1. Synergeyes case 1 Derek Louie

2. 35 y.o male presented 2009 for gradual progressive blur @ distance OD>OS x 5 years. Wears reading glasses to help @ near, but getting worse. VAs SC Near sc PH Right eye 20/200 / / / 20/40 Left eye 20/30 / / / 20/20 OU Current glasses none Manifest here: Manifest sphere cylinder axis Visual acuity Right eye -2.00 -3.50 011 20/60 Left eye -0.25 -1.00 111 20/20 Near add //+1.25 /,/

3. Exam findings: – Cornea OD – fleisher’s ring 1+ straie, no scarring – Cornea OS – clear – All other findings WNL Humphery atlas ordered. Keratoconus Dx, OD>>OS – see topography Fit last year with Synergeyes A lens, good correction OD only. Final lens: Synergeyes A/ 7.1 (8.4 skirt)/ - 2.75/14.5 ---20/25 Did well, returns this year with no problems for annual medical exam

4. Humphery topography 7/2009

6. Returned for annual exam 10/2010 No problems with vision, good comfort of lens, vision seems stable. 20/30 OD (thru hybrid lens) 20/25 OS (uncorrected) Cornea OD – 1+ punctate staining central inferior, no scarring – All other findings WNL Plan: Refit OD with steeper BC/different lens design

8. Initial Dx lens: Clearkone 250 vault/-4.50/14.5/ medium skirt Clearance central and light feather touch in ILZ, good movement

9. +3.50 Over-refraction of diagnostic lens = 20/30 vision Likely may improve when SPK/PEE resolves RTC 2 weeks for contact lens/cornea check

10. Decreased Vault: ClearKone 200 vault/-3.00/14.5/ medium skirt, Good movement (0.25 MOB) but too much touch central and in ILZ

12. Synergeyes Case 2 (if needed) 8 year old female with h/o traumatic corneal laceration due to stabbing herself in the right eye with a small knife when she was 3 y.o. Wore aphakic CL for several years, recently had sewn in IOL and pupilloplasty Best corrected vision with spectacles (+5.00- 6.00x010) 20/100, ph 20/80 – OS 20/20 sc

15. Started with synergeyes A/7.9/-3.00/14.5 +2.50 OR = 20/80 distance VA, 20/400 near Ordered in slightly steeper b/c to improve fit, and considered multifocal option for near VA

16. Final CL Rx: Synergeyes M /7.8 BC /-1.00,+2.25 add (2.2 seg size) /8.8 skirt/14.5 20/80 (ph20/70) with 20/60 near No improvement with over-refraction @ distance or near Referred for VT/ambylopia tx.