit monovision contact
lenses, as I don’t think they are as effective as
multifocal contact lenses. The patient loses depth
perception and prescribing multifocal lenses is
perceived by the patient as being more advanced.
Which patients suit multifocals?
CLARK: I recommend all patients to have a mul-
JOSHUA CLARK, Granata Eyecare, Hornsby NSW
HELEN GLEAVE, Professional Training Manager,
Alcon
HILTON SANDLER, OPSM, Chatswood NSW
What are the advantages of multifocal contact
lenses over monovision?
GLEAVE: It’s all about the vision. One of the ad-
vantages of prescribing multifocal contact lenses
is that you can think about the progression of the
patient through the different stages of presbyopia.
42 CONTACT LENSES 2012
tifocal trial and more than half accept. I think they
work best in low hyperopes, because uncorrected,
they are blurred at all distances. With low myopes
and emmetropes I take a few extra minutes to explain the design of the lens in more detail and to
set their expectations at a realistic level.
SANDLER: I fit a lot of multifocals and get fairly
equal performance with hyperopes and myopes. It
is personality and prescription driven. Forget about
the engineers and the pedantic types and take more
care with low prescriptions.
multifocal contact lenses
patient to understand that multifocal contact lenses
are not about performance on the acuity chart, but
about day-to-day functionality. I think you need to
be confident in your own fitting ability and build
patient confidence and trust in you.
CLARK: I say the vision is a bit softer for distance
and near, but in terms of lifestyle it works for
­everyday tasks. I keep it practical and take patients
outside of the consulting room to show them the
real world vision.
How do you explain the lens design?
SANDLER: I show patients a simple diagram of
near, a computer, and distance and use that to
explain simultaneous vision. Once the patient
sees that, they can understand how I balance the
prescription depending on their own vision requirements.
GLEAVE: I show patients the centre-near design
and tell them when they read at near the pupil
naturally closes down over the central reading
zone. Patients then quickly understand the benefit
of increasing light for reading.
How do you select the initial prescription?
GLEAVE: Most practitioners know the value of the
fitting guides. They are specific to each multifocal
lens design and based on experience with hundreds
of patients, so will give the best chance of success.
For the Air Optix Aqua Multifocal you want to
push the plus in the distance and err on the low
side with the Add.
CLARK: You need to understand what the patient
does with their eyes, so you know if they are predominantly working at distance, near or computer.
For the majority, it is computer. Dominance is also
important and the majority will want the distance
eye as dominant. Occasionally, it might work to
make the dominant eye for computer.
SANDLER: First assessment I reduce the light
down to decrease the depth of focus. It reduces the
initial blur at distance, so you can build confidence
quickly. If the patient wants more reading, I add
distance plus to the non-dominant eye. If they want
more distance, I fine-tune the distance prescription,
usually reducing plus. The Air Optix Aqua Multifocal centre-near design is simple. There is not much
you have to do to get it right.
How do you explain adaptation?
SANDLER: I explain the adaptation before the
fitting, but again I think it comes down to how
confidently you come across. If patients go looking
for the blur, they will see it and that is where patient
selection is key.
CLARK: When vision is good, I don’t go into it. If
near vision is down, I spend some time explaining
the lens design, but still mainly focus on getting the
patient out of the consulting room to experience the
lens in the real world.
GLEAVE: A common mistake is assessing the lens
too quickly. Practitioners will put the lens on and
if the patient says they are getting ghosting, they
disregard it. Ghosting is normal and if you send the
patient for a short walk outside of the consulting
room, they usually return with some adaptation already underway. Always advise the patient to wear
the lenses as early as possible in the day, as I have
found this speeds adaptation. It is better to leave
the fine-tuning of the prescription to the follow-up
appointment in one to two weeks.
How do you troubleshoot vision?
GLEAVE: At the first after-care, if the patient
needs more help at near, increasing plus in the
distance is easier to accept than looking through a
higher Add. I find great success with adding a small
amount of plus to the distance prescription in the
non-dominant eye.
SANDLER: I try to keep it simple. I give patients
the contact lenses, a set of +1.00 readers and don’t
dwell on the fine-tuning aspect too much.
CLARK: It is also important to tell patients their
eyes will continue to change with age. When their
vision does eventually change, they remember what
you said and understand it is their eyes and not due
to the contact lenses.
