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Posts Tagged ‘SynergEyes’

Christian’s Keratoconus Story – “ClearKone Changed the Way I See Life”

Thursday, June 23rd, 2011

My vision challenges began in junior high school when I started to wear glasses. Although my vision was fine at that time, things started to change when I entered high school. I began to notice that I wasn’t able to read the chalkboard. Even though I sat in the front row, I found it difficult and frustrating to read the teachers’ notes. I went back to my optometrist, who gave me another pair of glasses with a stronger prescription. Unfortunately, the new glasses only helped for a period of time. By the time I was in my junior year, my vision was a problem again. The new glasses no longer corrected my vision. I decided it was time to see a new optometrist. 

In my senior year of high school my new optometrist, Dr. Barry Leonard, diagnosed me with keratoconus. While I was glad to have found out the cause of my vision problems and learn that contact lenses could improve my eyesight, I could never have imagined the contradictions that came with contact lens wear. My doctor fit me in RGP lenses, which did improve my vision, but the lenses were so uncomfortable. My eyes were often irritated, so I would try to function without wearing the lenses. Unfortunately, my vision was so poor without them that I could not drive, see faces of friends at a distance, or read a book with small font. Keratoconus was truly affecting my daily activities!

Dr. Leonard then recommended that I try the ClearKone lens from SynergEyes. He explained that the rigid center would give me the visual acuity I needed, while the soft skirt would keep my eyes comfortable throughout the day. It sounded like a great option! As we began the fitting process, it was difficult for my lids to open wide enough for the lenses to be inserted. My eyes were so sensitive that my lids would close whenever the lens got near my eye. Thankfully, Dr. Leonard was very patient with me, and after many attempts, was able to insert the lenses.

Once I began wearing the lenses, I was amazed. My vision was clear and crisp, and the lenses were so comfortable that I could wear them all day long without irritation. It really was the best of both worlds!

I have now been wearing the lenses for several months, and my life has changed in so many ways. I can distinguish faces from a distance and see their expressions, which is so wonderful! I am also able to drive, use the computer, and read books with small font. I feel like I now have a normal life without the frustrations of poor vision. ClearKone lenses have truly changed the way I see life!

Melanie’s Keratoconus Story – “Life Inside an Impressionist Painting”

Tuesday, December 21st, 2010


ClearKone Sharing Vision Grant Recipient

Melanie's Keratoconus Story

I live inside an impressionist painting, where colors smear across the canvas and ghost images hover around any large object I can actually identify. At night, my world is ablaze with eight-pointed stars that spring from every source of light – headlights, streetlamps, neon signs and even candles on the altar at church. When I try to focus on your face, I see a double image of your features; your eyes and nose and mouth run together like melting wax. Like a blind person, I focus on your voice, your height and weight, and the way you move. I miss seeing you smile and roll your eyes and grimace – all the nuances that nurture communication. Because I can’t see you clearly, I often misunderstand. I’m a writer and graphic designer, but I can’t read the words on the monitor as I type them. I can’t read a letter or take legible notes when I talk on the phone. The more I enlarge the letters on my monitor, the more they smear. I squint. I turn my head, and try to capture a pinpoint of light that will fall on my retina at just the right angle and reflect a clear impression of what’s before me.


I’ve lived for 39 years as a classic myope, “seeing” new places and people and experiences through my enormous collection of novels, reference and business books, textbooks, biographies, and books on art, psychology and spirituality. At one time, I could take out my contact lenses before I went to bed, put on a pair of bottle-bottom glasses, and settle under my down comforter to read myself to sleep. Since having RK surgery some 17 years ago, however, there’s not a lens in the world that can filter light through my damaged corneas and hit the sweet spot on my retinas. If I want to read these days, I must wear both contact lenses and reading glasses, and maintain a powerful squint.

Now I’m locked into a smeared world filled with beautiful works of art and brilliant literature, as well as the simple pleasures and necessities of sight – the daily newspaper, the buttons in the elevator, the menu at the meat-and-three, the birthday card from a friend, the calorie count on a carton of yogurt. I can’t see any of them clearly enough to use them. Bursts of light are excruciating for my damaged corneas. Sometimes it’s seemed easier just to stay in bed in despair and sleep the days away.

