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Moodi Kupperman B.Sc Soflex
GP Lenses in your Clinique
Advantages to your customer
Improved corneal health Sharp, stable and clear vision Easy to handle Economic and easy cleaning process Comfortable throughout entire day Long lens life
GP Lenses in your Clinique
Advantages for you
Less chair time More profit Customer loyalty Less health problems for your customer’s eye
100 years from glass to GP, contact lens History
• 1508 Leonardo da Vinci illustrated the concept of contact lenses • 1823 British astronomer Sir John Herschel conceptualized practical lens design • 1887 First contact lens manufactured from glass, and fitted to cover the entire eye • 1939 Contact lenses first made from plastic • 1948 Plastic contact lenses designed to cover only the eye's cornea • 1971 Introduction of soft contact lenses • 1978 Introduction of GP contact lenses • 1981 FDA approved new soft contact lenses for extended (overnight) wear • 1986 Overnight wear of GP contact lenses became available • 1987 Introduction of disposable soft contact lenses 3/16/2013 • 1987 GP contacts available in next-generation 4 fluorosilicone acrylate materials
Silicone Methacrylic acid (Hema) = = = Oxygen permeability Wetting agents MethylMethAcrylate (MMA) 3/16/2013 Mechanical and optical stability 6 .Silicone Fluroine Methacrylic Acid Methylmethacrylate HEMA MMA Polymer (in Greek) = Poly .many.parts Fluoro-Silicone-Acrylate Fluorine. Meros .
RGP Lens Properties • Oxygen permeability / Oxygen Transmissibility • Surface characteristics – Wettability. reactivity • Dimensional stability • Flexural resistance • Hardness • Fracture resistance • Specific gravity • Index of refraction • Machining capabilities 3/16/2013 7 .
Standards for measuring Dk O2 O2 O2 O2 O2 O O2 O2 O2 O2O2 2 OO 2 2 O2 0.10 mm O2 O2 O2 O O2 2 O O2 2 O2 O2 O2 O2 0. Dk/t .20 mm The higher the Dk/t number the greater 3/16/2013 the oxygen transmissibility ! • • • • • • Coulometric Polarographic ISO Fatt ISO Fatt (revised) mm Hg hPa 8 .Is the thickness of the lens.Oxygen Transmissibility Dk .Is the materials permeability to oxygen.Is the materials oxygen transmissibility t .
MeniconZ=168 HDS100 Bxo Optimum Extra =100 Optimum Comfort=65 HDS=58 S4=32 S3=18 3/16/2013 10 .
Other Techniques for Measuring In Vivo Oxygen Transmissibility • • • • • Overnight Corneal Swelling Biochemical corneal changes Epithelial mitosis Corneal sensitivity Limbal vascular response 3/16/2013 11 .
Limbal Redness Low Dk CL High Dk CL 3/16/2013 12 .
Silicone Fluorine 3/16/2013 15 .
Measurement of the Material Wetting Properties In Vitro Sissile Drop – in air Captive Bubble – in water Wilhelmy Plate – Dynamic in water 3/16/2013 16 .
RGP Surface Modification • Bulk properties • Molecular membranes • Plasma treatment Plasma polymerization Treated Surface Untreated Surface Monomer 3/16/2013 18 .
RGP Surface Modification Manufacturing Induced Non-Wetting Residual Blocking / Polishing Pitch 3/16/2013 19 .
RGP Surface Modification Manufacturing Induced Non-Wetting Excessive Solvent Exposure 3/16/2013 20 .
RGP Surface Modification Manufacturing Induced Non-Wetting Excessive Heat Exposure 3/16/2013 21 .
Plasma Treatment The Cleaning stage Oxygen Surface Contaminant Plasma The oxygen plasma hits the lens surface with such force that it breaks-up any surface contaminants such as waxes. polishing pitch and residual residue left on the lens. 3/16/2013 22 .
Plasma Treatment The Surface Modification Stage • Electron ejected from a gas (oxygen) • Bombard the contact lens surfaces • The reaction between the gas molecules and the surface silicon molecules alters the hydrophobic silicon surface chemistry 3/16/2013 to one that is significantly more hydrophilic 23 .
Plasma Treatment BEFORE 3/16/2013 AFTER 24 .
Base Curve Radius Stability 3/16/2013 26 .
Flexural Resistance • In Vitro Laboratory measurement • In Vivo Residual astigmatism 3/16/2013 28 .
RGP Surface Scratches 3/16/2013 30 .
Fracture resistance 3/16/2013 32 .
