new options for the intolerant rgpwearer: minisclerals - cornea &...
TRANSCRIPT
![Page 1: New options for the intolerant RGPwearer: Minisclerals - Cornea & …cclsa.org.au/wp-content/uploads/2013/06/RichardVojlay... · 2014. 8. 13. · Keratoconus and Corneal grafts –Miniscleral](https://reader035.vdocuments.mx/reader035/viewer/2022081411/60a6784f460650190753b0ca/html5/thumbnails/1.jpg)
New options for the intolerant RGP wearer:Minisclerals
Richard VojlayAssociate Professor (Melb Uni) BSc Optom LOSc FVCO
Dip Oc Therapeutics Dip Humanities (Music)
![Page 2: New options for the intolerant RGPwearer: Minisclerals - Cornea & …cclsa.org.au/wp-content/uploads/2013/06/RichardVojlay... · 2014. 8. 13. · Keratoconus and Corneal grafts –Miniscleral](https://reader035.vdocuments.mx/reader035/viewer/2022081411/60a6784f460650190753b0ca/html5/thumbnails/2.jpg)
Successful RGP wearer –Keratoconus and Corneal grafts
What is a successful lens?
� Good vision
� Stable
Comfortable
2
� Comfortable
� Quiet eye (not red) with tolerable staining
� Can be reliably worn for most of the day.
� The aim is to generate an even bearing surface across the
cornea/graft, adequate but not excessive edge lift or to vault the
graft completely.
![Page 3: New options for the intolerant RGPwearer: Minisclerals - Cornea & …cclsa.org.au/wp-content/uploads/2013/06/RichardVojlay... · 2014. 8. 13. · Keratoconus and Corneal grafts –Miniscleral](https://reader035.vdocuments.mx/reader035/viewer/2022081411/60a6784f460650190753b0ca/html5/thumbnails/3.jpg)
Successful RGP wearer –Keratoconus and Corneal grafts
� RGP KC fitting
� VA with RGP 6/8-2
3
![Page 4: New options for the intolerant RGPwearer: Minisclerals - Cornea & …cclsa.org.au/wp-content/uploads/2013/06/RichardVojlay... · 2014. 8. 13. · Keratoconus and Corneal grafts –Miniscleral](https://reader035.vdocuments.mx/reader035/viewer/2022081411/60a6784f460650190753b0ca/html5/thumbnails/4.jpg)
Successful RGP wearer –Keratoconus and Corneal grafts
� RGP Corneal
graft fitting
� VA with RGP 6/5-2
4
![Page 5: New options for the intolerant RGPwearer: Minisclerals - Cornea & …cclsa.org.au/wp-content/uploads/2013/06/RichardVojlay... · 2014. 8. 13. · Keratoconus and Corneal grafts –Miniscleral](https://reader035.vdocuments.mx/reader035/viewer/2022081411/60a6784f460650190753b0ca/html5/thumbnails/5.jpg)
Keratoconus and Corneal grafts – RGP fitting
� Fitting irregular and asymmetrical surfaces - KC
5
![Page 6: New options for the intolerant RGPwearer: Minisclerals - Cornea & …cclsa.org.au/wp-content/uploads/2013/06/RichardVojlay... · 2014. 8. 13. · Keratoconus and Corneal grafts –Miniscleral](https://reader035.vdocuments.mx/reader035/viewer/2022081411/60a6784f460650190753b0ca/html5/thumbnails/6.jpg)
Keratoconus and Corneal grafts – RGP fitting
� Fitting irregular and asymmetrical surfaces – Corneal grafts
6
![Page 7: New options for the intolerant RGPwearer: Minisclerals - Cornea & …cclsa.org.au/wp-content/uploads/2013/06/RichardVojlay... · 2014. 8. 13. · Keratoconus and Corneal grafts –Miniscleral](https://reader035.vdocuments.mx/reader035/viewer/2022081411/60a6784f460650190753b0ca/html5/thumbnails/7.jpg)
Keratoconus – RGP fitting
� Fitting options – Small, Medium or Large
� Small
� Nipple cones
7
� Nipple cones
� 7.8 mm diameter
� Quadcurve
![Page 8: New options for the intolerant RGPwearer: Minisclerals - Cornea & …cclsa.org.au/wp-content/uploads/2013/06/RichardVojlay... · 2014. 8. 13. · Keratoconus and Corneal grafts –Miniscleral](https://reader035.vdocuments.mx/reader035/viewer/2022081411/60a6784f460650190753b0ca/html5/thumbnails/8.jpg)
Keratoconus – RGP fitting
� Fitting options – Small, Medium or Large
� Medium
� 9.0 mm diameter
8
� 9.0 mm diameter
� VA with RGP 6/6-2
� Quadcurve
![Page 9: New options for the intolerant RGPwearer: Minisclerals - Cornea & …cclsa.org.au/wp-content/uploads/2013/06/RichardVojlay... · 2014. 8. 13. · Keratoconus and Corneal grafts –Miniscleral](https://reader035.vdocuments.mx/reader035/viewer/2022081411/60a6784f460650190753b0ca/html5/thumbnails/9.jpg)
Keratoconus – RGP fitting
� Fitting options – Small, Medium or Large
� Medium
� 10.1 mm diameter
9
� 10.1 mm diameter
� VA with RGP 6/4-2
� Bi-sym CLC
