DW SCLERAL LENS DESIGN USING WAVE AND OCT

DW SCLERAL LENS DESIGN USING WAVE AND OCT IMAGING

Why DW scleral lenses 1. Great vision with new regular surface 2. Able to fit irregular corneas that can not be fitted with smaller corneal RGP’s – keratoconus, trauma, post surgical- Lasik, RK, PK 3. Great comfort since not touching cornea but landing on less sensitive conjunctiva – great alternative to corneal RGP’s, Hybrid lenses 4. Able to correct High plus and high minus Rx’s, Astigmatism and Multifocal 5. High Oxygen to cornea with new GP materials – less redness, improved corneal health 6. Treat Dry Eye with tear reservoir bathing cornea during daily wear 7. Stays in place – doesn’t pop out like smaller GP’s

SCLERAL LENS DESIGN 1. DIAMETER – HVID + 3. 5 TO 4. 0 2. AVERAGE ASTIGMATISM 3. RSYM TO START AND CAN ADD TORIC PC LATER 4. TANGENTIAL AND NO BLEND 5. NO PRISM – CAN ADD LATER FOR SPHERICAL PERIPHERAL CURVE DESIGN REQUIRING FRONT TORIC TO CORRECT RESIDUAL ASTIGMATISM 6. CENTER THICKNESS BETWEEN 34 -44 (HIGHER CYL FOR MORE IRREGULAR CORNEAS TO PREVENT FLEXING) 7. EDGE THICKNESS AT 26. CHECK THE EDGE BOX (TO GET FF EDGE) 8. FOZ MOVE OUT TO 9. 0 MM TO REDUCE GLARE OR EDGE OF OPTIC ZONE IN VISION 9. AIM FOR 250 UM CENTRAL CLEARANCE, 80 UM LIMBAL CLEARANCE AND 10 -20 D REVERSE CURVE 10. USE NEW WAVE SOFTWARE TO MAKE IT EASY

Problems with Sodium fluorescein (Na. Fl) - Used to visualize fit if back surface of lens within 20 um of corneal surface. Great for corneal RGP’s - Useful to see if Scleral lens touching cornea in steeper areas - Useful to watch Na. Fl flow under edge to see where edge is not aligning. - Not accurate enough when looking at limbal clearance - Not helpful when looking at edge alignment - I never use when fitting Scleral lens – use of Na. Fl required extra removal of scleral lens to rinse lens and eye

WHY USE OCT • Accurate to 1 -4 um • Clean (no drops) and Cool to show patient • Can see profile of lens from center to limbus to edge. I may use it like slit lamp beam to scan across lens to check how close is steepest (thinnest part of cornea) to back edge of lens • Can measure central clearance in microns and see how much settling occurs over time • Can see limbal approach towards edge and clearance • Can see edge alignment – digging in or lifting • Useful to check lab work - quality of edge- round, square, thick, thin, flat, ski-jump - Can verify central thickness of lens