To adequately explain why ClearKone® lenses made such a difference in my life, I have to explain the impact of my RK surgery. I started wearing glasses when I was eight and contacts when I was 12. I could always read without correction, but the glasses and/or contacts were critical if I needed to see anything beyond my books. When RK surgery came to the forefront in the early 1990s, I jumped on the bandwagon and had one major procedure and one “touch-up” performed on each eye by one of the city’s most prominent ophthalmologists. For a few weeks, I lived the miracle of 20/10 vision. I could see the lighted display on my clock in the middle of the night. I no longer had to baby expensive contact lenses or endure the pain of getting debris caught under them. I could move from reading to driving to computer work seamlessly, ride freely in a convertible without worrying about dirt flying into my eyes or my contacts drying out, swim and see at the same time, and best of all – my vision was better than it had ever been in my whole life!

My 20/10 days lasted for about a month, and then the unthinkable happened. My vision began to deteriorate, both at near vision and at a distance. My new crystal-clear world slipped away from me day by day, and I began what would be a 17-year quest to regain my sight. My doctors tried every contact lens available. While I could see fairly well with gas permeable lenses, they were pure misery to wear, rubbing against my RK incisions and forcing me to take them in and out, over and over, every day. My vision fluctuated so much in the course of a day that no prescription glasses ever gave me clear vision at any distance. With menopause, my dry eyes dried out even more. I had my tear ducts cauterized. I tried wearing nothing but glasses for months in hopes that my vision would stabilize and adapt to the glasses, but it didn’t work I moved to another city and new optometrists tried to help me. We tried various soft lenses, but they only draped themselves over my flat cornea and many incisions and did little to help me see, although they were more comfortable than gas perms. My optometrist tried piggy-backing a gas perm lens over a soft lens, but the lenses wouldn’t center. I spent endless hours on the internet and phone, talking with specialists throughout the country, trying to find the one doctor who might have a rare and unpublicized solution for failed RK procedures.

Finally, with the dawning of the new century, the first hybrid lenses came on the market, and after weeks and weeks of fittings and trial and error, for the first time, I had decent vision and decent comfort with monovision Soft Perm lenses. I still couldn’t be corrected with glasses, so I was heavily dependent on my contacts to read, drive, and work. Because my RK incisions were so prone to irritation, the hybrid lenses would periodically cause one or more of the incisions to open up. That was agony, both because of the pain and because I would be unable to wear the lens (and thus become visually disabled) until the incision healed enough for me to tolerate it again. This year I developed yet another problem with my hybrid lenses. Almost as soon as I’d insert them, they would cloud over with a thick, gluey substance. I spent more time taking them out and cleaning them than I spent actually wearing them!

Having moved back to Birmingham, I went back to UAB Eye Care and met Dr. Adam Gordon, who told me about ClearKone® hybrid contact lenses. From the first moment I felt that lens on my eye, I knew it was the answer I’d been searching for. Because the lens floated on a layer of fluid above my RK incisions, they were incredibly comfortable, and my visual acuity was better than it had been since my one-month bout of 20/10 vision 17 years earlier.

Questions Keratoconus Patients are Asking

Friday, July 30th, 2010

Q: I am a Keratoconus patient and have been wearing Soft Perm contact lens for over 10 years. I have now been fitted with the new ClearKone Synergeyes lens in both eyes. I get great vision with these contacts and comfort for the most part however my contacts cloud up at times, especially my left eye.  I know that these lenses are high in oxgyen – like 7 times more oxygen is received by the conrea compared to the Soft Perm – could this be the adpatation period? Shak

A: Shak, you bring up a very common issue faced by SynergEyes and other contact lens patients: “cloudy vision.”  There are several reasons for cloudy vision including an improper contact lens fit.  Please tell your contact lens fitter about this issue so that he/she can check the fit and make sure that it is correct.   More commonly, many patients experience cloudy vision because of the surface of their lens drying out or hazing over.  The surface of contact lenses requires extreme care in order to keep it wetable.  There are several steps that you may want to take in order to enhance the surface of the lenses.  1. Use the proper soap.  The soap that we use can have oils that cause the surface of the lens to become non-wetting.  Use lanoline free soaps that are free of perfume and fragrances.  2. After washing your hands, rinse your fingertips with the contact lens solution that you use prior to handeling your contact lenses (Unless you use a hydrogen peroxide solution such as Clear Care) 3. If you are getting cloudy vision consider switching to a different contact lens solution that creates a more wettable surface.   As always consult your contact lens fitter on any changes that you make to your lens wearing routine or solution use. Dr. Kading


Q: Since part of the hybrid lens is rigid, will I feel the lens in my eye?