Continued page 44
80
Multifocal
Monovision
70
% Presbyopic fittings
How do you set patient expectations with
multifocals?
SANDLER: The most important point is for the
60
13
50
45
40
48
30
20
10
0
25
USA
Australia
Figure 2. Percentage of presbyopic contact lens fittings
showing differences in presbyopic and multifocal contact
lenses in Australia versus USA
Adapted from Morgan and co-authors, 2011.1
43
CONTACT LENSES 2012
contact lenses mini-scleral
Experienced prescribers
share their views
From page 43
Vault and protect the
cornea with stability
I
How can you get started with multifocals?
GLEAVE: For many new presbyopes who have
never worn a correction, hearing about an alternative to full-time spectacle wear will be a great
relief. Targeting these low Add patients who need
less coaching through the adaptation period gives
you a chance to learn how a multifocal lens works
and how you want to talk to patients.
SANDLER: Be confident. Tell patients what the
multifocal lens can do and that they might need
a pair of readers for the restaurant or for very
small print. If you set the patient up with the right
­expectations, they will be very happy.
Breaking old habits may not be so difficult after
all. Fitting emerging presbyopes with multifocal
contact lenses provides better depth perception,3
intermediate vision4 and night driving2 than monovision and the limitations with monovision only
worsen as the patient’s Add increases.5,6 A small
investment in time up front not only sets your
patient up to wear contact lenses longer-term, but
also decreases your likelihood of having to solve a
problem later.
The Air Optix Aqua Multifocal precision profile
design has a smooth transition between the near
intermediate and far zones of the lens. All three Add
designs offer a smooth transition from the centre
near zone. The lenses provide a consistent Add effect, regardless of the patient’s distance prescription,
resulting in predictable clinical results with efficient
chair time. Air Optix Aqua Multifocal lenses are
made of the same breathable (Dk/t 138 @ -3.00
DS), deposit-resistant lotrafilcon B material as the
Air Optix Aqua single vision lenses.
1. Morgan et al. International contact lens prescribing in
2011. Contact Lens Spectrum 2012; 27: 26-32.
2. Woods J, Woods CA, Fonn D. Early symptomatic presbyopes: What correction modality works best? Eye Contact
Lens 2009; 5: 221-226.
3. Gupta N, Naroo SA, Wolffsohn JS. Visual comparison
of multifocal contact lenses to monovision. Optom Vis
Sci 2009; 86: E98-E105.
4. Situ P, Du Toit R, Fonn D, Simpson T. Successful monovision contact lens wearers refitted with bifocal contact
lenses. Eye Contact Lens 2003; 29: 181-184.
5. Jain S, Arora I, Azar DT. Success of monovision in presbyopes: review of the literature and potential applications to
refractive surgery. Surv Ophthalmol 1996; 40: 491-499.
6. Bennett E. Contact lens correction of presbyopia. Clin
Exp Optom 2008; 91: 3: 265-278.
44 CONTACT LENSES 2012
Russell Lowe
BScOptom FAAO
nterest in large diameter rigid gas permeable
lenses has risen rapidly due to technological
advances in design, fitting, analysis, manufacture
and modification.
Although there is some confusion and debate over
the nomenclature, mini-scleral lenses are generally
defined as lenses that have a total diameter ranging
from 13 to 16 mm.
Mini-sclerals offer two crucial advantages over
conventional RGPs. They have the potential to completely vault the cornea and land on the adjacent
limbal conjunctiva; and after settling, they display
little or no blink-induced movement. The corneal
surface is protected from mechanical or chemical
trauma and when bathed in a physiological solution
with adequate oxygen perfusion, a highly desirable
chamber environment is established.
Min-scleral lenses have been used in the treatment
of end-stage dry eye (DE) syndrome for many years
with life changing benefits, most notably pain relief.
The inherent comfort and ready patient acceptance of well-fitted mini-scleral lenses allow monocular treatment of keratoconus in cases in which
the corneal topography demonstrates significant
asymmetry in only one eye.
Mini-sclerals are also indicated for patients who
experience difficulty tolerating corneal lenses. The
larger optic zone diameter may be beneficial for
patients with large pupils.
