dr. smoradkova "esclera, news for irregular corneas"

www.neovizia.sk

ESCLERA Scleral lens - news for irregular corneas

Dr. Adriana Smorádková, Slovakia

ESCRS, London 2014

www.neovizia.sk 2www.neovizia.sk 2

Clinic NeoVízia

• our clinic specialize in cataract and refractive surgery, glaucoma, retina andkeratoconus

• my specialization is refractive surgery (FemtoLasik, PRK), glaucoma (SLT, LI)

and keratoconus (CXL, implantation Kerarings, Esclera)

Keratoconus

• we started implantation of kerarings in 2011

• we are implanting kerarings with femtosecond laser Visumax since March 2013

• we started application of ESCLERA in March this year


ESCLERA is a scleral lens with semi – scleral design

It performs new possibilities for correction of irregular cornea such as:

• keratoconus, pellucid marginal degeneration

• post implantation intracorneal rings segment

• post penetrating keratoplasties, corneal trauma, LASIK, PRK, Radial

Keratectomy

• dry eye

• Salzmann’s degeneration, Stevens – Johnson’s syndrome

• intolerance of soft contact lenses (myopia, hyperopia, astigmatism)

ESCLERA – scleral lens


Characteristic

• material is fluoro-silikon akrylat copolymer

• it has excellent optical properties, good stability

and oxygen permeability

• surface is plasma treated which makes lens wetter and cleaner

• surface is resistant to protein deposition

• the lens is bearing on the sclera without touching cornea

• between the cornea and the lens is a 100 microns

space, filled with saline fluid


Mechanism of action

• liquid between cornea and ESCLERA removes corneal irregularity

• Esclera optically replaced the front surface of the cornea

• operates on the principle of optical substitutions


Why is ESCLERA comfortable ?

• it has excellent stability on irregular cornea

• lens is large and always in center• it reduced movement• it has excellent visual acuity• exceptional comfort compared with

hard corneal lenses


History

Makro lens, Esclera 1 – 6

Esclera 7

This ESLERA is seventh generation of sclerallenses with new material, new surface modified by plasma, new sizes and curvature.


Size and models

• each lens has a customized design

• we have a trial set which consists 20 basic models with different sizes and corneal curvatures

• when we are choosing the right model we are

looking for lateral bowing curvature and

corneal diameter WTW - white to white

• the models have different....

diameter 16.0, 16.5, 17.5, 18.2 mm

diopter − 20 .... + 20 D

curvature 6.49 mm .... 8.44 mm


Trial set – 20 lens

Moderate cone(A,B)

Advanced cone(C,D)

Post surgicalSunken

Post surgicalBulging

Keratoconus Post LASIK, PRK, RK, PMD

Group A Group A Group B Group A

7,50 / 16,0 / 4,47 7,03 / 16,0 / 4,64 7,85 / 16,5 / 4,75 6,49 / 16,0 / 4,89

Group C Group C Group D Group D

7,85 / 17,5 / 5,20 6,89 / 17,5 / 5,64 7,85 / 17,5 / 5,20 6,89 / 17,5 / 5,64

Instruction

Specification of lens


Choosing the right model

• patient open eye lids

• we look from side and check corneal elevation

• than check white to white

• we are choosing predictive model from the trial set

• put saline solution + fluorescein into the lens

• apply the lens with face down

• and control it under the slit lamp


Ideal fit

Has 4 simple steps

• Size – ESCLERA must be 2 mm larger than the limbus

• Vault – is without touching

• SAG - Saggital Depth Value is 100 microns space

• Edge – without pressure vessels and

without movement


Trouble Shooting

too large SAG 250 um –steep fit

central bearing 2 mm-flat fit

flat lens, central bearing, bubbles, edge lift

Rules: 1. central bearing 1 mm -

increase SAG about 0,1 mm2. Vault more than 100 um -

decrease SAG... 50 um=0,1mm

peripheral bearing


Choosing the next model

• if it was an incorrect model, we must remove the lens

• than try another model

• again control under the slit lamp

• if it is correct model....

• patient has it inserted in the eye for 30 minutes

• we are doing manifest refraction - final lens power

• write all information to the order form

• patient’s lens is manufactured and delivered

• ESLERA is produced in 4 weeks

How to use Scleral Lenses Scleral Lens Education Society2.wmv



Lens care

• we must teach the patient how to use Esclera

• lens wear during day approximate 8 - 10 hours

• patients need cleaning solution, saline solution for rinse and applicationand GP (gas permeable) lens solution for conditioning in the box

• highlight possible complications associated with Esclera, which are such as other types of contact lenses

Esclera can last up 2 years if good care is taken

How to use Scleral Lenses Scleral Lens Education Society.wmv

How to use Scleral Lenses Scleral Lens Education Society.wmv




Keratoconus in our clinic

EYE 288

CXL 11

Keraring 85penetrating keratoplasties 2

CLE + AIOL Toric 6

Oper. cataract + IOL Toric 6

ESCLERA 17

now 8 patients wear


Case 1man, 33 years , keratoconus on both eyes

• myopia gravis, wearing glasses from 6 y. (o.dx: -7,25, -2,0/ 91, o.sin: -6,0, -0,5/85)