A: If you’ve never worn contact lenses before, or if you have only worn soft lenses, there may be a period of adaptation. Typically this adaptation period lasts for 3-5 days.

Your practitioner may want to build up your wearing time over a few days, and they will be able to recommend a wear schedule customized for you.

Q: I have had keratoconus for 4 years and it continues to get worse.  At what point should I consider surgery?

A: Approximately 20% of patients with keratoconus will have progression to the degree where corneal surgery is necessary.  The most common procedure performed is a full thickness corneal transplant also known as a penetrating keratoplasty (PKP).  In this surgery the diseased cornea is removed and replaced by a human donor cornea.  Luckily, transplantation of the cornea is the most successful of all organ transplants with a low rejection rate.  Many patients will still need the assistance of glasses or contact lenses for optimal vision. This is why many of the top corneal surgeons first refer their keratoconus patients to a contact lens specialist before operating. Answer by: Dr. Chou

Q: I’ve thought about getting Intacs, but I’ve heard that you still need to wear contact lenses after you’ve had Intacs surgery. Is this true?

A: Intacs is a relatively newer surgical method to address the corneal irregularity found in keratoconus. It involves the implantation of tiny plastic segments within the cornea. The result is to make the optical surface of the cornea relatively more regular, thus reducing the degree of vision distortion. This technology is only indicated for keratoconic corneas without scaring, yet have become contact lens intolerant. Results with Intacs have been encouraging, but once again are not a total solution for this disease. As with PK, patients who have had Intacs implanted most often still require contact lens correction for maximum vision. By making the corneal surface more regular contact lens fitting may be more successful following Intacs.

Keratoconus patients contemplating Intacs surgery should first consult with a qualified contact lens practitioner to investigate less invasive and potentially more effective treatment. Click here for an article on surgical options.  Answer by: Dr. Eiden.

Q: What is the best solution to use with my ClearKone® lenses?

A: There are several care systems approved for use with hybrid contact lenses.  You should always follow the instructions provided by your eye care professional with regard to caring for your lenses.  SynergEyes, the manufacturer of ClearKone lenses also has some recommendations that you can find on this website.

Q: Can I sleep in ClearKone® lenses?

A: ClearKone lenses are approved by the FDA for daily wear only.  Therefore you should never sleep in your lenses.   You should remove your lenses at the end of the day clean them and store them overnight.

Q: What do you suggest for dry eyes?

A: Use re-wetting drops approved for soft lenses like Optive to help with dryness.  It is also very important to digitally clean your lenses – ignore the “no rub” on solutions. Also using the non preserved products for insertion does seem to help as well, rather than using a multipurpose solution.

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Ask an Expert!

To submit a question, please send an email to askanexpert@synergeyes.com. We will review all questions and post an answer each week.

Please note: If you have an urgent question about your eye health, contact your eye care practitioner immediately. This page is designed to provide general information about vision, vision care and vision correction. It is not intended to provide medical advice. If you suspect that you have a vision problem or a condition that requires attention, consult with an eye care professional for advice on the treatment of your own specific condition and for your own particular needs.

The History of Hybrid Lens Technology

Thursday, July 1st, 2010

Patient excitement for a contact lens is created when the first lens placed on the eye provides good vision and feels great.  Success in contact lens wear depends upon the patient achieving their vision, comfort and eye health goals. At one time patients could only choose between rigid gas permeable lenses (RGPs) and soft lenses so patients often had to compromise on either vision or comfort. Today there is another technology option available called the hybrid contact lens. A hybrid contact lens combines the superior vision benefits of an RGP lens with the comfort benefits of a soft lens.  Hybrid lenses have come a long way since they were conceived in 1977.  Now in the 4th generation, the hybrid lens category has evolved to offer patients with all types of vision problems an opportunity to experience the benefits a hybrid contact lenses offers.

