Orthokeratology

This means the adaptation, elimination or decrease of the refractive adjustment with the use of contact lenses. Contact lenses are used to restabilize the cornea and to decrease the shortsightedness and astigmatism of the eye. The process is comparable to orthodontic straightening of teeth, with a difference: while teeth remain strengthened for an indefinite period, the cornea, being elastic, returns quickly to its original form. The lens is worn during the night and taken off in the morning. Correct vision is achieved with regular use, with no need for glasses or contact lenses during the day. Attributes of Suitable Clients prescription: spherical 0.75 to 5.00 DS cylinder up to 1.25 DS (WTR) up to 0.75 DS (ATR) corneal cylinder healthy physiological condition of the eye regular tear quantity no use of drugs/medicines good motivation ability to adapt to a regular daily routine Fitting stages comprehensive examination of the eye using a slit lamp tear quality and quantity diagnosis spectacles prescription corneal topographer test results to be saved as original data Lens Orders Fill out Soflex order form No 3 with the following information (see sample at end of document). spectacles prescription: SPH, CYL, AXIS cornea details: horizontal radius (Rh); vertical radius(Rv); vertical radius axis (V-Axis) corneal eccentricity (EEC) vertical iris diameter (VID) pupil size target of the SPH power (usually plano)

Soflex OverNight Lens

Soflex OverNight Lens Structure SPH R L -2.50 -2.25 CYL -1.25 -0.75 AXIS 10 170 Rh 44.29 44.12 Rv 46.17 45.86 VER. AXIS 100 80 ECC 0.36 0.36 VID 11.5 11.5 PUPIL SPH SIZE TARGET 4.50 0.00 1.50 0.00

Example data

The base curve of the lens has four main areas:

Back Optic Zone Radius: an area with a diameter of 6.0 mm, with a radius flatter than the

corneal radius, with the value of the required refractive adjustment plus 1.00 diopter. In the example: BC=8.27
Alignment/Fitting Curve: designed to hold the lens on the periphery of the cornea. The

area has to be in tangent with to the periphery of the cornea. Therefore, it is essential to measure the eccentricity of the cornea. The width of the alignment/fitting curve is 1.0 mm. In the example: 7.57 mm, width 0.5 mm; 7.98 mm, width 0.5 mm.
Reverse Curve: Calculated using special software, this curve links the Back Optic Zone

Radius and the Alignment/Fitting Curve. In the example: 7.27 mm, width 1.0 mm.
Peripheral Curve: The structure of the lens edge allows a regular tear flow underneath the

lens, providing comfort and easing removal of the lens from the eye. In the example: 10.27 mm, width of 0.3 mm. In total, the lens diameter is 10.60 mm. 2

Soflex OverNight Lens

Physiological Process on the Cornea During sleep, the pressure of the eyelid on the lens causes capillary pressure of the tears on the center of the cornea. This pressure transfers epithelial cells from the center to the periphery. The pressure is released at the periphery, causing the shape of the cornea to flatten (see figure no. 1). The width of the moved layer is expressed by the Munnerlyn formula:
(Optical Zone Dia) x Refractive Error x 1000 3

Before Beginning the Process

The result is measured in microns. The process has two phases: 1. The settling process lasts between 10 to 30 days. During this period, the quality of vision may vary on a daily basis: some days, vision will be accurate, and other days, visual quality may decrease. 2. Stabilization and conservation occurs during sleep. When lenses are worn all night long, there is no need for adjustment during the day. The aim is to reduce the number of nights during which the lenses are worn, while retaining accurate vision over several days.
During the Process

