Onefit Is the Game Changer

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Scleral lenses are a great option for just about anyone! • Those who experience dryness, discomfort, or contact lens intolerance Forget everything you think you • Athletes and active individuals – all eye know about contact lenses… shapes and conditions • All cornea types – normal to highly irregular Onefit is the game changer. • Those with Keratoconus, Astigmatism (toric), Presbyopia (multifocal or bi-focal), patients with less than optimum results from LASIK and Post-RK, and much more Onefit™ and Onefit™ MED scleral lenses are an excellent alternative to soft or gas permeable (GP) lenses. Soft lenses often dry out over the course of the day, causing discomfort Benefits of wearing Onefit™ and and fluctuating vision. GP lenses offer better vision than soft Onefit™ MED Scleral Lenses: lenses, but are usually less comfortable. Onefit™ and Onefit MED™ provide crystal clear and reliable vision • Consistent all day comfort and hydration performance with exceptional comfort! • Crisp vision with no fluctuation, halos or glare • Optimum oxygen to your cornea for Some lenses present challenges with certain prescriptions, long-term corneal health but Onefit™ and Onefit MED™ scleral lenses work great with most prescriptions and provide vision for distance, near and • Lens and tear layer provide protection from everything in between! wind, dust and debris Learn more at How do Onefit™ and Onefit™ MED scleral lenses work? “I have never been able to wear any type of contact lens because I have dry eyes and now I These lenses are made of materials that let oxygen easily and constantly pass through the lens. They incorporate a unique design that eliminates need bifocals to read. My doctor recently fit me irregularites of the shape on the front surface of your eye to correct your with Onefit™ lenses and I love them! I wear them vision. They are applied to the eye with a non-preserved saline solution that comfortably at least 15 hours a day, my vision is provides a thin cushion of fluid between the lens and your eye. This makes better than I see with my glasses, and I am able to them very comfortable, reduces redness and creates a healthy environment read with them as well!” for your eye. What’s the difference between Onefit™ and Onefit™ MED? S.B. – 52-year-old female, Atlanta, GA Onefit™ is designed for normal to moderately irregular corneas. Onefit™ MED is designed for highly irregular, medically indicated, or larger corneas. Onefit™ MED also allows your eye care provider to custom design a lens specifically for your eye! Here’s an overview, to help understand why your doctor may suggest one over the other. Onefit™: Onefit™ MED: • Astigmatism & Presbyopia • Moderate to severe keratoconus • Mild to moderate keratoconus • Moderate to severe ectasias • Mild to moderate irregular corneas • Post-RK, Post-LASIK, PMD And more! • Ocular Surface Disease • Astigmatism & Presbyopia • Larger corneas And more! Learn more at.

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Iol Calculations for Patients with Keratoconus
s THE LITERATURE IOL CALCULATIONS FOR PATIENTS WITH KERATOCONUS Work continues to improve refractive accuracy in this patient population. BY ALICE ROTHWELL, MBCHB, AND ANDREW M.J. TURNBULL, BM, PGCERTMEDED, PGDIPCRS, FRCOPHTH INTRAOCULAR LENS POWER CALCULATION TABLE 1. CLASSIFICATION OF KERATOCONUS SEVERITY IN EYES WITH KERATOCONUS Stage Keratometry Reading Savini G, Abbate R, Hoffer KJ, et al1 1 ≤ 48.00 D Industry support: K.J.H. licenses 2 > 48.00 D registered trademark name Hoffer to various companies 3 > 53.00 D ABSTRACT SUMMARY spherical equivalent. Myopic and stage 1 disease. Accuracy decreased Savini and colleagues compared hyperopic surprises were indicated by with more advanced keratoconus, with the prediction errors (PEs) of negative and positive PEs, respectively. a MedAE of greater than 2.50 D in all five standard formulas: Barrett Mean error (ME), median absolute stage 3 eyes. Universal II (BUII), Haigis, Hoffer Q, error (MedAE), mean absolute error, Holladay 1, and SRK/T. The study and percentage of eyes achieving within DISCUSSION included 41 consecutive keratoconic ±0.50 D, ±0.75 D, and ±1.00 D of the Keratoconus presents multiple eyes undergoing phacoemulsification refractive target were also calculated. challenges to IOL selection. First, and IOL implantation. Eyes were A hyperopic ME was found across all the standard keratometric index classified by disease severity (Table 1). five formulas. Across the whole dataset, cannot reliably be applied to these A subjective refraction was obtained the lowest ME (0.91 D) and MedAE eyes because this index depends on for each eye at 1 month postoperatively. (0.62 D) and the highest percentage a normal ratio between the anterior The PE for each eye was calculated by (36%) of eyes within ±0.50 D of target and posterior corneal surfaces, but subtracting the predicted spherical were achieved with the SRK/T formula.
