In-Office RGP Labs Can Make
All the Difference

BY HARVEY YAMAMOTO, O.D.
JAN. 1996

With the variety of unique cases that can be fit successfully with RGP lenses, I'm amazed that many practitioners make RGPs their second choice. I've found that I can often satisfy my most demanding fits with RGPs, thanks to an in-office lab. When I consider the improved corneal health, better visual acuity and greater long-term comfort that custom-fit RGPs afford patients, as well as the personal satisfaction and patient loyalty they afford me, I feel the extra effort is certainly worthwhile. Here are a few examples where an in-office lab made all the difference.

A DRY EYE CHALLENGE

K.S., a 30-year-old female, presented with blurriness in her distance vision, and glare, especially at night. Her last eye examination was two years prior to the visit and she was taking sulfacetamide drops due to allergies. Her unaided visual acuity was 20/400 OU. In her old lenses she saw 20/30 OD and 20/25 OS. Her keratometry readings were 7.30=BCR; -6.12; 8.6 dia.; 7.40 OZD; 0.10=CT OD and 7.30=BCR; -7.50; 8.6 dia.; 7.40OZD; 0.10=CT OS.

We prescribed new lenses in the Trans-Aire material. Although this solved her blurriness and glare problems, the patient returned one week later complaining that the new lenses were uncomfortable. We repolished the lenses, but she returned in a few days complaining of lens awareness and reduced wearing time. Slit lamp examination revealed mucin buildup inferiorly in both lenses. Her tear break-up was less than five seconds.

We surmised that the patient had developed dry eye and that the thickness of the lens most likely caused her problem. We concluded that thinner lenses with less mass might translate into less irritation, and the additional flexure might increase the tear pump. We decided to stay with the Trans-Aire material because we needed a lens that was as durable as the Polycon without sacrificing Dk. Because the Trans-Aire material is a silcone acrylate like the Polycon, we felt confident that it would sustain a thinner design with no aberrations and a Dk of 45. I prescribed 7.27BCR, -6.50, 9.0/7.80 (dia./OZD) OD;7.27BCR, -8.00, 9.0/7.80 (dia./OZD) OS. We made the lenses with a 0.09mm center thickness.

The patient immediately found her new lenses more comfortable. After one year, she has excellent visual acuity and good comfort with minimal use of ocular lubricants.

PRESBYOPIC SUCCESS

T.K., a 44-year-old female who wore RGP lenses, presented with keratoplasty on her right eye, and the advanced stages of keratoconus on her left eye. She complained of blurry distance vision and difficulty reading. She took Procardia 60 for hypertension.

To eliminate T.K.'s need for spectacle correction over her contact lenses (she was wearing a reading prescription of +1.50 OU), we prescribed a bitoric Target bifocal for her right eye, and a keratoconic aspheric design for the left eye. Again, we used theTrans-Aire material because of its performance excellence in unique custom fits and its low wetting angle.

This was a very complicated case that required a total of 12 buttons before we found the right design. However, the patient's satisfaction with her new lenses made this difficult case well worth the effort.

EFFICIENT AND PREDICTABLE

As these cases illustrate, the benefits of having your own in-office lab are obvious. In fact, many of my referrals are from fellow optometrists who don't have the same customizing capabilities for their contact lens patients. They know that I can offer patients optimal comfort and predictability every time with the convenience and efficiency of fewer office visits. CLS

Dr. Yamamoto practices in Ontario, Calif., and is the president of C&E Vision Group in San Clemente.