X-Cel Contacts Product and Fitting Guide We Fit Your Practice.TM

X-Cel Contacts Product And Fitting Guide We Fit Your Practice.TM

Our commitment to you. X-Cel® Contacts is a leading manufacturer of custom soft and specialty gas permeable contact lenses. In this resource and fitting guide, you will find detailed information on our complete product offerings. We are committed to providing you with high quality made to order contact lenses not available in other manufacturer’s product lines. X-Cel’s order fulfillment time, whether standard or extended parameters, are from 1 to 3 business days.

We believe the patient in your chair is our patient too. We take the same care in consultation and manufacturing that you do in patient evaluation and fitting. Ultimately, everything we do reflects on you in the eyes of your patients. Their good vision and satisfaction is your goal. Your complete satisfaction is our goal. Combine all this and you have an organization committed to the very best, in all we do.

1 www.xcelcontacts.com Table Of Contents

Products By Brand 2 Products By Condition 3-4 Consultation Services 79 Warranties 80 Materials 81-82 Diagnostic Sets for Custom Soft 83 Diagnostic sets for Specialty GP 84-86

Products By Brand

X-Cel Custom Soft X-Cel Specialty GP

Atlantis™ Scleral 38-39 Flexlens® Arc for Irregular Corneas 5-7 Reverse Geometry 40-41 Flexlens® Tri-curve Keratoconus 8-10 Apex™ Keratoconus 42-44 Flexlens® Post Refractive (PRS) 11-13 Pinnacle™ 45-47 Flexlens® Piggyback 14-17 Pinnacle™ Large Diameter 48-49 Flexlens® Large Diameter 18 Pinnacle IC 48-49 Flexlens® Aphakic 19 Titan™ Large Diameter 50-52 Flexlens® Toric 20-22 Solution™ Bifocal 53-55 Flexlens® Sphere 23 CV-4™ Multifocal 56-58 Westhin™ Toric 24-25 ProPlus™ Multifocal 59-60 Horizon™ Bi-Con Bifocal 26-28 Essential Solution™ 61-64 Horizon™ Bi-Con Toric 29-31 Visions™ Toric 65-69 Horizon™ Progressive 32-34 Visions™ Ultrathin 70-72 Horizon™ Progressive Toric 35-37 Starlens™ 73-75 X-Cel Thin™ 76-78

Horizon™ & Westhin™ denotes a Westcon™ Design

2775 Premiere Parkway, Suite 600 • Duluth, GA 30097 • 800-241-9312 • Fax 800.822.9235 2 Products by Condition

Irregular Cornea 1

- Atlantis Scleral 38-39

- Flexlens ARC 5-7

- Titan Large Diameter 50-52

- Pinnacle Large Diameter 48-49

- Pinnacle IC 48-49

- Flexlens Tri-Curve Keratoconus 8-10

- Reverse Geometry 40-41 9

Keratoconus

- Flexlens ARC 5-7

- Flexlens Tri-Curve Keratoconus 8-10

- Atlantis Scleral 38-39

- Apex Keratoconus 42-44

28 15

Post Surgical 11-13

- Flexlens Post Refractive (PRS) 11-13

- Flexlens Tri-Curve Keratoconus 8-10

- Flexlens Piggyback 14-17

- Flexlens Large Diameter 18

- Adult and Pediatric Aphakic 19

- Atlantis Scleral 38-39

- Titan Large Diameter 50-52

- Pinnacle Large Diameter 48-49

- Pinnacle IC 38 48-49

3 www.xcelcontacts.com Products by Condition

Aphakic 3

- Adult and Pediatric Aphakic 19

Presbyopia

- Horizon Bi-con Bifocal 26-28

- Horizon Bi-con Toric 29-31

- Horizon Progressive 32-34

- Horizon Progressive Toric 35-37

- Solution Bifocal 53-55

- CV-4 Multifocal 56-58

- ProPlus Multifocal 59-60

- Essential Solution 61-64

Astigmatism

- Flexlens Toric 20-22

- Visions Toric 65-69

- Horizon Toric 20-22

- Westhin Toric 24-25

Single Vision

- Flexlens Sphere 23

- Visions Ultrathin 70-72

- Starlens 73-75

- Pinnacle 45-47

- X-Cel Thin 76-78 45-47

2775 Premiere Parkway, Suite 600 • Duluth, GA 30097 • 800-241-9312 • Fax 800.822.9235 4 FLEXLENS® ARC

A Custom Soft Lens Design for Irregular Corneas The Flexlens ARC (Atypical Refractive Correction) is a custom soft lens design that fits like a regular toric contact lens. The lens is indicated for the visual correction of various ocular conditions including keratoconus, pellucid marginal degeneration, corneal transplants, post refractive surgery and/or any irregular cornea conditions.

Lens Design The Flexlens ARC design utilizes a standard back surface fitting curve with an enhanced center thickness to stabilize the correction over an aberrated cornea. If residual astigmatism is detected through the over-refraction a toric design is needed. Cylinder powers ranging from -0.75 up to a -10.00 are available with prism ballast to reduce lens rotation. There is a laser mark (V) at 6 o’clock to mark the location of the prism ballast. A range of base curves and center thicknesses can be manipulated to successfully fit a wide patient base. With no need to worry about peripheral curves or any other parameter that may complicate the fit, the Flexlens ARC is easy to fit, thus reducing chair time.

Below are cases where the Flexlens ARC should be considered:

PMD RK RK TRAUMA

CENTRAL NIPPLE POST PK CONE LARGE SAGGING CONE CONE

PRK PKP LASIK

5 www.xcelcontacts.com FLEXLENS® ARC

Parameter Availability - Available in single, 3, 6 & 12 packs.

MATERIAL Definitive Silicone Hydrogel 74% BASE CURVE 6.0 to 8.7mm in 0.1mm steps FITTING CURVE 8.6 Standard Back Surface Fitting Curve DIAMETER 13.0 to 16.0mm in 0.5mm steps POWER +20.00 to -20.00D CYLINDER -0.75 to -10.00D in 0.25D steps AXIS 1º to 180º in 1 degree steps PRISM 1.50 standard with 2.00 available THICKNESS .30mm or .50mm WARRANTY Initial lens: Unlimited exchanges and cancellation within 90 days Annual supplies: Non-warranted and non-refundable

Front View Sectional View

FRONT PERIPHERAL OPTIC ZONE CURVE TORIC OPTIC ZONE

FRONT FITTING OPTIC ZONE CURVE TORIC OPTIC ZONE PRISM

Flexlens® ARC Flexlens® PERIPHERAL FITTING CURVE CURVE PRISM

Basic Fitting Information For best visual acuity outcome, and reduced chair time, use of a fitting set is required.

If the Flat K is equal to or flatter than 49.00D (6.89), start with 8.1 Base Curve.

If the Flat K is steeper than 49.12 (6.87), start with 7.5 Base Curve.

For cylinder powers at -2.00 or lower, START WITH THE .30 THICKNESS

Over a -2.00 cylinder START WITH THE .50 THICKNESS

Insert lens and evaluate fit/position as you would a normal soft lens. High molecular fluorescein is provided if needed.

As your Flexlens ARC fitting experience broadens, your base curve philosophy may vary.

2775 Premiere Parkway, Suite 600 • Duluth, GA 30097 • 800-241-9312 • Fax 800.822.9235 6 FLEXLENS® ARC

Fitting Steps

1. Starting with the position evaluation of the lens, look for a well centered alignment with no more than 2mm of movement.

2. Centrally the lens should display slight central touch with no air bubbles or folds.

3. Let lens settle for 10 minutes before performing rotation, edge and acuity evaluation.

4. Check for lens rotation. Any rotation over 10 degrees requires next steeper base curve.

5. Evaluate the edge in complete 360 degree circle by checking all four gazes (Up, Down, Right, Left)

6. Perform sphere-cylinder over-refraction and compare to best achievable acuity of patient. (should be at least equal)

7. All evaluation information should be given to an X-Cel consultant for final lens order.

Troubleshooting

Problem 1st Change 2nd Change

Too little or no movement Flatten BC 0.3mm Decrease diameter 0.5mm

Excessive movement Steepen BC 0.3mm Increase diameter 0.5mm

Central air bubble Flatten BC 0.3mm Decrease diameter 0.5mm

Lens fold Steepen BC 0.3mm Increase diameter 0.5mm

Excessive touch Steepen BC 0.3mm

Unstable over-refraction Flatten BC 0.3mm

Unstable lens rotation Steepen BC 0.3mm Increase diameter 0.5mm

Increase prism to 2.00 BCVA not achieved with Go to 0.50 thick lens 0.30 thick lens Decrease diameter 0.5mm

7 www.xcelcontacts.com FLEXLENS® TRI-CURVE

For Moderate to Advanced Keratoconus The Tri-Curve Keratoconus Lens is indicated for daily wear use for the correction of refractive ametropia and specialized use such as atypical ametropia.