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Analysis of Human Corneal Igg by Isoelectric Focusing
Investigative Ophthalmology & Visual Science, Vol. 29, No. 10, October 1988 Copyright © Association for Research in Vision and Ophthalmology Analysis of Human Corneal IgG by Isoelectric Focusing J. Clifford Woldrep,* Robin L. Noe,f and R. Doyle Stulringf Parameters which regulate the localization and retention of IgG within the corneal stroma are complex and poorly understood. Although multiple factors are involved, electrostatic interactions between IgG and anionic corneal tissue components, ie, proteoglycans (PG) and glycosaminoglycans (GAG) may regulate the distribution of antibodies within the corneal stroma. Isoelectric focusing (IEF) and blotting analysis of IgG revealed a restricted pi profile for both central and peripheral regions of the normal cornea. Similar analysis of pathological corneas from keratoplasty specimens in Fuchs' dys- trophy and keratoconus reveal a variable IEF profile. In the majority of keratoplasty specimens from patients with corneal edema or graft rejection, there was generally little or no IgG detectable. These results suggest that in edematous corneas where there is altered PG/GAG in the stroma and modified fluid dynamics, there is a concomitant loss of IgG. These findings may have implications for immuno- logic surveillance and protection of the avascular cornea. Invest Ophthalmol Vis Sci 29:1538-1543, 1988 The humoral immune system plays an important the soluble plasma proteins through ionic interac- role in mediating immunologic surveillance and pro- tions. The PGs and GAGs have long been known to
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Management Modalities for Keratoconus an Overview of Noninterventional and Interventional Treatments
REFRACTIVE SURGERY FEATURE STORY EXCLUSIVE ONLINE CONTENT AVAILABLE Management Modalities for Keratoconus An overview of noninterventional and interventional treatments. BY MAZEN M. SINJAB, MD, PHD anagement of keratoconus has advanced TAKE-HOME MESSAGE during the past few years, and surgeons can • When evaluating patients with keratoconus, ask now choose among numerous traditional and them to stop using RGP contact lenses at least 2 modern treatments. Traditional modalities weeks before evaluation to achieve correct Msuch as spectacle correction, contact lenses, penetrating measurement of the corneal shape. keratoplasty (PKP), and conductive keratoplasty (CK) • Interventional management modalities include CK, are still effective; however, demand for the last two has PKP, DALK, ICRSs, CXL, phakic IOLs, or some decreased with the advent of modern alternatives, specifi- combination of these treatments. cally intrastromal corneal ring segments (ICRSs) and cor- • Making the right management decision depends neal collagen crosslinking (CXL). Caution should be used on the patient’s corneal transparency and stress when considering these newer treatment modalities, and lines, age, progression, contact lens tolerance, surgeons should be aware of their indications, contraindi- refractive error, UCVA and BCVA, K-max, corneal cations, conditions, and complications before proceeding thickness, and sex. with treatment. Keratoconus treatments can be divided into two cate- Some patients achieve good vision correction and comfort gories, interventional and noninterventional. In this article, with this strategy. particular attention is given to ICRSs and CXL, as they are Advances in lens designs and materials have increased the the most popular emerging interventional management proportion of keratoconus patients who can be fitted with modalities for keratoconus.