![Page 10: New options for the intolerant RGPwearer: Minisclerals - Cornea & …cclsa.org.au/wp-content/uploads/2013/06/RichardVojlay... · 2014. 8. 13. · Keratoconus and Corneal grafts –Miniscleral](https://reader035.vdocuments.mx/reader035/viewer/2022081411/60a6784f460650190753b0ca/html5/thumbnails/10.jpg)
Keratoconus – RGP fitting
� Fitting options – Small, Medium or Large
� Large
� 13.0 mm diameter
10
13.0 mm diameter
� Limbal Lift ACL
(previously K series)
![Page 11: New options for the intolerant RGPwearer: Minisclerals - Cornea & …cclsa.org.au/wp-content/uploads/2013/06/RichardVojlay... · 2014. 8. 13. · Keratoconus and Corneal grafts –Miniscleral](https://reader035.vdocuments.mx/reader035/viewer/2022081411/60a6784f460650190753b0ca/html5/thumbnails/11.jpg)
Corneal grafts – RGP fitting
� Fitting options – Small, Medium or Large
� Small
� 9.0mm diameter
11
� 9.0mm diameter
� VA with RGP 6/12-
![Page 12: New options for the intolerant RGPwearer: Minisclerals - Cornea & …cclsa.org.au/wp-content/uploads/2013/06/RichardVojlay... · 2014. 8. 13. · Keratoconus and Corneal grafts –Miniscleral](https://reader035.vdocuments.mx/reader035/viewer/2022081411/60a6784f460650190753b0ca/html5/thumbnails/12.jpg)
Corneal grafts – RGP fitting
� Fitting options – Small, Medium or Large
� Medium
� 10.8 mm diameter
12
� 10.8 mm diameter
� VA with RGP 6/6-
![Page 13: New options for the intolerant RGPwearer: Minisclerals - Cornea & …cclsa.org.au/wp-content/uploads/2013/06/RichardVojlay... · 2014. 8. 13. · Keratoconus and Corneal grafts –Miniscleral](https://reader035.vdocuments.mx/reader035/viewer/2022081411/60a6784f460650190753b0ca/html5/thumbnails/13.jpg)
Corneal grafts – RGP fitting
� Fitting options – Small, Medium or Large
� Large
� 13.00 mm diameter
13
� VA with RGP 6/6+2
� Limbal Lift ACL
(previously E series)
Quadrant Zoning – inferior tuck
![Page 14: New options for the intolerant RGPwearer: Minisclerals - Cornea & …cclsa.org.au/wp-content/uploads/2013/06/RichardVojlay... · 2014. 8. 13. · Keratoconus and Corneal grafts –Miniscleral](https://reader035.vdocuments.mx/reader035/viewer/2022081411/60a6784f460650190753b0ca/html5/thumbnails/14.jpg)
� Fitting options – Very large
� Scleral – custom, trial sets
� 23 mm diameter
Keratoconus and Corneal grafts – RGP fitting
14
23 mm diameter
� May be fenestrated for tear exchange
� Custom lenses can be very labour
intensive to produce
� Trial sets can reduce fitting times and
assist with reproducibility
![Page 15: New options for the intolerant RGPwearer: Minisclerals - Cornea & …cclsa.org.au/wp-content/uploads/2013/06/RichardVojlay... · 2014. 8. 13. · Keratoconus and Corneal grafts –Miniscleral](https://reader035.vdocuments.mx/reader035/viewer/2022081411/60a6784f460650190753b0ca/html5/thumbnails/15.jpg)
� Fitting options – Very large
� Minisclerals
15 - 16.0 mm diameter
Keratoconus and Corneal grafts – Miniscleral RGP lenses
15
� 15 - 16.0 mm diameter
� Vault cornea from sclera to
sclera
� Sealed system, no tear exchange
� High Dk material
� V with c/l: 6/6-2
![Page 16: New options for the intolerant RGPwearer: Minisclerals - Cornea & …cclsa.org.au/wp-content/uploads/2013/06/RichardVojlay... · 2014. 8. 13. · Keratoconus and Corneal grafts –Miniscleral](https://reader035.vdocuments.mx/reader035/viewer/2022081411/60a6784f460650190753b0ca/html5/thumbnails/16.jpg)
Successful RGP wearer – Keratoconus
� Predicting success – what works?, more reliable with keratoconus
Hopefully Very unlikely
16
![Page 17: New options for the intolerant RGPwearer: Minisclerals - Cornea & …cclsa.org.au/wp-content/uploads/2013/06/RichardVojlay... · 2014. 8. 13. · Keratoconus and Corneal grafts –Miniscleral](https://reader035.vdocuments.mx/reader035/viewer/2022081411/60a6784f460650190753b0ca/html5/thumbnails/17.jpg)
Unsuccessful RGP wearer – Keratoconus
� Intolerant RGP wearer – options
� soft carrier lens
� SynergEyes
17
� SynergEyes
� referral for an opinion by another optometrist
� referral for a corneal graft or regraft.
![Page 18: New options for the intolerant RGPwearer: Minisclerals - Cornea & …cclsa.org.au/wp-content/uploads/2013/06/RichardVojlay... · 2014. 8. 13. · Keratoconus and Corneal grafts –Miniscleral](https://reader035.vdocuments.mx/reader035/viewer/2022081411/60a6784f460650190753b0ca/html5/thumbnails/18.jpg)
� All of these lenses are successful - good vision, reliable wearing times,
stable, good comfort, no graft rejections.