NormalEyes 15.5
The recently-released NormalEyes 15.5 design
from Paragon Vision Sciences has several important
attributes that differentiate the product. Manufactured in Paragon’s HDS100 material with Dk of
100, the thin profile of the design and avoidance
of thick junction zones result in a lens with high
oxygen transmissibility.
The NormalEyes full diagnostic set comprises 72
lenses covering a wide range of parameter combinations so that fittings may be finalised without
extensive guesswork and extrapolation, minimising
the need for reorders. A 21-lens starter set will also
be available.
The NormalEyes design features three independent zones across the lens, intended to make fitting
relatively simple, with a minimum impost on chair
time. The lens is fitted from the periphery to the
centre, with each zone capable of manipulation
by the practitioner. The three key fitting variables
closely resemble those of the Paragon CRT system
for corneal reshaping: the base curve (BC), the
reverse zone depth (RZD) and the landing zone
angle (LZA).
mini-scleral contact lenses
Figure 1
Figure 2
One patient has corrected vision restored in one eye,
another patient finds relief from dry eye.
Base curve selection is ideally 0.1 mm flatter
than the flat K but this value is not critical. The
fitting set covers a range from 6.60 to 9.00 mm in
0.4 mm steps.
The RZD features a patented sigmoid curve in the
return zone to allow precise control of the sagittal
depth in 50 µm increments. When fully settled, the
lens is intended to clear the apex of the cornea by
at least 30 µm.
The landing zone has a Paragon CRT Dual Axis
feature with a deep meridian and a shallow meridian. The landing zone angle of the deep meridian
is a standard four degrees greater than the shallow
meridian to account for a near universal elevation
difference found in the sclera at a chord of about
13.0 mm. This feature produces a lens that is rotationally stable, allowing a front surface cylinder to
be prescribed in the event of residual astigmatism.
CASE REPORT
RC is a 58-year-old male with advanced keratoconic
ectasia of the right eye and a clear corneal graft
on the left. He developed a central nebula on the
right cornea following a small superficial abrasion
while gardening. The elevated lesion prevented him
from wearing an RGP lens, rendering the right eye
effectively non-functional.
For years, RC managed extremely well with an
‘off-label’ correction of his left post-graft eye using
a highly customised Paragon CRT reverse geometry
lens for daily wear that resulted in BCVA of 6/5.
With the advent of NormalEyes 15.5 it was
agreed to attempt another right eye correction.
Having access to a large number of trial lenses with
a range of RZD values expedited the fitting.
After determining the optimal landing zone angle,
the sagittal depth was increased by adjustment of
the RZD until adequate clearance of the nodule
was observed using parallel pipette biomicroscopy,
allowing for an additional 100 µm of conjunctival
compression that inevitably occurs with lens settling (Figure 1).
The base curve was selected using data from the
corneal topography elevation map. BCVA of 6/6 was
achieved despite the small central opacity. At four
weeks, RC was slowly developing proficiency with
the new requirements for lens handling and he was
delighted with the overall improvement in vision.
CASE REPORT
SB is a 29-year-old female medical practitioner with
a history of long-standing severe dry eye who was
referred to our clinic after moving to Melbourne
from Brisbane. Previous treatments included the full
gamut of tear supplements, eyelid therapy, punctal
occlusion and nutrition with limited success.
Biomicroscopy revealed minimal corneal staining, some limbal and bulbar conjunctival redness
and virtually absent inferior tear prisms with little
difference between right and left eyes.
We agreed to attempt simple management of
her ocular surface symptomatology with bandage NormalEyes mini-scleral lens fitting, allowing simultaneous correction of her low ATR
astigmatism.
The fitting itself was unremarkable (Figure 2)
but due to her overtly sensitive ocular surface, SB
found the process of lens application challenging
and needed a number of lengthy training sessions.
Without the coaching and encouragement of my
skilled technician, SB may not have realised the ocular comfort that she now enjoys every day.
45
CONTACT LENSES 2012
contact lenses material
Are we better off if our only choice is a
silicone hydrogel material?
T
Gregory W DeNaeyer
OD FAAO
References are available
from j.megahan@optometrists.asn.au, subject: Silicon hydrogel, 2012.