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Scleral Lenses and Eye Health
Scleral Lenses and Eye Health Anatomy and Function of the Human Eye How Scleral Lenses Interact with the Ocular Surface Just as the skin protects the human body, the ocular surface protects the human Scleral lenses are large-diameter lenses designed to vault the cornea and rest on the conjunctival tissue sitting on eye. The ocular surface is made up of the cornea, the conjunctiva, the tear film, top of the sclera. The space between the back surface of the lens and the cornea acts as a fluid reservoir. Scleral and the glands that produce tears, oils, and mucus in the tear film. lenses can range in size from 13mm to 19mm, although larger diameter lenses may be designed for patients with more severe eye conditions. Due to their size, scleral lenses consist SCLERA: The sclera is the white outer wall of the eye. It is SCLERAL LENS made of collagen fibers that are arranged for strength rather of at least two zones: than transmission of light. OPTIC ZONE The optic zone vaults over the cornea CORNEA: The cornea is the front center portion of the outer Cross section of FLUID RESERVOIR wall of the eye. It is made of collagen fibers that are arranged in the eye shows The haptic zone rests on the conjunctiva such a way so that the cornea is clear. The cornea bends light the cornea, overlying the sclera as it enters the eye so that the light is focused on the retina. conjunctiva, and sclera as CORNEA The cornea has a protective surface layer called the epithelium.
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Clinical Findings and Management of Posterior Vitreous Detachment
American Academy of Optometry: Case Report 5 Clinical Findings and Management of Posterior Vitreous Detachment Candidate’s Name, O.D. Candidate’s Address Candidate’s Phone number Candidate’s email Abstract: A posterior vitreous detachment is a degenerative process associated with aging that affects the vitreous when the posterior vitreous cortex separates from the internal limiting membrane of the retina. The composition of the vitreous gel can degenerate two collective ways, including synchysis or liquefaction, and syneresis or shrinking. Commonly, this process of separation occurs with the posterior hyaloid resulting in a Weiss ring overlying the optic nerve. Complications of a posterior vitreous detachment may include retinal breaks or detachments, retinal or vitreous hemorrhages, or vitreomacular traction. This case presentation summarizes the etiology of this ocular condition as well as treatment and management approaches. Key Words: Posterior Vitreous Detachment, Weiss Ring, Vitreous Degeneration, Scleral Depression, Nd:YAG Laser 1 Introduction The vitreous humor encompasses the posterior segment of the eye and fills approximately three quarters of the ocular space.1 The vitreous is a transparent, hydrophilic, “gel-like” substance that is described as a dilute solution of collagen, and hyaluronic acid.2,3,4 It is composed of 98% to 99.7% water.4 As the eye matures, changes may occur regarding the structure and composition of the vitreous. The vitreous functions to provide support to the retina against the choroid, to store nutrients and metabolites for the retina and lens, to protect the retinal tissue by acting as a “shock absorber,” to transmit and refract light, and to help regulate eye growth during fetal development.3,4 Case Report Initial Visit (03/23/2018) A 59-year-old Asian female presented as a new patient for examination with a complaint of a new onset of floaters and flashes of light in her right eye.