Hybrid Lenses – How they started.

The quest to develop a contact lenses that provides the opportunity for crisp vision and unparalleled comfort began in 1970 with the experimentation of placing a RGP lens on top of a soft lens known as a “piggyback system”. By using this piggyback combination, comfort was improved over RGP lenses and the quality of vision improved from soft lenses. The added benefits of good centration and increased lens stability on irregular corneas created a lens design used for the more complicated cases. The disadvantage of a “piggyback” system is the inconvenience of managing the four separate lenses. Also, on already compromised eyes the lack of oxygen and the possible adverse events of corneal swelling and blood vessel growth can be an issues with piggybacking lenses and always requires additional doctor follow up visits.  It seems reasonable if we could create a single contact lens with the advantages of both RGP and soft lenses, all the disadvantages of contact lenses would be solved. This was the first step in creating the revolutionary hybrid contact lens.

Two scientists named Erikson and Neogi had the idea that a combination lens with a hard center and soft skirt could be developed.  They patented technology that made this possible and that technology was acquired by a company called Precision Cosmet in 1977. This first “hybrid” design was known as the Saturn® lens. The idea behind this hybrid contact lens concept was to improve the performance and comfort of an RGP contact lens for irregular corneas.

In March of 1982, a pre-market investigation took place and the Saturn® lens was granted approval by the FDA in April of 1984.  With minimal customizable options and low oxygen permeability, the Saturn® lens was relegated to a problem solving lens.  Saturn lenses typically exhibited very little movement, called “tight lens syndrome” resulting in red eyes and problems of night time glare.

In 1986, a company called Sola Barnes-Hind then purchased the hybrid contact lens concept and technology and set forth to redesign the lens to address the performance issues. They named the product SoftPerm®. The SoftPerm® lens, was made out of the same material as the Saturn lens.  It had the advantage of improved comfort and additional parameters to properly fit patients. However, because the lens had low oxygen permeability and issues with the center separating from the soft skirt, the lens was still only used as a lens of last resort. A third redesign in 1989 by Sola Barnes-hind created the new SoftPerm lens but this design also suffered from its low oxygen permeability, and practitioners were still hesitant to accept it as a lens of first choice because of feared complications. Problems associated with lens sticking to the cornea and acute red eye problems further inhibited the use of these lenses.  The SoftPerm lens was discontinued in 2010.

Today, a company called SynergEyes is the only company successfully making hybrid contact lenses.

Read “Current Hybrid Lenses Technology”

Clinical Research Study – SynergEyes KC Lenses

Thursday, July 1st, 2010

Purpose: To discuss the initial results of fitting SynergEyes hybrid contact lenses (SynergEyes, Inc, Carlsbad, CA) for keratoconus (KC) and pellucid marginal degeneration (PMD).

Methods: The charts of patients fit with SynergEyes lenses during the first 7 months the lens was available on the Cornea Service at Wills Eye Institute (August 3, 2006 to March 5, 2007) were retrospectively reviewed.

Results: Sixty-one eyes (44 patients) with KC (58 eyes) or PMD (3 eyes) were fit with SynergEyes hybrid contacts. The mean age was 40 ± 12.6 years; the mean follow-up period was 7.8 ± 4.6 months. The most common indication for SynergEyes was rigid gas permeable (RGP) lens intolerance, 31 of 61 eyes (50.8%). Inability to fit with RGP was the indication in 8 eyes (13.1%), and 22 eyes (36%) were refit from SoftPerm (Ciba Vision, Corp, Duluth, GA). Twenty-two patients required refitting, including 17 base curve changes and 5 skirt changes. The success rate was 86.9% (53 of 61 eyes). Most failures (8 eyes of 6 patients) discontinued the lens within the first 1–2 months because of discomfort (5 eyes) or unsatisfactory vision (3 eyes).

Conclusion: SynergEyes lenses are a promising alternative for visual rehabilitation in patients with KC and PMD who are intolerant or unable to be fit in RGP lenses.

