1. Fitting Corneal Scleral GP’s The Lens of The Future

2. About Us… Family Owned Family Owned Over 60 years of Experience Over 60 years of Experience 25 Years of Clinical Experience 25 Years of Clinical Experience Optoform Lathing Technology Optoform Lathing Technology

3. What is a Corneal Scleral?

4. Advantages of Corneal Scleral Lenses GP Optics GP Optics Soft Lens Comfort Soft Lens Comfort Increased Rx Retention Increased Rx Retention Patient Savings Patient Savings Increased Profit Margins Increased Profit Margins

5. Lens Specifics Available in SV, Multifocal, Toric, KC Available in SV, Multifocal, Toric, KC and Reverse Geometry Designs and Reverse Geometry Designs Individually Designed Individually Designed Aspheric Curves Aspheric Curves Available in Boston XO, XO2 and HDS 100 Available in Boston XO, XO2 and HDS 100 Fenestrated or Non-Fenestrated Fenestrated or Non-Fenestrated

6. Patient Selection Current soft lens wearers (Especially Toric) Current soft lens wearers (Especially Toric) New Fits New Fits Keratoconus / PMD Keratoconus / PMD Post PKP Post PKP Synergeyes wearers/failures Synergeyes wearers/failures Emerging Presbyopes Emerging Presbyopes Dry Eye Patients Dry Eye Patients Patients with GPC Patients with GPC Current soft lens wearers (Especially Toric) Current soft lens wearers (Especially Toric) New Fits New Fits Keratoconus / PMD Keratoconus / PMD Post PKP Post PKP Synergeyes wearers/failures Synergeyes wearers/failures Emerging Presbyopes Emerging Presbyopes Dry Eye Patients Dry Eye Patients Patients with GPC Patients with GPC

7. Fitting Tips Diagnostic versus Empirical Fitting Greater fitting success with 8 lens Diagnostic set. Can Be fit empirically with ALL measurments; Refraction plus GP over-refraction Refraction plus GP over-refraction HVID measurement HVID measurement Manual K’s Manual K’s NO need for topograhphy NO need for topograhphy

8. What to expect Thinner tear layer Thinner tear layer (15 versus 80 microns) (15 versus 80 microns) Minimal movement +/- 1/2mm Minimal movement +/- 1/2mm Great comfort from initial insertion Great comfort from initial insertion Patients who say you are not putting that Frisbee in my eye! Patients who say you are not putting that Frisbee in my eye!

10. OCT Profile

11. Trouble Shooting Problem - Tight Fit Vessel drag Vessel drag Trapped air bubbles Trapped air bubbles Trapped Debris\Mucin Trapped Debris\Mucin Limbal Compression ring Limbal Compression ring Discomfort post removal Discomfort post removal Popping sound when removing Popping sound when removing 360 ring of seal-off usually around IPC 360 ring of seal-off usually around IPC

12. Seal Off

13. Keratoconus Fit Start with Diagnostic lens Start with Diagnostic lens Let Diagnostic lens settle 20 minutes Let Diagnostic lens settle 20 minutes Over refract (Sphere Power Only) Over refract (Sphere Power Only) Note where lower lens edge rests Note where lower lens edge rests Lift Upper Lid to observe fit Lift Upper Lid to observe fit Expect 2-3 mm central bearing Expect 2-3 mm central bearing

14. Keratoconus OCT Photo Credit Dr. Peter Wilcox

15. Corneal Scleral Lens Care Peroxide based system Peroxide based system Optimum CDS Optimum CDS Avoid all preservatives Avoid all preservatives Use DMV for removal Use DMV for removal Progent or Polish every 6 months Progent or Polish every 6 months

16. Photo / Oct courtesy of Dr. Peter Wilcox Photo / Oct courtesy of Dr. Peter Wilcox Thank You! www.CustomCraftLens.com