Indications Examples include, but are not limited to: irregular astigmatism created by keratoconus, trauma, or post/penetrating keratoplasty. The lens is for patients with moderate to advanced keratoconus and is ideal for those: • Who cannot adapt to a rigid lens material • With monocular keratoconus who wish to wear a soft lens in the fellow eye • Who experience decentered optics with a rigid lens material

Other patients who may benefit from the increased central thickness and rigidity of the Tri-Curve Keratoconus Lens for vision correction include those with: • Pellucid marginal degeneration • Refractive surgery

The Flexlens Tri-Curve Keratoconus lens can correct up to 6.00 diopters of irregular astigmatism, but may need a .65 center thickness to do so.

Below are cases where the Tri-Curve Keratoconus should be considered:

PMD RK RK TRAUMA

CENTRAL NIPPLE POST PK CONE LARGE SAGGING CONE CONE

2775 Premiere Parkway, Suite 600 • Duluth, GA 30097 • 800-241-9312 • Fax 800.822.9235 8 FLEXLENS® TRI-CURVE

Lens Design The Flexlens Tri-Curve Keratoconus Lens is based on a tri-curve posterior design. The optical success of the design is based on the standard center thickness that ranges from .45 to .65mm which is often thicker than the keratoconus cornea itself. The design incorporates a flat secondary curve of 1.2mm to 1.8mm flatter, depending on the base curve. A scleral curve with a radius of 2.2mm to 2.8mm flatter, depending on the base curve, is added peripherally to align with the scleral curve of the eye. For those patients who exhibit high degrees of irregular astigmatism, they may be better served with the Flexlens ARC design.

Parameter Availability - Available in single, 3, 6 & 12 packs. BASE CURVE 6.0 to 11.0mm in 0.1mm steps DIAMETER 10.0 to 16.0mm in 0.1mm steps POWERS +30.00 to –30.00D in 0.25D steps CENTER THICKNESS .45 to .65mm WARRANTY Initial lens: Unlimited exchanges and cancellation within 90 days Annual supplies: Non-warranted and non-refundable

Front View Sectional View Flexlens® Tri-Curve Flexlens®

Basic Fitting Information A diagnostic set is recommended foremost in successfully fitting this lens design. *If fitting a patient in the Definitive 74%, adjust the Base Curve 0.3mm steeper or the Diameter 0.3mm larger. BASE CURVE Select a diagnostic lens using the averaged keratometer value. EXAMPLE: “K’s” 52.00D @ 180 / 57.00D @ 090 Mean “K” (52.00D + 57.00D) /2 = 54.50D Diagnostic Lens 6.2mm Base Curve is Average K Lens Evaluation When evaluating the fit of the Tri-Curve Keratoconus Lens, the lens should exhibit: • Lens centration with 1.0 to 1.5mm of limbal draping • Lens movement of 0.25 to 0.50mm in primary position with normal blink, maintaining stable vision • Visual acuity within two lines of best corrected vision

9 www.xcelcontacts.com FLEXLENS® TRI-CURVE

Push Up Test If the lens decenters up, down, left, or right, the base curve is most likely too flat and the next steeper base curve should be evaluated. If the lens centers well, a simple “push-up” test will verify if the base curve is appropriate for the patient. Place your index finger on the patient’s lower lid margin and manually push the lower lid and evaluate the lens movement. If the decentered lens slowly drops into a centered position, the lens to cornea relationship is appropriate. If the lens remains in a superior decentered position, or if edge stand off is noted as the lens reaches the lower limbus, the base curve relationship is too flat. In this situation, the next steeper base curve/diameter should be evaluated. A steep fitting lens will exhibit resistance to the manual manipulation of the lens with the lower lid. In this situation, the next flatter base curve can be evaluated. Lens Power If the visual acuity is less than expected, an additional over-refraction should be performed. The most accurate results will be obtained after the lens is worn for three to seven days of daily wear, with the lens being worn at least four hours on examination day.

Troubleshooting

Patient Symptoms Objective Findings Possible Cause Plan Order new lens based on new Unacceptable vision on eye chart Incorrect refraction or over-refraction refraction or over-refraction Base curve too flat Steepen base curve by 0.3mm Lens not centered Diameter too small Increase diameter by 0.5mm Base curve too flat Flat Fit = patient will exhibit “clear, Steepen base curve by 0.3mm blur, clear” when blinking Poor visual acuity on Fluctuating vision Base curve too steep delivery or first follow-up Steep Fit = patient will exhibit “blur, Flatten base curve by 0.3mm clear, blur” when blinking Cylinder over-refraction 2.00 diopters Increase center thickness to .65mm and under; Center thickness too thin Sphero-cylindrical over-refraction provides Change to Flexlens ARC design, good vision Cylinder over-refraction over 2.00 Atlantis Scleral, Flexlens Piggyback diopters design or utilize spectacles over the lenses Lens is too steep Flatten base curve by 0.3mm Scleral indentation Lens is too large Decrease diameter by 0.5mm Vision decreases during the day Lens is too thick; material does not Increase water content of lens Corneal edema provide enough oxygen material, or decrease center thickness Lens is too steep Flatten base curve by 0.3mm Improper fit Evaluate fit Initial discomfort Incompatibility with solutions Change patient’s care system Base curve too flat Steepen base curve by 0.3mm Excessive movement Diameter too small Increase diameter by 0.5mm Base curve too steep Flatten base curve by 0.3mm Discomfort at day’s end Too little or no movement Diameter too large Decrease diameter by 0.5mm Lens dehydrating on eye Decrease water content of lens Base curve too steep Flatten base curve by 0.3mm Scleral indentation Diameter too large Decrease diameter by 0.5mm Base curve too flat Steepen base curve by 0.3mm Lens dislodges during wear Superior to inferior edge lift Diameter too large Decrease diameter by 0.5mm

2775 Premiere Parkway, Suite 600 • Duluth, GA 30097 • 800-241-9312 • Fax 800.822.9235 10 FLEXLENS® PRS

Soft Contact Lens Following Corneal Refractive Surgery

The Flexlens Post Refractive Lens is indicated for daily wear use for the correction of refractive ametropia and specialized use such as atypical ametropia following corneal refractive surgery.

Lens Design The Post Refractive Lens function allows the central optical portion of the lens to be flatter than the mid-periphery. The optical zone has a thickness of approximately .28mm at –1.00D, which provides stable optics over the central cornea. The peripheral lens carrier is as thin as, or thinner than, any standard soft lens to ensure maximum oxygen permeability to the peripheral cornea, limbus and conjunctiva.

Parameter Availability - Available in single, 3, 6 and 12 packs. BASE CURVE 6.0 to 11.0mm in 0.1mm steps DIAMETER 10.0 to 16.0mm in 0.1mm steps POWER +30.00 to –30.00D in 0.25D steps WARRANTY Initial lens: Unlimited exchanges and cancellation within 90 days Annual supplies: Non-warranted and non-refundable

POST LASIK RK RK

PRK LASIK

11 www.xcelcontacts.com FLEXLENS® PRS

Front View Sectional View

AOZ(Variable OZ) INTERMEDIATE ZONE

FLANGE BC (8.7mm)

LENS DIAMETER (15.0mm)

TRANSITION AOZ –- Anterior Optic ZonZone ANTERIOR BC - Base Curve ZONE OPTIC ZONE BC –Base Curve Flexlens® Post Refractive Lens Refractive Post Flexlens®

Basic Fitting Information *If fitting a patient in the Definitive 74%, adjust the Base Curve 0.3mm steeper or the Diameter 0.3mm larger. Central keratometric readings are of little value in fitting the Post Refractive Lens. A diagnostic set is recommended for most successful fitting of this lens. Select a lens from the diagnostic set with a base curve of 8.7mm and a diameter of 15.0mm. Allow the lens to settle a few minutes before performing the initial evaluation. If the diagnostic lens does not exhibit obvious edge lift, allow the lens to settle an additional 30 minutes. If the lens does exhibit edge lift or decenters in any direction, this indicates a flat fitting relationship and the next steeper base curve should be tried.

