contact lens case reports

Upgrade Patients When New Technology Becomes Available

BY PATRICK J. CAROLINE, FAAO, & MARK P. ANDRÉ, FAAO

In the more recent history of hybrid contact lenses, SynergEyes, Inc. has released a family of hybrids that incorporate a high-Dk GP center (Paragon HDS 100 [Paragon Vision Sciences], Dk 100) with a 31-percent water non-ionic soft lens skirt and 14.5mm overall lens diameter. The new SynergEyes PS lens is designed for patients who have highly oblate corneas following refractive surgery or penetrating keratoplasty.

Almost Perfect

Our patient underwent bilateral radial keratotomy surgery in the mid-1990s. Today, his left eye is stable with an uncorrected visual acuity of 20/25. However, his dominant right eye exhibits significant irregular astigmatism (Figure 1), with a best-corrected spectacle acuity of 20/80. Historically, the patient was unable to achieve adequate comfort with a wide range of GP lens designs.

Figure 1. Patient's corneal topography, right eye.

Figure 2. SynergEyes PS design on the patient's right eye.

We ultimately fit the right eye with a SynergEyes PS design (Figure 2), 8.4mm base curve, 8.6mm skirt radius, 14.5mm diameter, power –2.00D and a medium sagittal depth.

The patient has now successfully worn the PS design for 18 months. His wearing time is 14 hours a day with excellent comfort and stable 20/20 vision. The lens continues to be mobile with the blink, with 0.25mm of movement in primary gaze.

The patient is pleased with the lens performance, but he has developed 360 degrees of peripheral neovascularization at the incision sites (Figure 3). We continue to monitor the vascularization every four months and encourage as minimal wearing time as possible.

Figure 3. Incisional neovascularization with SynergEyes lens wear.

Stay Current With Technology

We have a number of SynergEyes patients waiting for the inevitable evolution of the modality to a higher-Dk soft skirt. Until then, we firmly believe that it's imperative to use the tools we currently have at our disposal. We inform every patient that the lenses they currently wear will most likely not be the lenses they will wear in two to three years. Contact lens technology is always in a state of evolution, and many limitations of our current lens designs are sure to be addressed with improved future products. Therefore, our mantra is three-fold:

1. Use the best tools we have at our disposal today to manage each patient's condition.
2. Carefully monitor any nonsight threatening complications.
3. Upgrade patients as new technologies enter the marketplace. CLS

Patrick Caroline is an associate professor of optometry at Pacic University. He is also a consultant to Paragon Vision Sciences. Mark André is an associate professor of optometry at Pacic University. He is also a consultant for CooperVision and SynergEyes, Inc.