In late 2019, Art Optical introduced Intelliwave Pro, a new line of custom soft lenses featuring freeform stabilization for rapid lens positioning and quick focusing, according to the company.

The Intelliwave Pro’s stabilizing system is licensed technology from UltraVision CLPL in the United Kingdom and features Peripheral Balancing Zones that interact with the top and bottom lids. Art Optical says that this interaction creates stabilizing forces that allow for rapid lens positioning and focusing, usually within 20 seconds. Quick and stable lens orientation ensures crisp, clear vision at all times and eliminates visual fluctuations during gaze excursions and head tilts, according to the company.

Intelliwave Pro is offered in aspheric, aspheric toric, multifocal, and multifocal toric designs, with a broad range of parameters. Art Optical says that Intelliwave Pro multifocal optics are truly flexible, combining center-near and center-distance designs with additional options to optimize vision for the dominant eye in today’s presbyopic population.

Intelliwave Pro contact lenses can be manufactured in Contamac’s Definitive (efrofilcon A, 74%) silicone hydrogel material, which is recommended as a quarterly replacement lens. Alternately, the lenses can be manufactured in hydrogel material for biannual replacement.

I recently talked with practitioners who are actively fitting the Intelliwave Pro contact lens in their practices. Here we share their clinical experiences.

Please tell us about your general experience with Art Optical’s Intelliwave Pro lens.

Chad Morgan, OD, who practices in Raleigh, NC, worked on the team that provided feedback during development of the lens and has had a very positive experience working with it.

Jennifer Branning, OD, who practices in Ludington, MI, says that she has been using the original Intelliwave lens since 2011 and immediately switched to the Intelliwave Pro lens when it became available. “I began using them more after attending a conference. I was intrigued with using a soft contact lens for some of my patients who had cones, in particular pellucid [marginal degeneration] patients,” she explains.

“The results were great, and I started to use the lens more and more for all types of patients,” she continues. “I now tend to use the lens as a first choice for many multifocal patients, in particular for patients who need a toric multifocal.”

Who are the best candidates for this lens and why?

Dr. Branning thinks that the Intelliwave Pro lens is great for anyone. “I think it is particularly suited for patients who have K readings that are not ‘average,’” she says. “For a multifocal lens to work optimally, it needs to fit well. It is great to have a customized lens option when it comes to a multifocal.”

According to Dr. Morgan, the best candidates for this lens are high hyperopes. “When I think about the optics and design of a contact lens for a high hyperope, I think about the optics in a spectacle lens. There is an increased thickness in the center of the spectacle lens,” he explains. “When there is an increased thickness in the center of a contact lens, the relationship between the eyelid and the lens can cause excessive movement or rotation. I have found that the peripheral balancing system has worked well in the way that it stabilizes the lens in these instances.”

Tell us about the fitting process for the Intelliwave Pro lens and what has worked best for you.

Dr. Morgan notes that the Intelliwave lens’ peripheral balancing zone allows for a different stabilization that holds well during blinks and during eye movement. Overall, he describes the fitting process as pretty straightforward. “For all of my custom lenses, I get corneal Ks (with [topography]), current refraction, horizontal visible iris measurements, eye dominancy, and pupil size in various lighting and while reading,” he says. “When troubleshooting, I have found that it is always best to have more information. When we document this information, it then also allows us to determine what patient parameters work best for certain lenses. When fitting the Pro design lens, I simply call in or have my tech call in with this information, and the consultants help us determine lens parameters. The lens is shipped, and then the patient returns for the evaluation.”

Dr. Branning also starts consultations with Ks and refraction. “Many times, we get things right the first time around because we can get the base curve that is right for the patient,” she says. “We sometimes have to tweak the lens and go with a distance-center design in both eyes or maybe decrease the diameter; but often the fitting process is very straightforward, and there aren’t many modifications required.

“The nice thing is that we can actually change the base curve and diameter to get the proper fit needed for a multifocal lens to function in a way that provides great vision,” Dr. Branning continues.

How has the Intelliwave Pro lens helped with troubleshooting for particular patients? Tell us about any success stories in that regard.

That ability to have the exact base curve needed is key to troubleshooting with particular patients, according to Dr. Branning. “If I am trying other products and not succeeding, it is typically a fit issue, and I know that with Intelliwave, I can address those problems and make the changes needed.”

She recalls a success story from this past summer. A 79-year-old female was a former patient who had moved and was currently seeing another provider. “She decided that she wanted to go with contact [lenses] again after years in glasses, so she returned to me in hopes of being fit with [lenses],” she says. “Her Rx is low minus with 1.00D of cylinder; she has mild cataracts, and her corneas are steep (more than 45.50D OD and OS). Definitely not the best candidate for a standard multifocal toric lens.”

So, Dr. Branning immediately recommended trying the Intelliwave lens design. “We are currently a beta test sight for the decentered near zone, so we went with that design,” she says. “She had 20/20 vision for distance and 20/25 for near with the initial diagnostic lenses, and she is absolutely thrilled.”

For Dr. Morgan, a trial lens that is on his shelves can be the simplest way to fit a patient with a contact lens. However, he notes that, unfortunately, this does not always work. “When prism ballasting is not efficient in the office or if patients come in complaining of intermittent blurred vision in toric lenses that they adjust with their finger during the day, I go straight to a customized approach,” he explains. He tells of a 52-year-old white female who has been a patient of his for several years. Her history included right lateral rectus muscle resection and left superior rectus muscle recession as a child, narrow angle glaucoma suspect with peripheral iridotomy, and peripheral retinal degeneration. Dr. Morgan notes that her spectacle refraction was more straightforward than her contact lens prescription was. “Over the years, I have learned to cut her spectacle prescription by –0.50D OD and OS to maintain extraocular muscle control.” Her prescription is OD +5.25 –1.25 x 039, +2.00D add and OS +4.75 –1.75 x 135, +2.00D add.

Dr. Morgan indicates that while her contact lens evaluation is never as straightforward given the correction on the surface, this patient is determined to stay in contact lenses. “Every other year or so, there is a visual change that requires a shift in her prescription. Unfortunately, this change does not follow the general rules and algorithms of fitting a contact lens,” he says. “She has worn hybrids, GPs, and other specialty soft lenses in her past. We never really know what direction her eyes are going to point at the initial dispense [due to esotropia]. Additionally, she never knows when one eye has turned, because she suppresses very well.

“Changing to the Intelliwave Pro design offered her immediate stabilized vision that is so key with her fitting. Any small change in the refraction from rotation, etc. will cause an eye turn,” he continues. He notes that he ended up with OD Intelliwave Pro Multifocal Toric +6.25 –1.75 x 031, with an 8.7mm base curve, 14.5mm diameter, a center-near zone of 0.50D, and +2.25D add and OS Intelliwave Pro Multifocal Toric +5.25 –1.75 x 137, with a center-near zone of 0.50D and +2.75D add.

“You may notice that the OD contact lens power versus the spectacle power does not correlate,” Dr. Morgan adds. “This is given to control the esotropia in the presence of the optics of the contact lens. The visual acuity is intentionally blurred OD to gain control at 20/30, and the OS is a 20/25. The patient is very functional and pleased to be able to continue in contact lenses.” CLS