Figure 1

Soflex OverNight Lens

Soflex OverNight Fitting Careful selection of the client is important for the success of the procedure. High motivation and readiness to compromise slightly on the quality of the vision will significantly increase the success rate. The client must be informed of alls advantages and disadvantages of the method, and be aware of amount of time required for the fitting and the follow-up stages. Ordering Soflex OverNight Lenses Fill out Soflex order form no. ____ with the following information (see sample at end of document): spectacles prescription: SPH, CYL, AXIS corneal details: horizontal radius (Rh); vertical radius (Rv); vertical radius axis (V-Axis) corneal eccentricity (EEC) vertical iris diameter (VID) pupil size SPH target power (usually plano) The data received by Soflex is transferred to special computer software, which provides production data to CNC-activated cutting machines. Lenses are produced according to individual client parameters. For practitioner and client convenience, the right and left lenses are produced from differently-tinted raw material: rightViolet, leftIce Blue. Lenses are delivered with a form listing the clients parameters as provided by the practitioner, as well as the lens production date. Dispensing Lenses to the Client Invite the client to receive the lenses at a one-hour afternoon session. Friday is preferable, so a work/study-free weekend can be used as initiation time. The client must also be available for a meeting the following morning. 1. Important! Put hydrating solution on the concave side of the lenses, to improve comfort and prevent bubbles from forming. 2. Insert the lenses. 3. Ask the client to sit with head held high and to stare downwards for a few minutes, until the lenses are comfortable. 4. About five minutes after insertion, using the slit lamp, check lens centration and movement (1.01.5 mm at every eyelid closure). 5. Check that vision with the lenses is correctat least 6:7:5.

Soflex OverNight Lens

>3.5 mm

6. Conduct a fluorescein test. The pictures should be similar to figure 2 (Bulls Eye). Trapped air bubbles, which will disappear during the first night, may be seen (see figure 3). 7. Remove the lenses. 8. Important! Instruct the client on correct insertion, removal and care of the lenses (see detailed instructions on pages 1012).

Figure 2

9. Instruct the client to sleep with the lenses that night and wear them until arrival at the clinic the next morning. IMPORTANT! The client must put hydrating drops in the eyes upon awakening. The morning after dispensing the lenses, carry out the following steps:

Figure 3

1. Vision test: Vision should be correct, at least 6:7:5. 2. Slit lamp test: Lenses should be centrated and should move 1 mm. There should be no unusual clinical findings.

>5.0 mm

3. Fluorescein test: The picture should resemble figure 4 (Bulls eye) 4. Remove the lenses. 5. Vision test: Vision after the first night will possibly measure from 6:6 up to 6:7:5 for a short time.

Figure 4

Soflex OverNight Lens

6. Corneal topographer measurement: The picture should resemble figure 5. For follow-up purposes, save L+R pictures under the clients name. 7. Schedule follow-up visits after the following intervals: two days, one month, three months, and every three months afterwards. Repeat steps one to six during each visit.
Figure 5 After the First Night

IMPORTANT! Remind the client to hydrate the eyes upon awakening and to remove the lenses a few minutes afterwards.

Figure 6 After One Week

Figure 7 Optimal Topography

>6.0mm

Figure 8 Fluorescein Picture

Figure 9 Optimal Fluorescein Picture

Soflex OverNight Lens

Troubleshooting No. 1 Problem Low-riding Lens Factor/Cause alignment curve (AC) too long Solution release alignment curve (AC) by 10 microns

High-riding Lens

AC too flat upper eyelid too stretched

tighten AC by 10 microns increase thickness of lens by 25%

Side-riding Lens

eyelid tension too high corneal cylinder ATR cornea not symmetric between nasal and temporal sides

increase width of second AC clean residue off lens

Central Island

AC too long corneal cylinder still present

if lens is centrated, flatten AC by 5 to 10 microns if lens is not centrated (see problems no. 1, 2, 3), centrate lens, check whether problem persists, and fix accordingly if cylinder is still not fixed, flatten BC according to findings

Soflex OverNight Lens

No. 5

Problem Central Staining

Factor/Cause lens not clean BC too flat low oxygen supply to cornea mainly mechanical irritation, obvious on fluorescein picture

Vaulting

reverse curve too steep AC too long

Solution Clean lenses thoroughly (see lens care instructions) steepen BC by 10 microns order lens made of a material with a higher oxygen permeability . reduce lens sag by 15 microns take care not to change the centration of the lens as a result of this reduction

Air Bubbles

insufficient tear flow under lens AC too long

if length and arch of air bubble is less than 45 and there is no staining, remind client to fill lens with hydrating solution before insertion if staining is present and air bubble is present after two or three days, exchange lens with one having AC flatter by 5 to 10 microns centrate using a/m methods if lens is already centrated, release AC by approx. 10 microns decrease diameter

Lens Imprint

lens not centrated AC too long during fluorescein test, marks from the lens can be seen on cornea

Soflex OverNight Lens

No. 9

Problem Under-responsiveness

Factor/Cause SPH target power too low lens creates vaulting some clients require a longer adjustment period, as a result of lower eyelid pressure, or of a less flexible cornea common among former contact lens (especially GPL) wearers A longer period should be allowed before changing lens data.

