1. Visual performance of Rose K2 lenses in various corneal disorders- A case series
Gauri Shankar Shrestha, M.Optom
Fellow of International Association of Contact lens Educators
Assistant Professor and Program Coordinator
B.P. Koirala Lions Center for Ophthalmic Studies
Institute of Medicine

2. Abstract
Visual performance of Rose K2 contact lenses in various corneal refractive disorders- case series
Gauri Shankar Shrestha, M.Optom, FIACLE, Assistant Professor, Maharajgunj Medical Campus, Tribhuvan University, phone:
Background: Rose K2 family of lenses which are computer controlled complex geometric lenses that mimic the the cornea topography and are fitted in complex corneal refractive disorders to deliver optimal comfort, vision and physiological compatibility. These lenses are indicated in keratoconus, pellucid marginal degeneration, post-graft, corneal irregularities, corneal dystrophies and degenerations, post- refractive surgeries and so on where vision couldn’t be improved satisfactorily with other optical corrections.
Purpose: To determine the visual performance of Rose K2 lenses in various refractive disorders.
Method: seven patients with various corneal disorders that include four cases of keratoconus, two cases of corneal repair following penetrating injury, one case of corneal degeneration were enrolled in to the study. All the cases with keratoconus had experience of wearing ordinary RGP lenses. Visual acuity was measured with habitual lenses when applicable at baseline visit and with Rose K2 lenses at the completion of study. Questionnaires were used to assess contact lens comfort and self reported assessment of vision.
Result: There was significant improvement in visual acuity in low and high contrast visual acuity chart. There were significant improvement in self reported comfort (79%) and self reported vision (90%) especially in advanced keratoconus, extreme toric cornea and unilateral cases of corneal disorders.
Conclusion: Rose K2 has a successful fit rate in advanced keratoconus, extremely toric cornea, and unilateral cases. Patients’ preference also demonstrates the usefulness of Rose K2 lenses in clinical practice.
Key Words: Rose K2, keratoconus, corneal degeneration, corneal truama

3. Vision in corneal disorders
Cornea- an unique refracting element that has received interventional or non-interventional refractive correction
Corneal disorders that causing corneal astigmatism can’t sometimes restore vision to normal even with proper refractive correction
Fitting contact lens in such cases is itself a challenge in restoring vision, comfort and corneal physiology
It is even challenging when the condition is unilateral
Cornea- a uniquely structured refracting element of eye- 2/3 of total refractive power of eye
Corneal disorders such as keratoconus, pellucid marginal disorders, corneal degenerations, corneal trauma results in irregular corneal astigmatism and a complex visual problem which sometimes can’t be restored with ordinary therapeutic measures
Fitting contact lens in such cases is itself a challenge in maintaing optimal comfort and corneal physiology apart from restoring vision
This effect is even challenging when the condition is unilateral

4. Contact lens for vision correction in corneal disorders
There is a lack of general consensus on visual correction that suits in corneal disorders
40+ design available
Recently Rose-K lens is being used to provide better visual performance and lens comfort

5. What is Rose K lens
Rose K2 lenses are unique geometrically designed CL
The goal is to bring all focal points onto the retina at a single point, regardless of BOZR or lens power by
incorporating a specific eccentricity value in BOZ,
stretching the optic zone without changing the fit
Incorporating an aspheric base curve
Manufacturing anterior curves relative to the posterior curves directly outside the BOZ
Rose K2 lenses are unique geometric designed series of contact lenses.
The design goal of the Rose K2 is to bring all focal points onto the retina at a single point, regardless of base curve radii or lens power
incorporate a specific eccentricity value in BOZ, as well as stretching the optic zone without changing the fit, to create the desired results in improved vision and comfort
The posterior surface has an aspheric base curve incorporated into the lens design and anterior curves are manufactured relative to the posterior curves directly outside the BOZ, which effectively increases the effective optic zone of the lens.