Push Up Test If the lens centers well, a simple “push-up” test will verify if the base curve is appropriate for the patient. Place your index finger on the patient’s lower lid margin and manually push the lower lens edge up to the lower limbus. Release your finger pressure from the lower lid and evaluate the lens movement. If the decentered lens slowly drops into a centered position, the lens to cornea relationship is appropriate. If the lens remains in a superior decentered position, or if edge stand off is noted as the lens reaches the lower limbus, the base curve relationship is too flat. In this situation, the next steeper base curve/diameter should be evaluated. A steep fitting lens will exhibit resistance to the manual manipulation of the lens with the lower lid. In this situation, the next flatter base curve can be evaluated.

Lens Fitting Evaluation When evaluating the fit of the Post Refractive Lens, the lens should exhibit: • Lens centration with 1.0 to 1.5mm of limbal draping • Lens movement of 0.25 to 0.50mm in primary position with normal blink • Visual acuity within two lines of best corrected vision

Post-Op K’s Range Base Curve Diameter Pre-Op K’s Range Base Curve Diameter 37.75 - FLATTER 9.0 15.0 41.75 or FLATTER 9.0 15.0 38.00 - 41.00 8.7 15.0 42.00 - 45.00 8.7 15.0 41.25 - STEEPER 8.4 15.0 45.25 - STEEPER 8.4 15.0

2775 Premiere Parkway, Suite 600 • Duluth, GA 30097 • 800-241-9312 • Fax 800.822.9235 12 FLEXLENS® PRS

Troubleshooting

Patient Symptoms Objective Findings Possible Cause Plan Incorrect refraction or Order new lens based on new Unacceptable vision on eye chart over-refraction refraction Lens not centered Base curve too flat Steepen base curve by 0.3mm Fluctuating vision Center thickness too thin Increase center thickness to .45mm Poor visual acuity on Cylinder over-refraction 2.00 delivery or first follow-up diopters and under; center Increase center thickness to .45mm Sphero-cylindrical thickness too thin over-refraction Change to Flexlens ARC lens provides good vision Cylinder over-refraction over 2.00 design, Atlantis Scleral, Piggyback diopters lens design or utilize spectacles over lenses Lens is too steep Flatten base curve by 0.3mm Scleral indentation Lens is too large Decrease diameter by 0.5mm Increase water content of lens Lens is too thick; material does not material, or decrease center provide enough oxygen Corneal edema thickness Vision decreases Lens is too steep Flatten base curve by 0.3mm during the day Lens is too large Decrease diameter by 0.5mm Change to lower water Incompatibility with material content Deposits Discuss care system with Care system not followed or not patient and change as adequate necessary Improper fit Evaluate fit Initial discomfort Incompatibility with solutions Change patient’s care system Base curve too flat Steepen base curve by 0.3mm Excessive movement Diameter too small Increase diameter by 0.5mm Base curve too steep Flatten base curve by 0.3mm Discomfort at day’s end Too little or no movement Diameter too large Decrease diameter by 0.5mm Lens dehydrating on eye Decrease water content of lens Base curve too steep Flatten base curve by 0.3mm Scleral indentation Diameter too large Decrease diameter by 0.5mm

13 www.xcelcontacts.com FLEXLENS® PIGGYBACK

For Advanced Keratoconus The Flexlens Piggyback Lens design is ideal for the patient who requires the optics of a rigid lens but has difficulty with the initial comfort of that material.

This lens is indicated where centration is difficult to achieve due to an irregular corneal surface. Patients who would benefit from this design could have: • Beginning to advanced keratoconus • Refractive corneal surgery • Pellucid marginal degeneration • Corneal trauma • Terrien’s marginal degeneration • Corneal surface disease • Penetrating Keratoplasty Lens Design The Piggyback Lens incorporates a central circular depression into the anterior surface of the soft lens carrier. The design recesses the GP lens within the soft lens eliminating upper lid dislodgement and maintaining centration of the GP optics over the pupil.

Below are cases where the Flexlens Piggyback lens should be considered:

PMD LASIK RK RK TRAUMA

CENTRAL NIPPLE POST PK CONE LARGE SAGGING CONE CONE PRK

Parameter Availability - Available in single, 3, 6 and 12 packs. BASE CURVE 6.0 to 11.0mm in 0.1mm steps DIAMETER 10.0 to 16.0mm in 0.1mm steps ANTERIOR CUT-OUT DIAMETER 6.5 to 12.5mm in 0.1mm steps POWER Plano WARRANTY Initial lens: Unlimited exchanges and cancellation within 90 days Annual supplies: Non-warranted and non-refundable

2775 Premiere Parkway, Suite 600 • Duluth, GA 30097 • 800-241-9312 • Fax 800.822.9235 14 FLEXLENS® PIGGYBACK

Front View Sectional View Flexlens® PiggybackFlexlens® Lens

Basic Fitting Information *If fitting a patient in the Definitive 74%, adjust the Base Curve 0.3mm steeper or the Diameter 0.3mm larger.

SOFT LENS BASE CURVE The Piggyback Lens fitting criteria is identical to any soft lens, with movement and centration the primary factors. The initial lens selection should be 1.0mm flatter than the patient’s flattest keratometric value (in mm). There should be lens centration with 1.0 to 1.5mm of limbal draping and lens movement should be minimal, 0.25 to 0.50mm in primary position with normal blink. EXAMPLE: “K’s” 52.00D @ 180 / 57.00D @ 090 Flat “K” 52.00D = 6.49mm Diagnostic lens 7.5mm Base Curve Recommended lens: 7.5mm Base Curve, 14.5mm Diameter, Plano Power, 10.2mm Anterior Cut-out Diameter

Diagnostic fitting of the soft lens is enhanced by inserting a GP lens that is 1.0mm smaller than the recessed cut-out diameter. GP Insert Lens: Take the keratometric reading for the insert lens over the piggyback carrier. For example, if the anterior cut-out is 10.2mm, the largest GP lens diameter would be 9.2mm. This will mimic the final weight and lid to lens interaction, allowing for a better evaluation.

NOTE: The soft lens skirt should be inserted first, followed by the GP lens being inserted on top of the soft lens.

Lens Evaluation When evaluating the fit of the Piggyback lens, the soft lens should exhibit: • Lens centration with 1.0 to 1.5mm of limbal draping

15 www.xcelcontacts.com FLEXLENS® PIGGYBACK

Push Up Test If the soft lens decenters up, down, left or right, the base curve is most likely too flat and the next steeper base curve should be evaluated. If the soft lens centers well, a simple “push-up” test will verify if the base curve is appropriate for the patient. Place your index finger on the patient’s lower lid margin and manually push the lower lens edge up to the lower limbus. Release your finger pressure from the lower lid and evaluate the lens movement. If the decentered lens slowly drops into a centered position, the lens to cornea relationship is appropriate. If the lens remains in a superior decentered position, or if edge stand off is noted as the lens reaches the lower limbus, the base curve relationship is too flat. In this situation the next steeper base curve/diameter should be evaluated. A steep fitting lens will exhibit resistance to the manual manipulation of the lens with the lower lid. In this situation, the next flatter base curve can be evaluated.

Gas Permeable Insert Once the appropriate soft lens has been designed, the GP lens is removed from the central cut-out with a standard GP suction device. Keratometry is performed over the central depression of the soft contact lens and a standard GP lens is designed as if it were being fit onto the cornea. A base curve is selected on “K” or .10mm steeper than the flat “K”. The GP lens diameter should be selected at least 1.0mm smaller than the anterior cut-out boundaries to facilitate lens movement and tear exchange.

Ensures centration of the rigid lens over the central cornea maintaining a comfort level

similar to a soft lens, allowing freedom of day to day activities without discomfort.