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Association Between Visual Field Damage and Corneal Structural
www.nature.com/scientificreports OPEN Association between visual feld damage and corneal structural parameters Alexandru Lavric1*, Valentin Popa1, Hidenori Takahashi2, Rossen M. Hazarbassanov3 & Siamak Yousef4,5 The main goal of this study is to identify the association between corneal shape, elevation, and thickness parameters and visual feld damage using machine learning. A total of 676 eyes from 568 patients from the Jichi Medical University in Japan were included in this study. Corneal topography, pachymetry, and elevation images were obtained using anterior segment optical coherence tomography (OCT) and visual feld tests were collected using standard automated perimetry with 24-2 Swedish Interactive Threshold Algorithm. The association between corneal structural parameters and visual feld damage was investigated using machine learning and evaluated through tenfold cross-validation of the area under the receiver operating characteristic curves (AUC). The average mean deviation was − 8.0 dB and the average central corneal thickness (CCT) was 513.1 µm. Using ensemble machine learning bagged trees classifers, we detected visual feld abnormality from corneal parameters with an AUC of 0.83. Using a tree-based machine learning classifer, we detected four visual feld severity levels from corneal parameters with an AUC of 0.74. Although CCT and corneal hysteresis have long been accepted as predictors of glaucoma development and future visual feld loss, corneal shape and elevation parameters may also predict glaucoma-induced visual functional loss. While intraocular pressure (IOP), age, disc hemorrhage, and optic cup characteristics have been long identifed as classic risk factors for development of primary open-angle glaucoma (POAG)1,2, the Ocular Hypertension Treatment Study (OHTS) suggested central corneal thickness (CCT) as a new risk factor for development of POAG3.
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Refractive Errors a Closer Look
2011-2012 refractive errors a closer look WHAT ARE REFRACTIVE ERRORS? WHAT ARE THE DIFFERENT TYPES OF REFRACTIVE ERRORS? In order for our eyes to be able to see, light rays must be bent or refracted by the cornea and the lens MYOPIA (NEARSIGHTEDNESS) so they can focus on the retina, the layer of light- sensitive cells lining the back of the eye. A myopic eye is longer than normal or has a cornea that is too steep. As a result, light rays focus in front of The retina receives the picture formed by these light the retina instead of on it. Close objects look clear but rays and sends the image to the brain through the distant objects appear blurred. optic nerve. Myopia is inherited and is often discovered in children A refractive error means that due to its shape, your when they are between ages eight and 12 years old. eye doesn’t refract the light properly, so the image you During the teenage years, when the body grows see is blurred. Although refractive errors are called rapidly, myopia may become worse. Between the eye disorders, they are not diseases. ages of 20 and 40, there is usually little change. If the myopia is mild, it is called low myopia. Severe myopia is known as high myopia. Lens Retina Cornea Lens Retina Cornea Light rays Light is focused onto the retina Light rays Light is focused In a normal eye, the cornea and lens focus light rays on in front of the retina the retina. In myopia, the eye is too long or the cornea is too steep.
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Treatment of Stable Keratoconus by Cataract Surgery with Toric IOL Implantation
10.5005/jp-journals-10025-1024 JaimeCASE Levy REPORT et al Treatment of Stable Keratoconus by Cataract Surgery with Toric IOL Implantation Jaime Levy, Anry Pitchkhadze, Tova Lifshitz ABSTRACT implantation in the right eye. On presentation, uncorrected We present the case of a 73-year-old patient who underwent visual acuity (UCVA) was 6/60 OU. Refraction was –0.75 successful phacoemulsification and toric intraocular lens (IOL) –5.0 × 65° OD and –3.25 –4.0 × 98° OS. Nuclear sclerosis implantation to correct high stable astigmatism due to and posterior subcapsular cataract +2 was observed in the keratoconus and cataract. Preoperative refraction was –3.25 – left eye. The posterior segments were unremarkable. 4.0 × 98°. A toric IOL (Acrysof SN60T6) with a spherical power of 16.5 D and a cylinder power of 3.75 D at the IOL plane and Corneal topography performed with Orbscan (Bausch 2.57 D at the corneal plane was implanted and aligned at an and Lomb, Rochester, NY) showed central thinning of 457 axis of 0°. Uncorrected visual acuity improved from 6/60 to microns and positive islands of elevation typical for 6/10. Postoperative best corrected visual acuity was 6/6, 6 months after the operation. In conclusion, phacoemulsification keratoconus in the right eye (Fig. 1). In the left eye a less with toric IOL implantation can be performed in eyes with pronounced inferior cone was observed (Fig. 2), without keratoconus and cataract. any area of significant thinning near the limbus typical for Keywords: Intraocular lens, Toric IOL, Keratoconus, Cataract pellucid marginal degeneration.2 Keratometry (K)-values surgery.