Successful RGP wearer – Corneal grafts
18
![Page 19: New options for the intolerant RGPwearer: Minisclerals - Cornea & …cclsa.org.au/wp-content/uploads/2013/06/RichardVojlay... · 2014. 8. 13. · Keratoconus and Corneal grafts –Miniscleral](https://reader035.vdocuments.mx/reader035/viewer/2022081411/60a6784f460650190753b0ca/html5/thumbnails/19.jpg)
�
Unsuccessful RGP wearer – Corneal grafts
� All of these lenses were unsuccessful - good vision, unreliable wearing
times, stable, variable comfort, graft rejections
� Difficult to predict a successful fitting on a corneal graft
19
![Page 20: New options for the intolerant RGPwearer: Minisclerals - Cornea & …cclsa.org.au/wp-content/uploads/2013/06/RichardVojlay... · 2014. 8. 13. · Keratoconus and Corneal grafts –Miniscleral](https://reader035.vdocuments.mx/reader035/viewer/2022081411/60a6784f460650190753b0ca/html5/thumbnails/20.jpg)
Patient’s reasons for intolerance –Keratoconus and Corneal grafts
� General discomfort
� Reduced and unreliable wearing times
� Poor quality vision, especially at night
20
� Poor quality vision, especially at night
� Intense discomfort from foreign bodies
� Contact lens instability – unusual eye positions
and sport
� Conjunctival hyperaemia
![Page 21: New options for the intolerant RGPwearer: Minisclerals - Cornea & …cclsa.org.au/wp-content/uploads/2013/06/RichardVojlay... · 2014. 8. 13. · Keratoconus and Corneal grafts –Miniscleral](https://reader035.vdocuments.mx/reader035/viewer/2022081411/60a6784f460650190753b0ca/html5/thumbnails/21.jpg)
� Minisclerals - characteristics
� No movement
� No lid interaction
Sealed system – no foreign bodies
Keratoconus and Corneal grafts – Miniscleral RGP lenses
21
� Sealed system – no foreign bodies
underneath the lens
� Tear film reservoir
� High DK material
� Excellent centration
� Large optic zone
� Will not displace
� minimal or no corneal bearing
![Page 22: New options for the intolerant RGPwearer: Minisclerals - Cornea & …cclsa.org.au/wp-content/uploads/2013/06/RichardVojlay... · 2014. 8. 13. · Keratoconus and Corneal grafts –Miniscleral](https://reader035.vdocuments.mx/reader035/viewer/2022081411/60a6784f460650190753b0ca/html5/thumbnails/22.jpg)
� Minisclerals – patient experience
� Excellent comfort
� No edge awareness or movement
� Excellent vision – especially at night
Keratoconus and Corneal grafts – Miniscleral RGP lenses
22
� Excellent vision – especially at night
� No problems on windy days
� Excellent stability – total security
� Easier to handle, more difficult to lose
� More reliable wearing times
Very comfortable, stable with excellent vision
![Page 23: New options for the intolerant RGPwearer: Minisclerals - Cornea & …cclsa.org.au/wp-content/uploads/2013/06/RichardVojlay... · 2014. 8. 13. · Keratoconus and Corneal grafts –Miniscleral](https://reader035.vdocuments.mx/reader035/viewer/2022081411/60a6784f460650190753b0ca/html5/thumbnails/23.jpg)
� Minisclerals - manufacturers
� Eyecon miniscleral – Capricornia Contact Lenses
� Gelflex
Keratoconus and Corneal grafts – Miniscleral RGP lenses
23
� Gelflex
� Contact Lens Centre – SSMax
� KATT – Capricornia Contact Lenses
![Page 24: New options for the intolerant RGPwearer: Minisclerals - Cornea & …cclsa.org.au/wp-content/uploads/2013/06/RichardVojlay... · 2014. 8. 13. · Keratoconus and Corneal grafts –Miniscleral](https://reader035.vdocuments.mx/reader035/viewer/2022081411/60a6784f460650190753b0ca/html5/thumbnails/24.jpg)
� Eyecon miniscleral (Capricornia)
� Trial set - base curves: 6.8 – 8.2 mm
� Diameter: 16.00 mm
Keratoconus and Corneal grafts – Miniscleral RGP lenses
24
� Diameter: 16.00 mm
� Periphery: standard or flat
� Material: Boston XO
� Fit assessed by measuring tear film depth
� Optimal clearance: 180 – 270 µ
� Avoid blanching of conjunctival vessels
![Page 25: New options for the intolerant RGPwearer: Minisclerals - Cornea & …cclsa.org.au/wp-content/uploads/2013/06/RichardVojlay... · 2014. 8. 13. · Keratoconus and Corneal grafts –Miniscleral](https://reader035.vdocuments.mx/reader035/viewer/2022081411/60a6784f460650190753b0ca/html5/thumbnails/25.jpg)
� Eyecon miniscleral – standard or flat edge
� 7.8 (16.00) -1.00, standard edge VA 6/10+2
Keratoconus and Corneal grafts – Miniscleral RGP lenses
25
![Page 26: New options for the intolerant RGPwearer: Minisclerals - Cornea & …cclsa.org.au/wp-content/uploads/2013/06/RichardVojlay... · 2014. 8. 13. · Keratoconus and Corneal grafts –Miniscleral](https://reader035.vdocuments.mx/reader035/viewer/2022081411/60a6784f460650190753b0ca/html5/thumbnails/26.jpg)
� Eyecon miniscleral
� staining
Keratoconus and Corneal grafts – Miniscleral RGP lenses
26
![Page 27: New options for the intolerant RGPwearer: Minisclerals - Cornea & …cclsa.org.au/wp-content/uploads/2013/06/RichardVojlay... · 2014. 8. 13. · Keratoconus and Corneal grafts –Miniscleral](https://reader035.vdocuments.mx/reader035/viewer/2022081411/60a6784f460650190753b0ca/html5/thumbnails/27.jpg)
� Minisclerals - measurements
� Topography – only out to 8mm
� Corneal sagittal height
Keratoconus and Corneal grafts – Miniscleral RGP lenses
27
� Standard RGP lens curves are based upon the
corneal curvature
� Miniscleral fitting is based on sag, so a flatter
base curve (7.8mm) may vault over a cornea
with maximal curve (6.8mm), due to a shallow
anterior chamber
� Trial lens fitting essential - base curve and sag
![Page 28: New options for the intolerant RGPwearer: Minisclerals - Cornea & …cclsa.org.au/wp-content/uploads/2013/06/RichardVojlay... · 2014. 8. 13. · Keratoconus and Corneal grafts –Miniscleral](https://reader035.vdocuments.mx/reader035/viewer/2022081411/60a6784f460650190753b0ca/html5/thumbnails/28.jpg)
� Estimation of anterior chamber depth – The Smith Method
� The Smith method allows the measurement of the anterior chamber depth.