Key Words: keratoconus, contact lenses, SynergEyes

(Cornea 2010;29:5-8)

Rigid gas permeable (RGP) contact lenses are the standard treatment for irregular astigmatism in keratoconus (KC) and pellucid marginal degeneration (PMD). However, many patients are intolerant to these lenses because of discomfort. Other patients, especially those with very steep and/or irregular corneas, experience frequent dislocation or decentration of the lenses.1,2 In such cases, the SynergEyes lens (SynergEyes, Inc, Carlsbad, CA), a third-generation hybrid lens with a RGP center and a soft skirt, is an option to overcome these difficulties and delay the need for penetrating keratoplasty (PKP).


Received for publication June 9, 2008; revision received March 31, 2009; accepted April 10, 2009.

From the Cornea Service, Wills Eye Institute, Jefferson Medical College, Thomas Jefferson University, Philadelphia, PA.

Reprints: Elisabeth J. Cohen, MD, Cornea Service, Wills Eye Institute, 840 Walnut St, Suite 920, Philadelphia PA, 19107 (e-mail: ecohen@willseye.org).

Copyright © 2009 by Lippincott Williams & Wilkins


The Saturn II (Barnes Hind, Inc, Irvine, CA) was the first-generation hybrid contact lens produced. A number of problems existed with this lens including discomfort and corneal neovascularization,3 which were felt to be because of hypoxia associated with the low diffusion solubility (Dk) materials and a tight fit. Modifications of the original Saturn II design resulted in the second-generation hybrid lens: the SoftPerm lens (SBH, Sunnyvale, CA). These lenses had the same design and materials but a larger diameter and modified edge design to allow better tear circulation. Despite having fewer complications than the first generation of hybrid lenses, the SoftPerm lens still achieved limited success because of a high rate of giant papillary conjunctivitis (GPC), chronic hypoxia, and breakage between the RGP and the soft portions.4 In an effort to overcome the many limitations of SoftPerm contact lenses, the SynergEyes hybrid lenses were developed. These lenses have a stronger RGP/hydrogel junction and a much higher oxygen permeability of the rigid center (Dk of 100 vs 14).5 In addition, the SynergEyes contact lenses are available with 2 skirt radii for each base curve and 3 skirt radii for special KC design lenses. A good range of RGP base curves (standard 7.10–8.0 in 0.10 steps and special KC design 5.7–7.10 in 0.2 steps) and a wide range of powers [220.0 to +20.0 diopters (D)] are available. In this study, we conducted a retrospective chart review to evaluate the initial results with SynergEyes lenses in the management of KC and PMD, in a corneal and contact lens referral practice with a special interest in the treatment of corneal ectasia.

MATERIALS AND METHODS

The medical records of patients fit with the SynergEyes contact lenses on the Cornea Service at Wills Eye Institute during the first 7 months the lens was available (August 3, 2006 and March 5, 2007) were obtained through a computerized patient database search and were retrospectively reviewed. The patient data collected included sex, date of birth, ocular diagnosis, and the indication for SynergEyes fitting. The corneal topographies used for trial lens fitting, obtained using the Zeiss Atlas topographer (Carl Zeiss Meditec, Inc, Dublin, CA), were reviewed. The steep and flat keratometries (Ks), simulated Ks, and average Ks were recorded. The patients’ previous visual acuity and method of correction (whether RGP, soft contact, SoftPerm, or glasses) were noted, in addition to the most recent manifest refraction, if available.

The lens data included the base curve, skirt, and power of the initial lens dispensed; the number of refits and reorders during the follow-up period; and the final base curve, skirt, and power of the lens at the last follow-up. When the base curve and/or skirt was changed, the direction of change was noted (flatter or steeper). The initial base curve and skirt of trial lens were selected on the basis of the corneal topography, starting on the flat K for the base curve of the RGP portion, and using a steep skirt if there was inferior steepening. Because of previous experience with hybrid lenses in patients with KC, the goal was to fit a relatively flat lens without significant inferior edge lift, to avoid tight fitting lenses.

