What To Do When…?

What To Do When…?

Ken Kopp, FCLSAKen Kopp, FCLSAClinical and Professional Clinical and Professional

Services ManagerServices ManagerParagon Vision SciencesParagon Vision Sciences

WTDW.. A CRT lens is broken.Our replacement policy is 30 Our replacement policy is 30 days from dispensing. days from dispensing.

Order a duplicate and return Order a duplicate and return any lens pieces in the any lens pieces in the original vial for credit.original vial for credit.

Spare lenses are vital.Spare lenses are vital.

Follow the suggested RZD/LZA combination Follow the suggested RZD/LZA combination and choose the BC closest to what is and choose the BC closest to what is suggested.suggested.

The OR will tell you the exact BC needed. The OR will tell you the exact BC needed.

Dispense and follow-up for adequate Dispense and follow-up for adequate centration. Order the correct BC.centration. Order the correct BC.

Extended set or order with warranty

WTDW…the suggested lens is not in my set.

Superior/Lateral or Superior and Lateral:Superior/Lateral or Superior and Lateral:

Increasing the RZD once (25 microns) or twice (50 Increasing the RZD once (25 microns) or twice (50 microns) until centered. Treatment zone will shrink. microns) until centered. Treatment zone will shrink. Then reduce the sag (RZD/LZA) to complete Then reduce the sag (RZD/LZA) to complete treatment.treatment.

Increase diameter as last resort. Increase diameter as last resort.

WTDW…the lens will not center.

WTDW…induced cyl is not eliminated.

If decreasing the sag (LZA/RZD) does not If decreasing the sag (LZA/RZD) does not “squash” the cyl and causes the lens to “squash” the cyl and causes the lens to decenter, withdraw and start over using a decenter, withdraw and start over using a deeper RZD but less LZA that originally deeper RZD but less LZA that originally suggested.suggested.

If the topography shows an oval treatment If the topography shows an oval treatment zone or an incomplete “red ring”, increase zone or an incomplete “red ring”, increase the RZD 25 microns.the RZD 25 microns.

These are normal adaptive symptoms. They These are normal adaptive symptoms. They should disappear after full treatment. should disappear after full treatment.

If not, it could be from the pupil dilating If not, it could be from the pupil dilating outside the treatment zone or high order outside the treatment zone or high order spherical aberration. spherical aberration.

Ask the patient to wear the lenses when Ask the patient to wear the lenses when halos are experienced. If yes, pupil dilation halos are experienced. If yes, pupil dilation is the cause. If not, reduce the sag (LZA).is the cause. If not, reduce the sag (LZA).

WTDW…halos and glare are a problem.

Alphagan P (off-label) Alphagan P (off-label)

WTDW…central staining or SPK is present.

Initial staining is common, especially in the higher Rx Initial staining is common, especially in the higher Rx (>-4.00). Review proper lubrication techniques and (>-4.00). Review proper lubrication techniques and offer either non-preserved drops or more viscous.offer either non-preserved drops or more viscous.

A sag increase (RZD or BC) may be indicated to ease A sag increase (RZD or BC) may be indicated to ease off the central pressure. Once staining is eliminated, off the central pressure. Once staining is eliminated, then return to original parameters.then return to original parameters.

If the staining is not eliminated, withdraw.If the staining is not eliminated, withdraw.

WDTW…a diameter change is needed.

The normal diameter is 10.5 mm. If the 10.5 lens covers The normal diameter is 10.5 mm. If the 10.5 lens covers the entire visible iris, an 10.0mm diameter is indicated.the entire visible iris, an 10.0mm diameter is indicated.

If a centered 10.5 mm lens displays at least 1mm of visible If a centered 10.5 mm lens displays at least 1mm of visible iris around the circumference, a larger lens could be worn. iris around the circumference, a larger lens could be worn.

In order to mimic the edge lift with a 10.5 lens and you need In order to mimic the edge lift with a 10.5 lens and you need to alter the diameter, decrease the LZA by one degree for a to alter the diameter, decrease the LZA by one degree for a 10.0 lens and increase the LZA by one degree for each .5 10.0 lens and increase the LZA by one degree for each .5 mm larger.mm larger.

Diameter availability range is from 10.0 to 12.0 mm.Diameter availability range is from 10.0 to 12.0 mm.The treatment zone size is fixed at 6mm.

WTDW…the patient calls after 3-6 months complaining of VA reduction.

Usually due to a build-up of deposits on the back Usually due to a build-up of deposits on the back surface of the lens.surface of the lens.

• Inspect the lenses for deposits.Inspect the lenses for deposits.• Dispense a separate GP daily cleaner.Dispense a separate GP daily cleaner.• Have the patient use a Q-tip to clean BC.Have the patient use a Q-tip to clean BC.• Soak in Progent. (in-office only)Soak in Progent. (in-office only)• Never polish the back surface of CRT.

WDTW…there are changes at the annual visit.

If there is no change in OR but the manifest/ centration If there is no change in OR but the manifest/ centration has slipped, replace the lenses with the same has slipped, replace the lenses with the same parameters.parameters.

If the OR has changed to the minus side, flatten the BC If the OR has changed to the minus side, flatten the BC accordingly but keep the RZD/LZA constant.accordingly but keep the RZD/LZA constant.

Don’t try to extend the wearing life of the lenses by Don’t try to extend the wearing life of the lenses by polishing. Micron changes in the lens shape can cause polishing. Micron changes in the lens shape can cause treatment disorders. treatment disorders.

WTDW…the VA of one eye does not match the fellow eye.

Are the lenses switched?Are the lenses switched?

If not, look at centration.If not, look at centration. Make necessary sag Make necessary sag changes in order to achieve proper centration.changes in order to achieve proper centration.

Verify the OR is correct and hasn’t changed.Verify the OR is correct and hasn’t changed.

If undertreatment is <-1.00, flatten BC by 0.1mmIf undertreatment is <-1.00, flatten BC by 0.1mmIf undertreatment is >-1.00D, decrease LZA by 1If undertreatment is >-1.00D, decrease LZA by 1

WTDW…a long term GP wearer wants CRT.

Pre-fitting data will help. If so, compare current K Pre-fitting data will help. If so, compare current K readings, topos, and Rx to confirm changes. readings, topos, and Rx to confirm changes.

If GP lenses were fitting centrally, trial CRT for If GP lenses were fitting centrally, trial CRT for positioning and OR. If normal pattern and OR…positioning and OR. If normal pattern and OR…continue treatment. continue treatment.

If GP lenses were superior riding, take baseline If GP lenses were superior riding, take baseline map and wait until the cornea stabilizes.map and wait until the cornea stabilizes.

WTDW…a CRT candidate/patient is pregnant.

Corneal changes usually do not affect wearing or Corneal changes usually do not affect wearing or treatment until the third trimester.treatment until the third trimester.

Use common sense. If the patient is Use common sense. If the patient is uncomfortable with their vision or wear ability, uncomfortable with their vision or wear ability, withdraw until postpartum is complete.withdraw until postpartum is complete.

WTDW…you haven’t seen a CRT candidate in months.

• Have a staff meeting to re-energize the group Have a staff meeting to re-energize the group to promote CRT.to promote CRT.

• Fill all POP materials. Fill all POP materials. • Make sure your DDS doesn’t look like Swiss Make sure your DDS doesn’t look like Swiss

cheese (many holes).cheese (many holes).• Review initial fitting and troubleshooting Review initial fitting and troubleshooting

techniques.techniques.

Thank you for participating!