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    Puttingthelastedsoftcontactlensresearchto Practice

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    grenoble-thiers
    The document describes a case study of refitting a long-time contact lens wearer whose previous lenses were being discontinued. Through trials of alternative lenses, all were found unsuitable due to excessive movement. By consulting recent research on sagittal heights of lenses, a replacement lens with similar sagittal height to the previous lens provided optimal comfort and fit.

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    Puttingthelastedsoftcontactlensresearchto Practice

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    grenoble-thiers
    8 views6 pages
    The document describes a case study of refitting a long-time contact lens wearer whose previous lenses were being discontinued. Through trials of alternative lenses, all were found unsuitable due to excessive movement. By consulting recent research on sagittal heights of lenses, a replacement lens with similar sagittal height to the previous lens provided optimal comfort and fit.

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    PuttingthelastedsoftcontactlensresearchtoPractice

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    The document describes a case study of refitting a long-time contact lens wearer whose previous lenses were being discontinued. Through trials of alternative lenses, all were found unsuitable due to excessive movement. By consulting recent research on sagittal heights of lenses, a replacement lens with similar sagittal height to the previous lens provided optimal comfort and fit.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    8 views6 pages

    Puttingthelastedsoftcontactlensresearchto Practice

    Uploaded by

    grenoble-thiers
    The document describes a case study of refitting a long-time contact lens wearer whose previous lenses were being discontinued. Through trials of alternative lenses, all were found unsuitable due to excessive movement. By consulting recent research on sagittal heights of lenses, a replacement lens with similar sagittal height to the previous lens provided optimal comfort and fit.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 6

    See discussions, stats, and author profiles for this publication at: https://www.researchgate.

    net/publication/375449840

    Putting the lasted soft contact lens research to Practice

    Experiment Findings · November 2023


    DOI: 10.13140/RG.2.2.24852.48003

    CITATIONS READS

    0 15

    1 author:

    Thibaud Syre
    Alpes Vision
    2 PUBLICATIONS 0 CITATIONS

    SEE PROFILE

    All content following this page was uploaded by Thibaud Syre on 07 November 2023.

    The user has requested enhancement of the downloaded file.


    Putting the lasted soft contact lens research to Practice

    Introduction

    In 2020, the COVID-19 pandemic wrought significant havoc on our healthcare system and
    daily lives. The implementation of public health measures, aimed at safeguarding the
    population, reshaped our professional landscape. We witnessed a surge in demand for
    contact lens fittings, coinciding with the return of our regular wearers seeking adjustments.
    These trends were primarily driven by the discomfort caused by mask-wearing, as well as the
    growing prevalence of remote work, which placed increased demands on near vision.
    Consequently, our workload escalated, necessitating the restructuring of our clinics for
    enhanced efficiency.

    Concurrently, as our contact lens fitting consultations surged, we observed a swifter


    discontinuation of older contact lens models by some manufacturers. However,
    discontinuing a lens type also entails the responsibility of providing wearers with new
    models that cater to their vision and comfort requirements. In this demanding environment,
    characterized by heightened activity, we contemplate the possibility of unearthing valuable
    solutions through university research.

    Case report

    Allow me to illustrate how such research, requiring no additional equipment beyond what is
    already available in our clinics, could streamline the process of refitting long-time wearers
    while minimizing the time spent in the chair.

    Consider the case of a 49-year-old male, a long-time contact lens wearer, who previously
    reported optimal comfort with his lenses:

    Soflens 66 Toric (Alphafilcon A) from Bausch&Lomb

    OD -4.75 (-1.25) 130° Diam : 14.50 Bc : 8.50

    OS -4.00 (-1.25) 90° Diam : 14.50 Bc : 8.50

    Visual acuity was good with OD 20/20 (1.0) and OS 20/20 (ODS 20/20)

    Fitting: Optimal, with excellent lens centering. A slight movement was observed during
    ocular versions, but a good return to the push-up position. Lens surface condition remained
    good after 11 hours of continuous wear.

    However, the reason for his appointment was the lens type the patient was currently
    wearing successfully was going to be discontinued, necessitating the search for an
    alternative. He had already sought assistance from his longstanding fitter but without
    success.

    Subsequently, we examined without lenses:


    Trial (and error)

    Here we find the trials done in the context of refit. It is important to note that these tests
    were repeated for the writing of this report, as we did not have access to the previous
    observations.

