Contact Lenses

DESCRIPTIONS OF PRODUCTS 137

Each application will only allow authorized operators to execute

The system will report data added, changed or deleted and the operator responsible with the day the change was made

All printing is performed in the background releasing the CRT for data entry

Productivity reports and graphs automatically summarizing appointments scheduled, procedures billed, patient diagnosis, income from patients referred, credits issued, and type of payment received

Prices begin at under $27,000 (included installation and training)

Ophthalmic Prediction Software, Inc. (OPSI) Ophthalmic clinical application software for the personal computer IOL Base

Determines lens power for implant surgery. A comprehensive medical record output is provided for each case showing predicted lens power for numerous desired refractions tor four major available formulas and numerous predicted refractions for different lens powers. Complete data base management capabilities are available for collecting preoperative, surgical, and postoperative IOL data. Adjusted A-constants are automatically computed by the program.

A Mark Assists in determining the surgical plan for radial

keratotomy surgeries. The formula used in the software is based on the analysis of data from Peter N. Arrowsmith M.D., the complete results of which have been published in the scientific literature. Surgeons can review over 150 possible surgical plans and in addition, T incis,ons are recommended for the correction of any astigmatism and computer graphics are used to show the precise location, length, and depth of these incisions. Also available is an interface between the pachymeter and computer to allow direct entry of pachymetry depth data which is used to automatically determine settings for the blade. Color graphics are used on the monitor and printed output to illustrate change in corneal depth and when blade

·settings should be adjusted. Complete data base management capabilities are also available for collecting radial keratotomy preoperative, surgical, and postoperative data.

Medical Statistics System Provides for a comprehensive analysis of all the clinical

data bases being accumulated. The user specifies desired analyses by referring to the appropriate ophthalmic data. The proper analyses are then chosen by the computer and performed.

Documentation and telephone support is provided for each software product.

Versions are available for the IBM PC and compatible personal computers.

Literature available

Ruiz Astigmatism Assists in determining the surgical plan for astigmatism

surgery using the Ruiz technique. Also provides recommended surgical parameters for radial keratotomy when it is suggested for myopia correction in addition to astigmatism correction. Color graphics are used on the monitor and printed output to illustrate change in corneal depth and when blade settings $hould be adjusted. Complete database management capabilities are also available for collecting preoperative, surgical, and postoperative refraction data.

Lathe Base Used in the operating room to determine surgical

parameters for myopic and hyperopic keratomileusis. Provides fast feedback and warnings when expected results will be undesirable. Complete database management capabilities are also available for collecting preoperative, surgical, and postoperative refraction data.

Price $950 to $3,995 for each software product, with discounts available for multiple purchases.

Contact Lenses

Bausch & Lomb, Inc. Daily-wear Soft Contact Lenses Extended-wear Soft Contact Lenses

MYOPIA SOFSPIN U3/U4 OPTIMA 38 B3/B4

MYOPIA/HYPEROPIA B&L 70 B&L 58

HYPEROPIA +U3/+U4 +B3/+B4

ASTIGMATISM OPTIMA Toric TO RIC-/TO RIC+

APHAKIA H3/H4, B3, N, F3 CW79 SILSOFT

PRESBYOPIA PA1 Crescent Bifocal

NaturaiTint®

RIGID GAS PERMEABLE LENSES HGP

THERAPEUTIC LENSES

L3/L4 H03/H04 Low-Minus Plus 03/04

138 OPHTHALMOLOGY • INSTRUMENT AND BOOK SUPPLEMENT 1986 ·

Bausch & Lomb produces a large variety of soft contact lenses for daily-wear. Myopia

NaturaiTint® B&L 70® OPTIMA™ 38 03®/04® SOFSPIN® U3®/U4® B&L 58™

Hyperopia +U3®/+U4® +B3®/+B4®

Aphakia H® Series B® Series N® Series F® Series

Presbyopia Astigmatism Crescent Bifocal OPTIMA™ Toric Lens PA1™ Bausch & Lomb Toric Lens

See listings below for specific lens parameters. Extended-wear soft Contact Lenses

Myopia Hyperopia Softens® B&L 58™ NaturaiTint® 03®/04® B&L 70® B&L 58™

See listings below for specific lens parameters.

NaturaiTint®

Aphakia SILSOFT® CW79®

Soft contact lenses for daily and extended wear tinted with non-toxic, non-leaching synthetic dyes that, in combination with eye color, produce a natural appearance to change or enhance eye color. Available as 03®/04®, U3®/U4®, and B3® lenses.

