LENS DYNAMICS, INC.

1. LENS DYNAMICS, INC.

2. SCLERAL HISTORY • Original contact lens • Hand ground glass lenses • Fit by casting a mold of the cornea

3. EARLY SCLERAL PERFORMANCE • Difficult to fit • Hard to manufacture and reproduce • Corneal hypoxia • Very short wearing times • Corneal molding – The negative kind

4. SCLERAL DEFINED • Mini-Sclerals – 12.5mm to 14.5mm • Medium Range Sclerals – 15.0mm to 18.0mm • Full Sclerals – 18.5mm to 28.0mm

5. SCLERALS – FIRST OR LAST RESORT?

6. WHY FIT A SCLERAL LENS? THE PRO: • To vault highly irregular corneas • To provide better visual acuity than soft lenses • To prevent lost lenses • New Oxygen permeable materials

7. WHY FIT A SCLERAL LENS? THE CON: • Harder to fit • Harder to insert and remove • Can reduce metabolic waste removal • Potential for hypoxia • Harder to fit

8. THE PRACTICAL: • First or Last Resort as a design? • Who fits sclerals at all? • Who fits sclerals as the design of First choice? • Who fits sclerals as a design of Last resort?

9. THE DESIGN: • 13.0mm, 13.5mm, 14.0mm • Lathe cut on DAC ALM lathes • Spherical back and front surfaces • Normally NOT fenestrated

10. HOW TO FIT • Start with a base curve close to average Ks • Trial for best alignment pattern as possible • Be sure there is NO conjunctival drag • Do spherical over-refraction • Need 0.5mm of movement

11. FITTING TIPS • Fill concave side with saline/wetting drops into posterior of trial lens • Dip fluorescein strip into solution • Insert using 2 fingers to handle the trial lens with patient looking at floor • Low riding lens – select flatter base curve • Flatten base curve to solve edge tightening

12. CASE HISTORIES

13. 48 years old, Caucasian male, OD cornea • Can’t use bi-toric • Quadrant Specific base curve not indicated • Temporal/superior area eliminates reverse curve design • Select Semi-Scleral 13.5 design CASE 1

14. 48 years old, Caucasian male, OD cornea • Average K is 47.00 D. or 7.18mm • Select 7.20mm BC from trial set, 13.5mm -4.00 • Acceptable fit with -2.25 over-refraction CASE 1

15. 22 years old, African American male, OS cornea • Superior, peripheral area too steep for Quadrant Specific base curve • Bi-toric not indicated • Select Semi-Scleral 13.5 design CASE 2

16. 22 years old, African American male, OS cornea • Average K is 47.00 D. or 7.18mm • Select 7.20 BC from trial set, 13.5mm • Lens too tight at edge and too much vaulting CASE 2

17. 22 years old, African American male, OS cornea • Select trial lens 0.2mm flatter or 7.40mm • Acceptable fit • Perform spherical over-refraction CASE 2

18. 31 year old Caucasion female, OD cornea • Bi-toric not indicated • Flatter areas too narrow for Quadrant Specific base curves • Reverse curve design not indicated • Select Semi-Scleral 13.5 design CASE 3

19. 31 year old Caucasion female, OD cornea • Average K is 46.25 D. or 7.30mm • Select 7.30mm trial lens from trial set • Low riding lens-select flatter base curve CASE 3

20. 31 year old Caucasion female, OD cornea • Select 7.50mm base curve from trial set • Acceptable fit with lens properly positioned • Perform spherical over-refraction CASE 3

21. Questions?