SoftSpecialEdition is a quarterly newsletter that provides independent updates from the international literature on soft specialty lens-related topics. View as Webpage
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World Wide Vision XXXXIII
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One-Size-Does-Not-Fit-All in Myopia Management
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Regarding myopia management, there is no one-size-fits-all treatment approach that will work for everyone. The analysis of one patient will be different from that of the next, even if they are the same age, the same sex, the same ethnicity and are presenting similar clinical data. A new method of measurement using an OCT instrument allows acquisition of quality images of the retinal choroidal thickness in response to different stimuli - e.g., to different lenses with different optics. This study shows that design matters in myopia management, because different lenses led to different choroidal response in various quadrants of the retina. A senofilcon A lens was the best option for most participants (14/24), but 10 subjects were adapted better with other designs. In fact, 6 were better served with an etafilcon A lens, while only 4 showed better results with an omafilcon A lens. For two subjects, all lenses led to choroidal thinning (suggesting no effectiveness over the long term). It is important to note that we talk here about an increase or a decrease, in percentage, of the choroidal volume after short-term exposure to visual stimuli through the tested devices.
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This does not translate to refractive change or axial length modification while wearing lenses. Results are predictive, but non-conclusive. The study does reinforce the fact that myopia management strategies must be customized to each patient, as different devices may lead to different outcomes. It appears that the individual threshold at which the myopic defocus overcomes the hyperopic defocus could lead to choroidal thickness change. Choroidal volume analysis is a promising new way to evaluate ocular response to visual stimulation. It may be a convenient way to test—in the short term—the individual response and to determine the best strategy for a given patient.
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This study set out to investigate whether there was an association between subjective comfort and both subjective and measured vision during the use of soft toric contact lenses. Thirty-six participants (31.1 ± 13.5 years) completed the study. Comfort scores were found to be associated with subjective vision quality and lens type. Greater comfort scores were observed with greater subjective vision quality scores - but visual acuity was not statistically significant in the model. This work suggests that symptoms of ocular discomfort may be more intense if there is also perceived reduced visual quality. There was a stronger positive correlation between comfort and subjective vision quality compared with comfort and measured visual acuity.
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Advances in Optics Drive Soft Lens Success
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In this article in Review of Cornea & Contact Lenses, Ian Cox, Pete Kollbaum and Eric Papas set out to review the advances in optics that drive soft lens success. They state that the manufacturing process of soft lenses with good optical qualities is not an easy task, especially not for lenses that have more advanced optics such as multifocal lenses. The newest generation of lenses, however, can be designed ánd tested using wavefront sensing metrology. This allows for advanced designs and for increased reproducibility of the lenses that come 'off the belt'. These improved multifocal designs aim to better meet the visual needs of the current era in which computers and hand-held electronic devices dominate the work environment, while simultaneously reducing the impact of glare and halos caused by sharp optical junctions between the power zones of previous lenses. But because substantial amounts of negative spherical aberration occur for powers as low as −4.00D, many myopic contact lens-wearing patients may have some spherical aberration corrected even with typical single vision soft contact lenses. All of this becomes increasingly relevant, it seems, in optimizing optics for myopia management in children.
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Secrets on Toric Soft Lenses
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Dave Kading in his 'materials & design' column in Contact Lenses Today shares an interesting clinical tool. If patients don’t like their soft toric lenses, they could just switch brands:
knowing what we know about sagittal depth and toric lens fitting, we can pretty easily become successful with our standard lenses. But every now and then, we encounter patients who say that their vision is blurry between blinks but that it always comes back to clarity. Naturally, we think that there must be instability with the rotation. Therefore, we would expect to see the lens rotate on blink. If that is the case, we need to find a lens that will “tighten up” to reduce rotation. However, what happens when you look in the slit lamp and notice that the lens is not rotating? Then the blurred vision may be due to the lens being too tight and “warping” when the patient blinks. He advises to: 1) Use the autorefractor to see whether there is stability in the over-refraction sphere component. 2) Observe on retinoscopy whether the mires remain stable within the blink. 3) Using a topographer, keratometer, or autorefractor, watch the rings when the patient moves; if they alter with the blink, then your patient’s lens is vaulting and flexing between blinks. You need to find a lens than, that has less sagittal depth (a flatter lens). With that, you may find stability in both the cylinder rotation and the spherical flexure.
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The United Colours of Lenses
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This impressive report from Brazil covers the outcomes and complications of colored soft contact lenses to improve aesthetics or eye function in visually impaired or blind patients. This unique retrospective study enrolled 109 patients (ages 4–80 years). Eighty-six patients had unilateral blindness, and 14 patients had functional disorder. Most of the patients presenting for improved aesthetics had anterior segment pathology (68%), mainly secondary to trauma resulting in leukoma (an opacity of the cornea). Patients with functional visual impairment received filtered soft lenses for color blindness, diplopia, or photophobia. No serious complications were observed in any of the cases, and 95% of patients were satisfied with the soft lens application received. In summary: colored soft lenses can cover ocular surface imperfections in visually impaired or blind eyes of patients who are seeking better cosmesis or improved functional vision.
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Thibaud Syre from France is sharing another of his outstanding case reports, in line with a previous item in this newsletter. This time it concerns a prosthetic lens on a patient who has advanced glaucoma and complications due to uveitis. The lens is made by Swisslens in Switzerland. The method is to first fit a non-colored lens (this one with a base curve of 11.00mm and a diameter of 13.4mm), after which the lens is ordered in the desired color, with a color range 'of the rainbow' to choose from.
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Specialty Soft Lenses In Your Practice
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Daniel Fuller describes in this one-hour webinar the importance of looking at soft specialty lens options. He explains that over the six hours that he was in practice earlier that day, about 30-40% of the patients in his chair were specialty soft lens wearers. Practitioners are confronted on almost a daily basis with patients who claim that they can’t wear contact lenses. These patients often represent outliers on the bell-shaped curve of stock parameters or have unique conditions that are amenable to management with specialty soft lenses. This case-based presentation assists practitioners in identifying these patients and in custom tailoring solutions. See the full webinar below or click this link for free CE registration offered by Contact Lens Spectrum.
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