NaturaiTint® colors: aqua, crystal blue, jade green, sable See listings below for specific lens parameters.

Myopia

SOFSPifl!®: Myopic daily wear. Designed for easy handling. Lens diameter suitable for most patients.

Material: Polymacon % H20: 38.6% Manufacturing process: Spincast Diameter: 14.0 mm Power: -0.25 D to -5.00 D in 0.25 D steps; also -5.50

D and -6.00 D Center thickness: 0.05 mm to 0.09 mm (varies with

sphere power) U3®/U4®: Myopic daily wear. Ultrathin design for excellent 02 transmission. Durable for long lens life.

Material: Polymacon % H20: 38.6% Manufacturing process: Spincast Diameter:

U3®: 13.5 mm U4®: 14.5 mm

Power: U3®: Plano to -9.00 D (In 0.25 D steps to -5.00 D, and in 0.50 D steps from -5.00 D to -9.00 D) NaturaiTint® U3®: Plano to -6.00 D U4®: -0.25 D to -9.00 D (In 0.25 D steps to -5.00 D, and in 0.50 D steps from -5.00 D to -9.00 D) NaturaiTint® U4®: -0.25 D to -6.00 D

Center thickness: 0.07 mm

OPTIMA™ 38: Myopic daily wear. Spincast anterior surface. Lathe cut posterior surface.

Material: Polymacon % H20: 38.6% Manufacturing process: Spincast anterior

Lathe cut posterior Diameter: 14.0 mm Sagittal depth:

SAG 1: 3.60 mm SAG II: 3.82 mm

Power: -0.25 D to -5.00 D in 0.25 D steps, also -5.50 D and -6.00 D


B3®/B4®: Standard thickness minus lens for myopic daily wear.


B3®: 13.5 mm B4®: 14.5 mm

Power: B3®: -0.25 D to -20.00 D (In 0.25 D steps to -5.00 D, and in 0.50 D steps from -5.00 D to -20.00 D) NaturaiTint® B3®: -0.25 D to -6.00 D B4®: Plano to -9.00 D (In 0.25 D steps to -5.00 D, and in 0.50 D steps from -5.00 D to -9.00 D)


L3®/L4®: Myopic daily wear. Thin design and easy handling for patients with special handling needs. ·


L3®: 13.5 mm L4®: 14.5 mm

Power: -0.25 D to -3.00 D in 0.25 D steps Center thickness: 0.06 mm

H03®/H04®: Ultrathin, high minus daily wear for the myopic patient.


· H03®: 13.5 mm H04®: 14.5 mm

Power: -8.00 D to -20.00 D in 0.50 D steps Center thickness: 0.035 mm

Low-Minus: Myopic daily wear for patients needing low-minus correction. · Material: Hefilcon B % H20: 45% Manufacturing process: Lathe cut Diameter: 14.0 mm Base curve: 8.3 mm, 8.6 mm Power: -0.25 D to -3.50 D in 0.25 D steps Center thickness: 0.06 mm


03® /04®: Myopic daily or cosmetic extended wear. Exceptionally thin lens. High 02 transmissibility. Material: Polymacon % H20: 38.6% Manufacturing process: Spincast Diameter:

03®: 13.5 mm 04®: 14.5 mm

Power: 03®: -1.00 D to -5.00 D in 0.25 D steps, also -5.50

D and -6.00 D NaturaiTint® 03®: -1.00 D to -6.00 D 04®: -1.00 D to -5.00 D in 0.25 D steps, also -5.50

D, -6.00 D, and plano NaturaiTint® 04®: -1.00 D to -6.00 D, plano


Myopia/Hyperopia

B&L 70®: High water lens for daily and cosmetic extended wear. Myopic and hyperopic patients.

Material: Lidofilcon % H20: 70% Manufacturing process: Lathe cut Diameter: 14.3 mm Base curve:

Minus lens: 8.4 mm, 8.7 mm, g_o mm Plus lens: 8.7 mm, g_o mm

Power: Plano to ±5.00 D in 0.25 D steps, also ±5.50 D and ±6.00 D

Center thickness: Minus lens: 0.14 mm Plus lens: 0.17 mm to 0.25 mm

B&L 58™: Mid-water content lens for myopic daily and cosmetic extended wear.