� Turn the beam to horizontal
Keratoconus and Corneal grafts – Miniscleral RGP lenses
28
� Turn the beam to horizontal
� Illumination arm set at 60 degrees
� Use the right eyepiece for the right eye measurement
� Narrow beam
� High illumination
� Minimal beam length
� Focus on anterior lens capsule
� Observe separate out of focus image on endothelium
![Page 29: New options for the intolerant RGPwearer: Minisclerals - Cornea & …cclsa.org.au/wp-content/uploads/2013/06/RichardVojlay... · 2014. 8. 13. · Keratoconus and Corneal grafts –Miniscleral](https://reader035.vdocuments.mx/reader035/viewer/2022081411/60a6784f460650190753b0ca/html5/thumbnails/29.jpg)
Keratoconus and Corneal grafts – Miniscleral RGP lenses
29
![Page 30: New options for the intolerant RGPwearer: Minisclerals - Cornea & …cclsa.org.au/wp-content/uploads/2013/06/RichardVojlay... · 2014. 8. 13. · Keratoconus and Corneal grafts –Miniscleral](https://reader035.vdocuments.mx/reader035/viewer/2022081411/60a6784f460650190753b0ca/html5/thumbnails/30.jpg)
Keratoconus and Corneal grafts – Miniscleral RGP lenses
30
![Page 31: New options for the intolerant RGPwearer: Minisclerals - Cornea & …cclsa.org.au/wp-content/uploads/2013/06/RichardVojlay... · 2014. 8. 13. · Keratoconus and Corneal grafts –Miniscleral](https://reader035.vdocuments.mx/reader035/viewer/2022081411/60a6784f460650190753b0ca/html5/thumbnails/31.jpg)
� Estimation of anterior chamber depth – The Smith Method
� Extend length of beam until the images meet
� Measure the length by reading off the slit lamp
Keratoconus and Corneal grafts – Miniscleral RGP lenses
31
� Measure the length by reading off the slit lamp
� Conversion factor of 1.4 x reading = central anterior chamber depth in mm
� E.g. 3.860, 4.250, 5.154
![Page 32: New options for the intolerant RGPwearer: Minisclerals - Cornea & …cclsa.org.au/wp-content/uploads/2013/06/RichardVojlay... · 2014. 8. 13. · Keratoconus and Corneal grafts –Miniscleral](https://reader035.vdocuments.mx/reader035/viewer/2022081411/60a6784f460650190753b0ca/html5/thumbnails/32.jpg)
� Fitting philosophy is based on matching the sag of the eye at a chord of 15mm to
that of the lens with an allowance for apical clearance
Keratoconus and Corneal grafts – Miniscleral RGP lenses
32
![Page 33: New options for the intolerant RGPwearer: Minisclerals - Cornea & …cclsa.org.au/wp-content/uploads/2013/06/RichardVojlay... · 2014. 8. 13. · Keratoconus and Corneal grafts –Miniscleral](https://reader035.vdocuments.mx/reader035/viewer/2022081411/60a6784f460650190753b0ca/html5/thumbnails/33.jpg)
� Parameters
� Base curve/optic – cornea zone
Transitional curves - limbal zone, adjusts differences in
Keratoconus and Corneal grafts – Miniscleral RGP lenses
33
� Transitional curves - limbal zone, adjusts differences in
elevation from mid periphery and past the limbus
� Peripheral curves - scleral zone – allows for adjustment
of alignment on the sclera, to reduce or increase edge
clearance
![Page 34: New options for the intolerant RGPwearer: Minisclerals - Cornea & …cclsa.org.au/wp-content/uploads/2013/06/RichardVojlay... · 2014. 8. 13. · Keratoconus and Corneal grafts –Miniscleral](https://reader035.vdocuments.mx/reader035/viewer/2022081411/60a6784f460650190753b0ca/html5/thumbnails/34.jpg)
Keratoconus and Corneal grafts – Miniscleral RGP lenses
� Fitting
� Measure corneal sag and select trial lens with next highest sag
� Anaesthetic is optional, can be useful for the patient to experience the lens
34
� Anaesthetic is optional, can be useful for the patient to experience the lens
� Must be inserted bubble free
� Fill lens with saline, add fluorescein
� Inserted using large suction cup holder as a support
� Observe bearing and clearance, tear thickness profile across the lens
� If initially okay, review after 30 minutes
� Removed with DMV-45 assisted by lower lid manipulation
![Page 35: New options for the intolerant RGPwearer: Minisclerals - Cornea & …cclsa.org.au/wp-content/uploads/2013/06/RichardVojlay... · 2014. 8. 13. · Keratoconus and Corneal grafts –Miniscleral](https://reader035.vdocuments.mx/reader035/viewer/2022081411/60a6784f460650190753b0ca/html5/thumbnails/35.jpg)
Keratoconus and Corneal grafts – Miniscleral RGP lenses
� KATT (Capricornia)
� Development of KATT from Eyecon miniscleral
� Increased knowledge of scleral curvature, better alignment
35
� Incorporating anterior chamber depth, sag measurements
� Introduction of tangential curves to alter sag
� Material Boston XO2 (Dk 141)
� Tear film: Central clearance – 300 µ, Limbal clearance - 200 µ
� Known Lens centre thickness (300 µ)
� Trial set: 6.0 mm (sag 5.715) to 8.0 mm (sag 3.9844)
