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ROSE K2 SoftTM
Irregular Cornea
Practitioner’s Fitting Guide
ROSE K2 Soft
• ROSEK2Softisadailywearsoftlensforirregularcorneas.ROSEK2Softisa6monthreplacementlensmanufacturedfromhydrogelmaterials.
• Primaryindications:IntolerancetoGPlenses,newcontactlenswearerswithirregularcorneas,earlytomoderateirregularcorneas,ifacuitywithconventionalsoftlensesisunsatisfactory,iftheenvironmentisunsuitableforGPwear,ifaGPlensmaybeunstable,e.g.sport.
• Contraindications:Otherocularpathologyorwhensatisfactoryacuitycannotbeattainedattheinitialfittingwithbestsphero-cylindercorrectionorapinhole.
Applications
• Asphericbackopticzone• Frontsurfacetoric• Frontsurfaceaberrationcontrol• Preciseedgeliftcontrol• Prismballaststabilization• Reversegeometry
Design
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Parameter range• BCrange:7.40to9.00in0.20increments• Diameterrange:14.30to15.30mmin0.10increments
Standarddiameter:14.80mm• Powerrange:-30.00Dto+30.00Din0.25Dincrements• Cylinder:-0.25Dto-10.00Din0.25Dincrements• Cylinderaxis:0°to180°in1°increments• Prismballast:Range0.75Dto2.0Din0.05steps.Standardprism1.2D• CentreThickness:0.25mmto0.60mmin0.01steps
StandardCentreThickness:0.35mm• Edgelifts:5Options-Standard(0),Increased(+1.0),(+2.0),
Decreased(-1.0), (-2.0)• Material:Contaflex GM Advance 49%
Fitting Set• Eightlensesin0.20mmincrementsfrom7.40mmto8.80mm• Diameter:14.80mm• CentreThickness:0.35mm• Standardlift• Prismballast1.2D• Lasermarkedatbaseofprism
Applications
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ROSE K2 Soft Fitting Procedure Fitting Overview
ROSEK2Softfollowsthesamesimple,systematicfivestepfittingprocessas allROSEKdesigns:
Step 1: Base Curve SelectionSelecttheBCwhichyieldsthebestvisualacuity,fittingasflataspossible.
Step 2: Peripheral FitAdjusttheperipherytooptimizelensfit,locationandmovement.
Step 3: DiameterTheedgeofthelensshouldextendtoapproximately1.5mmbeyondthelimbus.
Step 4: LocationThelensshouldcentreequallyaroundthelimbus.
Step 5: MovementOnblink,approximately1.0mmofmovementshouldbeobserved.
1. Seeconditionguideaboveforselectionofthefirsttriallens.2. Afterinsertion,allowthelenstosettlefor3to5minutesbefore assessingthelens.3. ChoosetheBCwhichgivesthebestfit.Thisisindicatedby:
• Movementofapproximately1.0mmshouldbeobservedonblink.• Nosignificantdecentrationonupwardgaze-thiswouldindicatealoosefit• Noscleralindentationonremoval-thiswouldindicateatightfit• Lensiscomfortable.• Nofluting.FlutingmayindicateaflatBC• Thelasermarkshouldremainrelativelystableandnotrotatemorethan20degreesfromthe6
o’clockposition.4. Fitasflataspossible.FlatterlensesoftengivebetterVA.5. Oncethebestfithasbeenattained,havethepatientsqueezethelidstightlywithlensin situto
ensurethatthisistheoptimumBCthatgivesthebestvision:• If,onopeningthelids,VAisimmediatelybetterbutthendeteriorates,chooseaflatterBC.• If,onopeningthelids,theVAisworseandslowlyimproves,thismayindicatethatatighterBC
isrequired.
Note: If the BC requires adjusting but the fit is then not optimal, the periphery can be adjust-
ed to correct this. See Step 2: Peripheral Fit.
Keratoconus and Corneal inserts:Selectalens0.80mmto1.00mmflatterthanmeanKsormean3mmSimKs.
Corneal Grafts, PMD and LASIK:SelectalenswithaBCequaltothemeanKsor3mmSimKs.
Guide to first trial lens by condition
Objective: SelecttheBCwhichyieldsthebestvisualacuity,fittingasflataspossible.
Step 1: Base Curve Selection
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Note that the periphery of the lens can be adjusted independently of the base curve.