Material: Etafilcon A % H20: 58% Manufacturing process: Lathe cut Diameter: 14.0 mm, 14.5 mm Base curve:

14.0 mm lens: 8.2 mm, 8.5 mm, 8.8 mm 14.5 lens: g_1 mm

Power: Plano to -g.oo D (In 0.25 D steps to -5.00 D, and in 0.50 D steps from -5.00 D to -g.oo D)

Center thickness: 0.08 mm to 0.27 mm Hyperopia

+U3®/+U4®: Ultrathin low plus lens for daily wear. Material: Polymacon % H20: 38.6% Manufacturing process: Spincast Diameter:

+U3®: 13.5 mm +U4®: 14.5 mm

Power: +0.25 D to +5.00 D in 0.25 D steps, also +5.50 D and +6.00 D

Center thickness: 0.07 mm +B3®/+B4®: Low plus daily wear. Standard thickness for ease of handling.

Material: Polymacon

% H20: 38.6% Manufacturing process: Spincast Diameter:

+B3®: 13.5 mm +B4®: 14.5 mm

Power: +0.25 D to +5.00 D in 0.25 D steps, also +5.50 D and +6.00 D


Astigmatism

OPTIMA™ Toric: Daily wear for the astigmatic patient. Computer controlled lathing with BAUSCH & LOMB Toric Generator for outstanding lens-to-lens reproducibility.

Material: Hefilcon B % H20: 45% Manufacturing process: Lathe cut Diameter: 14.0 mm Base curve:

Stock: 8.3 mm, 8.6 mm MTO: 8.3 mm, 8.6 mm, 8.g mm

Sphere: Stock: +4.00 D to -6.00 D in 0.25 D steps MTO: +6.00 D to -7.00 D in 0.25 steps

Cylinder: Stock: -0.75 D, -1.25 D, -1.75 D MTO: -0.75 D to -2.75 Din 0.50 D steps

Axis 0:

Stock: 70°, 80°, goo, 100°, 110°, 160°, 170°, 180°, 10°, 20° MTO: so to 180° in so steps

Center thickness: Stock: 0.10 mm to 0.28 mm MTO: 0.10 mm to 0.33 mm

Centration: Prism ballasted Optical Zone: 8.0 mm Chamfer Width: 1.g mm

TORIC-/TORIC+: Astigmatic daily wear. Material: Hefilcon B % H20: 45% Manufacturing process: Lathe cut Diameter: 14.0 mm Base curve: 8.3 mm, 8.6 mm Sphere:

TORIC-: Plano to -6.00 D in 0.25 D steps TORIC+: +0.25 D to +4.00 D in 0.25 D steps

Cylinder: TORIC-: -1.75 D, -1.25 D, -0.75 D TORIC+: -1.75 D, -1.25 D

Axiso: 70°, 80°, goo, 100°, 11 oo, 180°, 1 oo, 20° (plus 160°, 170° for TORIC-)

Center thickness: TORIC-: 0.10 mm to 0.18 mm TORIC+: 0.18 mm to 0.24 mm

Centration: Prism ballasted

Aphakia

H3®/H4®, B3®, N®, F3®: High plus daily or extended wear for the aphakic patient.

Material: Polymacon


% H20: 38.6% Manufacturing process: Spincast Diameter: 13.5 mm, 14.5 mm Power:

H3®/H4®: +6.50 D to +20.00 Din 0.50 D steps B3®: + 11.00 D to +20.00 D in 0.50 D steps N®: +6.50 D to + 18.50 D in 0.50 D steps F3®: +6.50 D to +20.00 D in 0.50 D steps

CW79®: High water lens for aphakic daily or extended wear. Material: Lidofilcon % H20: 70% Manufacturing process: Lathe cut Diameter: 14.4 mm Base curve: 8.1 mm, 8.4 mm, 8.7 mm Power: + 10.00 D to +20.00 D in 0.50 D steps Center thickness: 0.49 mm to 0.79 mm

SILSOFT®: Extended wear for adult and pediatric aphakic patients. 100% silicone polymer with exceptionally high 02 permeability.