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Distribution of Anterior and Posterior Corneal Astigmatism in Eyes with Keratoconus
Distribution of Anterior and Posterior Corneal Astigmatism in Eyes With Keratoconus MOHAMMAD NADERAN, MOHAMMAD TAHER RAJABI, AND PARVIZ ZARRINBAKHSH PURPOSE: To investigate the magnitude, with-the-rule ERATOCONUS (KC) IS A PROGRESSIVE, USUALLY (WTR) or against-the-rule (ATR) orientation, and vec- bilateral ectatic corneal disorder, characterized by 1,2 tor components (Jackson astigmatic vectors [J0 and J45] K corneal thinning and protrusion. KC starts at and blurring strength) of the anterior and posterior puberty and progresses to the third or fourth decade of corneal astigmatism (ACA and PCA) in patients with life, causing myopia and astigmatism, which results in keratoconus (KC) in a retrospective study, and to try to severe vision distortion and sometimes even blindness.1 find suitable cutoff points for ACA and PCA in an Astigmatism is a refractive error that is mostly caused by attempt to discriminate KC from normal corneas. toricity of the anterior corneal surface leading to visually DESIGN: Retrospective age- and sex-matched case- significant optical aberration. Both the anterior and poste- control study. rior corneal surfaces contribute to the total corneal METHODS: Using the Pentacam images, the aforemen- astigmatism. Recently, the direct and quantitative mea- tioned parameters were compared between 1273 patients surement of the posterior corneal measurements in a with KC and 1035 normal participants. clinical setting has been possible with new imaging tech- RESULTS: The mean magnitude of the ACA and PCA nologies such as slit-scanning, Scheimpflug, or optical was 4.49 ± 2.16 diopter (D) and 0.90 ± 0.43 D, respec- coherence devices.3,4 tively. The dominant astigmatism orientation of the Assessment of the corneal astigmatism plays an impor- ACA was ATR in KC patients and WTR in normal par- tant role in vision correction procedures such as rigid gas- ticipants (P < .001), while for the PCA it was WTR in permeable lens prescription or intraocular lens (IOL) im- KC patients and ATR in normal participants (P < .001).
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Corneal Cross-Linking in Infectious Keratitis David Tabibian1,5*, Cosimo Mazzotta2 and Farhad Hafezi1,3,4
Tabibian et al. Eye and Vision (2016) 3:11 DOI 10.1186/s40662-016-0042-x REVIEW Open Access PACK-CXL: Corneal cross-linking in infectious keratitis David Tabibian1,5*, Cosimo Mazzotta2 and Farhad Hafezi1,3,4 Abstract Background: Corneal cross-linking (CXL) using ultraviolet light-A (UV-A) and riboflavin is a technique developed in the 1990’s to treat corneal ectatic disorders such as keratoconus. It soon became the new gold standard in multiple countries around the world to halt the progression of this disorder, with good long-term outcomes in keratometry reading and visual acuity. The original Dresden treatment protocol was also later on used to stabilize iatrogenic corneal ectasia appearing after laser-assisted in situ keratomileusis (LASIK) and photorefractive keratectomy (PRK). CXL efficiently strengthened the cornea but was also shown to kill most of the keratocytes within the corneal stroma, later on repopulated by those cells. Review: Ultraviolet-light has long been known for its microbicidal effect, and thus CXL postulated to be able to sterilize the cornea from infectious pathogens. This cytotoxic effect led to the first clinical trials using CXL to treat advanced infectious melting corneal keratitis. Patients treated with this technique showed, in the majority of cases, a stabilization of the melting process and were able to avoid emergent à chaud keratoplasty. Following those primary favorable results, CXL was used to treat beginning bacterial keratitis as a first-line treatment without any adjunctive antibiotics with positive results for most patients. In order to distinguish the use of CXL for infectious keratitis treatment from its use for corneal ectatic disorders, a new term was proposed at the 9th CXL congress in Dublin to rename its use in infections as photoactivated chromophore for infectious keratitis -corneal collagen cross-linking (PACK-CXL).