6. Lens very tight /Narrow bearing zone
Large OZ ---advanced cone
Advanced keratoconus

7. Wide bearing area Pooling eliminated
I tried this but it didn’t work. WHY ask audience

8. ROSE K1 vs ROSE K2 ROSE K1 ROSE K2 Aspheric back surface
Multiple back curves
ROSE K2
Aspheric back surface

9. No Aberration Control Rose K
6.20
8.70
-17.75
Graph of power across optic zone
-17.75
Again the power of the same lens in graph form showing the power increase that effectively occurs on a non aberration controlled lens.
There is almost a dioptre of difference over an optic zone size of just under 5.00mm on a lens with a power in the centre of
-18.60
2.00
1.0
1.0
2.0 9

10. Aberration Control Rose K2
6.20
8.70
-17.75
Graph of power across optic zone
This is the same lens showing the power readings in graph form.
Across the optic zone of 5.00mm you can see that the power is consistent.
Patients who require lenses with high power correction clearly benefit from lenses that are manufactured using aberration control.
Keratoconus patients are an obvious group but not the only ones that will benefit from this type of manufacturing capability.
Aberration controlled curves are applicable to both RGP and soft lenses whether moulded or lathe cut.
-17.75
2.0
1.0
0.0
1.0
2.0 10

11. Eg 5.5/9.0/–16.50 std decreased lift
ROSE K2
ECC VALUE OVER THE BOZ WILL CHANGE DEPENDANT ON :
BASE CURVE
POWER
REFRACTIVE INDEX
THICKNESS
Eg 5.5/9.0/–16.50 std decreased lift
Rose K ecc = 0.578
If Power changed to – ecc = 0.628
If Base changed to ecc = 0.593

12. Features of Rose K Lens Easy fitting Flexible edge lift system
Extensive diameter and base curve
Aberration control
Advanced fitting options
Fit all corneal shapes, sizes and stages of keratoconus

13. Rose K2 Designs Rose K2 Rose K2 NC Rose K2 IC Rose K2 PG Rose K2 XL
Primary application
Oval Cone NC
Moderate and steep NC
PMD, Keratoglobus, LASIK, Induced ectasia,
PK,
Keratoconus, PMD, PG, LASIK, any irregular cornea,
2ndary application
Early PMD
All NC
Oval cone,
Decentered cone, post trauma
oval cone, NC, LASIK
Polluted work condition, stability for sport or working environment
Advanced fitting options
Toric peripheral curve
Asymmetric corneal quadrantic specific
Toric back, front bitoric surfaces
Reverse geometry lens periphery-IC design (Ghosting, glare and flare eliminated/reduced)

14. Identifying cone type using a topographer

15. Fitting characteristics
Steep fit
Flat fit
Optimal fit

16. Edge Profile

17. Asymmetric corneal technology (ACT)
Aapplied to posterior surface of lens at 6 o’clock to resove nferior edge lift
Improve cornea to lens fitting relationship
Improve comfort and lens positioning
Asymmetric Corneal Technology is applied to the posterior surface of the lens at the 6 o’clock position to more closely fit a steeper inferior zone. The result is enhanced lens fit, comfort and stability, which helps resolve inferior edge lift-off and lower lid interact
Traditionally, the only way to deal with inferior corneal steepening was to decrease the overall lens diameter to fit above or inside the steeper inferior quadrant. Unfortunately, this approach yields smaller optic zone diameters and associated halos, glare, ghosting and unstable
Asymmetric Corneal Technology improves lens performance for the irregular cornea patient.
lens positioning.
Asymmetric Corneal Technology can be applied to any Rose K2 lens design (Figure 2). It simplifies fitting, is easy to use and will optimize final lens performance by improving the cornea-to-lens fitting relationship. This will improve comfort, lens positioning and corneal health, while reducing the number of office visits (chair time) needed to arrive at the final lens fit
Traditional approach- ↓TD- Small OZD