140 Centered Lens Position Optimum Comfort HDS S4 S3 1.270 1.Specific gravity Superior Lens Position Inferior Lens Position Material name Menicon z Optimum Extra HDS100 Specific Gravity 1.126 3/16/2013 34 .200 1.170 1.160 1.160 1.100 Bxo 1.
453 +1.415 +1.25 +0.25 Menicon Z Bxo 3/16/2013 1.25 +1.440 1.490 Add Pwr +1.Material Index and Add Power • Higher index materials can be made thinner while maintaining the same refractive power low n Material PMMA I/R 1.449 1.75 36 high n .75 HDS HDS 100 1.
Raw Material Properties Material name Menicon z Optimum Extera HDS100 Bxo Optimum Comfort HDS S4 S3 3/16/2013 Wetting Angle Oxygen Permeability (Dk) Hardness (Rockwell R)* Refractive Index Specific Gravity 24 3 42 49 6 14.442 1.126 39 PMMA 0 1.446 1.440 1.470 1.160 1.490 .200 1.5 100.7 12.437 1.160 1.140 1.449 1.270 1.0 1.415 1.8 30 160 100 100 100 65 58 32 18 112.170 1.0 105.100 1.431 1.
OP8 OPT. OP5. Soflex ND. Tri. OP2.All Soflex gas permeable lens design are available in all the above materials !!! Ski. SPHRD…… 3/16/2013 40 .
The Soflex ND • Soflex .ND is our Polish Free flexible Gas Permeable contact lens which is incredibly comfortable for customers to wear and convenient for practitioners to fit. 3/16/2013 41 . • The lens base curve has a unique aspheric optic zone and continuous periphery that controls the edge lift and rounds the edge. This revolutionary design allows maximum comfort and easy fitting.
Fast Tool Servo 3/16/2013 42 . This combination together with Plasma treatment gives the lens excellent wettability.ND is produced on computer controlled diamond turning lathes using advanced raw materials.The Soflex ND Soflex‟s Soflex . high oxygen permeability and reliable parameter stability.
Polish Free • • • • • • High reproducibility rate Excellent optics Accurate parameters Stable parameters High quality surface finish High comfort all day long 3/16/2013 43 .
Fitting the Soflex ND 1. Initial data gathering 2. RGP lens Rh Rv Axis Sph Cyl Axis HVID BUT R 3/16/2013 L 44 . Ordering of the Soflex – ND. Lens Fit Analysis 3.
Initial data gathering • Recent routine refraction – note the visual acuity and back vertex distance. • Keratometry and/or Topography 3/16/2013 45 . • Full eye examination including a slit-lamp assessment.
ND lens should be fitted using the lid attachment method Tear film quantity and quality assessment using the slit lamp. The Soflex .Initial data gathering Tips: Measurements are required of the Horizontal Visible Iris Diameter (HVID). - The position of the eye lids is important. the vertical palpebral aperture. The HVID gives an initial clue as to the overall lens diameter. and the pupil diameter in various illumination conditions. Observing the tear prism Tear break-up time with fluorescein - 3/16/2013 46 . usually approximately 2 mm less than HVID.
3/16/2013 47 . An assessment and note of the lens fit and performance is made.A suitable Soflex . Suitable modifications may be suggested to improve the fit and these may be discussed.ND lens is selected from the Trial Set Box based on the available information and inserted into one eye.
ND lens has a Back Optic Zone Radius of curvature (BOZR) nearest to the flattest keratometry „K‟ reading. Tip: For each 0.05mm from lens BC (steeper) 3/16/2013 48 . to spread the lens pressure on the cornea more evenly and to improve comfort. For this lens design the lens BOZR on flattest „K‟ is preferable. An aspheric lens design is more likely to closely follow the midperipheral corneal contours.75D corneal astigmatism reduce 0.Lens fit analysis The first choice Soflex . An aspherical design lens can often mask corneal astigmatism better.
A steeper fit would often be needed • If the lens power is a high minus power of greater than -7. +7.00 49 -7.00 . A flatter fit and larger diameter would often be needed.00 3/16/2013 -3. the lens front surface shape and thickness may affect the fitting.00D. the center of gravity is posterior to the corneal apex and the lids can grasp the relatively thicker lens transitional zone to lift the lens.Effect of Lens Thickness • If a lens has a back vertex power (BVP) of greater than +4.00D.