46 CONTACT LENSES 2012
here has been no better time in history to be a
contact lens practitioner. The lens designs and
modalities that are currently available provide
practitioners with unprecedented options that they
can offer their contact lens patients. In the past
two decades, the contact lens industry has moved
towards frequent-replacement soft contact lenses
instead of conventional quarterly or annual replacement hydrogels for the correction of ametropia and
presbyopia.
The current trend within the soft lens arena is the
accelerating global shift from the use of hydrogel to
silicone hydrogels lenses (SiHy) as lens material of
choice by eye-care practitioners.1 Silicone hydrogel
lenses were introduced in 1999 for extended wear
and continuous wear with the promise of having
fewer complication rates, particularly microbial
keratitis, based on the fact that SiHy lenses have
oxygen transmissibility that in some cases is four
to five times higher than that of typically available
hydrogel lenses.
In reality, most of us chose to use SiHy lenses
for daily wear regardless of these safety and health
promises. Now we see SiHy materials slowly penetrating even the daily disposable lens segment. What
has 12 years of clinical experience with SiHy lenses
taught us about their ability to meet the promise of
a safer lens wearing experience?
Many practitioners soon learned through direct
experience that continuous wear was not safer
with SiHy lenses with respect to microbial keratitis.
These observations were validated in large-scale
epidemiological studies.2,3,4 Having a proven safety
benefit over typical hydrogel lenses, particularly
for daily wear, the SiHy market has continued its
rapid growth, and as pointed out by Nathan Efron
and colleagues on page 3 in this issue of Contact
Lenses, SiHy lenses represent 68 per cent of the new
lens fittings in Australia. In the United States, the
number is 73 per cent.5 If this trend continues, it
is obvious that in the not too distant future, SiHy
lenses could be near 100 per cent of soft contact lens
new fittings. The question that must be asked is: are
we better off if our only option is a SiHy material?
and Brennan have suggested that this transmissibility (Dk/t) threshold would be 20 units across
the entire lens for daily wear.7 In fact, Morgan
and Brennan postulate that transmissibility above
this level follows the law of diminishing returns.7
In other words, increased transmissibility above
this threshold does not significantly improve the
physiological status of the cornea. Although many
current hydrogel designs do not meet this threshold across the entire lens, the transmissibility wars
among different SiHy lenses is unwarranted as the
lowest oxygen transmissibility of any SiHy lens is
sufficient for daily wear patients.
Oxygen and the cornea
Multiple lens properties contribute to contact lens
comfort, including material modulus, lens design
(lens edge shape and thickness profile) and surface
properties. Wetting agents, lens care solutions, the
patient’s physiology and replacement schedule all
factor into the contact lens comfort equation. There
is debate about whether SiHy lenses are more comfortable compared to hydrogels; the data are highly
confounded based on differing study designs that
There is no question that SiHy lenses have virtually
eliminated hypoxic related complications that some
lens patients experienced with low Dk/t hydrogel
lenses.6 The two most notable clinical signs of hypoxia included limbal redness and vascularisation,
but it is important to understand what the threshold
transmissibility is that prevents hypoxic-related
complications for the daily wear patient. Morgan
Cost benefit
The addition of silicone to hydrogel polymers to
increase oxygen permeability has been fraught with
complications from the start. Most notably, the
diminished wettability caused by the hydrophobic
nature of silicone has largely been overcome by
surface treatments, the addition of wetting agents
or with the use of newer lens care products.
Other lens-related complications have resurfaced
after the wider adoption of SiHy lenses. Silicone
hydrogel lenses have a relatively higher modulus
compared to hydrogel materials, which generally
increases with increasing Dk.8 The higher modulus
of SiHy lenses has, at least in part, been associated
with mechanical complications such as contact
lens papillary conjunctivitis (CLPC), conjunctival
splits, superior epithelial arcuate lesions (SEAL),
and unintentional orthokeratologic effects.8
Recent epidemiological evidence has shown that
SiHy materials, unlike hydrogel materials, are an
independent risk factor for the development of
corneal inflammatory events (CIE).9 CLPC and
symptomatic CIE are particularly concerning
complications because they can lead to discontinuation of contact lens wear requiring pharmacologic
intervention or eventually drop out from contact
lens wear. With all of this in mind, at some point
we have to start to reconsider the cost versus benefit
of SiHy lenses based on individual patient needs.