The outcome data included the best visual acuity with the SynergEyes contact lens and the need for power adjustment and over refraction, duration of lens use, and temporary or permanent lens discontinuation. The reason for discontinuation was noted and analyzed. Subjective complaints included discomfort, visual problems, and issues related to lens handling. Objective complications included GPC, superficial punctate keratitis, dry eye syndrome (DES), corneal epithelial defects or abrasions, pannus or neovascularization, corneal edema, corneal ulcers, and broken or torn contact lenses. Management and outcome of complications were also reviewed.

RESULTS

The charts of 44 patients (61 eyes) were reviewed, and included 26 males and 18 females, with an age range of 19–62 years (mean age 40.1 6 12 years). Twenty-seven patients had 1 eye fit and 17 had bilateral fitting. The bilateral cases were often those who wore SoftPerm lenses previously. The ocular diagnosis was KC in 58 eyes; only 3 eyes had PMD. The average follow-up for these patients was 7.86 4.6 months (range from 1 to 17 months).

Indications for the SynergEyes contact lens were RGP lens intolerance in 31 eyes (50.8%), inability to fit with RGP lenses in 8 eyes (13.1%), and conversion from SoftPerm in 22 eyes (36%). The mean logarithm of the minimum angle of resolution visual acuity with correction before the SynergEyes fit was 0.46 6 0.42 (range 0–2), which is approximately 20/60 (range 20/20 to counting fingers at 2 feet). The disease severity was variable, with steep Ks by topography ranging from 47 to 77 D. Two eyes had very irregular poor quality topographies so the Ks could not be analyzed. The mean steep K was 56.8 6 6.1 D (corresponding to a radius of curvature of 5.95 mm). The mean flat K was 45.7 6 6.7 (corresponding to a radius of curvature of 7.37 mm).



Figure 1

Figure 1. Relation of final SynergEyes base curve (Syn) and flat K (F1.K).



The mean final SynergEyes base curve was 7.67 6 0.34 mm (range 6.7–8.2 mm). The final SynergEyes base curve was usually flatter than the flat K (36 of 61 eyes, 59%), and the base curvewas equal to flat K in 6 eyes (9.8%) (Fig. 1). Seventeen eyes (27.8%) were fit flatter than steep (Fig. 2). The steep skirt was used for 45 eyes (73.8%), and the flat skirt was fit in 16 of the eyes (26.2%). Most of the patients wore the contacts for 10–12 hours. Visual acuity was excellent (20/20 to 20/25) in 19 of 61 eyes (31.1%) and very good (20/30 to 20/40) in 38 eyes (62.3%). Three eyes had visual acuity of 20/50 to 20/100, and 1 eye with a visual acuity of 20/200 discontinued the lens. The mean best logarithm of the minimum angle of resolution visual acuity with the contact lens was 0.22 6 0.18 (range 0–1), which corresponds to 20/32 (range 20/20 to 20/200). The lens visual acuity with SynergEyes was better or equal to that obtained with the previous correction in most of the cases (52 of 61 eyes, 85.2%). However, some patients (9 of 61 eyes, 14.8%) had better vision with their previous correction, 3 of whom stopped the SynergEyes contact lens.

Refits were necessary in 22 eyes (36.1%), including base curve changes in 17 eyes (27.9%), evenly divided between tighter (9) and looser (8) fits. Five eyes had changes in the hydrogel skirt only. Thirteen eyes had power changes. Two or 3 refits were necessary in 13 eyes (21.3%) throughout the course of follow-up.



Figure 2

Figure 2. Relation between final SynergEyes fit (Syn) and the steep K (St. K).



Complications occurred in almost one third of the eyes (19 of 61 eyes, 31.1%). The most common were GPC and allergies in 7 eyes (11.5%). These patients were treated with topical mast cell stabilizers and/or antihistamines. DES was diagnosed in 5 eyes (3 patients). A corneal abrasion occurred in 1 eye over a scar, but the patient was able to resume the contact after healing and use of ointment at bedtime. One corneal ulcer less than 1 mm in diameter with surrounding edema and neovascularization occurred in a patient with atopy. This responded to intensive topical antibiotic treatment. The patient resumed lens use but decreased the wear time from 15 to 16 hours per day to 10 hours. Two contact lenses developed tears in the hydrogel portion and not the RGP/hydrogel junction (Table 1). Four of the eyes with complications were refit with looser base curves, including 2 with DES and 2 with worsening allergies. One eye with GPC was refit with a looser skirt.

