Edward S. Bennett, OD, MSEd, FAAO, FSLS
Professor Emeritus, University of Missouri St Louis College of Optometry
President and Executive Director




GPLI Educational Spotlight:

Hybrid Applications for Normal and Irregular Corneas:

Tiffany Andrzejewski OD, FAAO

This webinar, presented this past Tuesday night, February 16, should be archived under the “webinars” tab on www.gpli.info any day now. This represented the most contemporary and clinical presentation on hybrid applications and fitting that I have ever had the pleasure of viewing. Some of the highlights include:

I.                  Hybrids Versus Sclerals
==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

==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

2021 GPLI Monthly Webinar Series

March 16, 2021

OrthoK: Initial Fitting Challenges and Problem-Solving

=====Presented by
Michael J. Lipson, OD, FAAO
8:00 PM Central


April 20: Edward Boshnick OD, FAAO:
Scleral Lens Practice Management

May 18: Karen G. Carrasquillo OD, PhD, FAAO, FSLS, FBCLA: 
Management of the Scleral Lens Ocular Surface Disease Patient Beyond the Fit

June 15: Heidi Miller OD, FAAO, FSLS:
Pediatric Specialty Contact Lens Applications

July 20: Jeff Walline OD, PhD, FAAO: 
Myopia Management Update

August 17: Stephanie L. Woo OD, FAAO, FSLS:
Contact Lens Management of Keratoconus

September 21: Renee Reeder OD, FAAO, FSLS: Custom Soft Lens Update for Healthy and Irregular Cornea Patients

October 19: Jason Jedlicka OD, FAAO, FSLS:
Software Applications for Specialty Lens Designs

November 16: Greg DeNaeyer OD, FAAO, FSLS: Beyond the Basics: Advanced scleral lens design

December 21: Maria K. Walker OD, MS, FAAO, FSLS: GP Material Update


GPLI Resources Spotlight:

As was communicated in the last newsletter, many resources on www.gpli.info were impacted by the discontinuation of FLASH by Adobe. Fortunately, due to the efforts of Dr. Todd Zarwell with our GPLI Toric and Spherical Lens Calculator and Ursula Lotzkat from Wink Productions we have updated many of our popular resources including the following:
1)   GP Fitting, Evaluation, and Problem-Solving module. This revision has been completed and should be available any day now under the “Education” category on the home page. This was originally the fluorescein pattern evaluation and GP problem-solving series that was available over 30 years ago. With the technical expertise of a former book co-author of mine, Dr. Milton Hom, it was converted first to a DVD and then launched online. I consider it a hidden gem because it greatly compliments “Click N’ Fit” for understanding fluorescein patterns and the impact of lens design changes, but also includes videos pertaining to solving problems such as lens decentration, desiccation, and poor surface wettability.

2)   Building Your Practice with GP Bifocals and Multifocals. Another under-rated comprehensive resource located under the “Education” “By Lens Type” “Presbyopia/Multifocals”, this module has no less than 17 resources for ECPs, staff, and patients. The following five resources have been updated and should be available any day now.
=====a.    GP Presbyopic Lens Options video series
=====b.    Choosing the Right Patient; Choosing the Right Lens ==========video series
=====c.     GP Multifocal and Bifocal Fitting and Evaluation video ==========series
=====d.    Marketing Contact Lens Services to Your Presbyopic ==========Patients video series
=====e.    GP Lens Application and Removal video series

In addition, there are a number of other resources on this sight including a Professional Fee Calculator that can be used for any contact lens patient, a two video series entitled 1) “Setting Patient Expectations”, and 2) “Handling Patient Telephone Inquiries”, both featuring the talents of GP fitting expert-turned-actress Sue Connelly Schnell, a patient reading card, and downloadable PDFs of the following: “Presenting Options Card for the ECP”, “Scripts to Answer Patient Questions”, “Presenting Options Card for Staff”, "Glossary of Terminology”, and a “Patient Brochure”.

3) GP Lecture Series. This is yet another hidden gem which includes a 4-part series on contact lens management of keratoconus including diagnosis/evaluation, corneal topography (my favorite!), fitting, and troubleshooting by leading expert Dr. Christine Sindt. It also includes a lecture by Dr. Sindt on “Pediatric Fitting Techniques” and one that I presented on “Optimizing GP Initial Comfort”. These are located under the “Education” tab on the home page

In Memorium:
Gina Sorbara OD, MSc, FAAO, FBCLA

The GP world lost a true friend this past week with the passing of Dr. Gina Sorbara on February 10th after a long illness. If you are not aware of her contributions in the GP field I would be more than happy to communicate her accomplishments. She was an exceptional clinical researcher and helped make the Centre for Contact Lens Research at the University of Waterloo School of Optometry and Vision Research one of the leading research centers in the world. Specifically, she spearheaded the clinical studies pertaining to GP research and published extensively as it pertained to corneal and scleral GP design, fitting, and applications for both healthy and irregular corneas. I know Vinita Henry and I benefited from her contribution of the GP lens design and fitting chapter in the last few editions of our text. One of the greatest compliments I could give Gina is that she shared Vinita’s qualities of selflessness and a desire to work tirelessly behind the scenes to help other people. She was Diplomate in the Cornea, Contact Lenses & Refractive Technologies Section of the American Academy of Optometry and a Fellow in the British Contact Lens Association. However, her legacy primarily pertains to her work in worldwide contact lens education on behalf of the International Association of Contact Lens Educators (IACLE) and we all owe her a debt of gratitude for her extensive service to other people.  

Orders shipped to the USA only - complimentary

1)   GP Lens Management Guide (download only)

2)   Fluorescein Pattern Identification Card

3)   Correcting Presbyopia Tips Card

4)   Contact Lens Clinical Pocket Guide

5)   In-Office Disinfection of Multi-Patient Use Diagnostic Contact Lenses

6)   See with Your Contacts Even When You’re Not Wearing Them (Orthokeratology Patient Brochure which can be downloaded as well)

7)   Look as Young as You Feel (Multifocal Patient Brochure which can be downloaded as well)

8)   Scleral Lenses are Big News (Scleral Consumer Brochure which can be downloaded as well)

9)   Caring for Your GP Lenses (Care and Handling Patient Brochure which can be downloaded as well)

10)   Myopia Management (Myopia Patient Brochure for which the references can be downloaded from this site)

11)  Reading Verification Card (features both passages on one size of varying acuity and different types of print – newspaper, etc. – on the other side)

12) Scleral Lens Care Tips, Application and Removal Card

Our contact lens industry is growing thanks to each of us connecting with each other, hoping for the best and believing in what we do!!

GP Lens Institute

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(800) 344-9060 (USA & Canada)

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