2775 Premiere Parkway, Suite 600 • Duluth, GA 30097 • 800-241-9312 • Fax 800.822.9235 16 FLEXLENS® PIGGYBACK

Troubleshooting

Patient Symptoms Objective Findings Possible Cause Plan Order new GP lens based on new Unacceptable vision on eye chart Incorrect refraction or over-refraction refraction or over-refraction Steepen base curve by 0.50D and Base curve too flat adjust power GP Lens not centered Order new soft lens with smaller Anterior cut-out too large anterior cut-out Lens too small Increase soft lens diameter by 0.5mm Poor visual acuity on Soft lens not centered delivery or first follow-up Lens too loose Steepen soft lens base curve by 0.3mm Bubble between posterior surface of Flatten GP base curve by 0.50D and Incorrect GP base curve GP and anterior surface of soft lens adjust power GP lens too large for anterior cut-out Incorrect GP diameter Reduce GP diameter to fit into cut-out Steepen GP base curve by 0.50D and GP base curve too flat Build up of foreign matter between adjust power lenses Excessive edge lift of GP lens Reduce edge lift of GP lens Flatten base curve of soft lens by Base curve of soft lens too steep 0.3mm Diameter of soft lens too large Reduce soft lens diameter by 0.5mm Flatten GP base curve 0.50D and Corneal edema GP base curve too steep adjust power Increase water content of soft lens Water content of soft lens too low material Dk of GP lens too low Increase Dk of GP lens material Steepen GP base curve 0.50D and GP base curve too flat Vision decreases adjust power during the day GP lens dislodges Soft lens base curve too steep Flatten soft lens base curve by 0.3mm Edge of GP lens too thick Reduce edge profile of GP lens GP diameter too large Reduce GP diameter to fit into cut-out Call Consultation for best material Incompatibility with material recommendation Care system not followed or not Discuss care system with patient and Deposits adequate change as necessary GP lens too large trapping debris in Reduce GP diameter to fit into cut-out cut-out Base curve of soft lens too flat Steepen soft lens base curve by 0.3mm Excessive movement Diameter of soft lens too small Increase soft lens diameter by 0.5mm Initial discomfort Base curve of soft lens too steep Flatten soft lens base curve by 0.3mm Too little movement Diameter of soft lens too large Reduce soft lens diameter by 0.5mm

NOTE: The gas permeable lens should be rinsed with saline or a multi-purpose soft lens solution prior to inserting it into the soft lens.

17 www.xcelcontacts.com FLEXLENS® LARGE DIAMETER

Custom Soft Large Diameter The Flexlens Large Diameter is ideal for protection of eyes that have undergone keratoprosthesis (K-Pro/Alphacor), conditions where conventional soft lenses are not large enough in diameter to fit properly (i.e. megalocornea, pterygia, etc.), and refractive ametropia when large diameter soft lenses are needed to provide adequate centration.

Lens Design The Flexlens Large Diameter is a spherical soft lens made in a large diameter often used for therapeutic purposes. Due to the large diameter, the posterior surface of the lens is three curves unlike standard spheres which are two curves. The anterior side has a lenticular cut to reduce overall lens thickness.

Standard Parameters - Available in single, 3, 6 & 12 packs. BASE CURVE 7.0 to 11.0mm in 0.1mm steps DIAMETER 16.1 to 24.0mm in 0.1mm steps POWER +30.00 to -30.00D in 0.25 steps MATERIALS Methafilcon A 55% WARRANTY Initial lens: Unlimited exchanges and cancellation within 90 days Annual supplies: Non-warranted and non-refundable

Horizon Sphere is available in the same parameters

2775 Premiere Parkway, Suite 600 • Duluth, GA 30097 • 800-241-9312 • Fax 800.822.9235 18 FLEXLENS® APHAKIC

Adult & Pediatric The Flexlens Aphakic Lens is indicated for daily wear use for the correction of refractive ametropia and specialized use such as atypical ametropia. The lens is available for those patients who have undergone cataract removal either as a child or an adult. The range of available lens parameters makes it an ideal lens for any patient who cannot tolerate a GP lens after surgery.

Parameter Availability - Available in single, 3, 6 & 12 packs. BASE CURVE 6.0 to 11.0mm in 0.1mm steps DIAMETER 10.0 to 16.0mm in 0.1mm steps POWER +00.00 to +50.00D in 0.25D steps WARRANTY Initial lens: Unlimited exchanges and cancellation within 90 days Annual supplies: Non-warranted and non-refundable

*If fitting a patient in the Definitive 74%, adjust the Base Curve 0.3mm steeper or the Diameter 0.3mm larger.

Horizon Aphakic is available in the same parameters

19 www.xcelcontacts.com FLEXLENS® TORIC

Designed for Success. Guaranteed to Fit. The Flexlens Toric Lens is indicated for daily wear use for the correction of visual acuity in aphakic and non-aphakic persons with non-diseased eyes with myopia or hyperopia and possesses refractive astigmatism not exceeding 10.00D.

Lens Design

The Flexlens Toric Lens utilizes a back surface toric design, with 1.50D of prism ballast to stabilize rotation. There is a laser mark (V) at 6 o’clock to mark the location of the prism ballast. For those patients with high degrees of irregular astigmatism that cannot achieve optimal visual acuity can try a rigid gas permeable lens, Flexlens ARC or the Piggyback design.

Standard Parameters *If fitting a patient in the Definitive 74%, BASE CURVE 8.0 to 9.2mm in 0.1mm steps adjust the Base Curve 0.3mm steeper or the DIAMETER 13.5 to 15.0mm in 0.1 steps Diameter 0.3mm larger. POWER +10.00 to -10.00D in 0.25D steps CYLINDER -0.50 to -10.00D in 0.25D steps AXIS 1º Increments up to 180º CENTER THICKNESS .16mm at -3.00D

Parameter Availability - Available in single, 3, 6, & 12 packs Base Curve 6.0 to 11.0mm in 0.1mm steps Diameter 10.0 to 16.0mm in 0.1mm steps Power +40.00 to –40.00D in 0.25D steps CYLINDER –0.50 to –10.00D in 0.25D steps Axis 1º increments up to 180º WARRANTY Initial lens: Unlimited exchanges and cancellation within 90 days Annual supplies: Non-warranted and non-refundable

Horizon Toric is available in the same parameters

2775 Premiere Parkway, Suite 600 • Duluth, GA 30097 • 800-241-9312 • Fax 800.822.9235 20 FLEXLENS® TORIC

Front View Sectional View Flexlens® Toric Lens Toric Flexlens®

Basic Fitting Information The Flexlens Toric Lens is fit using a nomogram method which utilizes the Flat keratometry value.

Flat “K” Reading Suggested Base Curve Suggested Diameter 45.00D and steeper 8.0mm to 8.3mm 14.0 43.25D to 44.75D 8.3mm to 8.6mm 14.0 or 14.5 41.25D to 43.00D 8.6mm to 8.9mm 14.5 or 15.0 41.00D and flatter 8.9mm to 9.2mm 15.0

The chosen lens should be placed on the eye and allowed to settle for a minimum of 20 minutes before evaluating the fit for movement, rotation, and centration. The ideal lens fit should exhibit good centration with approximately 0.25 to 0.50mm of lens movement in primary position. If upon evaluation, the lens rotates more than 10 degrees and your over-refraction does not yield good visual results, consider a change in base curve and/or diameter prior to ordering a new lens that incorporates the cross cylinder as determined by your over-refraction. If lens rotates 10° or less and yields a stable over- refraction then re-order based on new lens that incorporates the cross cylinder as determined by your over-refraction.

21 www.xcelcontacts.com FLEXLENS® TORIC

Troubleshooting

Patient Symptoms Objective Findings Possible Causes Plan

Sphere/cylinder off axis If over-refraction yields good results, reorder new powers indicated Lens rotates 10 degrees or less Diameter too small Increase diameter by 0.5mm

Steepen base curve by 0.3mm and incorporate over Poor visual acuity on Base curve too flat refraction. Re-order new lens (as long as O/R is delivery or first Lens rotates 10 degrees or stable and consistent). follow-up more Increase diameter 0.5mm and incorporate over Diameter too small refraction. Re-order new lens (as long as O/R is stable and consistent).

Diameter too small Increase diameter by 0.5mm Lens does not rotate but is decentered Base curve too flat Steepen base curve by 0.3mm

Lens too steep Flatten base curve by 0.3mm Scleral indentation Lens is too large Decrease diameter by 0.5mm

Corneal edema Material does not provide Change to a higher water content material enough oxygen Vision decreases during the day Lens too steep Flatten base curve by 0.3mm Lens rotates out of position at days end Lens is too large Decrease diameter by 0.5mm

Incompatibility with material Lower water content material. Deposits Care system not followed or Discuss care systems with patient and change as inadequate necessary Occasional rotation of lens Diameter too small Increase diameter by 0.5mm Unstable vision Slight edge lift Base curve too flat Steepen base curve by 0.3mm

Improper fit Evaluate fit Initial discomfort Incompatibility with solutions Change patient’s care system

Base curve too flat Steepen base curve by 0.3mm Excessive movement Diameter too small Increase diameter by 0.5mm

Discomfort at days end Base curve too steep Flatten base curve by 0.3mm

Too little or no movement Diameter too large Decrease diameter by 0.5mm

Lens dehydrating on eye Decrease water content of lens

2775 Premiere Parkway, Suite 600 • Duluth, GA 30097 • 800-241-9312 • Fax 800.822.9235 22 FLEXLENS® SPHERE

For An Exact Fit Every Time The Flexlens Spherical Lens is indicated for daily wear use for the correction of higher degrees of ametropia. The lens is available in a large diameter with or without a thick edge and also with 1.50D or 2.00D of prism.