18. Toric Peripheral curve

19. Materials and method Subjects 12 eyes of 7 patients
5 cases of B/L keratoconus as confirmed by Corneal topography
One case with RE terrien’s marginal degeneration
one case with LE corneal scars (traumatic) with pseudophakia

20. Keratoconus Experience with wearing spherical RGP lenses
Visual acuity was measured with habitual lenses at baseline visit and with Rose K2 lenses at the completion of study (minimum 6 months)
Topographic analysis was performed in each case
Location of apex of the cone was determined
select trial lens based on Sim K and type of corneal irregularities (Fitting guidelines)

21. Traumatic corneal scar with pseudophakia & Terrien’s marginal degeneration
Have experience with trial of spherical RGP lenses
BSCVA and Visual acuity with Rose K2 lenses at the completion of study was measured
Keratometry/topography was performed

22. Severity of cone (Keratoconus)
Mild <47D
Moderate 47-52D
Severe cone >52 D
Classification of Astigmatism
High astigmatism>3.00Dc
Irregular- principal axis scews >10⁰

23. Fitting procedure
A Rose K diagnostic lens set and fitting procedure were followed according to Rose K guidelines
Based on initial lens fit on slit lamp, new trial lens base curve was chosen unless successful fitting was achieved
A fit was considered successful if the patient achieved acceptable vision, comfort and corneal health.
Final over refraction was determined after 30 minutes of lens fittings
A Rose K diagnostic lens set and fitting procedure were followed according to Rose K guidelines.
Based on initial lens fit on slit lamp, new trial lens base curve was chosen unless satisfactory/optimal fitting is achieved
feather touch as the steepest curve, light bearing at mid-periphery and adequate edge lift and clearance
Final over refraction was determined after 30 minutes of lens fittings.

25. Procedures
After ordered Rose K lens was procured, patients were followed up in a week to make sure fitting of lens is OK
Then patients were followed up in a month, three months and every six months
Evaluation of contact lens comfort and self reported assessment of vision was considered for evaluation at least after 6 months

26. Procedures The questionnaire
Patients were asked to report contact lens wearing time, number of lens removals per day, and self assessment of vision and comfort for each eye
they were asked if they preferred the Rose K lenses or the habitual CLs
Score: grade 1 to 10 (Comfort, vision & lens preference)
(10 very comfortable, 1 very irritating)

27. Analysis
Visual acuity was analysed by comparing the baseline visual acuity to the outcome visual acuity for each eye.
A “flat eye” and a “steep eye” were designated for each patient based on the steep keratometric reading for each eye.

28. Case 1 (RK)- 19 yrs/M (Keratoconus)VA
Unaided
BSCVA
Sph RGP
Rose K Rx
Sim K
Remark
Steep eye
1/60
6/18
6/6
-6.0/ -6.25
45.1/ 52.3
ACT/SFL
Flat eye
5/60
6/5
-2.5/-1.75
43.1/ 45.3

30. Case 2 (JS)- 16 yrs/M (keratoconus)VA
Unaided
BSCVA
Sph RGP
Rose K Rx
Sim K
Remark
Steep eye
4/60
6/12
6/6
6/5
-1.5/ -2.0
43/47.1
ACT
Flat eye
-2.0/-2.25
42.5/45.6
SSL

32. Case-3 (RK)- 20yrs /M KeratoconusVA
Unaided
BSCVA
Sph RGP
Rose K Rx
Sim K
Remark
Steep eye
1/60
6/60
6/12
6/6
-12.0/ -4.5
56.7/ 63.5
ACT / TPC
Flat eye
6/36
6/9
-8.0/ -4.0
54.2/56
ACT/ TPC

33. Case- 4 (AR)- 24yrs /M KeratoconusVA
Unaided
BSCVA
Sph RGP
Rose K Rx
Sim K
Remark
Steep eye
6/36
6/18
6/9
+0.5/ -3.5
49.8/ 59.2
RK2
Flat eye
6/60
0.0/ -3.0
49.9/ 55.4
RK 2