Solution enlarge base radius to add approx. 0.50 to 0.75 diopters to the SPH target power In case lens creates vaulting, fix this (see problem no. 6) and continue tests. If these changes do not have any effect, the client may be unsuitable for this type of process.

10

Reduced Holding Time

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Ghosting at Night

centrate lens change to a lens with wider optic area (see problem no. 6) The cornea may be naturally very flexible, and may not hold its shape for the duration of one full day. In low light, the iris change to wider optic widens, and a shadow is area (6.2 to 6.4 mm) seen

lens not centrated reverse curve too wide low level vaulting

Soflex OverNight Lens

Lens Care Care of these lenses is identical to care of gas permeable lenses (GPL). Before handling contact lenses, wash your hands and dry them thoroughly. It is advisable to have the lenses cleaned at a laboratory every three months.

1. Wet the eye with hydrating solution a few minutes before removing the lens from the eye. 2. Remove the lens and place it in the palm of the hand. 3. Put a few drops of cleaner under and in the curve of the lens. 4. Rub both sides of the lens with the index finger, for approx. 2030 secs. 5. Clean the edge of the lens with a cotton-swab stick moistened with a few drops of cleaner. 6. Rinse the lens thoroughly in saline solution. 7. Immerse the lens in conditioner in a clean case. 8. Repeat the process with the second lens.

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Soflex OverNight Lens

Inserting the Lenses 1. To avoid confusion, always start with the same lens!

2. Take the first lens out of the case. 3. Rinse the lens in saline solution. 4. Check that there is no dirt residue on the lens. 5. Put a few drops of hydrating solutions in the curve of the lens. 6. Balance the lens on the index finger, and with the middle finger of the same hand, pull the bottom eyelid downwards. 7. With the index or middle finger of the other hand, lift the upper eyelid. 8. Gently place the lens on the cornea. 9. Slowly release the eyelid and blink a few times. The lens should position itself on its own. 10. Check that the position and eyesight are correct. 11. Repeat the process with the second lens. In case of incorrect vision: If the lens is not positioned correctly, remove and reinsert it. If there is dirt residue, remove and clean the lens, and reinsert it. If the lenses were inadvertently switched, remove both lenses, switch them, and reinsert them.

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Soflex OverNight Lens

Removing the Lenses Approximately four minutes before removing the lenses, wet them with a few drops of hydrating solution, and make sure they move freely in the eyes. It is advisable to remove the lenses while sitting at a table spread with a clean towel, leaning on the table, facing downwards toward the towel.

Choose among three methods of lens removal:

Eyelid Method 1. Position the index finger on the external corner of the eye. Pull the skin outwards and slightly downwards, keeping the eye open.

2. Blink rapidly. The lens will be pushed out by the eyelid and will fall onto the clean towel.
Fingers Method 1. Position the tip of one index finger in the center of the edge of the upper eyelid. Position the tip of the other index finger in the center of the edge of the lower eyelid.

2. Press lightly on the upper eyelidthe lens will rise. Next, push the lower eyelid upwardsthe lens will come out and fall onto the clean towel.
DMV Rubber Pump Method DANGER! Improper use of this method can cause damage to the cornea.

1. Wet the tip of the pump with immersion liquid. 2. Using a mirror, position the center of the pump on the surface of the lensthe pump will stick to the lens. 3. Gently pull the pumpthe lens will easily come off, attached to the pump.

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Soflex OverNight Lens

FAQ
What is Orthokeratology? This means the adaptation, elimination or decrease of the refractive adjustment by the use of contact lenses. Contact lenses are used to restabilize the cornea and to decrease the shortsightedness and astigmatism of the eye. The process is comparable to orthodontic straightening of teeth, with a difference: while teeth remain straightened for an indefinite period, the cornea, being elastic, returns quickly to its original form. The lenses are worn during the night and taken off in the morning. Correct vision is achieved with regular use, with no need for glasses or contact lenses during the day. Why wear Soflex OverNight lenses? no need to wear contact lenses or glasses during the day ideal for active people or for those who work in difficult environments stabilization of short-sightedness Is the Ortho K suitable for everybody? The lenses are suitable for powers of up to 4.50 spherical diopters and up to 1.00 cylindrical diopters. For higher prescriptions it is possible to reduce the power slightly. The lenses are unsuitable for irregularly flat or convex corneas. Unknown factors such as cornea complexity and flexibility can affect the level of adjustment. Although success rate is very high, 100% success cannot be promised. What is the procedure? First of all, a complete eye evaluation has to be carried out, including corneal topography and a vision check. This allows the optometrist to evaluate the health of the eye and cornea, and the suitability of the client. The client receives a pair of Soflex OverNight lenses made of a flexible material with very high oxygen permeability, to be worn during the night. The morning afterwards, the client returns for an eye examination and an evaluation of the changes in the cornea. A week later, another examination and cornea evaluation is carried out. Most significant change occurs during the first few days, while final stabilization of the cornea occurs at a slower pace, and continues during a period of up to three months, depending on the level of myopia. Wearing time depends on several factors, but the ultimate aim is for the client to wear the lenses every two or three nights, and to see correctly during the following days without the need for glasses or contact lenses.