Comfort and drop-out
drug eluting contact lenses
make it difficult to asses the cumulative research
outcomes.10-20
Keep in mind that there are many variables that
significantly contribute to the comfort of contact
lens wear. Ideally, researchers would be able to
study each of these by manipulating one variable
at a time on a common prototype.21 Additionally,
it is a stretch to attribute new SiHy lens comfort
directly to increased transmissibility. If we concede
and conclude that SiHy lenses are more comfortable, then why as recently as 2007 are contact
lens dissatisfaction (26.3 per cent) and permanent
discontinuation (24 per cent) as high as historical
rates with hydrogel lenses, considering that the
primary self-reported reason for lens dissatisfaction
and discontinuation were ocular symptoms (dryness
and discomfort)?22
The future
We have 12 years of experience with silicone hydrogel materials. The increased transmissibility of
SiHy materials has pleasantly reduced hypoxic signs
in some of our patients wearing low Dk hydrogel
lenses. In other ways, SiHy lenses have been somewhat disappointing. They have failed to reduce the
incidence of MK with extended wear and continuous wear. Despite suggestions that SiHy lenses are
relatively more comfortable, rates of dissatisfaction
and discontinuation remain high. This is apart from
the fact that SiHy lenses may put some patients at
greater risk for mechanical related complications
or corneal inflammation that may lead to drop-out.
The perception that SiHy lenses are the be all
and end all material has put tremendous pressure
on contact lens manufacturers to use SiHy for all
their new designs. It is not surprising that 68 per
cent of fittings are SiHy lenses—it is the only choice
that practitioners have if they want to use new lens
designs. This has created a positive feedback loop
with almost unstoppable momentum.
Wouldn’t we all be better off if we had an improved hydrogel or a novel lens material to offer
some of our patients? Wouldn’t it be great if we
had a lens with the benefits of both hydrogel and
silicone hydrogel materials? If we did, SiHy lenses
would be more of a niche product for select patients
who require increased transmissibility to maintain
a normal physiological response.
It is hard to say what is going to happen in the
next five years but I hope that when I walk into
my diagnostic soft lens room, I am not limited to
a SiHy-only selection.
Polymer film releases glaucoma
medication over extended period
E
yenovations, a new company based in Cambridge, Massachusetts,
is developing the technology to allow glaucoma patients to receive
medicine without relying on frequent eye-drops.
Daniel Kohane, director of the Laboratory for Biomaterials and
Drug Delivery at Children’s Hospital in Boston, collaborated with
Joseph Ciolino, a clinical fellow at Massachusetts Eye and Ear Infirmary. They developed a hydrogel lens with a polymer film that contains
the medication. By altering the properties of the polymer film and the
lens, the rate of release can be controlled.
Achieving extended release of drugs has been an elusive goal for
researchers. The Eyenovations team says its lenses deliver high doses
of medication for up to 100 days. The company plans to develop
commercial lenses that deliver drugs for up to 30 days, which is the
US Food and Drug Administration’s limit for single-use contact lenses.
The company is focusing on developing lenses that will treat the
growing number of people in the ageing population who will suffer
from glaucoma. The developers say that the lenses could also be used
to treat other eye conditions and to provide antibiotics following eye
surgery. Animal testing on the lenses has begun and plans for clinical
tests are scheduled for the near future.
Anaesthetic relief for up to
seven days
C
ontinuous anaesthetic release for up to one week through silicone
hydrogel contact lenses has been made possible by researchers at
the University of Florida, USA.
In the study, nano-sized vitamin E aggregates within the lenses acted
as barriers for drug diffusion, increasing the release durations for
some common hydrophilic ophthalmic drugs. Typically, commercial
silicone hydrogel contact lenses release most ophthalmic drugs for
only a few hours.
The researchers concluded that the vitamin E loaded silicone contact
lenses could provide continuous anaesthetics release for about one to
seven days, depending on the method of drug loading in the lenses. The
results suggest that the method could be useful for post-operative pain
control after corneal surgery such as the photorefractive keratectomy
procedure for vision correction.
Langmuir 2012; 28: 2: 1478-1487
47
CONTACT LENSES 2012