    1st trial :

    Ultra for Astigmatism (Samfilcon A) from Bausch&Lomb

    OD -4.75 (-1.25) 130° Diam : 14.50 Bc : 8.60

    OS -4.00 (-1.25) 90° Diam : 14.50 Bc : 8.60

    Result: Excessive lens movement and visual instability. The lenses cannot be worn longer
    than one hour.

    2nd trial:

    Oasys for Astigmatism (Senofilcon A) from Johnson&Johnson

    OD -4.75 (-1.25) 130° Diam : 14.50 Bc : 8.60


    OS -4.00 (-1.25) 90° Diam : 14.50 Bc : 8.60

    Result: Improved lens stability, but excessive movement persisted. The discomfort was
    reported after a few hours of wear, rendering this lens unsuitable as a substitute for the his
    previous lenses.

    3rd trial:

    Biofinity toric (Comfilcon A) from Cooper Vision

    OD -4.75 (-1.25) 130° Diam: 14.50 Bc: 8.70

    OS -4.00 (-1.25) 90° Diam: 14.50 Bc: 8.70

    Result: Even though the surface of this lens appeared to be greatly improved, the dynamic
    behavior remained unacceptable. The patient even noted that, during trials, the entire lens
    slid over the cornea.

    Making a Change

    In a fresh perspective on this refitting challenge, we turned to the latest research insights. In
    January 2021, van der Worp et al. introduced a CL-SAG analysis for today's most popular soft
    lenses. Notably, Soflens 66 Toric (Alphafilcon A) exhibited the highest SAG in the chart at
    4157 µm. This aligns with historical practices of using this lens for steeper corneas
    specifically, as confirmed by this research.

    It is therefore interesting to compare the previously used unsuccessful lenses with the CL-
    SAG value of his previous successful lens :

    For the Ultra for Astigmatism (Samfilcon A), the SAG difference is 188 µm.

    For the Oasys for Astigmatism (Senofilcon A), the SAG difference is 277 µm.

    For the Biofinity toric (Comfilcon A), the SAG difference is 297 µm.

    This correlation with clinical analysis is striking. Regardless of the radius of curvature and
    lens diameter (the only parameters easily accessible to the fitter), it is evident that the
    sagittal height of a soft lens significantly influences its behavior on the wearer's eye.

    With this revelation, we opted to select a lens with the closest SAG to Soflens 66 Toric
    (Alphafilcon A). Consequently, we ordered the following lenses for trial:

    Biotrue One Day for Astigmatism (Nesofilcon A) from Bausch&Lomb

    OD -4.75 (-1.25) 130° Diam: 14.50 Bc: 8.40

    OS -4.00 (-1.25) 90° Diam : 14.50 Bc : 8.40

    According to van der Worp et al., the CL-SAG of Biotrue One Day for Astigmatism (Nesofilcon
    A) is 4153 µm. Compared to the historical lens, the SAG difference is only 7 µm.
    After one day's wear, the patient reported regaining the comfort he had with his old lenses.
    The examination revealed a well-centered lens with good mobility and a movement back to
    the standard location was observed as is desired. The surface condition remained
    unchanged, even after extended wear and when the lenses are removed, fluorescein
    examination reveals no staining.

    Closing Remarks

    In summary, this case underscores how university research, utilizing existing clinic
    equipment, can rapidly identify a first-choice replacement lens. In this instance, it could have
    averted three unsuccessful trials, saving considerable consultation time. It also prompts us
    to reconsider our lens selection methodology, both initially and for optimization purposes.
    Moreover, this case report reaffirms that there is no direct correlation between the
    diameter/base curve and the actual behavior of the worn lens on-eye.

    This also prompts us to reconsider the significance of made-to-order soft contact lenses,
    which continue to be an effective tool for controlling the sagittal heights of the fitted lenses.
    In our case, we had the option to also switch to a daily replacement; otherwise, we would
    have had to opt for custom soft lenses.
    It would therefore be interesting to pursue this work to complete the lens types analyzed
    with new lenses that come to the market, and facilitate the use of this work at a time when
    the notions of sagittal height are being gaining more attention with the increasing
    popularization of scleral lens fitting

    1
    van der Worp E, Lampa M, Kinoshita B, Fujimoto MJ, Coldrick BJ, Caroline P. Variation in sag
    values in daily disposable, reusable and toric soft contact lenses. Cont Lens Anterior Eye.
    2021;44(6):101386. doi:10.1016/j.clae.2020.11.006

    View publication stats

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