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Perspectives on Presbyopia
PERSPECTIVES ON PRESBYOPIA EXTRA CONTENT FOUR PATIENTS AVAILABLE FIVE EXPERTS BY MARY WADE, CONTRIBUTING WRITER ew presbyopia treatments, such as the corneal inlays Kamra and Raindrop, are slowly wending their way through the U.S. Food and Drug Administration approval process. Entirely new approaches to intraocular lenses (IOLs) are in development internationally. Meanwhile,N patients arrive in your office daily, seeking better vision without reading glasses. What are the best treatments to offer them right now? EyeNet asked five leading refractive surgeons to review four hypothetical patients with pres- byopia or pre-presbyopia. The differing recommendations made by these clinicians illustrate the range of valid approaches. The surgeons emphasize that, in all cases, it’s critical to conduct a thorough assessment, talk with patients about their vision priorities, discuss the pros and cons of various approaches, and mention the option of “watchful waiting”—that is, forgoing treatment for the time being. When patients are considering corrective surgery, one of the surgeon’s most important tasks is to help them form realistic expectations regarding visual outcomes and possible complications. (See “Counseling Caveats.”) For those patients who choose to pursue vision correction surgery, the perspectives presented by these refractive experts can help to guide treatment choices with today’s technologies. BONNIE A. HENDERSON, MD KEVIN M. MILLER, MD J. BRADLEY RANDLEMAN, MD STEVEN I. ROSENFELD, MD, FACS SONIA H. YOO, MD ALFRED T. KAMAJIAN T. ALFRED eyenet 37 eventually need cataract surgery, prior refractive surgery may make accurate refraction difficult and constrain lens choices. It makes sense to leave the corneas pristine in older patients.
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Review of the Impact of Presbyopia on Quality of Life in the Developing and Developed World
Acta Ophthalmologica 2014 Review Article Review of the impact of presbyopia on quality of life in the developing and developed world Ariana D. Goertz,1 William C. Stewart,2 William R. Burns,3 Jeanette A. Stewart2 and Lindsay A. Nelson2 1University of Nevada, Las Vegas, Nevada, USA 2PRN Pharmaceutical Research Network, LLC, Cheyenne, Wyoming, USA 3Encore Vision, Inc., Fort Worth, Texas, USA ABSTRACT. (Barbero 2013). Everyone eventually Purpose: To examine the public health impact of presbyopia regarding its effect develops presbyopia but symptoms on quality of life (QoL) and society in both the developed and developing worlds. may vary. The major risk factor for Methods: A database was created from articles found on PubMed, the Cochrane presbyopia is age although the condi- Library and Science Direct using the following search terms: presbyopia, QoL, tion may be affected by other factors accommodation, impact, cost, prevention, treatment and public health. Articles including disease, trauma and medica- were accepted into the database if they addressed presbyopia and public health. tions (American Optometric Associa- Results: This study showed in the developed world presbyopic subjects treated tion 2010). with reading glasses suffered a reduction in QoL parameters compared with Presbyopia is classically believed to those who were younger and emmetropic. A small minority of subjects were result from hardening of the lens although other causes have been assessed to be a candidate for additional non-spectacle treatment measures. In described as well such as changes in undeveloped areas, the manifestations of presbyopia were similar to the tissue elasticity and the ciliary body developed world in symptoms, age and reduced QoL.
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