Objective: Adjusttheperipherytooptimizelensfit,locationandmovement.
Step 2: Peripheral Fit
Step 3: Diameter
• ForsmallerHVID’s,decreasethediametertoachieve1.5mmoutsidethelimbus.• ForlargerHVID’s,increasethediametertoachieve1.5mmoutsidethelimbus.• Ifthelenscausesanysignificantscleralindentation,gosmaller(and/orincreasetheedgelift).
Fitting Tip
Ifindoubt,leavethediameterslightlylargerratherthansmaller.
Objective: Theedgeofthelensshouldextendtoapproximately1.5mmbeyondthelimbus.
Step 4: Location
• Thelensshouldnotlocatedownsignificantlyonupwardgaze.• Thelasermarkshouldlocatewithin20degreesof6o’clock.• Toimprovelocation:
a. Steepenthebasecurve.b. Increasethediameter.c. Decreasetheedgelift. Lensshowinglowlocation
Objective: Thelensshouldcentreequallyaroundthelimbus.
• Fiveperipheraloptionsareavailable:Standard, Increased (+1.0) andIncreased(+2.0) (toloosenthefit)orDecreased(-1.0) and Decreased(-2.0) (totightenthefit).
• IncaseswherethevisionisacceptablebuttheoverallfitisTIGHT:Smallbubblesmaybe trappedatthelimbus,thelensmaynotmovesufficiently,scleral-conjunctivalindentationMAY beseenonremoval,limbalinjectionmayappearafterseveralhoursofwearorinitialcomfort maybegoodbutdeterioratesafterseveralhoursofwear.Orderincreasedlift
• IncaseswherethevisionisacceptablebuttheoverallfitisLOOSE:Thelensmovesexces- sively,particularlyonupwardgaze,mayfluteinonequadrant(morecommonlyinthelower quadrants),isuncomfortableoninsertionanddoesnotsettle.Orderdecreasedlift
• Looselensesmaycausethelaserlineonthelenstolocatemorethan20degreesawayfrom the6o’clockposition.
Fitting Tip Forverysteepnippleorovalcones,aflatterperipherymayberequired.
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Step 5: Movement
• Withthepatientlookingstraightaheadorslightlyup,usethebottomlidagainsttheloweredgeofthelenstopushthe lensupwardsandobservehowquicklyitreturnstoitsoriginalposition.Thiswillgiveamoreaccurateassessmentofhowtightorloosethelensis.Thelensshouldreturntoitsnaturalrestingpositionwithinseconds.
• Toincreasemovement,increasetheedgelift,decreasethediameterand/orflattenthebasecurve.
• Todecreasemovement,decreasetheedgelift,increasethediameterand/orsteepenthebasecurve.
Fitting Tip
Judgethemovementafterthelenshassettledbutnotlongerthan5minutesafterinsertion.
Objective: Onblink,approximately1.0mmofmovementshouldbeobserved..
Refraction
Bestcorrectedvisualacuityisaprimarydriverforselectionoftheappropriatebasecurve.An inability to attain satisfactory vision at the fitting is a contraindication for proceeding with the fitting.Thestandardofvisioncanbeanexcellentindicatoroftherelationshipofthebacksurfaceofthelenstothecornea.Thebasecurveshouldbevariedtoattainbestpossiblevisualacuityandthentheperipheralsystemand/ordiameterchangedtoimprovethefitifrequired.
Generally, fitting flatter base curves gives better VA.
At the fitting
1. Allowthelenstosettlefor5to10minutesbeforeperforminganover-refractionincludinganyastigmaticcomponent.Repeatafter20minutestoconfirmthefinalfitandrefraction.
2. Performthefinaloverrefractionwiththelightson,usingatrialframe,aspupilsizecanaffectthefinalrefraction.
3. Iftheoverrefractionhasacylindergreaterthan2.00D,placethisinatrialframeandhavethepatientmanuallyrotatethelensinthetrialframetochoosethebestvision.Rotatelensawayfrombestvisionandaskpatienttorepeattheprocedure2moretimes.
4. Oncethecorrectcylinderandaxishasbeenestablishedadd+1.00Dand-1.00Dspheresoverthisfinalrefractioninthetrialframe;refinewith+0.50and-0.50spheres.