![Page 36: New options for the intolerant RGPwearer: Minisclerals - Cornea & …cclsa.org.au/wp-content/uploads/2013/06/RichardVojlay... · 2014. 8. 13. · Keratoconus and Corneal grafts –Miniscleral](https://reader035.vdocuments.mx/reader035/viewer/2022081411/60a6784f460650190753b0ca/html5/thumbnails/36.jpg)
Keratoconus and Corneal grafts – Miniscleral RGP lenses
� KATT (Capricornia)
� Spherical or aspheric central
optic zone (10mm)
36
� Tangent curve that runs parallel
to the ocular surface (14mm)
� Second tangent curve zone that
allows for sag variation
� Peripheral curve that meets
the sclera (15.0- 16.5mm)
![Page 37: New options for the intolerant RGPwearer: Minisclerals - Cornea & …cclsa.org.au/wp-content/uploads/2013/06/RichardVojlay... · 2014. 8. 13. · Keratoconus and Corneal grafts –Miniscleral](https://reader035.vdocuments.mx/reader035/viewer/2022081411/60a6784f460650190753b0ca/html5/thumbnails/37.jpg)
Keratoconus and Corneal grafts – Miniscleral RGP lenses
� KATT (Capricornia) - Second tangent curve zone that
allows for sag variation
37
![Page 38: New options for the intolerant RGPwearer: Minisclerals - Cornea & …cclsa.org.au/wp-content/uploads/2013/06/RichardVojlay... · 2014. 8. 13. · Keratoconus and Corneal grafts –Miniscleral](https://reader035.vdocuments.mx/reader035/viewer/2022081411/60a6784f460650190753b0ca/html5/thumbnails/38.jpg)
Keratoconus and Corneal grafts – Miniscleral RGP lenses
� KATT (Capricornia)
38
![Page 39: New options for the intolerant RGPwearer: Minisclerals - Cornea & …cclsa.org.au/wp-content/uploads/2013/06/RichardVojlay... · 2014. 8. 13. · Keratoconus and Corneal grafts –Miniscleral](https://reader035.vdocuments.mx/reader035/viewer/2022081411/60a6784f460650190753b0ca/html5/thumbnails/39.jpg)
Keratoconus and Corneal grafts – Miniscleral RGP lenses
� KATT (Capricornia)
� Patient RU: Diagnosed PMD @ 30, wearing soft c/l's, accountant
� Very poor reaction to RGP c/l’s in late 30’s – very uncomfortable, will not
39
� Very poor reaction to RGP c/l’s in late 30’s – very uncomfortable, will not
try again
� Rx: R +2.50/-7.50x85 VA 6/8-2 L +4.00/-4.50x73 VA 6/8+2 (variable)
� Vision with current soft lenses: R 6/24+2 L 6/24-
� Topography R 7.17 @ 169, 9.44 @ 79
![Page 40: New options for the intolerant RGPwearer: Minisclerals - Cornea & …cclsa.org.au/wp-content/uploads/2013/06/RichardVojlay... · 2014. 8. 13. · Keratoconus and Corneal grafts –Miniscleral](https://reader035.vdocuments.mx/reader035/viewer/2022081411/60a6784f460650190753b0ca/html5/thumbnails/40.jpg)
Keratoconus and Corneal grafts – Miniscleral RGP lenses
� KATT (Capricornia) - Patient RU
40
![Page 41: New options for the intolerant RGPwearer: Minisclerals - Cornea & …cclsa.org.au/wp-content/uploads/2013/06/RichardVojlay... · 2014. 8. 13. · Keratoconus and Corneal grafts –Miniscleral](https://reader035.vdocuments.mx/reader035/viewer/2022081411/60a6784f460650190753b0ca/html5/thumbnails/41.jpg)
Keratoconus and Corneal grafts – Miniscleral RGP lenses
� KATT (Capricornia) - Patient RU, trial lens inserted with fluorescein
� RE: KATT 7.8 (16.50), sag: 3.9674 after 30minutes
41
![Page 42: New options for the intolerant RGPwearer: Minisclerals - Cornea & …cclsa.org.au/wp-content/uploads/2013/06/RichardVojlay... · 2014. 8. 13. · Keratoconus and Corneal grafts –Miniscleral](https://reader035.vdocuments.mx/reader035/viewer/2022081411/60a6784f460650190753b0ca/html5/thumbnails/42.jpg)
Keratoconus and Corneal grafts – Miniscleral RGP lenses
� KATT (Capricornia) - Patient RU
� RE: KATT 8.0 (16.50) sag: 4.1133 7.0 (16.50), sag: 4.4444
42
![Page 43: New options for the intolerant RGPwearer: Minisclerals - Cornea & …cclsa.org.au/wp-content/uploads/2013/06/RichardVojlay... · 2014. 8. 13. · Keratoconus and Corneal grafts –Miniscleral](https://reader035.vdocuments.mx/reader035/viewer/2022081411/60a6784f460650190753b0ca/html5/thumbnails/43.jpg)
Keratoconus and Corneal grafts – Miniscleral RGP lenses
� KATT (Capricornia) – Fluorescein added to external tear layer, compare lens
thickness (300µ) to tear lens thickness
43
![Page 44: New options for the intolerant RGPwearer: Minisclerals - Cornea & …cclsa.org.au/wp-content/uploads/2013/06/RichardVojlay... · 2014. 8. 13. · Keratoconus and Corneal grafts –Miniscleral](https://reader035.vdocuments.mx/reader035/viewer/2022081411/60a6784f460650190753b0ca/html5/thumbnails/44.jpg)
Keratoconus and Corneal grafts – Miniscleral RGP lenses
� Central NasalTemp
44
![Page 45: New options for the intolerant RGPwearer: Minisclerals - Cornea & …cclsa.org.au/wp-content/uploads/2013/06/RichardVojlay... · 2014. 8. 13. · Keratoconus and Corneal grafts –Miniscleral](https://reader035.vdocuments.mx/reader035/viewer/2022081411/60a6784f460650190753b0ca/html5/thumbnails/45.jpg)
Keratoconus and Corneal grafts – Miniscleral RGP lenses
