I. Hybrids Versus Sclerals
Pros:
==a. Soft part adapts to scleral shape
b. Allows tear flow under lens
c. Reduces post-lens tear layer “fogging”
d. Fit with lower clearance
e. Optics of lens closer to entrance pupil
f. Increased oxygenation
g. Streamlined fitting approach
Cons:
==a. More difficult to fit with very asymmetric/irregular corneas
b. More frequent replacement
c. Smaller OZ can result in flare
d. Less customizable
II. Hybrids in the Year 2021
=====a. 84Dk silicone skirt with higher modulus to minimize tight ==========fits and improved resistance to protein binding
=====b. Available with Tangible HydraPEG
=====c. 130 Dk GP center with UV blocker
=====d. GP/Soft Skirt Hyperbond®
III. Hybrid Applications for Normal Corneas
=====a. Candidates:
i. Moderate-to-high refractive error
ii. Similar corneal and refractive astigmatism
iii. Comfort issues with corneal GP lenses
iv. Reduced vision with spherical/toric soft lenses
v. Active lifestyle
=====b. Duette Lens
i. Aspheric GP center (8.5mm with 7.0mm OZD); ===============14.5mm OAD
ii. 13 BCR (7.1 – 8.3mm); 3 skirt curves, & Power ===============+10 to -15D
iii. Desire mild central clearance with fluorescein
=====c. SynergEyes iD (individually designed) Lens
i. Launched last month
ii. OZD: increased from 7.0 to 8.5mm with a mono-===============curve design
iii. Allows for better centration and distribution of ===============weight
iv. MTO per K readings in .12D increments
v. Fit mid K (not to exceed 1D steeper than “K”)
vi. The skirt has a new linear design that follows ===============the scleral shape to reduce tension and less ===============lens tightening which increases comfort and ===============eases removal
vii. Precisely MTO based on HVID
viii. Can use SynergEyes iD Lens Calculator for ===============empirical fitting at Link to calculator
ix. The fit should should show mild clearance with ===============a brighter or denser “halo” of pooling at the ===============peripheral edge of the GP
=====d. Problem-Solving
i. Decentered Lens: Steepen BC 0.50D and/or ===============skirt radius
ii. Excessive movement: steepen skirt radius
iii. No movement: Is BCR appropriate? If so, flatten ===============skirt curve
iv. Comfort: Could be excessive movement, poor ===============fit, trapped air bubble or lid awareness
v. Vision: The final lens power should be within ===============0.50D of spherical portion of spectacle Rx ===============when vertex converted
IV. Hybrid Lenses for the Presbyope
=====a. Indications
i. Any amount of astigmatism although , ≤ 0.75D ===============residual
ii. Patients not satisfied with soft multifocal vision
iii. Patients not satisfied with GP lens comfort
iv. Patients not satisfied with vision through soft ===============toric monovision
v. Patients not satisfied with vision with soft toric ===============multifocals
=====b. Duette Progressive Designs
i. Center-Distance for emerging presbyope with ===============adjustable center 1.8 – 4mm zone
ii. Center-Near design for moderate-advanced ===============presbyopes with 3mm central zone and ===============available in 3 add powers
iii. Empirical fitting
=====c. SynergEyes iD Multifocal
i. Utilizes extended depth of focus optics as ===============designed by the Brien Holden Vision Institute
ii. The goal is to provide good vision at all ===============distances, minimizing visual disturbances like ===============ghosting and haloes resulting in consistent ===============performance across individual pupils, ===============decentration, or ocular aberrations.
iii. Unique power profile with optics that are ===============continuously and rapidly changing; smooth ===============uncompromised transition of vision
iv. Has also been used as a tool in myopia ===============management
V. Hybrid Care and Handling
=====a. Removal
i. Clean, dry fingers
ii. Use index and thumb together and make a “V” ===============and place at 5 & 7 o’clock positions of lens ===============and pinch off with patient viewing straight ===============ahead
=====b. Care
i. Digital cleaning is a must!
ii. GP care systems contraindicated
iii. Approved care regimens for Tangible Hydra-===============PEG include Clear Care and Biotrue
VI. Hybrid Lenses for Irregular Corneas
=====a. Indications
i. Prolate Corneas (keratoconus, corneal graft, ===============corneal ectasia)
ii. Oblate Corneas (Post-refractive surgery, sunken ===============graft)
iii. Asymmetric Corneas (PMD, corneal scarring)
=====b. Poor Candidates
i. Patients with mid-peripheral corneal ===============obstructions or intracorneal rings
ii. Patients with corneal apex squarely in the mid-===============periphery
iii. Patients with significant OSD
iv. Patients with poor corneal rigidity (i.e., following ===============RK surgery)
v. Corneal transplants/tilted grafts
vi. Keratoglobus
======c. UltraHealth
i. Has a reverse geometry aspheric GP section
ii. 11 vaults for fitting and 4 skirt curves
iii. Candidates
===============1. Unilateral irregularity
===============2. Central irregularities
===============3. Alternative to soft toric (vision), piggyback ====================(less hassle/handling), or scleral lenses ====================(less fogging, handling & cost concerns)
iv. Fitting Considerations
===============1. Lens should clear central cornea by 100-====================150 microns at initial fit
===============2. After lens wear it should vault by ≥ 50 ====================microns (lens is 200 microns thick if ====================judging by optic section)
v. Troubleshooting
===============1. Excessive Movement
====================a. Skirt is too flat (steepen skirt)
====================b. Vault is too deep (reduce vault)
===============2. Air Bubbles
====================a. Insertion error
====================b. If it occurs under lens with the blink; =========================steepen skirt
==========Typically order with flat-medium skirts
===============3. Glare & Haloes
====================a. Vault too high
====================b. Lens is decentered
====================c. May be pupil/OZ issue
===============4. Comfort
====================a. Add Tangible HydraPEG
====================b. Ensure appropriate solution use
====================c. Proper insertion & removal; =========================encourage not to insert forcefully =========================as this can cause mechanical =========================staining and also tight lens =========================issues
====================d. Apical touch is present
vi. UltraHealth FC
===============1. For oblate corneas: more lift ====================paracentral/midperiphery; less central ====================vault
===============2. Also useful for patients having a flatter ====================cornea than that available in the ====================UltraHealth
