|CIBA’s Focus Dailies Torics provide patients with a comfortable, clean lens every morning.|
Updating toric cls can make a huge difference in your patient’s cl success.
Our office is well stocked with fitting sets of all the major manufacturers’ latest and greatest contact lenses (plus many of our old reliable choices). With the newest technology lenses, it’s never been easier to properly fit astigmatic patients with lenses that provide lasting comfort and stable, clear vision. Here are a few real-life cases where a change in lens design or features improved the patient’s contact lens wearing experience.
SAME BRAND, SAME LINE
A current contact lens patient aged 35 presented with a complaint of slightly blurred vision at distance, glare around car headlights, and occasional eyestrain with computer use. The patient’s refraction indicated an increase in his astigmatism in each eye from -0.50D a year ago to -1.00D, making him an excellent candidate for a toric lens.
Pleased with the comfort of his current ACUVUE® ADVANCE® lenses (by VISTAKON, Division of Johnson & Johnson Vision Care, Inc.), the patient was simply upgraded to the ACUVUE OASYS® for ASTIGMATISM. This astigmatic lens uses the Accelerated Stabilization Design, which keeps the lens in position and minimizes shift and rotation by employing four stability zones, instead of the typical single ballast zone. HYDRACLEAR® PLUS makes the lens smooth, breathable, and moist. Easy for first-time toric lens wearers to adapt to, it is available in an 8.6mm base curve, a 14.5mm diameter,
|CooperVision’s Biofinity Toric helps reduce rotation and improve lens stability while optimizing lens/lid interaction.|
sphere powers of +6.00D to -9.00D, and cylinder of -0.75D, -1.25D, and -1.75D in 10° increments, and -2.25D cylinder in axis 90 and 180, +/- 20° across most powers. It is approved for daily wear on a two-week replacement schedule or extended wear for up to six nights and seven days.
A surgical resident aged 31 came for his annual exam reporting good lens comfort, despite long wearing time most days and somewhat abnormal sleeping habits. He uses artificial tears upon waking when he wears his lenses to sleep in while doing his surgical rotations. Though he is considering LASIK surgery, he is looking for more comfortable wearing time from his contact lenses. A slight change in his prescription was found and corneal topography indicated some mild corneal steepening, primarily inferiorly, that can be related to a reduced oxygen supply to the cornea. Slit lamp examination revealed mild vessel encroachment from the limbus and a very mild degree of neovascularization. We discussed the importance of a healthy corneal surface and avoiding complications from contact lens wear that could alter his candidacy for future LASIK.
|TORIC PEARLS Prior to choosing a toric lens, discuss factors for success with patients. Investigate the patient’s wearing time; previous compliance with lens replacement and disinfection; seasonal allergies; exposure to dry, windy conditions; and visual demands. Also consider the health of the corneal surface, presence of any lid margin disease, and dry eye symptoms.
Unlike spherical lenses, toric lenses need a few more minutes to settle into place before evaluating their stability and any rotation. Remember to check centration and movement in primary, upgaze, and downgaze. If lens rotation is present, use the LARS principle (Left Add, Right Subtract) to choose a new lens where the scribe marks are positioned properly. Estimate the number of degrees of rotation and add that to the manifest refraction axis. This will be the new axis of the lens.
Due to his work hours and vision needs, we recommended that he update his contact lenses to a high oxygen permeable silicone hydrogel material. He was fitted with CooperVision, Inc.’s Biomedics® Toric monthly replacement lens. It features the Optimized Ballast toric lens design that has a constant horizontal iso-thickness across the ballast area to help reduce rotation and improve lens stability while optimizing lens/lid interaction. Aquaform® Comfort Science™ creates a naturally moist lens. The Biofinity Toric lens has a base curve of 8.7mm, a diameter of 14.5mm, and a Dk/t of 116. It is currently available in sphere powers from +8.00D to -10.00D; cylinder powers of -0.75D, -1.25D, -1.75D, and -2.25D; and axes choices of 10 to 180 in 10° steps. The lens is a daily wear offering with FDA approval for up to six nights of extended wear, making it ideal for this busy surgeon’s lifestyle.
Another alternative to the Biofinity Toric lens for this patient is CIBA VISION’s AIR OPTIX® for ASTIGMATISM. This monthly silicone hydrogel replacement lens also has one of the highest oxygen transmissible soft toric lenses available, according to the company. The lens remains stable on the patient’s eye due to CIBA’s Precision 8|4™ design. This gives the lens a wide optic zone for enhanced visual acuity and minimizes the interaction between the lens and the lower lid. The surface treatment helps resist protein and lipid deposits. It has a base curve of 8.7mm and a diameter of 14.5mm. Spherical powers range from +6.00D to -10.00D; cylinder powers of -0.75D, -1.25D, -1.75D, and -2.25D; with cylinder axes around the clock in 10° steps. The lens has 33% water content and a Dk/t of 110. Its recommended replacement is four weeks and has FDA approval for up to six nights of extended wear.
Seasonal allergies and lid margin disease had a patient aged 22 ready to give up contact lenses until
|VISTAKON’s ACUVUE OASYS for ASTIGMATISM is easy for first-time toric lens wearers to adapt to.|
she was fit into toric daily disposables. When she previously came to our office, she was educated about her lid margin disease and proper lens disinfection and how they were affecting her symptoms of contact lens intolerance and dry eyes. Now that her condition has improved with treatment, we took the additional step of daily replacement contacts to prevent her allergies from causing further problems with lens wear.
The patient had been throwing away her two-week disposable toric lenses about every 10 days because that was the maximum number of days she could wear them before they felt uncomfortable. She was hardly getting her money’s worth by throwing them away so soon. Once fit with CIBA’s Focus® DAILIES® Torics, she was thrilled to have comfortable, clean lenses every morning. The single-use lenses are available in a power range from +4.00D to -8.00D sphere, with a cylinder power of -0.75D and -1.50D at six axis locations (20°, 70°, 90°, 110°, 160°, and 180°). Featuring a thin zone toric design, the lens is manufactured with a base curve of 8.6mm and diameter of 14.2mm, and has a water content of 69%.
While the convenience of daily toric replacement is a feature that patients love, the high compliance rate of replacement is a benefit to practitioners. Daily toric disposable lenses can be significantly more profitable for practices as patients are more likely to return for their annual examination.
Eric L. Bran, Professional Editor for Vision Care Product News, is in a private group practice at Ridgefield Family Eye Care and The Institute for Sports Vision in Ridgefield, CT.
WHERE TO FIND IT
800-241-5999 • cibavision.com
800-341-2020 • coopervision.com
VISTAKON, Division of Johnson
& Johnson Vision Care, Inc.
800-843-2020 • jnjvisioncare.com