5. TheLasermarkshouldlocatewithin20degreesof6o’clock.Anyrotationeithernasallyortemporallymustbecompensatedfor,oralternativelyshownintheordersothelabcanmakethecompensation.Usenotationfortherotationofeither‘NASAL”or“TEMPORAL”.
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When dispensingAllowthelenstosettlefor5minutesandperformanaccuratesphero-cylinderover-refraction.Recordthisresultanddispensethelens.
First followup exam (at 2 weeks)Ensurethepatienthaswornthelensforatleastonehourandperformanaccuratesphero-cylinderover-refraction.• Ifthisisthesameorsimilartotheover-refractionrecordedatthedispenseanewlenspowercanbe
orderedifrequired.• Ifthisissignificantlydifferenttotheover-refractionrecordedatthedispense,performafurtherover
refractionatleast3dayslater.• Twosimilarover-refractionsmustberecordedatsubsequentexaminationsbeforeanewlenspower
shouldbeordered.
Refraction Tips
• Pushthemaximumplus-itiseasytooverminustheRx.• VAatthefittingisanaccurateindicationofthebestfinalVAyouwillobtainwithROSEK2Soft.Donotproceedwiththefitting
iftheBCVAisnotadequateatthefitting.• Auto-refractionoverROSEK2Softisinaccurateandhaslittleornoapplicationfordeterminingthecorrectpower.
Refraction (continued)
ACT: Asymmetric Corneal Technology
Becauseoftheunusualshapeofsomeirregularcorneas,theROSEK2Softlensmay,insomerarecases,fluteattheedge.Thiswillusuallyoccurinthelowerhalfbetween4o’clockand8o’clock,eventhoughtherestofthefitmayappearideal.TheROSEK2SoftACTdesignallowsthelenstobetightened(tucked)overasinglequadrantwiththeaxisofthesteepen-ingexactlydefinedbythefitter,independentoftheprismbal-lastat270.TwodifferentgradesofACTareoffered:• StandardACT(1.0):Thisiswheretheflutingmaynotbe
apparentinthestraightaheadgaze,butbecomesobviouswhenthepatientlooksup,downorlaterally
• DoubleACT(2.0):Usedwhentheflutingisalwaysobvi-ous,eveninstraightaheadgaze.
Unlessstatedbythefitter,theACTaxiswillbeplacedat270,thesameaxisastheprismballast.
Fitting Tip
Inferiorcornealsteepeningmaycausethelenstoridelow,andflutingmaynotbeappar-entuntilthelensispushedupviathelidtocentreoverthepupil(seeabove).InthesecasesuseACT1.0
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1. Rubbingofthelenssurfacewithaconcentratedsoftlenscleaneris stronglyrecommendedtoremovelenssurfacedebrisand contaminants.Afterlensremoval,placethelensonthefingerofthe dominanthand,placeseveraldropsofthesoftlenscleaneronthe palmoftheotherhand,andthenrubthelensincirclesoverthepalm foratleast30seconds.Rinsewithmulti-purposesoftlenssolution beforestoringthelensinthecase.
2. Recommended replacement is 6 months or shorter.
3. Thematerial inROSEK2Softhasbeentestedwithbothhydrogen peroxideandmulti-purposelenscareregimens.
Practitioner Trial Lens Care Instructions
• Day 1:4hours.• From Day 2 until the first follow up examination at 2 weeks:Increasewearingtime2hours
perday,uptoamaximumof8hours.• After the first follow up examination at 2 weeks:Wearingtimemaybeincreasedtoamaxi-
mumof12hours.• After the second follow up examination at 1 month:Wearingtimecanbeincreasedtoallday
wear.Regularexaminationsat6monthlyintervalsfromthenonarerecommended.
Itisstronglyrecommendedthatlensesinthediagnosticsetbetreatedassingleuseonly.Afteruse,diagnosticlensesshouldbediscardedandreplaced.
Patient Handling and Lens Care Recommendations
Eyecarepractitionersshouldreviewlenscaredirectionswiththepatient,bothbasiclenscareinformationandspecificinstructionsonthelenscareregimenrecommendedforthepatient.
Lens care
Recommended Follow-up and Wearing Schedule
©2015ROSEKISATRADEMARKOFMENICONCO.,LTD.,NAGOYAJAPANUS-RK405/1-DT11/2015
Multilens AB Skinnefjällsvägen 1 435 25 Mölnlycke Sweden+46 (0)31-88 75 [email protected]