Lens Design Standard soft lens fitting principles apply to the Flexlens Spherical Lens. Lens selection should be 4.00D flatter than the patient’s flattest keratometric value. There should be lens centration with 1.0 to 1.5mm of limbal draping and lens movement should be minimal, 0.25 to 0.50mm in primary position with normal blink.

Standard Parameters BASE CURVE 8.0 to 9.2mm in 0.1mm steps *If fitting a patient in the Definitive 74%, DIAMETER 13.5 to 15.0mm in 0.1mm steps adjust the Base Curve 0.3mm steeper or the POWER +10.00 to –10.00D in 0.25D steps Diameter 0.3mm larger.

Parameter Availability - Available in single, 3, 6 & 12 packs. BASE CURVE 6.0 to 11.0mm in 0.1mm steps DIAMETER 10.0 to 16.0mm in 0.1mm steps POWER +40.00 to –40.00D in 0.25D steps WARRANTY Initial lens: Unlimited exchanges and cancellation within 90 days Annual supplies: Non-warranted and non-refundable

Horizon Sphere is available in the Original same parameters and is available Eye Color for tinting. See Below:

Aqua Brown

Green Blue

23 www.xcelcontacts.com WESTHIN™ TORIC

Soft Toric Contact Lens for Daily Wear The Westhin Toric is indicated for Daily Wear use for the correction of visual acuity in aphakic and non-aphakic patients with non-diseased eyes with myopia and hyperopia and who process refractive astigmatism not exceeding 10.00 diopters.

Lens Design The Westhin Toric is a lathe cut back surface toric utilizing the dual thin zone for stabilization. The inferior and superior peripheral area of the lens is thinner allowing it to position under the upper and lower lids while the slightly thicker area will position between the lids. There are two “V” axis marks horizontally at 3 & 9 o’clock to determine axis location.

Standard Parameters - Available in single, 3, 6 & 12 packs BASE CURVE 8.0 to 9.5mm in 0.1mm steps DIAMETER 13.5 to 15.5mm in 0.1mm steps POWER +20.00 to -20.00D in 0.25D steps CYLINDER -0.50 to -10.00D in 0.25D steps AXIS 1º increments up to 180º WARRANTY Initial lens: Unlimited exchanges and cancellation within 90 days Annual supplies: Non-warranted and non-refundable

2775 Premiere Parkway, Suite 600 • Duluth, GA 30097 • 800-241-9312 • Fax 800.822.9235 24 WESTHIN™ TORIC

Troubleshooting

Patient Symptoms Objective Findings Possible Causes Plan

Sphere/cylinder off axis If over-refraction yields good results, reorder new powers indicated Lens rotates 10 degrees or less Diameter too small Increase diameter by 0.5mm

Steepen base curve by 0.3mm and incorporate over Poor visual acuity on Base curve too flat refraction. Re-order new lens. (as long as O/R is delivery or first Lens rotates 10 degrees or stable and consistent). follow-up more Increase diameter 0.5mm and incorporate over Diameter too small refraction. Re-order new lens. (as long as O/R is stable and consistent).

Diameter too small Increase diameter by 0.5mm Lens does not rotate but is decentered Base curve too flat Steepen base curve by 0.3mm

Lens too steep Flatten base curve by 0.3mm Scleral indentation Lens is too large Decrease diameter by 0.5mm

Incompatibility with material Lower water content material. Deposits Care system not followed or Discuss care systems with patient and change as inadequate necessary

Occasional rotation of lens Diameter too small Increase diameter by 0.5mm Unstable vision Slight edge lift Base curve too flat Steepen base curve by 0.3mm

Improper fit Evaluate fit Initial discomfort Incompatibility with solutions Change patient’s care system

Base curve too flat Steepen base curve by 0.3mm Excessive movement Diameter too small Increase diameter by 0.5mm

Discomfort at days end Base curve too steep Flatten base curve by 0.3mm

Too little or no movement Diameter too large Decrease diameter by 0.5mm

Lens dehydrating on eye Decrease water content of lens

25 www.xcelcontacts.com HORIZON™ BI-CON BIFOCAL

Soft Bifocal Contact Lens for Daily Wear The Horizon Bicon Bifocal Sphere is indicated for Daily Wear use for the correction of visual acuity with non-diseased eyes with myopia, hyperopia, and presbyopia and less than -0.75 diopters of refractive astigmatism.

Lens Design The Bicon Bifocal Sphere is a back surface spherical lens utilizing the double slab off for stabilizing cylinder axis. The “V” axis orientation marks are located horizontally at 3 & 9 o’clock. The center near zone is variable in size and power.

Standard Parameters - Available in single, 3, 6 & 12 packs BASE CURVE 8.0 to 9.2mm in 0.1mm steps DIAMETER 14.0 to 15.0mm in 0.1mm steps SPHERE RANGE +20.00 to -20.00D in 0.25 steps ADD POWER Up to +4.00 ADD in 0.25 steps ADD ZONE 1.8, 2.0, 2.5, 3.0, 3.5, 4.0 WARRANTY Initial lens: Unlimited exchanges and cancellation within 90 days Annual supplies: Non-warranted and non-refundable

2775 Premiere Parkway, Suite 600 • Duluth, GA 30097 • 800-241-9312 • Fax 800.822.9235 26 HORIZON™ BI-CON BIFOCAL

Basic Fitting Information:

Step 1 From the keratometry reading select the initial base curve from the chart Flattest Keratometry measurement Suggested base curve Select a Lens from 38.00 to 41.00 8.9 or flatter the Diagnostic Set 41.25 to 45.00 8.6 to 8.9 45.25 to 48.00 8.3 or steeper

From the horizontal visible iris diameter choose the initial diameter from the chart HVID measurement Suggested diameter Less than 11.0mm 14.0mm or smaller 11.0mm to 12.0mm 14.5mm Greater than 12.0mm 15.0mm or larger Select a trial lens for the dominant eye with a 2.5mm near zone and a 3.0mm near zone for the non- dominant eye.

Once the trial lens is inserted and allowed to settle evaluate the fit for movement, and centration. The ideal Step 2 lens fit should exhibit good centration with approximately 0.25 to 0.50mm of lens movement in primary position. Insert lens

If the lens decenters up, down, left, or right, the base curve is most likely too flat and the next steeper base Step 3 curve should be tried and evaluated.

Push Up Test If the lens centers well, a simple push-up test will verify if the base curve is appropriate for the patient.

To perform a push-up test, place your index finger on the patients lower lid margin and manually push the lower lens edge upward to the lower limbus. Release your finger pressure from the lower lid and evaluate the lens movement.

If the decentered lens slowly drops into a center position, the lens to cornea relationship is appropriate.

The base curve relationship may be too flat if the lens remains in a superior decentered position, or if the edge standoff is noted as the lens reaches the lower limbus. If this occurs, the next steeper curve/diameter should be evaluated.

A steep fitting lens will exhibit resistance to the manual manipulation of the push-up test. In this situation, the next flatter base curve should be tried and evaluated.

Once the ideal fit is achieved perform a sphero-cylinder over refraction to determine best distance acuity. Step 4 Once best distance correction is determined over-refract for best near vision preferably using hand held lenses. If the over refraction does not result in acceptable visual acuity in either distance or near consider Final Evaluation a change in base curve and or diameter and repeat the over refraction procedure. For the Bi-Con toric or sphere lenses, if the patient is reporting ghosting or 3D vision in distance order the initial lenses with smaller near zones. If ghosting or 3D vision is observed in the near vision order the initial lens with larger near zones. Please note that the Horizon Progressive toric or sphere near zones are a fixed size and cannot be altered. If your patient has smaller than average pupil sizes it is advisable to fit the Bi-Con with the small near zones.