� KATT (Capricornia) - Patient RU - Staining after 11 hours wearing time
� V with KATT: 6/6-2
� Regular daily wear
45
� Regular daily wear
� Up to 16 hours/day
� Excellent comfort
� No difficulty handling lenses
![Page 46: New options for the intolerant RGPwearer: Minisclerals - Cornea & …cclsa.org.au/wp-content/uploads/2013/06/RichardVojlay... · 2014. 8. 13. · Keratoconus and Corneal grafts –Miniscleral](https://reader035.vdocuments.mx/reader035/viewer/2022081411/60a6784f460650190753b0ca/html5/thumbnails/46.jpg)
Keratoconus and Corneal grafts – Miniscleral RGP lenses
� KATT (Capricornia) - Patient NW: KC, bilateral grafts, wearing RGP c/l's
� L wearing reverse geometry bitoric 8.2x6.8(10.5) spherical periphery- successful
� V with c/l: 6/15, with over refraction: 6/8-
46
� Lost RGP lens, lab unable to duplicate fitting or Rx (poor VA) + discomfort
![Page 47: New options for the intolerant RGPwearer: Minisclerals - Cornea & …cclsa.org.au/wp-content/uploads/2013/06/RichardVojlay... · 2014. 8. 13. · Keratoconus and Corneal grafts –Miniscleral](https://reader035.vdocuments.mx/reader035/viewer/2022081411/60a6784f460650190753b0ca/html5/thumbnails/47.jpg)
Keratoconus and Corneal grafts – Miniscleral RGP lenses
� KATT (Capricornia) - Patient NW: graft, Topography L 6.48 @ 19 / 8.61 @ 109
47
![Page 48: New options for the intolerant RGPwearer: Minisclerals - Cornea & …cclsa.org.au/wp-content/uploads/2013/06/RichardVojlay... · 2014. 8. 13. · Keratoconus and Corneal grafts –Miniscleral](https://reader035.vdocuments.mx/reader035/viewer/2022081411/60a6784f460650190753b0ca/html5/thumbnails/48.jpg)
Keratoconus and Corneal grafts – Miniscleral RGP lenses
� KATT (Capricornia) - Patient NW: 6.2(16.50), sag: 5.1969
� V with c/l: 6/6-2
48
![Page 49: New options for the intolerant RGPwearer: Minisclerals - Cornea & …cclsa.org.au/wp-content/uploads/2013/06/RichardVojlay... · 2014. 8. 13. · Keratoconus and Corneal grafts –Miniscleral](https://reader035.vdocuments.mx/reader035/viewer/2022081411/60a6784f460650190753b0ca/html5/thumbnails/49.jpg)
Keratoconus and Corneal grafts – Miniscleral RGP lenses
� KATT (Capricornia) - Patient NW: 6.2(16.50), sag: 5.1969
� Staining after wear
49
![Page 50: New options for the intolerant RGPwearer: Minisclerals - Cornea & …cclsa.org.au/wp-content/uploads/2013/06/RichardVojlay... · 2014. 8. 13. · Keratoconus and Corneal grafts –Miniscleral](https://reader035.vdocuments.mx/reader035/viewer/2022081411/60a6784f460650190753b0ca/html5/thumbnails/50.jpg)
Keratoconus and Corneal grafts – Miniscleral RGP lenses
� KATT (Capricornia) – Patient AR - KC - previously worn soft c/l's, LE graft
@ 22, farm labourer
� Topography: L 6.43 @ 56 / 7.70 @ 146
50
![Page 51: New options for the intolerant RGPwearer: Minisclerals - Cornea & …cclsa.org.au/wp-content/uploads/2013/06/RichardVojlay... · 2014. 8. 13. · Keratoconus and Corneal grafts –Miniscleral](https://reader035.vdocuments.mx/reader035/viewer/2022081411/60a6784f460650190753b0ca/html5/thumbnails/51.jpg)
Keratoconus and Corneal grafts – Miniscleral RGP lenses
� KATT (Capricornia) – Patient AR - LE graft 6.5(16.50), sag: 4.8486
51
![Page 52: New options for the intolerant RGPwearer: Minisclerals - Cornea & …cclsa.org.au/wp-content/uploads/2013/06/RichardVojlay... · 2014. 8. 13. · Keratoconus and Corneal grafts –Miniscleral](https://reader035.vdocuments.mx/reader035/viewer/2022081411/60a6784f460650190753b0ca/html5/thumbnails/52.jpg)
Keratoconus and Corneal grafts – Miniscleral RGP lenses
� KATT (Capricornia) – Patient AR - LE graft
52
![Page 53: New options for the intolerant RGPwearer: Minisclerals - Cornea & …cclsa.org.au/wp-content/uploads/2013/06/RichardVojlay... · 2014. 8. 13. · Keratoconus and Corneal grafts –Miniscleral](https://reader035.vdocuments.mx/reader035/viewer/2022081411/60a6784f460650190753b0ca/html5/thumbnails/53.jpg)
Keratoconus and Corneal grafts – Miniscleral RGP lenses
� KATT (Capricornia) – Patient AR - KC - RE
� Topography: R 7.13 @ 70 / 7.77 @ 80
53
![Page 54: New options for the intolerant RGPwearer: Minisclerals - Cornea & …cclsa.org.au/wp-content/uploads/2013/06/RichardVojlay... · 2014. 8. 13. · Keratoconus and Corneal grafts –Miniscleral](https://reader035.vdocuments.mx/reader035/viewer/2022081411/60a6784f460650190753b0ca/html5/thumbnails/54.jpg)
Keratoconus and Corneal grafts – Miniscleral RGP lenses
� KATT (Capricornia) – Patient AR – RE KC
� CLC Centra PGA
� 7.2(10.1), V with c/l: 6/10-2
54
� 7.2(10.1), V with c/l: 6/10-2
![Page 55: New options for the intolerant RGPwearer: Minisclerals - Cornea & …cclsa.org.au/wp-content/uploads/2013/06/RichardVojlay... · 2014. 8. 13. · Keratoconus and Corneal grafts –Miniscleral](https://reader035.vdocuments.mx/reader035/viewer/2022081411/60a6784f460650190753b0ca/html5/thumbnails/55.jpg)
