1. Advanced Contact Lenses
Desinee Drakulich O.D.

2. Disclaimer
I have no affiliation, nor do I received financial compensation from any of the companies or brands used in this presentation.

3. Brief History of Contact Lenses
1508   Leonardo da Vinci illustrates the concept of contact lenses
1823   British astronomer Sir John Herschel conceptualizes 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 approval of new soft contact lenses for extended (overnight) wear
1986   Overnight wear of GP contact lenses becomes available
1987   Introduction of disposable soft contact lenses
1987   GP contacts available in next-generation fluorosilicone acrylate materials
1996   Introduction of one-day disposable soft lenses
2002   Silicone-hydrogel contact lenses first marketed
2002   Overnight orthokeratology approved by FDA
2010   Custom-manufactured silicone-hydrogel lenses become available
                              

4. Types of Soft Contacts
Spherical
Aspheric
Toric
Multifocal

5. Spherical Soft Contact
A spherical contact lens bends light evenly in every direction (horizontally, vertically, etc.). They are typically used to correct myopia and hyperopia.

6. Aspheric Soft Contacts
Aspheric contact lenses, on the other hand, have varying curvatures across the surface, changing from the edge to the center of the lens. This gradient change of curvature allows for a different interaction between the lens and light entering the eye. The bending of light as it enters the eye through an aspheric lens produces, theoretically, a clearer image.

7. Toric Soft Contacts
A toric contact lens has a different focusing power horizontally than it does vertically, and as a result can correct for astigmatism. Because a toric lens must have the proper orientation to correct for a person's astigmatism, a toric contact lens must have additional design characteristics to prevent the lens from rotating away from the ideal alignment. This can be done by weighting the bottom of the lens or by using other physical characteristics to rotate the lens back into position. Some toric contact lenses have marks or etchings that can assist the eye doctor in fitting the lens.

8. Toric Designs

9. LARS

10. Rotation
Right Eye
Left Eye
x 090
x 110

11. Remember LARS
Left Add
Right Subtract

12. Rotation Right Eye Left Eye 10 ‘ 10 ‘ -1.50-1.25 x 090

13. Multifocal Soft Contacts
Different types of lenses that give two or more focal pts
Monovision
Bifocal
Modified Monovision
Concentric Ring Multifocal
Simultaneous Viewing Multifocal

14. Monovision Soft Contacts
Probably the oldest method of correcting both distance and near with a soft contact. It is simply correction the patients dominate eye for distance and their non-dominate eye for near.
Advantages – easy to calculate, less expensive, patient doesn’t have to change current brand of contacts and can be used for patients with astigmatism
Disadvantages – when the difference between the two eyes gets too large the patient will loss some depth perception. Only works for about 70% of people.

15. Monovision
Distance
Near

16. Bifocal soft contacts
This was a simple design of near center focal point lens. Simply the center of the lens was corrected for near and the other part of the lens was corrected for distance.
Advantages – excellent near vision
Disadvantages – poor distance vision, didn’t correct for astigmatism

17. Bifocal soft contact

18. Modified Monovision
Took the technology of monovision and bifocal design and merged them together. The dominate eye was corrected with a distance center, near peripheral contact and the non-dominate eye was corrected with a near center, distance peripheral contact.
Advantages – gave clearer distance vision in most people. Does have an astigmatic version.
Disadvantages – still slightly reduced depth perception.

19. Modified Monovision N D
Dominate Eye
Non-dominate Eye

20. Concentric Ring Multifocals
This contact lens design uses multiple rings of distance and near vision to create multiple focal points.
Advantages – usually give better distance and near vision. Generally doesn’t reduce depth perception.
Disadvantages – tend to be more expensive

21. Concentric Ring MultifocalD N

22. Simultaneous Viewing Contacts
This design utilizes the fact that light travels in parallel rays so when the patient is looking straight ahead the parallel light rays create a distance focal point and when the patient is converging to see near the parallel light rays create a secondary near focal point.
Advantages – the patient never see both focal points at the same time so distance and near vision tend to be very good. Depth perception is not affected.
Disadvantages – expensive and don’t work for astigmatic corrections.

23. Simultaneous Viewing Contacts
Light Rays N D

24. Rigid Gas Perm Lenses
Not as popular now as they were in the 1970’s and 80’s
Uses a rigid or hard material to give the corneal a new spherical surface.
Many different types depending on the patients visual needs.
Because they do not conform to the front surface to the cornea like a soft lens design and fitting perimeters must be calculated properly to ensure patient comfort and vision.

25. Types of Hard Contacts Spherical Aspheric Bi-Toric (Back or Front)
Multifocal
Specialty (semi-scleral, scleral and hybrid)
Ortho - K

26. Spherical and Aspheric
Can be used for patients with > 2.00 D of astigmatism.
They work by using the patients own tear film to fill in small amounts of astigmatism.
Generally can be fit with a small diameter lens between 8.7 to 9.6 diameter.
Generally give very clear distance vision

27. Spherical and Aspheric

28. Bi-Toric (Front or Back)
Bi-Toric rigid gas perms can be used for patients with >2.00 D of astigmatism.
Which lens you choose depends on the location of the astigmatism.
If the astigmatism is corneal or residual determines which lens to use. This is often calculated by the manufacturing lab.

29. Bi-Toric RGPs

30. Multifocal RGPs
The back surface provides an add value of approximately with additional add power generated on the front surface in increments to a combined maximum add power of
These lenses can also be used for patients with astigmatism.
Similar to the soft contacts these come in different designs.

31. Different types of multifocal RGPs

32. Specialty RGPs
In general these lenses are used for people who have irregular corneas.
Causes of irregular corneas.
Keratoconus – a degeneration of the cornea causing thinning usually in the inferior nasal portion of the cornea.
Ectasis – thinning of the central cornea secondary to lasik surgery.
Irregular surface from RK
Pellucide degeneration – like keratoconus except more inferior including a much large area of the cornea.
Post Graph – for people who have had corneal transplants

33. Rose K RGPs for Keratoconus
Three primary types of Rose K lenses
Rose K (dia: 8.5 to 9.6) for nipple cone
Rose K2IC (dia: 10.5 to 11.2) for large oval cone
RK Reverse geometry (10.5 to 11.2) for post graph

34. Jupiter lenses for Keratoconus
A large scleral contact usually between and 18.0 diameter.
Give maximum vision and comfort for people with irregular corneas and dry eye.
Generally fit using an OCT scan to visualize the corneal clearance.

35. Scleral RGPs

36. Hybrid RGPs
Hybrid lenses were developed to give the exceptional vision of an RGP with the comfort of a soft contact.
The first models had a soft contact with slits in the front surface to insert a RGP. This model didn’t give great distance vision. (Flex Lens)
The second model fused a soft skirt around a center RGP. This gave much better vision and comfort but the design was flawed which made removal very difficult. (Synergeyes).
The third model was similar to the second, however, the skirt was modified to make removal easier. This lens is also available in a bifocal design (Duette)

37. Hybrid lenses

38. Ortho – K Lenses Design to flatten the cornea while you sleep.
A temporary solution to nearsightedness and small amounts of astigmatism.
Advantages – no need for contacts or glasses during the day.
Disadvantages – expensive, temporary, uncomfortable to sleep in and only good for nearsightedness between 1.00D to 6.00 D with astigmatism less the 1.25 D.

39. Ortho – K Lenses

40. Thanks You
Any questions