27 www.xcelcontacts.com HORIZON™ BI-CON BIFOCAL

Troubleshooting

Patient Symptoms Plan

Steepen base curve by 0.3mm Excessive Movement Increase diameter by 0.5mm

Flatten base curve by 0.3mm No Movement Decrease diameter by 0.5mm

Steepen base curve by 0.3mm Poor Centration Increase diameter by 0.5mm

Increase diameter by 0.5mm Excessive rotation, more than 20 degrees Steepen base curve by 0.3mm

Order new lenses based on sphero-cylindrical Unsatisfactory visual over-refraction, providing over-refraction results in acuity for distance good end point vision. Westcon will calculate new lens powers from your over-refraction

Increase zone diameter .5mm Unsatisfactory visual acuity for near Adjust add power

Ghosting at distant vision Decrease zone diameter .5mm in both eyes

Ghosting at near vision Increase zone diameter .5mm in both eyes

Fluctuating vision or over- Fit problem, normally corrected with a change in base refraction fails to give curve or diameter acceptable visual acuity

Lack of intermediate vision Decrease add power on the dominate eye

2775 Premiere Parkway, Suite 600 • Duluth, GA 30097 • 800-241-9312 • Fax 800.822.9235 28 HORIZON™ BI-CON BIFOCAL TORIC

Soft Bifocal Contact Lens for Presbyopic Patients The Horizon Bi-con Bifocal Toric is indicated for Daily Wear use for the correction of visual acuity with non-diseased eyes with myopia, hyperopia, and presbyopia having refractive astigmatism not exceeding 10.00 diopters.

Lens Design The Horizon Bi-con Bifocal Toric is a back surface toric utilizing the double slab off for stabilizing cylinder axis. The “V” axis orientation marks are located horizontally at 3 & 9 o’clock. The center near zone is variable in size and power.

Standard Parameters - Available in single, 3, 6 & 12 packs BASE CURVE 8.0 to 9.2mm in 0.1mm steps DIAMETER 14.0 to 15.0mm in 0.1mm steps SPHERE RANGE +20.00 to -20.00D in 0.25 steps CYLINDER RANGE -0.50 to -10.00D in 0.25 steps BIFOCAL ADD POWER +0.50 to +4.00D in 0.25 steps AXIS 1º increments up to 180º WARRANTY Initial lens: Unlimited exchanges and cancellation within 90 days Annual supplies: Non-warranted and non-refundable

29 www.xcelcontacts.com HORIZON™ BI-CON BIFOCAL TORIC

Basic Fitting Information:

If the lens decenters up, down, left, or right, the base curve is most likely too flat and the next steeper base Step 3 curve should be tried and evaluated.

Push Up Test If the lens centers well, a simple push-up test will verify if the base curve is appropriate for the patient.

If the decentered lens slowly drops into a center position, the lens to cornea relationship is appropriate.

A steep fitting lens will exhibit resistance to the manual manipulation of the push-up test. In this situation, the next flatter base curve should be tried and evaluated.

Once the ideal fit is achived perform a sphero-cylinder over refraction to determine best distance acuity. Once best distance correction is determined over-refract for best near vision preferably using hand held Step 4 lenses. If the over refraction does not result in acceptable visual acuity in either distance or near consider a change in base curve and or diameter and repeat the over refraction procedure. For the Bi-Con toric Final Evaluation or sphere lenses, if the patient is reporting ghosting or 3D vision in distance order the initial lenses with smaller near zones. If ghosting or 3D vision is observed in the near vision order the initial lens with larger near zones. Please note that the Horizon Progressive toric or sphere near zones are a fixed size and cannot be altered. If your patient has smaller than average pupil sizes it is advisable to fit the Bi-Con with the small near zones.

2775 Premiere Parkway, Suite 600 • Duluth, GA 30097 • 800-241-9312 • Fax 800.822.9235 30 HORIZON™ BI-CON BIFOCAL TORIC

Troubleshooting

Patient Symptoms Plan

Steepen base curve by 0.3mm Excessive Movement Increase diameter by 0.5mm

Flatten base curve by 0.3mm No Movement Decrease diameter by 0.5mm

Steepen base curve by 0.3mm Poor Centration Increase diameter by 0.5mm

Increase diameter by 0.5mm Excessive rotation, more than 20 degrees Steepen base curve by 0.3mm

Unsatisfactory visual Increase zone diameter .5mm in both eyes acuity for near Adjust add power

Ghosting at distant vision Decrease zone diameter .5mm in both eyes

Ghosting at near vision Increase zone diameter .5mm in both eyes

Fluctuating vision or Fit problem, normally corrected with a change in base over-refraction fails to give curve or diameter acceptable visual acuity

Lack of intermediate vision Decrease add power on the dominate eye

31 www.xcelcontacts.com HORIZON™ PROGRESSIVE

Soft Contact Lens for Presbyopic Patients The Horizon Progressive Sphere is indicated for Daily Wear use for the correction of visual acuity with non-diseased eyes with myopia, hyperopia, and presbyopia and less than -0.75 diopters of refractive astigmatism.

Lens Design The Horizon Progressive Sphere is a spherical bi-curve back surface. These lenses are center near and the zones are 3.0 for the non-dominant eye and 2.5 for the dominant eye. The near zone power is aspherical providing for intermediate vision while the distance zone surrounding the near zone is spherical.

Standard Parameters - Available in single, 3, 6 & 12 packs BASE CURVE 8.0 to 9.2mm in 0.1mm steps DIAMETER 14.0 to 15.0mm in 0.1mm steps POWER +20.00 to -20.00D in 0.25D steps ADD ZONE Dominant or Non-dominant ADD POWER Up to to +3.50 in 0.25 steps WARRANTY Initial lens: Unlimited exchanges and cancellation within 90 days Annual supplies: Non-warranted and non-refundable

2775 Premiere Parkway, Suite 600 • Duluth, GA 30097 • 800-241-9312 • Fax 800.822.9235 32 HORIZON™ PROGRESSIVE

Basic Fitting Information:

If the lens decenters up, down, left, or right, the base curve is most likely too flat and the next steeper base Step 3 curve should be tried and evaluated.

Push Up Test If the lens centers well, a simple push-up test will verify if the base curve is appropriate for the patient.

If the decentered lens slowly drops into a center position, the lens to cornea relationship is appropriate.

A steep fitting lens will exhibit resistance to the manual manipulation of the push-up test. In this situation, the next flatter base curve should be tried and evaluated.

Once the ideal fit is achived perform a sphero-cylinder over refraction to determine best distance acuity. Step 4 Once best distance correction is determined over-refract for best near vision preferably using hand held lenses. If the over refraction does not result in acceptable visual acuity in either distance or near consider a change in base curve and or diameter and repeat the over refraction procedure. For the Bi-Con toric Final Evaluation or sphere lenses, if the patient is reporting ghosting or 3D vision in distance order the initial lenses with smaller near zones. If ghosting or 3D vision is observed in the near vision order the initial lens with larger near zones. Please note that the Horizon Progressive toric or sphere near zones are a fixed size and cannot be altered. If your patient has smaller than average pupil sizes it is advisable to fit the Bi-Con with the small near zones.

33 www.xcelcontacts.com HORIZON™ PROGRESSIVE

Troubleshooting

Patient Symptoms Plan

Steepen base curve by 0.3mm Excessive Movement Increase diameter by 0.5mm

Flatten base curve by 0.3mm No Movement Decrease diameter by 0.5mm

Steepen base curve by 0.3mm Poor Centration Increase diameter by 0.5mm

Increase diameter by 0.5mm Excessive rotation, more than 20 degrees Steepen base curve by 0.3mm

Unsatisfactory visual Order new lenses after determination of adjusted near acuity for near power using hand-held lenses

Fluctuating vision or over- Fit problem, normally corrected with a change in base refraction fails to give curve or diameter acceptable visual acuity

2775 Premiere Parkway, Suite 600 • Duluth, GA 30097 • 800-241-9312 • Fax 800.822.9235 34 HORIZON™ PROGRESSIVE TORIC

Soft Contact Lens Option for Your Astigmatic Presbyopes The Horizon Progressive Toric is indicated for Daily Wear use for the correction of visual acuity with non-diseased eyes with myopia, hyperopia, and presbyopia having astigmatism not exceeding 5.00 diopters.

Lens Design The Horizon Progressive Toric is a back surface toric utilizing the double slab off for stabilization. There are two “V” axis marks horizontally at 3 & 9 o’clock to determine axis location. These lenses are center near and the zones are 3.0 for the non-dominant eye and 2.5 for the dominant eye. The near zone power is aspherical providing for intermediate vision while the distance zone surrounding the near zone is spherical. Three material options are available along with a wide parameter range.

Standard Parameters - Available in single, 3, 6 & 12 packs BASE CURVE 8.0 to 9.2mm in 0.1mm steps DIAMETER 14.0 to 15.0mm in 0.1mm steps POWER +20.00 to -20.00D in 0.25D steps CYLINDER RANGE -0.75 to -5.00D in 0.25D steps AXIS 1º increments up to 180º ADD POWER Up to +3.50 ADD 0.25D steps WARRANTY Initial lens: Unlimited exchanges and cancellation within 90 days Annual supplies: Non-warranted and non-refundable

35 www.xcelcontacts.com HORIZON™ PROGRESSIVE TORIC

Basic Fitting Information:

If the lens decenters up, down, left, or right, the base curve is most likely too flat and the next steeper base Step 3 curve should be tried and evaluated.

