In July 2021, X-Cel Specialty Contacts launched REMLens, which the company says is a highly adjustable yet easy-to-fit orthokeratology (ortho-k) design for the management of myopia, manufactured exclusively in Boston Equalens II (Bausch + Lomb) material. REMLens is designed to yield a Rapid Eye Molding (REM) effect for patients who have low-to-moderate myopic refractive errors.

REMLens can be prescribed to patients of all ages who are diagnosed with low to moderate myopia (up to –5.00D sphere and up to –1.50D of astigmatism). X-Cel says that with an 89% first-fit success rate, REMLens offers certified eyecare professionals a lens design that has a broad range of parameter flexibility and a significant reduction in chair time when fitting empirically from Ks and prescription.

REMLens features four independently adjustable fitting zones, five diameter sizes (each with three optic zone options), and Dynamic Edge Profile, providing on-eye comfort in an open- and closed-eye setting, according to the company. Additionally, X-Cel says that certified ECPs utilizing the online REMLens Calculator can reduce chair time on new fits or refits and maintain historical patient information.

Here we share the clinical experiences of two practitioners who are prescribing REMLens in their practices.

Please tell us about your general experience with X-Cel Specialty Contacts’ REMLens.

According to Jordan Jangula, OD, who practices in Jamestown, ND, the REMLens has worked very well for him. “It is very easy to use,” he says, “and has been very successful, generally on the first fit.”

Nicholas McColley, OD, MBA, who practices in Greenfield, IN, says his experience with REMLens has been unique. “It allows for more customization of parameters for my patients, making a more tailored and successful experience,” he explains.

Who are the best candidates for this product and why?

Dr. McColley believes the best candidates for REMLens are myopic children and pre-presbyopic myopic adults, although, he notes that he’s had some success with early presbyopic adults hoping to get away from glasses. Specifically, he says that most of the candidates have myopic prescriptions between –0.50D and –4.00D with less than 1.50D of with-the-rule astigmatism.

“The ability to manipulate a smaller optic zone and toric profile have allowed for some success with higher myopes and against-the-rule (ATR) astigmatism,” he states. Other candidates include children undergoing myopia management from ages 5 years and up, adults who are poor candidates or wary of laser-assisted in situ keratomileusis (LASIK), and patients who are comfortable in contact lenses. “However, I have found success using it on patients who are ‘too dry’ for soft contact lenses or LASIK,” he explains.

Dr. McColley notes that the design of the lens—with an algorithm that allows for independent curves and independent optic zone diameters—opens up the possibilities for patients who were not previously candidates for orthokeratology. “We’ve used this lens in many applications,” he adds.

Dr. Jangula says that he discusses myopia control and ortho-k with any adolescent showing significant myopia progression. However, he will look at low myopes who have minimal to no astigmatism, as they are the easiest to fit. Typically, he says he looks at kids around 7 or 8 years old who are showing myopia progression. “When my son was 8 years old, his manifest refraction was –0.75D sphere in both eyes, so I fit him in ortho-k lenses,” he explains. “Now at age 11, he is using the REMLens, and his last manifest refraction was still –0.75D sphere in both eyes.”

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

Dr. McColley has fit the majority of his patients empirically and his best first-lens success happens when he can provide X-Cel’s consultants with Ks (not sim-Ks from a topographer), refraction, a topography with white-to-white, and eccentricity measurements. He has also recently used a fitting set.

“The fitting set stays true to X-Cel’s philosophy of fitting inside to out,” he says. “I start with the base curve that should provide the right amount of applanation (from the company’s online calculator). If the lens centers, you are done and can order. If it does not center, continue to move to steeper lenses until the lens is centered. Tell the consultants what lenses are used, and they can combine the correct base curve with the correct independent Return Zone, Stabilization Zone, and Dynamic Edge profile.

“My first-lens success rate has been astounding using either fitting method,” he continues. “But if they haven’t been first-lens successes, I provide the consultants with a refraction/wear time, over-refraction, and fit assessment, and they are easily able to make necessary changes with a warranted, no-return policy that makes my accounting easy.”

For Dr. Jangula, the fitting process can sometimes be a little challenging because he doesn’t have a topographer at two of his three locations. “I start with the refraction and keratometry values, and then assess the fluorescein pattern of the lens on the eye. Based on that fluorescein pattern and the corrective response, I then make adjustments, if needed.”

How has X-Cel’s REMLens helped with troubleshooting for particular patients?

However, Dr. Jangula has been able to fit this lens without a topographer. He recalls a 6-year-old boy who came in for a full exam with a habitual prescription of –1.50 –0.75 x 048 OD and –1.50 –0.50 x 156 OS. At the exam, his manifest refraction was –3.00 –0.50 x 023 OD and –3.00 –0.50 x 163 OS. After Dr. Jangula discussed the risks of myopia progression and the options for myopia control with his parents, they decided to proceed with the REMLens.

“After two weeks of wearing the first lens, his uncorrected visual acuities were 20/25 OD, 20/25⁺¹ OS, and 20/20 OU. The manifest refraction now measured –0.75D sphere OD and –0.25D sphere OS. I then consulted with the lab, and we adjusted the base curve of each lens. After one week of wear, the patient improved to a strong 20/20 OD, OS, and OU,” he recounts. “His parents were so pleased with the result; I was asked to fit his sister as well.”

Dr. McColley tells of a difficult case that hits close to home—himself. “I have been trying to fit myself in ortho-k lenses since optometry school but have always had trouble. My prescription should be a slam dunk for ortho-k, but my eyelids are too tight and pull lenses up, my cornea is rather large, which causes stabilization issues, and I’m a big baby when it comes to comfort,” he says. “I finally got another brand to semi-work about a year ago. I was able to achieve 20/25 vision OD and OS, but the treatment zone was smaller than my pupil and I had mild decentration, so I got terrible aberrations.”

Dr. McColley worked with X-Cel’s fitting team, and they tried a couple of lenses for him. “We increased the diameter of the lens, and the Return Zone and Stabilization Zone were changed, but the biggest help was making the diameter of the optic zone larger—larger than any other manufacturer was able to,” he continues. “Now, I see 20/15 OD and OS, am comfortable all night, and haloes are significantly less than they were with the last design. I wear them every day now!” CLS