Contact Lens Spectrum Supplements

Special Edition 2017

Contact Lens Spectrum

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c l s p e c t r u m . c o m C O N T A C T L E N S S P E C T R U M S P E C I A L E D I T I O N 2 0 1 7 19 PRACTICE BUILDING Food and Drug Administration. While pharmaceutical agents such as atropine will likely play a role, contact lenses will be used primarily to provide the necessary op- tics to slow axial elongation. Multifocal soft lenses are demonstrating success for myopia control, but we are still not absolutely sure of the best optical configuration or add power to prescribe for varying levels of early myopia combined with the age of the patient. Orthokeratology lenses are a consideration as well (Figure 7). The optics provided to the central and periph- eral retina by the reshaped cornea after orthokeratology appear to be ideal based on what we know today. Sophisticated new instrumentation in this area will al- low us to accurately measure peripheral refractive error. This will enable us to finally be able to document what is occurring refractively in this area of the retina to control axial growth. 9. START FITTING (MORE) SCLERAL LENSES Today's contact lens specialists usually have a high level of interest in scleral lenses. Over the past 8 to 10 years, this field has evolved rapidly, with more than 40 designs available from 20+ lens manufacturers in North America alone. Most often, practitioners consider scleral lenses as de- vices for managing irregular corneas after disease, injury, surgery, or extreme ocular dryness. Candidly, they have been life-changing for thousands of patients who have struggled with previous contact lens fits. Keep in mind that scleral lenses have other uses. Pa- tients with poor vision who have been unsuccessful with soft lenses can see better while still achieving all-day com- fort. Patients with soft lens-induced dry eye can benefit from scleral lenses as well, and these lenses continue to show promise for presbyopia. fer the most flexibility in that they can be designed with the optics in the right place at the right time, and they are not so dependent on pupil size and dynamics. Translat- ing, segmented type lenses (Figure 6), which are often a go-to design for higher add powers, should be considered for early presbyopes as well. Once these designs are suc- cessfully fit, a simple power change is usually all that is needed as the patient ages. Stay tuned for a new approach, decentered optics in presbyopic lens designs. It is well established that a pa- tient's visual axis does not coincide with the geometric center of the cornea or that of a well-centered, rotation- ally symmetric lens. Thus, the patient's line of sight does not match the location of the lens optics, particularly in varying lighting conditions. We are relying on decentered optics to improve visual results significantly and expect these designs to become available in the near future. 7. APPRECIATE TORIC SOFT LENSES (YOUR PATIENTS DO) Most eyecare practitioners feel quite comfortable pre- scribing toric soft lenses, but they are usually reserved for eyes with refractive astigmatism of 1.25D or more. Con- sider a toric soft lens for residual astigmatism of 0.50D or more when spherical. Also, consider offering custom soft lenses for patients with astigmatism, and not just for the power. Being able to prescribe a specific amount of ballast or to alter the base curve/diameter combination is helpful to stabilize toric lenses. For patients with astigmatism and presbyopia, cus- tom-made soft designs are an excellent alternative. 8. BE FAMILIAR WITH CONTACT LENSES FOR MYOPIA CONTROL Over the next few years, myopia control will begin to come of age as the first products are cleared by the U.S. Figure 6. Translating GP trifocal design. Figure 7. Well-fitting orthokeratology lens.

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