• we implanted keraring to the left eye and we proposed penetrating keratoplasties or to tryESLERA to the right eye. He wanted to try ESCLERA

eye UCVA BCVA AR CCT CCT -thinnest

K1 K2 K max

OD 0,01 0,2 -21,5,-2,0/171 418 381 53,0 59,0 66,5

OS 0,05 0,6 -9,5,-4,25/78 474 439 49,0 52,5 60,8

penetrating keratoplasties orESCLERAKeraring

Transplantation Keraring


Case 1 - conclusion

Method: OD: ESCLERA ( fitting 2/2014, wear from 5/2014)

OS: implantation of keraring (surgery 1/2014)

before after

eye UCVA BCVA AR BCVA MR

0D 0,01 0,2 -21,5,-2,0/171 ESCLERA 0,9

OS 0,05 0,6 -9,5,-4,25/78 Keraring 0,7 -5,0

the patient is satisfied


Case 2man, 38 years old, keratoconus on both eye, doctor – cardiologist, keratoconus both eyes

• myopia gravis, wearing glasses from 4 y. (o.dx: -3,0, o.sin: -4,0)

• we implanted kerarings to both eyes, after surgery the vision improved significantly

eye UCVA BCVA AR CCT K1 K2 K max AL

OD 0,5 0,9 -5,0,-9,75/26 469 46,5 53,75 61,1 24,38

OS 0,05 0,3 -13,5,-10,0/178 474 53,25 59,0 65,7 24,59

KeraringKeraring ESLERA


Case 2 - conclusionMethod: OD: implantation of keraring (1/2014)

OS : implantation of keraring (7/2013)...ESCLERA (fitting 2/2014, wear from 6/2014)

• but the left eye had low vision, so we decided to try ESCLERA

before after

eye UCVA BCVA AR method BCVA MR/AR

OD 0,5 0,9 -5,0,-9,75/26 Keraring 1,0 -3,0

OS 0,05 0,3 -13,5,-10,0/178 Keraring 0,5 -10,0-1,25/152 ESCLERA 1,0



Case 3woman, 47 years, keratoconus on both eye

• right eye with myopia gravis, ambylopia, fundus myopicus, cataract scutelaris, strabizmus,

• left eye with myopia medii

• she is wearing hard corneal lens on the left eye (now she has problem with tolerance)

• wearing glasses from 20 y. (o.dx: -3,5, o.sin: -3,0,-1,0/156)


OD 0,01 0,05 -16,25,-5,75/70 484 46,25 49,75 51,4 29,91

OS 0,1 1,0 -4,5,-3,75/156 458 48,5 51,25 55,5 23,7

ESCLERAESCLERA


Case 3 - conclusion

Method: OD: ESCLERA (fitting 5/2014)

OS: ESCLERA (fitting 5/2014)

We proposed to try ESCLERA to both eyes.

UCVA BCVA AR BCVA

before after

OD 0,01 0,05 -16,25,-5,75/70 ESCLERA 0,05

OS 0,1 1,0 -4,5,-1,0/149 ESCLERA 1,0



Case 4man, 35 years, keratoconus on both eye, wearing glasses from 11 y. (o.dx: -6,75, -2,5/48, o.sin: -8,0,-3,5/105)

• he had implantation of myoring combined with CXL to the left eye at another clinic in 2013

• after surgery was his vision still very low, with halo and glare effect

He wanted keraring to the right eye, but he was afraid of surgery and finally he decided to try ESCLERA.


OD 0,05 0,8 -12,75,-4,75/38 447 48,75 51,25 51,4 26,10

OS - myoring 0,1 0,4 -8,0,-6,25/1 370 45,5 46,75 55,5 26,48

ESCLERAESCLERA


Case 4 - conclusion

Method: OD: ESCLERA (fitting 6/2014)

OS: ESCLERA (fitting 6/2014)

UCVA BCVA AR BCVA

before after

OD 0,05 0,8 -12,75,-4,75/38 ESCLERA 0,9

OS 0,1 0,3 -8,0,-6,25/1 ESCLERA 0,3

He ordered ESCLERA to both eyes.


Case 5man, 46 years, keratokonus on left eye, he doesn’t have glasses

• we proposed implantation of kerarings to the left eye. After surgery the vision was 0.5, so we decided to tryESCLERA

Keraring ESCLERA

eye UCVA BCVA AR CCT K1 K2 Kmax

OD 0,9 1,0 +1,0,-0,5/63 571 44,25 45,00 45,5

OS 0,16 0,4 -3,75, -12,5/96 537 48,75 57,25 58,7

Kerarings 10/2013SI5 160/300 - sup.SI5 90/250 - infer

UCVA post keraring 0,5 AR -3,5, -3,0/84


Case 5 - conclusion

Method: OS: ESCLERA (fitting 7/2014)

UCVA AR BCVA

post implantation keraring after

OS 0,5 -3,5, -3,0/84 ESCLERA 0,8

He ordered ESCLERA to the left eye.


Final conclusion

• has excellent stability

• excellent visual acuity

• it is comfortable to wear

And this is a new type of correction for patients

with keratoconus and irregular cornea.

www.neovizia.sk 27www.neovizia.sk 27Thank you for your attention!

dr. smoradkova "esclera, news for irregular corneas"

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