Material: Silicone Manufacturing process: Cast molding Diameter:

Adult: 11.3 mm, 12.5 mm Pediatric: 11.3 mm

Base curve: Adult: 7.5 mm, 7.7 mm, 7.9 mm, 8.1 mm, 8.3 mm Pediatric: 7.5 mm, 7.7 mm, 7.9 mm

Power: Adult: + 12.00 D to +20.00 D in 1.00 D steps Pediatric: +23.00 D to +32.00 D in 3.00 D steps

Presbyopia

PA1™: Daily wear for presbyopia. Variable focus design provides smooth power transition from lens center to midperiphery.

Material: Polymacon % H20: 38.6% Manufacturing process: Spincast Diameter: 13.5 mm Power: -6.00 D to +6.00 D in 0.25 D steps (Nominal

functional add: 1.50 D) Center thickness: 0.15 mm

Crescent Bifocal: Daily wear for presbyopia.

Material: Hefilcon % H20: 45%

Truncated crescent segment design for smooth translation between near and distance correction.

Manufacturing process: Lathe cut Diameter:

Low plus lens: 13.5 mm Minus lens: 14.0 mm

Base curve: 8.6 mm, 8.9 mm Power:

+5.00 D to -5.00 D in 0.25 D steps ±5.50 D, ±6.00 D Add + 1.50 D, +2.00 D, +2.50 D

Center thickness: Low plus lens: 0.15 mm to 0.21 mm Minus lens: 0.16 mm to 0.40 mm

Rigid Gas Permeable Lenses

H.G.P.: Daily wear for the myopic, hyperopic, or astigmatic patients. Silicone acrylate polymer.

Material: ltafacon A Manufacturing process: Lathe cut (Stock parameters) Diameter: 9.0 mm, 9.5 mm Base curve:

9.0 mm lens: 7.40 mm to 8.10 mm in 0.05 mm steps 9.5 mm lens: 7.40 mm to 8.30 mm in 0.05 mm steps

Power: +6.00 D to -6.00 D (Made to order parameters) Diameter: 8.5 mm, 9.0 mm, 9.5 mm Base curve: 7.00 mm to 9.00 mm in 0.05 mm steps Power: +9.00 D to -20.00 D

GP26: Daily wear for myopic, hyperopic or astigmatic patient. Lens offers exceptional oxygen permeability (28.7 x 10-11

@ 35°C) for excellent physiological response. Material: ltafocon B Manufacturing process: Lathe cut Diameters: 8.5 mm, 9.0 mm, 9.5 mm Sphere powers: +9.00 D to -20.00 D in 0.25 D steps Base curve: 7.00 mm to 9.00 mm in 0.05 mm steps

Therapeutic Lenses

SOFLENS (polymacon) Therapeutic Lens Applications Lens u U3 B4 04 T

Diameter 12.5 mm 13.5 mm 14.5 mm 14.5 mm 14.5 mm

Center Thickness 0.07 mm 0.07 mm 0.12 mm 0.06 mm 0.15 mm

All Bausch & Lomb SOFLENS clear,m single vision contact lenses are approved for the following indications:

Chemical and thermal burns Recurrent erosions and abrasions Post -operative keratoplasty Painful bullous keratopathy Recurrent indolent ulcers Erosions secondary to trichiasis

Breger-Moeller Welt Contact Lenses

For corneal astigmatism-up to 3.00 D, use flexinyl design. Gas Permeable. Guaranteed fit.

For new contact lens patients-Aspheric base curves to match patient's cornea. Eccentricity values 0.5 to 0.6. Single vision lens almost problem free. Gas Permeable. Guaranteed fit.

For residual astigmatism-New design, front-back-or Bitoric. Gas Permeable. Guaranteed fit. Simplified optics. On K fitting.

For presbyopes-Spherical concentric Bifocal. Any power and add. Gas Permeable. Guaranteed fit.

For presbyopes-Aspheric concentric multifocal, distance, intermediate, near all powers and all adds. Gas Permeable. Guaranteed fit.


Fitting Guide for Residual Astigmatism and High Corneal Astigmatism Toric

The new BMW TORIC with a Guarantee fit Warranty has made torics and bitorics a viable modality.

The l•ms is designed to fit on K. At one stroke this eliminates the 2/3 or 3/4 contemporary fitting method where success is found only in expertise hands.

On K fitting eliminates innumerable visits caused by lenses failing to center and hold axis. On K fitting eliminates the complication of using crossed cylinders. In short, on K fitting keeps lenses centered and on axis and makes toric fitting as uncomplicated as spherical lens fitting.