34. Case 5 (MK), 15yr/F VA Unaided BSCVA Sph RGP Rose K Rx Steep eye CFCF
6/36
6/12
6/9
-18.0/ -6.0
Flat eye
6/6
+1.0/ -3.0

35. Case 6 (PH)- 20 yr/F VA Unaided BSCVA Sph RGP Rose K Rx Sim K Remark
Steep eye
CF 1ft
6/60
6/12
6/9
-8.0/-6.0
45.0/41.2 IC
Flat eye
6/6
Soft lens
-2.75
42.9/41.5

36. Case 7, 17yrs/F VA Unaided BSCVA Rose K Rx Sim K Remark Steep eye 6/60
6/18
6/6
+2.0/-6.0
39.0/ 50.5 XL
Flat eye -
-NA
0.00

38. Table: Analysis of variables b/w steep eye and flat eye
Description
Steep eye
Flat eye p
Mean Sim K±SD
52.15±5.81
51.06± 5.21
0.10
Q(4.5mm)
-2.33±0.55
-2.01±0.86
0.14
Spherical equivalent RE
-8.3±6.96
-6.1±5.84
0.13
No of trial
1.76±0.6
1.84±0.7
0.7
BSCVA (MAR)
5.28±3.45*
3.85±3.03**
0.04
S RGP (MAR)
1.41±0.49NS
1.2±0.40NS
0.40
Rose K (MAR)*
1.2±0.28
0.82
*0.01 * * 0.03

39. Self reported vision and comfort
Eye
Wearing time (hrs)
Number of lens removal
Self assessment of vision
Comfort
Lens preferences
Case 1 SE 12 1 9 8 FE 5 6
Case 2
Case 3 14 2 7
Case 4
12-14
Case 5
Case 6
Case 7 10

40. Self reported vision and comfort
Variables
Steep Eye
Flat Eye p
Wearing time
12.14±2.03
12.33±2.01
0.71
Self assessment of vision
9±0.0
8±1.7
0.15
Comfort
7.3±0.75
7.6±0.54
0.44
Lens preferences
7.4±0.78
7.4±0.89
0.95

41. Self reported vision in Keratoconus
Mild (<47.00D)
Moderate ( D)
Severe (>52D)
7.66 ±2.3 9
8.83± 0.40
Self reported vision in toric cornea
Up to 3.00 DC
>3.00DC
7.75±1.98
9.0±0.0
Self reported vision in unilateral cases
Self reported vision
9±0.0

42. Self reported comfort in keratoconus
Mild (<47.00D)
Moderate ( D)
Severe (>52D)
7.75±0.5 8
7.44± 0.83
Self reported comfort in toric cornea
Up to 3.00 DC
>3.00DC
7.25±0.5
7.41±0.67
Self reported comfort in unilateral cases
Comfort
7±0.0

43. Discussion and Conclusion
A practitioner with rose K lens may require average two lenses/trial for determining appropriate fitting
Preliminary report suggest a successful fitting rate
Regarding vision, No significant difference in visual acuity
b/w SE and FE
b/w Sph RGP and Rose K

44. Discussion and Conclusion
relative appraisal of self reported vision and comfort
Self reported vision apparently seen better with corneal steepening, high corneal toricity and unilateral cases

45. References
Rose P. Unanswered questions letter. Contact Lens Spectrum 1999;14:15.
Betts AM, Mitchell GL, Zadnik K. Visual Performance and Comfort with the
Rose K Lens for Keratoconus. Optom Vis Sci 2002;79:
Sudharman PM, Rathi V, Dumapati S. Rose K Lenses for Keratoconus—An Indian Experience. Eye Contact Lens 2010; 36(4):1-3.
Jain AK, Sukhija J. Rose-K contact lens for keratoconus. Indian J Ophthalmol 2007;55:121-5.

46. Thank You