Push Up Test If the lens centers well, a simple push-up test will verify if the base curve is appropriate for the patient.

If the decentered lens slowly drops into a center position, the lens to cornea relationship is appropriate.

A steep fitting lens will exhibit resistance to the manual manipulation of the push-up test. In this situation, the next flatter base curve should be tried and evaluated.

2775 Premiere Parkway, Suite 600 • Duluth, GA 30097 • 800-241-9312 • Fax 800.822.9235 36 HORIZON™ PROGRESSIVE TORIC

Troubleshooting

Patient Symptoms Plan

Steepen base curve by 0.3mm Excessive Movement Increase diameter by 0.5mm

Flatten base curve by 0.3mm No Movement Decrease diameter by 0.5mm

Steepen base curve by 0.3mm Poor Centration Increase diameter by 0.5mm

Excessive rotation, more Increase diameter by 0.5mm than 20 degrees Steepen base curve by 0.3mm

Unsatisfactory visual Order new lenses after determination of adjusted near acuity for near power using hand-held lenses

Fluctuating vision or Fit problem, normally corrected with a change in base over-refraction fails to give curve or diameter acceptable visual acuity

37 www.xcelcontacts.com ATLANTIS™ SCLERAL

It’s a 1-2-3 Fit Strategy Atlantis is a scleral lens design that performs well on any patient with an irregular cornea, including keratoconus, pellucid marginal degeneration, corneal transplants, post refractive surgery, post corneal rings, and ocular surface disease. Scleral lenses have also been utilized on regular corneas, dry eye patients, and athletes. Lens Design The Atlantis proprietary lens design was developed to provide a problem solving solution along with a simplified fitting system with the 1-2-3 fit strategy. The unique peripheral curve calculation will allow central clearance while providing good distribution of pressure in the landing area, adequate edge lift and overall superior comfort.

Below are cases where the Atlantis Scleral should be considered:

PMD RK RK TRAUMA

CENTRAL NIPPLE POST PK CONE LARGE SAGGING CONE CONE

PRK PKP LASIK

2775 Premiere Parkway, Suite 600 • Duluth, GA 30097 • 800-241-9312 • Fax 800.822.9235 38 ATLANTIS SCLERAL

Standard Parameters BASE CURVE 6.50 to 9.00mm, 7.03 to 9.00mm, 7.18 to 9.00mm DIAMETER 15.0, 16.0 and 16.5 POWER +20.00 to -20.00D in 0.25D steps MATERIAL Boston XO and Boston XO2 COLOR Ice Blue, Clear WARRANTY Two exchanges per eye or cancellation within 90 days

Basic Fitting Information The Atlantis lens is best fit utilizing a diagnostic set and the 1-2-3 Fit Guide. The fitting philosophy is based on the premise of customizing the lens fit by manipulating 3 zones to control the sagittal height relationship of the lens to the anterior ocular surface. The design offers 3 proprietary zones which each has a specific function and are independent of each other. The diagnostic set will offer laser markings to easily identify the 3 proprietary zones to ensure an easier evaluation process for the practitioner.

A comprehensive fit guide or fitting tutorial, is available for download at www.xcelcontacts.com, or call your local branch.

Each set contains:

24 GP Atlantis Lenses 1 Fitting Guide 4 Patient Insertion/Removal Guides 2 Single Use Saline 2 Small DMV’s 2 Large DMV’s 3 Lap Towels 1 Pen Light with Cobalt Blue Filter 3 Fluorescein Strips

39 www.xcelcontacts.com REVERSE GEOMETRY

Optimal Stabilization The Reverse Geometry lens design can be used for patients with any irregular cornea including Lasik, RK, PRK and PKP to aid in comfort and over all fit.

Lens Design The Reverse Geometry lens has a central optical zone with a flatter radius of curvature as compared to the adjacent intermediate curve to allow better centration for irregular corneas.

*If being used for corneal reshaping the following material options are available:

Boston XO & XO2: Red or Yellow Equalens: Red or Yellow Paragon HDS: Violet Paragon HDS 100: Yellow

Below are cases where the Reverse Geometry should be considered:

LASIK RK PRK PKP

Standard Parameters BASE CURVE 6.00 to 12.00mm DIAMETER 8.0 to 12.6mm POWER +50.00 to -50.00D in 0.25D steps WARRANTY Two exchanges per eye or cancellation within 90 days

2775 Premiere Parkway, Suite 600 • Duluth, GA 30097 • 800-241-9312 • Fax 800.822.9235 40 REVERSE GEOMETRY

Troubleshooting

Patient Symptoms Plan

Steepen base curve by .50D Excessive Movement Steepen Reverse Curve and Peripheral curves by 1.00mm each

Flatten base curve by .3mm Restricted Movement Flatten Reverse Curve and Peripheral curves

Increase Diameter by .3mm Decentration in any Direction Decrease OZ by .3mm

Bearing in Intermediate Flatten Reverse Curve and Peripheral curve by 1.00mm each

Flatten Base Curve by .50D Centrally Bubbles Flatten Reverse Curve by .75mm

Peripherally Steepen Peripheral Curves by 1.00mm with a .2 width

41 www.xcelcontacts.com APEX™ KERATOCONUS

Fitting Forgiveness Apex is indicated for the early, moderate and advanced keratoconus patient. With a thin lens profile, this lens allows quick and easy adaptation to lens wear.

Lens Design The Apex™ Keratoconus Lens is an aspheric thin lens design. This proprietary design is based upon the belief that those patients who are successful with GP lenses must be fitted with a lens that minimizes apical interaction, avoids impingement of the peripheral cornea, specifically in the flatter superior quadrant, and places the optical zone over the pupil. In order to meet this challenge, the posterior surface has a spherical optical zone radius small enough to allow tear exchange yet large enough to provide good vision without excessive flare. In addition, the posterior lens surface has enough eccentricity to adequately align with the flattening seen in the peripheral keratoconic cornea.

Below are cases where the Apex Keratoconus should be considered:

CENTRAL NIPPLE CONE LARGE SAGGING CONE CONE

Standard Parameters BASE CURVE 4.96 to 8.44mm DIAMETER 7.9 to 10.5mm POWER +30.00 to -30.00D PERIPHERY Steep, Medium, Flat WARRANTY Two exchanges per eye or cancellation within 90 days

2775 Premiere Parkway, Suite 600 • Duluth, GA 30097 • 800-241-9312 • Fax 800.822.9235 42 APEX™ KERATOCONUS

Basic Fitting Information The following are proven guidelines to aid in the fitting of keratoconus with X-Cel’s Apex proprietary lens design. This design has a number of inherent “fitting forgiveness factors” to aid lens performance.

OBJECTIVES: • Maintain centration of the spherical posterior optical zone over the visual axis to maximize vision and minimize flare.

• Minimize interaction of the lens and the typically more elevated corneal apex.

• Establish a “grip” or fulcrum points along the horizontal meridian to maintain centration of the lens.

• Avoid impingement in the peripheral and mid-peripheral cornea, especially in the superior quadrant. Impingement can result in limited wear time, poor comfort, inferior lens decentration, and poor tear film replenishment during the blink that can result in epithelial breakdown.

• Consider the use of a topical anesthetic for patients who are not currently wearing GP lenses. By blocking the reflex tear mechanism, and the use of wratten filter, a more accurate fluorescein pattern may be determined. Apex is indicated for the early, moderate and advanced keratoconus patient. With a thin lens profile, this lens allows quick and easy adaptation to lens wear.

• Insert the “mean” diagnostic lens (45.00D -4.00 9.3) on the eyes(s) regardless of keratometry. Step 1 • Apply proper amount of fluorescein and observe with a cobalt light. Select Base Curve • If a constant “black” appearance is observed over the corneal apex, steepen the base curve until a “lightening” is observed during the blink. • If the corneal apex is vaulted or a bubble is observed trapped beneath the lens, flatten the base curve.

• If lens is decentered, increase lens diameter. Step 2 • If proper centration is achieved and inferior edge stand off is observed, decrease lens diameter. Evaluate Diameter • If poor tear exchange over the apex is observed during the blink, consider reducing the diameter.

• Three edge lift values available are steep, medium, and flat. (all lenses in the diagnostic set are medium) Step 3 • If insufficient edge lift is observed, consider the next flatter edge lift value. Determine Periphery • If excessive edge lift is observed, utilize the next steeper edge lift value.