It is recommended that torics be used on more than 2.00 D or corneal astigmatism. A bitoric lens fit on K will maintain axis. It will rotate less than 2%. Any residual astigmatism is neutralized by a cylindrical component on the front surface of the lens.

Fitting Procedure Please note the fitting procedure is the same as for

spherical lenses. 1. Determine K readings and axis in both meridians.

The toric base curves of the lens are fit in alignment to the toric curves of the cornea. Accuracy of the fit is based on K readings.

2. Furnish spectacle RX and vertex distance if over ±4.00 D.

3. Determine amount of residual astigmatism by overrefracting with a hard spherical contact lens. These parameters in our toric design will produce an initial lens that will be the final fit and final power qualified by the accuracy of the findings.

Fitting Data K Readings and Axis

Accuracy is critical to insure centering, axis and movement. Data from a previous contact lens wearer with a changed cornea is invalid unless the cornea has been rehabilitated.

Refraction Record in minus cylinder form. Accurate determination of residual astigmatism is best by overrefraction with a hard spherical contact lens.

Diameter of Lens Computer parameters needed to determine lens diameter are measurements of the corneal and pupil diameter, the palpebral fissure and the upper lid position in relation to the pupil.

Lens Movement Improved Tear Circulation Management of Edema

Lens rotation of less than 2% and vertical movement of about 1.0 mm will not effect optical stability.

Best results in improvement of tear circulation and management of edema includes the following design.

(a) Fit the steeper meridian 0.25 D flatter (in selected cases go 0.50 D flatter) than K. Note: the flatter meridian is always fit on K. (b) Gas Permeable material eliminates edema with on K fitting.

For single vision problem cases: TOPOGRAFY™ LENSNEW SINGLE VISION ASPHERIC FITTING GUIDE This new design has an aspherical base curve component from the center of the lens outward, of the same topography and profile as the cornea, but at the periphery, the flattening ellipse merges into a sphere and meets the cornea for zero edge lift. This allows the lids to glide smoothly over the lens edge with patients unaware of the lens. The Topografy lens is unlike edge to edge aspheric lenses with curves that continue to flatten to the edge and tell the patient a lens is there.

Topografy™ lens is not only the most comfortable, but it is the easiest hard lens to fit. 1. It has no bearing area since the back surface of the

lens and the cornea have the same topography and profile, fitting problems related to bearing areas are eliminated.

2. The Topografy lens naturally centers because it has the same topography as the cornea and it is fit on K. A no-nonsense on K fit (without an add on steepness of 0.1 mm to 0.15 mm) is all you need when the back surface of the lens has the same topography as the cornea.

3. The entire base curve is an optical zone. The same optic covers the entire back surface of the lens. There is a smooth transition as the back surface approaches the edge of the lens. Large optics eliminate glare and is suitable for night driving.

4. Topografy is the easiest hard lens to fit because in general there is an absence of these symptoms: Discomfort, Corneal Insult, High & Low Riders, Edema, CCC, Glare, Lens Feel, Lid Irritation, 3 & 9 o'clock staining, Abrasions, Pressure Points, Tight Symptoms, Punctate Staining.

Fitting A. Prescribe base curve on K-Use Keratometer B. Prescribe Power-Same as with spherical lens C. Diameter-9.0 & larger D. OZ-entire back surface of lens is an optical zone E. Movement-0.5 mm to 1.5 mm F. Fluorescein-even pattern, no pooling, no dark

areas G. Wearing Schedule-none, just wear it. When

Topografy lenses are made of gas permeable material, no adaptation is necessary.

H. Comfort-"No feel" and "unaware" are patient responses, and comfort is reported as extraordinary and outstanding.

Checking & Handling Same as spherical lenses for checking base curves, diameter, center thickness, power, insertion and removal.

THE ASPHERIC BASE CURVE Authorities agree that the curve of the cornea is aspheric with a measured rate of flattening of 0.5-0.6 eccentricity. A full explanation of aspherical curves and eccentricity values and how measured is contained in a Joe Breger newsletter available upon request.

142 OPHTHALMOLOGY • INSTRUMENT AND BOOK SUPPLEMENT 1986

Indications for the Topografy™ Lens A. For original fitting of contact lens patients in a

community practice where 20/20 V.A. in total comfort with little or no problems will stimulate referrals of friends and relatives.

B. For refitting of all hard lens patients with problems of edema, non centering, abrasions, staining and discomfort.

C. For refitting of soft lens patients with problems of lens spoilage, lens fragility, red eye, dirty lens surfaces and less than 20/20 V.A.

