Fitting hydrophilic lenses with special optical zones aFter corneal traumatisms, synechia and physiological large pupils: 4 case studies

Mercedes Burgos-Martínez1, BSc, MSc, Mónica Álvarez1, BSc, Laura Berasategui2, BSc, Santiago Jeremías3, BSc, Ramón García3, BSc, Pedro Rubio4, BSc, Mónica Monzón5, BSc, Steve Wright6, DO, FBDO CL 1. mark´ennovy Personalized Care, Madrid, Spain / 2. Ópticas 2000, Madrid, Spain / 3. General Óptica, Vigo, Spain / 4. Ripovisio Centre Optic, Ripollet, Spain / 5. Óptica Prima Luce, Sevilla, Spain / 6. mark’ennovy Personalized Care, UK [email protected]

INTRODUCTION Technical characteristics of the contact lenses are shown in Table 1. A summary of visual results and parameters is shown in Table 2. CONCLUSION

diameter Base curVe sphere cylinder SNELLEN- Special Custom contact lenses are a viable option for special cases with deformed or very Occasionally standard contact lenses do not provide the right solution for special cases. In characteristics (mm) (mm) (d) (d) aXes LOGMAR VA WITH large pupils, the torical and spherical 4TUV® and SPH4UV®, that can be commonly found these cases special parameters are needed. CONTACT FOZD FINAL CONTACT CONTACT Optoform Lathed Lens TYPE LENS MATERIAL (MM) SPECS RX BSCVA LENS PARAMS LENS in the high street practice. Suitable contact lenses in special cases can improve vision quality compared to spectacles Hioxifilcon B 49% 8.00 to 9.80 +/-23.00 -0.75 to -8.00 Traumatism Tc: 0.09 Prism: 1D 14.50 0.25 to +/-10.00 0.25 to -4.00 All 5º by tennis ball, Hioxifilcon +9.50 with Special suitable contact lenses, by decreasing or removing reflections and halos, improve and improve the quality of life for these patients. 0.30 Steps 0.50 from +/-10.50 0.50 from -4.50 A SPH4UV 10.00 bifocal of 1.0 15.00 8.60 +10.50 1.0 UV + Blue Handling Tint absence of B (49%) +2.50 add the quality of life for these patients. Four clinical cases are presented where larger optical zones are needed due to physical 1 Orientation Line crystalline lens Torn iris due to +9.00 -1.00 reasons to avoid reflections, halos and obtain appropriate vision. an explosion 50º and Table 1. Summary of technical characteristics of the contact lenses fitted. B of a grenade, 4TUV Hioxifilcon 9.00 near reading 0.7 14.50 8.30 +11.00 0.7 REFERENCES absence of B (49%) glasses of -1.25 40º crystalline lens +2.50 All patients reported reflections and halos with standard contact lenses, none reached METHOD +14.50 and 1. Gonzalez-Meijome JM, Jorge J, Almeida JB, Parafita MA. Soft contact lenses for comfortable vision with them. Most of them were intolerant to RGPs or fitting was not Complication Hioxifilcon near reading C of IOL implant SPH4UV A (59%) 8.00 glasses of 0.8 14.50 8.90 +16.50 0.80 keratoconus: Case report. Eye Contact Lens. 2006;32:143-7. satisfactory due to decentred lenses and bad vision as a consequence. The patient with and synechia +2.50 Patient A, 21 years old, presented with a displaced and deformed pupil due to an impact 2. Burgos M, Carballo J. Fitting hydrofilic toric contact lenses with special parameters after synechia also felt dryness with her current lenses and wanted to also improve comfort. Large of a tennis ball when she was 9 years old. There was absence of a crystalline lens. Contact physiological Hioxifilcon -6.50 -1.25 14.50 8.60 -6.00 intracorneal ring surgery: two case studies. Clinical Conference of the British Contact D pupil (right 4TUV B (49%) 11.00 100º 0.8 -1.00 100º 1.25 lens (CL) prescription (Rx) was +10.50 D. Contralateral eye presented CL Rx of -5.50 D. eye) Lens Association. Birmingham. 2008; 29 de mayo-1 de junio. Poster.

Patient B showed a torn iris due to an explosion of a grenade during military service and Large Hioxifilcon -7.25 -0.50 3. Yamazaki ES, Da Silva VC, Morimitsu V, Sobrinho M, Fukushima N, Lipener C. RESULTS AND DISCUSSION physiological SPH4UV B (49%) 11.00 80 0.65 14.50 8.60 -6.75 1.25 the absence of crystalline lens. CL Rx was +11.00 -1.25 40º. No Rx in contralateral eye. pupil (left eye) Keratoconus special soft contact lens fitting. Eye Contact Lens. 2007 Nov;33(6 Pt

1):300-3. Patient C suffered from a complication of IOL implant, with synechia and anisocoria Table 2. Summary of visual results and parameters for each case. posterior to crystalline lens dislocation. CL Rx needed was +15.50 D. All patients achieved satisfactory vision with visual acuity equal to or better than spectacles 4. Olali C, Mohammed M, Ahmed S, Gupta M. Contact lens for failed pupilloplasty. J Patient D had physiological pupils of 9.50 mm. Slit lamp and topographer were used and reflections disappeared. The one exception was the anisocoric patient that finally Cataract Refract Surg. 2008 Nov;34(11):1995-6. discontinued due to getting demotivated after a few tests, returning to her previous lenses to determine the size of the pupil diameter. Patient reported she had never achieved Corneal integrity was not significantly affected in any case after three months with wearing 5. Reed JW. Corneal tattooing to reduce glare in case of traumatic iris loss. Cornea. 1994 despite not being an ideal solution. satisfactory vision with any contact lens or spectacles. times of between 6 and 15 hours. Comfort was good all day as well as handling in all cases. Sep;13(5):401-5. Hioxifilcon B (49%) was employed to manufacture special front optical zones of 10.00, Physical fitting was correct, with good centration and movement, and the toric lenses In order to minimise modifications to contact lenses and to reduce the risk of patient 9.00, 8.00 and 11.00 mm respectively. Diameters and base curves were also custom-made. stable. A fitting is shown in Figure 2. demotivation an optical diameter larger than the standard of 8.00 is an option, for example ACKNOWLEDGEMENTS Lenses were bicurve, and back surface toric with prism ballast, designs of 4T UV and 4SH the successful cases between 9.00 and 11.00 mm. UV geometry is shown in figure 1. Special lenses are described in literature for irregular corneas such as keratoconus, intracorneal rings implantation, pellucid marginal degeneration,.. 1 – 3, but the majority of The authors would like to thank. these cases don’t require larger front optical zones in soft lenses, which are quite commonly GEOMETRY found in high street practice. If halos were persistent, a second action would be to tint Jesús Carballo and the Technical Team of Customer Services of mark´ennovy (Esther cosmetic iris over these lenses 4, 5 with these parameters in order to remove them and Giménez, Elena Durán, M.Jesús Vázquez,…) as well as Professional Services (Beatriz maintain optical quality. Fernández and Elsa García). Ophtalmic lenses are not an optionfor most of these patients due to their high refractive errors and anisometropia. Contact lenses are a more adequate solution for their.

FRONT OPTICAL ZONE

Figure 2. Eye with torn iris, decentred pupil and absence of crystalline lens. Fitted with 14.50 8.30 +11.00 -1.25 40º Hioxifilcon B 49%.

14.50 MM

1D PRISM BICURVE , BACK TORIC SURFACE

Figure 1. Geometry of lens fitted.