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Soflex OverNight Lens

What are the advantages of Ortho K? correct vision with no glasses or contact lenses no need for surgery completely reversible process painless risk free lenses may be worn during the day or night use of contact lenses has a long, successful record no age limit What are the disadvantages of Ortho K? stabilization occurs only after three months and numerous visits to the optometrist success is not guaranteed optometrists instructions must be strictly followed Is Ortho K preferable to laser eye surgery? Definitely! reversible process (unlike surgery!) painless no shadow vision no damage to Baumans layer eventual changes in vision can be easily handled less expensive treatment with drugs is unnecessary Is this a revolutionary new treatment? Yes and no. The principles of the method were determined in 1962. However, todays computer technology, oxygen-permeable raw materials and high-precision instruments, such as the corneal topographer, promise a higher success rate than ever. Is the treatment safe? This treatment has helped many people become independent of glasses and contact lenses while incurring no damage to the eyes. In contrast with keratotomy, there is no damage to the eyes or corneas such as scarring, which might cause problems with night vision. However, contact lenses must be properly maintained, to ensure that the eyes remain healthy. Is Ortho K suitable for me? The treatment suits almost everyone. The optometrist will be able to determine your suitability. Will I need to wear glasses or contact lenses? Once the prescription is stabilized, the lenses will ensure continued stability. Therefore, there is no need for glasses or contact lenses during the day. Clients who use reading glasses will still need them.

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Soflex OverNight Lens

How long does it take to see correctly without glasses? The change occurs from within a few hours to up to a few days. The amount of time needed for stabilization varies from client to client. Is it possible to match lenses to eyes which have gone through a keratotomy procedure? Yes. In most cases, the Ortho K can help after RK surgery , and is also beneficial for astigmatism that can result from RK surgery. However, Ortho K does not heal scars and does not help with impaired night vision following RK. Children might experience changes in prescription. Can Ortho K help? Yes, the treatment can slow or halt the progress of myopia and other refractive problems, offering a more optimistic future to younger clients. What is the cost of Ortho K treatment? In general, Ortho K is less expensive than laser surgery (PRK). Cost is determined according to the complexity of the case. In simple cases, the price ranges between $1000 and $1500, according to the length of treatment and the number of lenses changed. Prices vary from clinic to clinic. Your optometrist will inform you of the full cost of treatment. Is the treatment permanent? After optimum results have been achieved with initial treatment, maintenance lenses are distributed. The maintenance lenses stabilize the prescription and must be used on a regular basis and according to the optometrists instructions, or the prescription will return to its original status. The maintenance lenses may be used during the day or night, at the clients convenience.

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Soflex OverNight Lens

Soflex Order Form No. 3

Soflex OverNight Lenses Order Form

Name of the clinic Client Name Date: Order No.:

Fill in the following table in case of a new client order:

SPH CYL AXIS Rh Rv VER. AXIS ECC IRIS DIA. PUPIL DIA. SPH TARGET

R L It is advised to send a topographic figure to: zivia@soflexcontacts.com

Comments: A topographic figure was sent under the name: ________________________________ Yes/No

Order for a returning client or a lens correction

Mark previous lens details for each eye separately For a lens correction you must send a topographic figure showing how the lens sits on the cornea, to e-mail: zivia@soflexcontacts.com Add comments regarding required correction and description of the florescein figure. Lens Details Power Delivery Note or Barcode No. Delivery date

Basis R L Comments:

Diameter

A topographic figure was sent under the name: ________________________________ Yes/No

Ordered by: ________________________________________________