For Presbyopia The Commissioner of Patents has granted Patent No.

4,418,991 to Joe Breger for a new design in contact lenses for Presbyopia. This new lens is Presbiflex™ Ill, and has made fitting presbyopes more of a certainty and less of an art. New optics of spheres and aspherics and a base curve mimicking the curves of the cornea has made fitting easy and Presbiflex the lens of choice of presbyopes.

This lens has meaningfully increased the number of satisfied patients and it would be well to consider refitting previous multifocal contact lens failures with this new modality that has no segments, no intermediate blur, no prism bulk and no head movements.

Presbiflex is available in gas permeable Boston II, Paraperm, or Optacryl. Presbiflex in gas permeable material is easier to fit because lenses can be made tighter for better centering without risk of edema, stinging, burning, spectacle blur or discomfort associated with steep lenses.

Fitting Centering the lens is the key to visually satisfied patients.

The lens is designed to keep the geometric center of the lens within the pupillary margin, and with centering, vision for near, intermediate and distance becomes instant and steady.

That portion of the base curve which fits the cornea has an eccentricity value of 0.6 which is the same as the 0.6 eccentricity value of the cornea, so the lens mimics the corneal curves and will automatically center. This finely tuned fit is dependent upon accurate K readings.

The patented optical design has spherical distance optics with aspherical optics for near and intermediate. (See Joe Breger's Newsletter on Aspherical Optics and Eccentricity Values.)

Presbyopes have the ability to pick and choose one of the optics which suits best at the moment, under the principle of simultaneous vision in which images from distant and near objects are all incident on the retina at the same time. For example, an accountant looking at papers spread on his desk at 10, 16, and 30 inches, and a wall clock ten feet away or at objects out of the window at infinity-all reading matter and objects, from near to infinity, will be seen comfortably with excellent V.A. at the patient's will.

Selecting Patients Best patients are:

1. Single vision contact lens wearers who have become presbyopic.

2. Spectacle wearers with distance correction that now need a near add.

3. Patients who have previously failed with other bifocals or other presbyopic lenses that are not at this optically advanced design state of the art.

4. Binocular Aphakes. Clinical experience has shown that these patients are

contraindicated: 1. Flatter corneas than 39.00 D. 2. Previous contact lens failures. 3. Low refractive error, under 1.00 D correction for

either near or distance. 4. Greater than 3 diopters of corneal cylinder. 5. More than one diopter against the rule corneal

astigmatism. 6. More than one diopter of residual astigmatism. 7. Distorted corneas.

Fitting Data K Readings & Axis is critical to insure centering.

Adjust eye piece for each patient. Repeat reading and average for accurate fit.

Refraction is recorded in minus cylinder form. Give vertex distance if correction is ±5.00 D or more.

Near add, get better results by pushing plus power. Diameter of cornea is used as an indication of lens

diameter. Diameter of Pupil measures normal room light. A well

fit lens will have the geometric center of the lens within the pupillary margins at all times. A larger pupil will allow for greater lens movement.

Palpebral Fissure is a factor in determining lens diameter. Anticipate tight lens symptoms with narrow palpebral fissures. Gas permeable lenses will manage these symptoms.

Upper Lid Position is a factor in determining lens diameter.

Present contact lens wearer should record contact lens RX. If over ±5.00 D, did you use the back or the front to measure? What is the vertex distance?

Tints specify color. Base Curve

The spherical center of the optic is 3 to 4 diopters steeper than flattest K to allow up to 3.00 D of add. At center is the optic part of the lens and not the fitting part. The fitting part of the lens, an aspheric curve which mimics the eccentricity of the cornea fits in alignment to the cornea and results in a comfortable lens which centers.

Lens Power and Power Progression Can be verified at any point on the lens with a lensometer and pinhole aperture.

Diameter 8.8 to 9.5. Peripheral curves are highly blended with edge apex

placed in relation to K for minimal standoff. All parameters can be verified by the practitioner. Our

consultants stand ready to assist and advise on fitting procedues and adjustments, although with the new design, fitting has become as routine as single vision


lenses. Good centering, inherent in the lens design is 95% of the battle.

Fitting Pearls Allow several minutes to pass after insertion. Excess tears cause decentration and a false fitting

picture. A properly inserted lens should not produce tearing on initial insertion. Initial insertion should be by the practitioner, even with long time contact lens patients.