Keratoconus and Corneal grafts – Miniscleral RGP lenses
� KATT (Capricornia) – Patient AR – RE KC
� 7.2 sag: 4.4444
� V with c/l: 6/8
55
� V with c/l: 6/8
![Page 56: New options for the intolerant RGPwearer: Minisclerals - Cornea & …cclsa.org.au/wp-content/uploads/2013/06/RichardVojlay... · 2014. 8. 13. · Keratoconus and Corneal grafts –Miniscleral](https://reader035.vdocuments.mx/reader035/viewer/2022081411/60a6784f460650190753b0ca/html5/thumbnails/56.jpg)
Keratoconus and Corneal grafts – Miniscleral RGP lenses
� KATT (Capricornia) – Patient AR – RE KC
56
![Page 57: New options for the intolerant RGPwearer: Minisclerals - Cornea & …cclsa.org.au/wp-content/uploads/2013/06/RichardVojlay... · 2014. 8. 13. · Keratoconus and Corneal grafts –Miniscleral](https://reader035.vdocuments.mx/reader035/viewer/2022081411/60a6784f460650190753b0ca/html5/thumbnails/57.jpg)
Keratoconus and Corneal grafts – Miniscleral RGP lenses
� KATT (Capricornia) – Patient AB – KC - R graft, wearing Eyecon
miniscleral in LE
57
![Page 58: New options for the intolerant RGPwearer: Minisclerals - Cornea & …cclsa.org.au/wp-content/uploads/2013/06/RichardVojlay... · 2014. 8. 13. · Keratoconus and Corneal grafts –Miniscleral](https://reader035.vdocuments.mx/reader035/viewer/2022081411/60a6784f460650190753b0ca/html5/thumbnails/58.jpg)
Keratoconus and Corneal grafts – Miniscleral RGP lenses
� KATT (Capricornia) – Patient AB – R graft
� After suture removal: Rx RE +2.50/-9.50x167 VA 6/8-
� Topography: R 6.92 @ 78 / 8.77 @ 168
58
![Page 59: New options for the intolerant RGPwearer: Minisclerals - Cornea & …cclsa.org.au/wp-content/uploads/2013/06/RichardVojlay... · 2014. 8. 13. · Keratoconus and Corneal grafts –Miniscleral](https://reader035.vdocuments.mx/reader035/viewer/2022081411/60a6784f460650190753b0ca/html5/thumbnails/59.jpg)
Keratoconus and Corneal grafts – Miniscleral RGP lenses
� KATT (Capricornia) – Patient AB – R graft 6.5(16.50), sag: 4.8486
59
![Page 60: New options for the intolerant RGPwearer: Minisclerals - Cornea & …cclsa.org.au/wp-content/uploads/2013/06/RichardVojlay... · 2014. 8. 13. · Keratoconus and Corneal grafts –Miniscleral](https://reader035.vdocuments.mx/reader035/viewer/2022081411/60a6784f460650190753b0ca/html5/thumbnails/60.jpg)
Keratoconus and Corneal grafts – Miniscleral RGP lenses
� KATT (Capricornia) – Patient AB – R graft
60
![Page 61: New options for the intolerant RGPwearer: Minisclerals - Cornea & …cclsa.org.au/wp-content/uploads/2013/06/RichardVojlay... · 2014. 8. 13. · Keratoconus and Corneal grafts –Miniscleral](https://reader035.vdocuments.mx/reader035/viewer/2022081411/60a6784f460650190753b0ca/html5/thumbnails/61.jpg)
Keratoconus and Corneal grafts – Miniscleral RGP lenses
� KATT (Capricornia) – Patient AB – R graft
61
![Page 62: New options for the intolerant RGPwearer: Minisclerals - Cornea & …cclsa.org.au/wp-content/uploads/2013/06/RichardVojlay... · 2014. 8. 13. · Keratoconus and Corneal grafts –Miniscleral](https://reader035.vdocuments.mx/reader035/viewer/2022081411/60a6784f460650190753b0ca/html5/thumbnails/62.jpg)
Keratoconus and Corneal grafts – Miniscleral RGP lenses
� KATT (Capricornia) – Patient SR – KC – bilateral grafts, LE ICL, LE intense
chronic discomfort, LE Rx -6.50 VA 6/15
� Topography: R 6.72 @ 173 / 7.36 @ 83
62
![Page 63: New options for the intolerant RGPwearer: Minisclerals - Cornea & …cclsa.org.au/wp-content/uploads/2013/06/RichardVojlay... · 2014. 8. 13. · Keratoconus and Corneal grafts –Miniscleral](https://reader035.vdocuments.mx/reader035/viewer/2022081411/60a6784f460650190753b0ca/html5/thumbnails/63.jpg)
Keratoconus and Corneal grafts – Miniscleral RGP lenses
� KATT (Capricornia) – Patient SR – LE intense chronic discomfort
63
![Page 64: New options for the intolerant RGPwearer: Minisclerals - Cornea & …cclsa.org.au/wp-content/uploads/2013/06/RichardVojlay... · 2014. 8. 13. · Keratoconus and Corneal grafts –Miniscleral](https://reader035.vdocuments.mx/reader035/viewer/2022081411/60a6784f460650190753b0ca/html5/thumbnails/64.jpg)
Keratoconus and Corneal grafts – Miniscleral RGP lenses
� KATT (Capricornia) – Patient SR – LE intense chronic discomfort
� V with L c/l + over refraction: 6/6-2
64
![Page 65: New options for the intolerant RGPwearer: Minisclerals - Cornea & …cclsa.org.au/wp-content/uploads/2013/06/RichardVojlay... · 2014. 8. 13. · Keratoconus and Corneal grafts –Miniscleral](https://reader035.vdocuments.mx/reader035/viewer/2022081411/60a6784f460650190753b0ca/html5/thumbnails/65.jpg)
Keratoconus and Corneal grafts – Miniscleral RGP lenses
� KATT (Capricornia) – Complications
� Excessive conjunctival bearing
65
