Dr. Reeder presented a very contemporary webinar complete with clinical pearls and pertinent cases pertaining to custom soft lenses for astigmatic and irregular cornea patients. She is a graduate of the University of Alabama-Birmingham College of Optometry prior to completing a residency in cornea and contact lenses at the Indiana University School of Optometry. For many years she was Chief of the Contact Lens Service at the Illinois College of Optometry prior to recently accepting the position of Department Chair in Clinical Education at the University of Pikeville, Kentucky College of Optometry. She is currently Secretary of the AOA Contact Lens and Cornea Section Council, and is a Diplomate and Diplomate Award Committee member of the American Academy of Optometry Cornea, Contact Lenses & Refractive Technologies Section. She is an advisory board member of the GPLI and the first educator to receive the GPLI “GP Practitioner of the Year” award.
Highlights of her webinar included the following:
I. Why Custom Soft Lenses
==========a. Patients wearing off the shelf standard soft lenses with corneas ===============exhibiting atypical corneal size or shape risk the following:
===============i. Poor Centration
===============ii. Insufficient or Excessive Movement
===============iii. Decreased Comfort
===============iv. Decreased Wearing Time
===============v. Possible Neovascularization
II. Custom Soft Lens Availability: Many CLMA laboratories offer custom solutions to address:
==========a. Sagittal needs
==========b. Large or small diameters
==========c. Steeper/flatter base curves
==========d. Parameter availability:
===============i. Torics: Higher power cylinders, often with axis in 1˚ ====================increments
===============ii. Multifocals: More toric options, higher adds, and ====================wavefront designs
III. Healthy Cornea Cases
==========a. Steeper than average cornea with a small horizontal visible iris ===============diameter; success with an 8.2mm BCR in a 13.0mm OAD custom soft ===============lens
==========b. Larger than average (12.4mm) corneal diameter; success was achieved ===============with a 15.0mm OAD custom soft lens
==========c. Highly myopic with moderate astigmatic correction; success achieved ===============with a 14.5mm OAD and the following powers in a custom soft toric ===============correction:
===============OD: -8.50 – 3.75 x 022 and OS: -9.00 – 3.75 x 167
IV. Custom Soft Lenses for the Irregular Cornea
==========a. Candidates
===============i. Unilateral kones
===============ii. Patients who have failed with either corneal or scleral ====================GP lenses
===============iii. Patients who dislike piggybacks
===============iv. Initial kone fits: very straightforward on mild-to-====================moderate kones and easier to handle than sclerals ====================or hybrids
===============v. Post PKP: especially plateau grafts
===============vi. PMD: more forgiving than corneal lenses with better ====================centration
===============vii. Post Refractive Surgery
==========b. Important Parameters, Fitting, Evaluation, and Care
===============i. Parameters: Base Curve, Diameter, and Thickness
===============ii. Topography
===============iii. Corneal Profile Evaluation
===============iv. Shape
===============v. Examples of Representative Lens Designs
===============vi. Lens Care
==========c. Representative Cases
===============i. Mild Kone with corneal GP intolerance; refit ====================successfully with custom soft lens
===============ii. Advanced Kone who had failed with both piggyback ====================and scleral lens in one eye; refit successfully with ====================custom soft toric with a steep skirt design
===============iii. Advanced Kone with high myopia and large HVID. =====================Successfully fit into a 15.0mm OAD custom soft =====================toric lens design
===============iv. Post PKP keratoconus patient who experienced =====================numerous failures with corneal GP lenses due to =====================poor lens position; successfully fit into a large =====================OAD, steep BCR, reverse geometry custom soft =====================toric design
===============v. Patient is aphakic and experienced penetrating ====================trauma with surgical repair resulting in a very ====================irregular cornea and has failed with corneal, ====================intralimbal, and corneoscleral lenses due to poor ====================centration; successfully fitted into a steep base ====================curve, high plus power custom soft toric lens
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