Control tearing of new contact lens patients by having patient look down immediately after insertion and wait a few minutes.

Look for geometric center remaining within margin of pupil upon blink, primary position and excursions.

Flourescein pattern is small central pool with even faint green under rest of lens. The small apical pool verifies the 3 to 4 diopters steeper for add. The faint even pattern under rest of lens verifies an alignment fit mimicking the corneal curve.

Lens movement is necessary to eliminate debris under the lens, even with gas permeables. Minimum movement is 1.0 mm and maximum movement is up to pupil margin.

Wearing schedules and lens care is the same as your normal office hard lens or gas permeable procedures.

Evaluating the Fit and Adjustment A lens which doesn't move is tight. A lens which moves

outside of the pupil margin is loose. If a lens is tight, a smaller lens and/or flatter base curve

is indicated. If a lens is loose, a larger lens andjor a steeper base curve is indicated.

Good vision, both near and distance depends upon good centering

Where a patient can see near only, suspect that the lens is not centered. The distance correction is in the very center of the lens and if the center distance foci of the lens is not on the optical axis, the patient will not see distance but will read very well. Adjust lens to center.

Decentration can also cause a lack of both distance and near vision due to prismatic tear layer and an overrefraction will not be valid. Adjustment of the lens for centering is the same as in any hard lens-tightening the lens either by a larger diameter or by a steeper base curve.

A remake lens is indicated. A plus tear layer is needed for near If the lens is centered and the patient sees distance but

not near, check the central tear layer with slip lamp or with fluorescein. If the tear layer in center is negative, i.e. if there is no tear pooling and no plus tear layer, then the patient will not see near. Adjustment is to steepen the lens by 0.5 D or more. A remake lens is indicated here.

If there is too heavy a central pooling, and there is poor distance vision, a 0.5 D flatter lens is indicated.

Excessive movement will cause variable vision both near and distance.

Check visual acuity On the first visit, if there is adequate vision, it can be

expected to improve to be very acceptable vision by the second visit, and further improve thereafter. Do not be too quick to over-refract. Vision will improve with patient as routinely as adaptation. When vision is stable, over-refract and order new RX if indicated.

Presbiflex is sold on a per lens basis or on a Guarantee Fit Plan, which is three 3 pair, (3 lenses for each eye) within 3 months. A case not resolved in that time should be cancelled. The lenses will either work or not work. 8 of 10 will work. There is a cancellation charge.

CIBA Vision Care Softcon®-EW (vitilcon A)

An extended wear soft lens durable enough for daily wear.

Diameters/base curves

Cosmetic 8.1 mm/14.0 mm 8.4 mm/14.0 mm 8.7 mm/14.0 mm 8.7 mm/14.5 mm

(Minus Powers Only)

APHAKIC (+10.00 D to +18.00 D)

7.8 mm/14.0 mm 8.1 mm/14.0 mm 8.1 mm/14.5 mm 8.4 mm/14.0 mm 8.4 mm/14.5 mm 8.7 mm/14.0 mm

Center thickness .10 mm (minus) to .44 mm (APHAKIC) Powers

*-8.00 D to +5.00 D in .25 D steps +5.50 D to + 18.00 D in .50 D steps

Lens catalog and sales brochure available Price

Cosmetic $17 per lens APHAKIC $55 per lens

Performance warranty and manufacturers warranty Softcon® (vifilcon A)

A soft contact lens indicated for myopia, hyperopia, aphakia, therapeutic conditions and astigmatism up to 2.50 D.

Diameter 14.0 mm, 14.5 mm Base curves

7.8 mm (14.0 mm B.C.) 8.1 mm (14.0 mm & 14.5 mm B.C.)

8.4 mm (14.0 mm & 14.5 mm B.C.) to .64 mm (APHAKIC)

Powers -8.00 D to +5.00 D in .25D steps +5.50 D to + 18.00 D in .50 D steps

Lens catalog available Price

Cosmetic $49.90 per lens Aphakic (+10.00 D to +18.00 D) $55.00 per lens

Performance warranty and manufacturers warranty Aotoric® Custom Lens

A custom toric hydrogel lens to compliment your stock toric practice

Diameter 14.0 mm Base curves 8.1 mm to 9.5 mm in .1 mm increments or

to order Center thickness .16 mm at -3.00 D Sphere powers -20.00 D to +20.00 D


Cylinder powers to -6.00 D in .25 D steps Cylinder axis to order (5° increments) Lens catalog available Price $66 per lens Performance warranty and manufacturers warranty