The most common complaint was discomfort, occurring in 16 eyes (26.2%), resulting in the stoppage of the contact in 5 eyes and accounting for (5 of 8 eyes) 62.5% of the failures. Interestingly, 1 patient decided to resume SoftPerm lenses because it came in a looser base curve (8.1) and then returned to be refit with the SynergEyes when the company provided lenses with the looser parameters (Table 2).

Failures occurred in only 8 of 61 eyes (13.1%) of 7 patients; lens discontinuation was early in 5 patients (1–2 months). The reason for failure was discomfort in 5 eyes. Two patients underwent PKP and 1 is considering PKP; 1 eye went back to RGP’s and 1 resumed SoftPerm lenses temporarily. Unsatisfactory vision was the cause of failure in 3 eyes, 2 of whom returned to RGP. One remained without correction because it was the same as with the contact lens (20/40) because of a traumatic cataract in this eye and had a PKP in the other eye (Table 3).

DISCUSSION



Table 1

Table 1. Complications of the SynergEyes Lens



Our initial experience with the SynergEyes lenses has been very positive with a success rate of 86.9%. These lenses have an important role in visual correction in many patients with KC or PMD who have failed RGP lenses because of poor fit or discomfort and would otherwise require surgery. In addition, patients are very enthusiastic about these lenses and often comment that they have changed their lives for the better. Patients often request to have their other eye fit with a SynergEyes. Because of the problems of dry eyes and allergies that have occurred in some patients and were also reported in the previous generations of hybrid lenses, we prefer to wait 3–6 months before fitting the second eye, unless the patient is already using SoftPerm bilaterally. We advise patients to lubricate their eyes regularly when wearing the contacts, to treat any allergies chronically, and limit their lens wearing time to 12–14 hours per day.



Table 2

Table 2. Complaints and Their Outcome



Second-generation hybrid lenses, SoftPerm, offered a reasonable alternative to RGP lenses when they became intolerable or difficult to fit, but they still achieved limited success. Chung et al6 reported breakage of the lens at the RGP/hydrogel junction as the most common complication (48.5% of cases). In this study, only 2 patients (3.2%) reported torn contacts. This is because of the differences in lens design, with an improved RGP/hydrogel junction (Table 4).5

The major shortcoming of the SoftPerm lenses was the chronic hypoxia resulting from the low oxygen permeability of both the rigid center and the soft skirt, which gave rise to high incidence of neovascularization and pannus formation (27.3% in Chung’s study).6 The SynergEyes design with the high oxygen permeability has resulted in a very low rate of the chronic hypoxia and subsequent neovascularization and pannus formation, at least during the relatively short-term follow-up. Only 1 eye of 61 in our study (1.6%) developed neovascularization and that was in a patient who overwore the lens 18 hours per day and developed a small presumed bacterial corneal ulcer.



Table 3

Table 3. Reasons for Discontinuation of SynergEyes Contact Lenses and Further Management



Discomfort, probably because of hypoxia was also reported by Chung et al6 to be a major issue with SoftPerm lenses occurring in 40% of the cases, accounting for 82% of the failures. Discomfort was less common in our patients in this series (16 of 61 eyes, 26.2%) and most patients (11 of 16, 68.7%) resumed lenses wear successfully.



Table 4

Table 4. Contact Lens Parameters for -3.00 D SoftPerm and SynergEyes Contact Lenses



Another complication of SoftPerm contact lenses was the high incidence of GPC, which occurred in 27.3% of the cases in Chung’s study.6 In our study with the SynergEyes, it only occurred in 11% of the cases (7 of 61 eyes). This is close to the rate in conventional soft contacts (10%), yet higher than that for RGP lenses, which is less than 5%.7 Patients with KC often have allergies.8 Lenses with a hydrogel component that are only replaced every 6 months are likely to aggravate allergies. This can be managed with regular enzymatic cleaning using a hydrogen peroxide system and with the chronic use of topical mast cell stabilizers/antihistamine drops (before and after lens use.)