Step 4 • Over-refract the most appropriate diagnostic lens to determine lens power to be ordered. Determine Power

43 www.xcelcontacts.com APEX™ KERATOCONUS

Troubleshooting

Patient Symptoms Possible Causes Plan

Steepen Base Curve by 1.00 D Lens Riding High Reduce Diameter by .3 mm

Movement with Blink Flatten Base Curve by 1.00D Lens Riding Low No Movement Decrease Diameter by .3mm

Steepen Base Curve by 1.00 D Excessive Movement Increase Diameter by .3mm

Flatten Base Curve by 1.00D Restricted Movement Decrease Diameter by .3mm

Flatten Base Curve by 1.00D Centrally Decrease Diameter by .3mm Bubbles Decrease Edge Lift (Flat to Medium, Medium to Steep) Peripherally Decrease Diameter by .3mm

Clean Lens New Lens Change Material Surface Non Wetting Clean Lens Older Lens Order New Lens

Reduce Edge Lift (Flat to Medium, Medium to Steep) Too Much Edge Lift Increase Diameter by .3 mm

Increase Edge Lift (Steep to Medium, Medium to Flat) Not Enough Edge Lift Decrease Diameter by .3mm

2775 Premiere Parkway, Suite 600 • Duluth, GA 30097 • 800-241-9312 • Fax 800.822.9235 44 PINNACLE™

Aspheric Comfort Design For the myopic or hyperopic patient who shows moderate to high amounts of with the rule corneal and refractive astigmatism.

Lens Design The Pinnacle lens design is a continuous aspheric concave geometry design with adjustable edge lifts to aid in fit and comfort.

Standard Parameters BASE CURVE 6.00 to 9.90mm DIAMETER* 7.5 to 9.9mm POWER +60.00 to -60.00D PERIPHERY Steep, Medium, Flat WARRANTY Unlimited exchanges and cancellation within 90 days

*Base curve radius restricts diameter range available.

45 www.xcelcontacts.com PINNACLE™

Basic Fitting Information:

CORNEAL BASE CURVE Step 1 Select Base Curve Plano to 1.00D On Flat K

1.12D to 1.50D 0.25D steeper than Flat K

1.62D to 2.00D 0.50D steeper than Flat K

2.12D to 2.50D 0.75D steeper than Flat K

2.62D or more Discuss with Consultant

Step 2 BASE CURVE DIAMETER Choose Diameter Small Recommended Large

7.10 to 7.38mm 8.7 mm 9.0 mm 9.3 mm

7.42 to 8.08mm 9.0 mm 9.3 mm 9.6 mm

8.13 to 8.49mm 9.3 mm 9.6 mm 9.9 mm

Determine the lens power to be ordered. First, vertex the distance power of the spectacle prescription to Step 3 the corneal plane, if necessary. Determine Periphery Next adjust for tear layer effects depending on the base curve selected. When fitting steeper than K, compensate for the tear layer effect with minus power. When fitting flatter than K, compensate for the tear layer effect with plus power.

This nomogram is based on using the recommended diameter.

*Smaller diameter – fit 0.25D steeper * Large diameter – fit 0.25D flatter

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Troubleshooting

Patient Symptoms Possible Causes Plan

Steepen Base Curve by .50 D Lens Riding High Reduce Diameter by .3 mm

Movement with Blink Steepen Base Curve by .50D Lens Riding Low No Movement Decrease Diameter by .3mm

Steepen Base Curve by .50 D Excessive Movement Increase Diameter by .3mm

Flatten Base Curve by .50D Restricted Movement Decrease Diameter by .3mm

Flatten Base Curve by .50D Centrally Decrease Diameter by .3mm Bubbles Decrease Edge Lift (Flat to Medium, Medium to Steep) Peripherally Decrease Diameter by .3mm

Reduce Edge Lift (Flat to Medium, Medium to Steep) Too Much Edge Lift Increase Diameter by .3 mm

Increase Edge Lift (Steep to Medium, Medium to Flat) Not Enough Edge Lift Decrease Diameter by .3mm

47 www.xcelcontacts.com PINNACLE™ LARGE DIAMETER PINNACLE™ IC

Solutions for Irregular Corneas Pinnacle Large Diameter or Pinnacle IC can be used for any irregular cornea patient, including lasik, corneal transplants and injuries to aid in comfort and overall fit.

Lens Design The Pinnacle Large Diameter and Pinnacle IC lens designs are continuous aspheric concave geometry designs with adjustable edge lifts and a large diameter to aid in stability and comfort for irregular corneas. Standard Parameters - Pinnacle Large Diameter BASE CURVE 6.00 to 9.90mm DIAMETER* 10.0 to 11.2mm POWER +60.00 to -60.00D PERIPHERY Steep, Medium, Flat WARRANTY Unlimited exchanges and cancellation within 90 days Standard Parameters - Pinnacle IC BASE CURVE 6.00 to 9.90mm DIAMETER* 11.3 to 12.6mm POWER +60.00 to -60.00D PERIPHERY Steep, Medium, Flat WARRANTY Unlimited exchanges and cancellation within 90 days

*Base curve radius restricts diameter range available on both Large Diameter and IC.

Below are cases where either Pinnacle design should be considered:

LARGE SAGGING PRK PKP LASIK CONE

RK RK TRAUMA

2775 Premiere Parkway, Suite 600 • Duluth, GA 30097 • 800-241-9312 • Fax 800.822.9235 48 PINNACLE™ LARGE DIAMETER PINNACLE™ IC

Troubleshooting

Patient Symptoms Possible Causes Plan

Steepen Base Curve by .50 D Lens Riding High Reduce Diameter by .3 mm

Movement with Blink Steepen Base Curve by .50D Lens Riding Low No Movement Decrease Diameter by .3mm

Steepen Base Curve by .50 D Excessive Movement Increase Diameter by .3mm

Flatten Base Curve by .50D Restricted Movement Decrease Diameter by .3mm

Flatten Base Curve by .50D Centrally Decrease Diameter by .3mm Bubbles Decrease Edge Lift (Flat to Medium, Medium to Steep) Peripherally Decrease Diameter by .3mm

Reduce Edge Lift (Flat to Medium, Medium to Steep) Too Much Edge Lift Increase Diameter by .3 mm

Increase Edge Lift (Steep to Medium, Medium to Flat) Not Enough Edge Lift Decrease Diameter by .3mm

49 www.xcelcontacts.com TITAN™ LARGE DIAMETER

For the Management of Irregular Corneal Conditions Good candidates for this gas permeable lens design include:

- Irregular corneas, associated with: • Centration Problems – spherical, oblique, and ATR corneas • Post Surgical – RK, Lasik, PKP, Intacs, and Ecstasia • Corneal Dystrophies – KC & PMD • Corneal Trauma – Scars due to injury

- Patients with regular astigmatism: • Especially those that experience variable vision with soft and soft toric lenses

Lens Design The Titan is a large diameter gas permeable lens with an aspheric posterior surface. This posterior surface allows the large diameter lens to avoid becoming too tight in the peripheral and mid-peripheral area of the cornea. More than one aspheric value of eccentricity is available with this design.

Below are cases where the Titan should be considered:

LARGE SAGGING PRK PKP LASIK CONE

PMD RK RK

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Parameter Availability BASE CURVE 6.75 to 9.93mm DIAMETER 11.3 to 12.3mm in 0.1mm steps POWERS +60.00 to -60.00D EDGE LIFT Steep, Medium, Flat MATERIAL Recommended in Optimum Extra WARRANTY Two exchanges per eye or cancellation within 90 days

Basic Fitting Information:

Start with a diagnostic lens that is approximately one diopter flatter than the flattest K, regardless of the Step 1 amount of corneal astigmatism. Select Base Curve

Adjust the Base Curve through Fluorescein evaluation. The goal is to equally distribute the mass of the lens Step 2 avoiding areas of vault and/or bearing of the corneal surface. Use of a wratten filter is suggested. Evaluate Fluorescein

Step 3 It is suggested that the steeper edge lifts be “earned”. Evaluate Diameter These larger lens diameters ride adjacent to the limbus which tends to be significantly flatter than the central and paracentral areas of the anterior cornea. and Periphery The medium and flatter edge lift values are most common.

The final lens should display good centration, minimal corneal surface interaction, and some movement in Step 4 all gazes. Final Evaluation

Not enough edge lift = order Flat PC Too much edge lift = order Steep PC When the most appropriate base curve is determined, refract over the lens to determine the final power.

51 www.xcelcontacts.com TITAN™ LARGE DIAMETER