Aosoft® (Tetrafilcon A) A spherical daily wear standard thickness lens Diameter 13.2 mm Vaults/base curves 0/9.0 mm, 1/8.7 mm, 11/8.4 mm,

111/8.1 mm, IV/7.8 mm Center thickness Minus -.08 mm to .17 mm Plus -.17

mm to .28 mm Powers -9.75 D to +6.50 D in .25 D steps Lens catalog available Price $18 per lens Manufacturers warranty

Aosoft® Superthin (tetrafilcon A) A thin spherical soft contact lens Diameter 14.25 mm Base curves 8.2 + 8.6 mm Center thickness .05 mm Powers -.25 D to -7.75 Din .25 D steps Lens catalog available Price $12 per lens Manufacturer's warranty

BI-SOFT® (tefilcon) A soft bifocal contact lens for presbyopic patients Diameter 13.8 mm Base curves 8.3, 8.6, 8.9 (plus only) mm Center thickness .07 mm at -3.00 D, .12 mm at +3.00

D, (varies with power) Powers -6.00 D to +6.00 D (0.25 D steps) Adds + 1.50, +2.00, +2.50, +3.00 Lens catalog and sales brochure available Price $48 per lens Performance warranty and manufacturer's warranty

Torisoft® (tefilcon) Unique "thin zone" design, for astigmatic patients Diameter 14.5 mm Base curves 8.6, 8.9, 9.2 mm Center thickness .95 mm at -3.00 D, .14 mm at +2.00

D (varies with power) Sphere powers PL to -6.00 D Cylinder power -1.00 D and -1.75 D Cylinder axes 0 to 180° in 1 oo increments. 8.6, 8.9 base

curves. 180°, goo (±20°) in 10° increments only for 9.2 base curve

Lens catalog available Price $45 per lens Performance and manufacturer's warranty Torisoft Softcolors available as special order

Narcissus Medical Foundation Cosmetic and Prosthetic Soft Contact Lenses Soft Contact Lenses

The Narcissus Medical Foundation, directed by LeRoy G. Meshel MD and Mr. Vernon Gregory, was formed for the purpose of developing and refining new optical devices among which are the prosthetic and cosmetic

gel lenses. Our new process has made it possible to place any image in colors on any portion of any hydrophilic gel contact lens. The imagery is stable and nontoxic. Each lens is specifically designed and fabricated tor the individual patient This has been found to be the only effective way to obtain optimum cosmetic and visual results.

Our lenses have been successfully used by over 17,000 patients worldwide. The lens is used to dramatically improve the appearance and vision of eyes which have incurred corneal damage of various types as well as to reduce photophobic symptoms in such pathological states as albinism, aniridia, and colobomatous eyes, both congenital and surgical. "Black-out" lenses have proved successful in the treatment of amblyopia, in patients with diplopia, and when used during minor surgery about the eyes.

These devices can now be obtained for medical purposes through the Foundation. Experience has shown that a better individual lens design and fitting can be accomplished if the patient is seen in San Francisco. In most cases, the appropriate lens can be fabricated from data obtained in one examination. If it is not possible for the patient to be seen in San Francisco, we will attempt to supply the proper device by mail. The following information must be included when requesting a lens: 1. Name of patient and diagnosis 2. A short clinical history and specific purpose for the

lens 3. Good quality color slides of the patient's full face,

two eyes only, and each eye separately 4. Keratometry readings from the good eye and, when

possible, from the damaged eye 5. Corneal diameter 6. Refractive error, if any, converted 7. Pupillary size in millimeters of the good eye in

average room light 8. Results of trial lens fitting with any conventionally

available soft contact lens (eg. Bausch & Lomb, Hydrocurve, American Hydron, Cooper)

9. Any other information you think is appropriate Research and development at the Foundation is funded

solely by the directors, appreciative patients, and friends. The demand for our lenses is increasing, and newer processes require more sophisticated equipment and increased personnel. To enable us to continue our work on these very important devices, we ask that a donation accompany each request for a lens.

Price: Donation requested of $175 per lens adjusted in accordance to patient's financial status

One-month warranty

Contact Lens Accessories

CIBA Vision Care Aosept®

Disinfection and Neutralization/Storage Solution

Documents

Contact Lenses