Cohen et al9 reported 3 cases of Acanthamoeba keratitis in SoftPerm users, 1 requiring therapeutic keratoplasty, accounting for one third of Acanthamoeba keratitis in that series of contact lens–related corneal ulcers. Also Mah- Sadorra et al10 reported 1 case of Acanthamoeba associated with SoftPerm lenses in a more recent study. On the other hand, Maguen et al,4 Binder et al,11 and Chung et al6 reported no infectious keratitis with SoftPerms. None of our recent cases of Acanthamoeba keratitis (44 cases 2004–2007) were associated with hybrid lenses.12 We recommend disinfection with H2O2 systems such as Ultracare (AMO, Inc, Santa Ana, CA) and Clear care (Ciba Vision, Corp, Duluth, GA) because of their reported improved efficacy against Acanthamoeba compared with multipurpose solutions.13

The SynergEyes lenses are a major advance in the management of KC. Anecdotally, they improve the quality of lives in patients who have previously failed RGP lenses. Further studies on contact lens–related quality of life issues in KC are currently underway. We consider RGP lenses the gold standard for patients with KC because they provide excellent vision and have the best safety record. However, SynergEyes lenses enable many RGP failures to avoid surgery, including patients with mild to moderate disease who have discomfort with RGP lenses and those with advanced disease, without central scarring, who cannot be successfully fit with RGP. We recommend that patients with KC who are RGP failures be refit with SynergEyes before recommending surgery.

REFERENCES

1. Lass JH, Lembach RG, Park SB, et al. Clinical management of keratoconus. A multicenter analysis. Ophthalmology. 1990;97:433–445.

2. Asbell PA, Dunn MJ. Fitting the abnormal cornea. In: Krachmer JH, Mannis MJ, Holland EJ, eds. Cornea: Diagnosis and Management. St Louis, MO: Mosby-Year Book Inc; 1997:1457–1460.

3. Maguen E, Martinez M, Rosner IR, et al. The use of Saturn lenses in keratoconus. CLAO J. 1991;17:41–43.

4. Maguen E, Caroline P, Rosner IR, et al. The use of the SoftPerm for the correction of irregular astigmatism. CLAO J. 1992;18:173–176.

5. Pilskalns B, Fink BA, Hill RM. Oxygen demands with hybrid contact lenses. Optom Vis Sci. 2007;4:334–342.

6. Chung CW, Santim R, HengW, et al. Use of SoftPerm contact lenses when rigid gas permeable lenses fail. CLAO J. 2001;27:202–208.

7. Keech PM, Ichikawa L, Barlow W. A prospective study of contact lens complications in a managed care setting. Optom Vis Sci. 1996;73: 653–658.

8. Bawazeer AM, Hodge WG, Lorimer B. Atopy and keratoconus: a multivariate analysis. Br J Ophthalmol. 2000;84:834–836.

9. Cohen EJ, Fulton JC, Hoffman CJ, et al.Trends in contact lens related corneal ulcers. Cornea. 1996;15:566–570.

10. Mah-Sadorra JH, Yavuz SG, Najjar DM, et al. Trends in contact lens related corneal ulcers. Cornea. 2005;24:51–58.

11. Binder PS, Kopecky L. Fitting the SoftPerm contact lens after keratoplasty. CLAO J. 1992;18:170–172.

12. Thebatiphat N, Hammersmith KM, Rocha FN, et al. Acanthamoeba keratitis a parasite on the rise. Cornea. 2007;26:701–706.

13. Hiti K,Walochnik J, Haller-Schober EM, et al. Viability of Acanthamoeba after exposure to a multipurpose disinfecting contact lens solution and two hydrogen peroxide systems. Br J Ophthalmol. 2002;86:144–146.

Eye Doctor Testimonials

Thursday, July 1st, 2010

“The ClearKone® lens has revolutionized the way we fit patients with keratoconus. It represents “a quantum leap” improvement. Patients are ecstatic with the quick fitting process that results in a comfortable fit and excellent vision.”

– Robert L. Gordon, O.D.

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