ND lens Over All Diameter ( OAD ) is 9.Lens Diameter The Soflex . • A small lens diameter is used where palpebral aperture is small 3/16/2013 50 .20 are also available upon request • A large overall lens diameter may be preferred in order to help pupil coverage. and in some cases to stabilize the lens fit if there is excessive lens movement.60mm – Standard Diameter 9.00 and 10. to assist lens centration particularly if the palpebral aperture is wide.
The slitlamp with the cobalt blue filter can be used for a more detailed view of the lens fit pattern and tear flow.Lens Fit The Soflex . The lens centration. 3/16/2013 51 . the patient blinks several times and the fluorescein pattern observed using the Burton lamp for a general view with the patient‟s head in a natural position.ND lens fit is assessed after a drop of fluorescein is instilled. movement and fit should be noted. both in the primary position of gaze and on various eye movements.
Fluorescein pattern Flat fit • An apical bearing fluorescein pattern reflects a flat fitting relationship. An apical bearing 3/16/2013 52 . This can be easily managed via selecting a steeper base curve radius. This relationship can ultimately result in corneal distortion in the region of bearing. Photo shows a Flat Pattern.
An apical clearance 3/16/2013 53 . Select a flatter base curve radius to improve the fitting relationship. This can cause peripheral seal off. resulting in poor tear exchange and possibly adherence.Fluorescein pattern Steep fit • An apical clearance fluorescein pattern reflects a steep fitting relationship. Photo shows a Steep Pattern.
This is not necessarily equal to an "On K" base curve selection due to the asphericity of the cornea. Photo shows an Alignment Pattern. 3/16/2013 54 .Fluorescein pattern Normal fit • Strive for an alignment ("even") fluorescein pattern.
. mid-peripheral touch and edge clearance of about 0.Alignment type fluorescein pattern shows alignment or slight apical clearance over the central 7.00mm region.With lids held apart. 3/16/2013 55 .With normal lid position.50mm width. . . the lens should slowly drop downwards.Satisfactory lens centration. the lens peripher should not move beyond the limbus.A good fit shows .
00 / Raw Material / Clinique name / Px name • • The ordered lens specification must be clearly written. See Back Vertex Correction table ( There should be an approximate change of 0.37D for every 4. 3/16/2013 56 .00 -5.60 7.80 • -3.00 diopters of power.60 7.Lens ordering • The ocular refraction (Oc.Rx) at the corneal plane can be calculated from the spectacle prescription and the back vertex distance (BVD). ) Trial Lens: Soflex – ND 9.80 Over refraction: Soflex – ND 9.25 -8.
high oxygen transmissibility and very good physical properties. Tip: The choice of RGP lens material will depend on physiological characteristics of the patient. however we are also able to manufacture the lens from other materials depending on your patients needs. This material has excellent wettability and deposit resistance.Choice of the raw material The Soflex . 3/16/2013 57 .ND is manufactured from “state of the art” raw material Optimun Comfort as a standard.
10.16 mm @ -3.00 to 8.20mm ( 9.Green For diameters and base curves outside the standard range. please inquire 3/16/2013 58 .Lens Parameters Lens Specifications: Material Optimum Comfort Surface Treatment: Base Curve : Diameter: Central Thickness: Sphere Power: Back Design: Front Design – Spheric: Plasma 7.40mm 9.60.00DS Any Medium Asphericity + Blended Bevel Sphere + Lenticular DK 65 x 10 -11 @ 35º Tint Blue.00mm ) 0.
film and residue on the lens surface. Cleaning is necessary to remove mucous. 3/16/2013 59 . while disinfecting is used to prevent germs from causing eye infections.Cleaning and disinfecting • Cleaning and disinfecting the Soflex .ND lenses is an important procedure that must be performed immediately every time lenses are removed. There are many different brands of lens care products available for GP contact lenses.
Follow up regime is essential 3/16/2013 60 . but includes educating the patient in the appropriate wear and care of the lens and continuing to monitor the eye at the regular aftercare visits. Tip: Remember .Follow up • The practitioner is reminded that successful Soflex ND lens fitting is not just obtaining a contact lens of correct curvature and power.
05mm steeper BCR for every 0. if large pupil size) .. small fissure size) 3/16/2013 61 .Select 0.Change base curve radius (BCR) a minimum of +/-0.Fitting tips Fitting Tip Checklist • Parameter Changes .05mm flatter BCR for every 0.Select 0.6mm increase in diameter (i.6mm decrease in diameter (i.1mm ( from the Trial Set ) ..e.6mm • To maintain the same fitting relationship: .e.Change overall diameter a minimum of 0.
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