![Page 66: New options for the intolerant RGPwearer: Minisclerals - Cornea & …cclsa.org.au/wp-content/uploads/2013/06/RichardVojlay... · 2014. 8. 13. · Keratoconus and Corneal grafts –Miniscleral](https://reader035.vdocuments.mx/reader035/viewer/2022081411/60a6784f460650190753b0ca/html5/thumbnails/66.jpg)
Keratoconus and Corneal grafts – Miniscleral RGP lenses
� KATT (Capricornia) – Complications
� Conjunctival hyperaemia Faint diffuse spk staining
66
![Page 67: New options for the intolerant RGPwearer: Minisclerals - Cornea & …cclsa.org.au/wp-content/uploads/2013/06/RichardVojlay... · 2014. 8. 13. · Keratoconus and Corneal grafts –Miniscleral](https://reader035.vdocuments.mx/reader035/viewer/2022081411/60a6784f460650190753b0ca/html5/thumbnails/67.jpg)
Keratoconus and Corneal grafts – Miniscleral RGP lenses
� SSMax (Contact Lens Centre)
� 5 zones - Cornea zone, Transitional curves and Peripheral curves
� Overall Diameter: 15.80 mm
67
� Overall Diameter: 15.80 mm
� Material Boston XO (Dk 100)
� Trial set: 6.0 (sag 5.03) – 8.2 (sag 3.54)
� Central clearance: 45 – 50 µ
� Edge width: 0.75 – 1.0 mm
![Page 68: New options for the intolerant RGPwearer: Minisclerals - Cornea & …cclsa.org.au/wp-content/uploads/2013/06/RichardVojlay... · 2014. 8. 13. · Keratoconus and Corneal grafts –Miniscleral](https://reader035.vdocuments.mx/reader035/viewer/2022081411/60a6784f460650190753b0ca/html5/thumbnails/68.jpg)
Keratoconus and Corneal grafts – Miniscleral RGP lenses
� SSMax (Contact Lens Centre)
� Each curve is defined by eccentricity and width and can be varied to
increase or reduce the alignment profile across the lens
68
increase or reduce the alignment profile across the lens
� Edge lift to promote tear exchange
� Design Configurations – Spherical, Toric Periphery, Back Surface Toric,
Front Surface Toric, Bitoric, Bi-Sym, Quad-Sym
![Page 69: New options for the intolerant RGPwearer: Minisclerals - Cornea & …cclsa.org.au/wp-content/uploads/2013/06/RichardVojlay... · 2014. 8. 13. · Keratoconus and Corneal grafts –Miniscleral](https://reader035.vdocuments.mx/reader035/viewer/2022081411/60a6784f460650190753b0ca/html5/thumbnails/69.jpg)
Keratoconus and Corneal grafts – Miniscleral RGP lenses
� SSMax (Contact Lens Centre) – Patient SR – KC - R graft
� Topography: R 6.93 @ 53 / 8.37 @ 143
69
![Page 70: New options for the intolerant RGPwearer: Minisclerals - Cornea & …cclsa.org.au/wp-content/uploads/2013/06/RichardVojlay... · 2014. 8. 13. · Keratoconus and Corneal grafts –Miniscleral](https://reader035.vdocuments.mx/reader035/viewer/2022081411/60a6784f460650190753b0ca/html5/thumbnails/70.jpg)
Keratoconus and Corneal grafts – Miniscleral RGP lenses
� SSMax (Contact Lens Centre) – Patient SR – R graft
70
![Page 71: New options for the intolerant RGPwearer: Minisclerals - Cornea & …cclsa.org.au/wp-content/uploads/2013/06/RichardVojlay... · 2014. 8. 13. · Keratoconus and Corneal grafts –Miniscleral](https://reader035.vdocuments.mx/reader035/viewer/2022081411/60a6784f460650190753b0ca/html5/thumbnails/71.jpg)
Keratoconus and Corneal grafts – Miniscleral RGP lenses
� SSMax (Contact Lens Centre) – Patient SR – R graft
� 6.4 sag: 4.60 6.6 sag: 4.45
71
![Page 72: New options for the intolerant RGPwearer: Minisclerals - Cornea & …cclsa.org.au/wp-content/uploads/2013/06/RichardVojlay... · 2014. 8. 13. · Keratoconus and Corneal grafts –Miniscleral](https://reader035.vdocuments.mx/reader035/viewer/2022081411/60a6784f460650190753b0ca/html5/thumbnails/72.jpg)
Keratoconus and Corneal grafts – Miniscleral RGP lenses
� SSMax (Contact Lens Centre) – Patient SR – R graft
� 7.8 sag: 3.71 7.2 sag: 4.04
72
![Page 73: New options for the intolerant RGPwearer: Minisclerals - Cornea & …cclsa.org.au/wp-content/uploads/2013/06/RichardVojlay... · 2014. 8. 13. · Keratoconus and Corneal grafts –Miniscleral](https://reader035.vdocuments.mx/reader035/viewer/2022081411/60a6784f460650190753b0ca/html5/thumbnails/73.jpg)
Keratoconus and Corneal grafts – Miniscleral RGP lenses
� SSMax (Contact Lens Centre) – Patient SR – R graft
� 7.2 sag: 4.04, V with c/l: 6/8+2, over: +1.50/-2.00x45 VA 6/5
� Front Surface Toric ordered – 7.0 base
73
![Page 74: New options for the intolerant RGPwearer: Minisclerals - Cornea & …cclsa.org.au/wp-content/uploads/2013/06/RichardVojlay... · 2014. 8. 13. · Keratoconus and Corneal grafts –Miniscleral](https://reader035.vdocuments.mx/reader035/viewer/2022081411/60a6784f460650190753b0ca/html5/thumbnails/74.jpg)
� Minisclerals - summary
� Another viable option for KC and corneal graft fitting
� Design development is ongoing
Keratoconus and Corneal grafts – Miniscleral RGP lenses
74
� Effective communication with manufacturers is essential when
using complex designs
� Better edge design required to facilitate tear exchange and reduce
conjunctiva compression
Very comfortable, stable with excellent vision