During the summer of 2021, AccuLens released Maxim 3D, its newest scleral design. Maxim 3D is a free-form design that is tailored to accurately vault the cornea and to precisely align to the scleral shape at any axis, 360º around, according to the company.

AccuLens says that the custom landing haptic begins at the mid-cornea and seamlessly matches the elevation changes on the cornea to the sclera using advanced geometry Contour Enhanced Landing (CEL). The CEL aligns to the natural shape of the eye, providing an exceptional fit, according to the company.

Maxim 3D also incorporates “Inverse Technology,” allowing prolate or oblate designs. AccuLens says that Maxim 3D is available in any diameter and correction including multifocal and HD (high definition) optics.

Maxim 3D is available in several different options. Maxim 3D Front Toric is the same as the standard Maxim 3D but with a cylinder correction on the front, with double slab-off. Maxim 3D AMF/AMF Front Toric is a free-form aspheric multifocal design—up to +1.75D add—and, if needed, cylinder correction. Maxim 3D Periscopic and Periscopic Front Toric are multifocal designs with an offset center add (On Point adjusted). And, the Maxim 3D with Double Slab-Off is needed in the event that the back surface is not aligning and needs assistance.

Here we share the clinical experiences of practitioners who are fitting Maxim 3D lenses in their practice.

Please tell us about your general experience with AccuLens Maxim 3D lenses.

Michael Everson, OD, who practices in Sugar Land, TX, notes that it has been very easy and enjoyable to work with AccuLens. He says that according to AccuLens, the Maxim 3D lens can be fit by following a few simple steps. “[The company] simplifies the scleral fitting process by allowing practitioners to not have to worry about the complex fitting angles of the eye,” Dr. Everson says. “You just have to take a topography of the cornea and ideally 10mm outside of the limbus.

“We use Eaglet Eye’s Eye Surface Profiler (ESP) and then a lens that the computer algorithm says works best based on the scans taken. Then, we simply place that lens on the eye, evaluate the fit, and perform an over-refraction,” he continues. “Maxim 3D then makes it simple to input the over-refraction data into the AccuLens order form accessed via the Eaglet Eye ESP.”

He noted that this data is sent to AccuLens along with the topography of the eye. “The consultants are able to design a free-form lens to match the contours of the eye for a better first fit than what most other standard lenses can provide,” Dr. Everson adds.

Alex Gibberman, OD, who practices in Loveland, OH, says that he is also a big fan of the Maxim 3D lens. He notes that he has been fitting scleral lenses for about five years and currently averages about 12 new scleral fits per month. “Over the past few years, I have seen AccuLens continue to update its designs as newer technology has become available—from a back-surface toric lens to a quadrant-specific back-surface design and now to a more free-form back-surface design in the Maxim 3D. This allows for a truly customized lens,” he says. “As many scleral lens fitting practitioners know, most scleral profiles are not spherical or even toric but are irregular and have different curvatures and elevations in all quadrants. With the Maxim 3D, we can now account for even the most highly irregular scleras by specifying any and all clock hours that need to be adjusted.”

In addition, Dr. Gibberman notes that the Maxim 3D can be a center-near or -distance multifocal with an adjustable multifocal zone. He says that it also offers the option to offset the multifocal optics to account for lens decentration, which can be measured with the laser-marked trial lens system called On Point. “Even with a decentered multifocal and free-form back-surface profile, the Maxim 3D can still utilize a front toric if needed as well as any type of notching or vault over top of a pinguecula in any quadrant,” he says.

Who are the best candidates for this product and why?

According to Dr. Gibberman, this lens can do it all. “In combination with the ESP, this lens has really reduced chair time and office visits for our scleral patients,” he says. “The Maxim 3D is for any scleral patient. It simply allows for more customization, which means better centration and alignment and happier patients.”

Dr. Everson thinks that this product is very easy to use on new patients or on patients who have tried other standard scleral lenses and have not had success with comfort or vision. He also believes that these lenses are a great choice for new practitioners trying to learn how to fit scleral lenses. “It takes out the process of having to specify intricate fitting changes on a diagnostic lens, as this process is done by the consultants via the topography,” he says.

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

One unique feature of Maxim 3D in its diagnostic lenses is the On Point Alignment system. Dr. Everson notes that this feature looks like a target reticle on the scleral lens and makes it very easy to see decentration of the lens on the eye. “Any practitioner who has fit a multifocal scleral lens knows how difficult it is to center the lens on the eye for maximal comfort and vision,” he says. “This feature makes it easy to tell the consultants exactly how to decenter the optics for optimal first fits and to reduce the amount of reorders.

“The consultants are also fantastic to work with and are very knowledgeable about the fitting process of their lenses,” he adds.

In doing the fitting steps that Dr. Everson mentioned earlier, practitioners will be able to tell where the lens haptics are tight or loose, at what angle (clock hour), and what the central vault and limbal coverage are. “And best of all,” he says, “patients will undoubtedly be surprised by how comfortable the lens is.”

AccuLens explains that the key is the 12-lens Maxim 3D trial set, which is designed with spherical haptics to allow for a precise zero point for fit assessment. The company also notes that there is no need for multiple trial sets, toric peripheral curve trial lenses, or an excessive number of trial lenses—all that is needed is one lens and one assessment.

Dr. Everson adds that the Maxim 3D lens has definitely helped speed up the fitting process in his clinic and has reduced time spent ordering the lenses. “I’ve been using the product for about five months, and most of the first lens fits have been near perfect,” he says. “The Maxim 3D lens has positively impacted our practice by reducing chair time, increasing comfort on first dispenses, reducing the amount of time spent on ordering lenses, and producing happier patient outcomes.”

How has AccuLens Maxim 3D helped with troubleshooting for particular patients? Tell us about any success stories in that regard.

Dr. Everson tells of a woman who had just moved to his area from Florida and who was referred by a local Houston corneal surgeon. She was never particularly happy with the feeling of contact lenses throughout the day, which is why she was refit three times when she lived in Florida. “This was an ideal candidate for the Maxim 3D lens, because she had been in three different standard scleral lens designs and was not tolerating any of them for a length of time,” he says. “The maximum amount of time that she was able to wear any of the lenses was three hours, and then they would fog up and her eyes would become extremely red.

“With her first set of Maxim 3D lenses, she was able to wear the lenses for 10+ hours without any fogging or discomfort issues. This has continued for the six months that she has worn them,” he says. “The patient told us that she was able to get back to playing tennis and driving long distances for camping trips and to get back to her daily activities that were interrupted by removing her lenses previously.”

Dr. Gibberman recalls a patient who had a history of extraocular muscle surgery and keratoconus and, as a result, had a highly irregular and asymmetric scleral profile. “The patient tried scleral lenses years ago also using an AccuLens scleral, and we seemed to fix one issue and create two more before giving up,” he says. “We recently decided to try again using the Maxim 3D combined with data from the ESP, and we were able to successfully fit the patient this time and with minimal lens adjustments needed.” CLS