34
Corneal Aspheric GP Lenses with
Peripheral Support Control
Rafael Clérigo Gonçalves Ldo. OCV,MSc
Technical Director–Lenticon Europe
1. Introduction
o Basic Concepts
o Corneal Physiology and Form
Coefficients
o Design of the Elipsys lens
o Material
o Data sheet
2 How to Fit Elipsys
o Types of fitting
o Regular Cornea
o Initial lens calculation
o Assessment of fitting
o Irregular Cornea
o Initial lens calculation
o Assessment of fitting
3. Elipsys Empirical Calculator
o Initial lens calculation
o Recalculation of new lens (adjustment of parameters)
4. Elipsys Multifocal
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+ +++
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⌐ P Value (p)
⌐ Asphericity (Q)
⌐ Eccentricity (e)
⌐ Shape Factor (SF)
p Q e SF
p - 1+Q 1-e2 1-SF
Q p-1 - -e2 -SF
e 1 − 𝑝 −𝑄 - 𝑆𝐹
SF 1-p -Q e2 -
1. Introduction: Basic ConceptsCorneal Physiology and Form Coefficients
E. Oblata Q>0
E. Prolata -1<Q<0
1. Introduction: Basic ConceptsDesign of the Elipsys lens
ZonaÓptica
Esférica
(5mm)
Sphero-Aspheric design on the posterior section
with peripheral support control that allows a better
corneal alignment optimizing the tear exchange,
maintaining its centering and stability.
Multisphere geometry on the anterior side.
Indicated for patients with regular corneas or
irregular corneas with keratoconus or other corneal
ectasias.
Design with optical zone of variable diameter that
allows it to stay centered and stable in most
irregular corneas.
The new concept of "peripheral support control" is ideal for corneas that have different levels of eccentricity. Based on a
statistical analysis, a nomogram was created identifying several levels of eccentricity for the different corneal conditions.
Material
Property Optimum Extra
Classification Focon III 4
USAN Roflufocon D
Oxygen Permeability (Dk) 100 barrers
Refractive index 1,431
Hardness (Shore D) 75
Retracting contact angle 3º
Visibility Tint Azul
Recommended Replacement 18 – 24 months
1. Introduction: Basic Concepts
1. Introduction: Basic Concepts
Data sheet
2. Cómo adaptar Elipsys
IMPORTANT
Before starting, make sure you have :
o Updated graduation, AVsc and AVcc
o Current Keratometry or Topography
o Horizontal diameter of Visible Iris (DHIV)
o Pupillary diameter (subpalperal adapters, LC MF, etc.)
o Evaluation of the patient's tear
o Valuation of the corneal surface (Avoid surprises)
o A good anamnesis (previous adaptations, expectations, etc.)
KNOW YOUR PATIENT
SUBPALPEBRAL FITTING
Ø Large Posterior Optical Zone
Wide bands
Base Radio equal to and / or greater
than Kflat
2. How to Fit Elipsys
INTERPALPEBRAL FITTING
o Ø Large Posterior Optical
Zone
o Narrow peripheral bands
o Base Radio equal to or less
than Kflat
o Ø total <Parpebral opening
2. How to Fit Elipsys
9,60 mm DIA 9,80 mm DIABetween 9,80 mmand
DHIV – 1,4 mm
Step # 1: Calculate the Total Diameter of the lens
Cornea Regular and Irregular - Elipsys Family (STD, KC and SE)
2. How to Fit Elipsys
Elipsys STD & Elipsys SE
AC: 0.00 a 0.75 D AC: 0.75 a 1.75 D
DIAMETER BC DIAMETER BC
9.60 Kflat + 0.05 mm 9.60 Kflat
9.80 Kflat + 0.05 mm 9.80 Kflat
11.20 Kflat + 0.25 mm 11.20 Kflat + 0.20 mm
Design NOT recommended for values> 2.00 D of corneal cylinder
(regular)
It would condition the focus, comfort and visual stability.
Regular Cornea - Elipsys STD and Elipsys SE
Step 2: Selection of the base curve
Select the lens from Fitting Set, with the base curve that is closer to the value
obtained according to the calculations indicated by the table:
2. How to Fit Elipsys
Diameter BC
9.60 y 9.80𝐾𝑓𝑙𝑎𝑡+𝑘𝑠𝑡𝑒𝑒𝑝− 0,10
2
11.20𝐾𝑓𝑙𝑎𝑡+𝑘𝑠𝑡𝑒𝑒𝑝+ 0,10
2
Regular Cornea - Elipsys STD and Elipsys SEStep 2: Selection of Base Curve
For values> 2.00 D of corneal cylinder (regular) or astigmatism <2.00 D but with an extension of limbus to
limbus,
Treat the case as if it was an Irregular Cornea.
Select the lens out of the fitting set, with the base curve that is closer to the value obtained according to the
calculations indicated by the table:
Analyze fluorogram and evaluate :
centering and lifting of the edgeLow edge lifting → ask for Exc. "MED”
Excessive edge lifting → Try a steeper BC
2. How to Fit Elipsys
42.19 (8.00) @ 180 / 42.92 (7.86)@ 90
Kflat = 42.19 D (8.00mm)
Corneal Cyl= 0.73 D
Base Curve= Kflat + 0.05 mm
= 8.05 mm
Base Curve= Kflat + 0.25 mm
= 8.25 mm
Between 9,80
mmand DHIV
– 1,4 mm
First Fitting Lens: 8.00/-0.50/9.80/STD (Elipsys STD)
or
8.30/+1.00/11.20/STD (ElipsysSE)
2. How to Fit ElipsysRegular Cornea - Elipsys STD and Elipsys SE
Step #1 Step #2
1- Static Behavior (holding eyelids and
focusing the lens):
o Movement of the contact lens
without eyelid action (Push Up)
o Static fluorogram (acceptable,
open, closed)
If the GP Contact Lens provides good AV, comfort and absence of problems, the
fitting is good
2- Dynamic Behavior (under the action of the
eyelids)
o Movement
o Centering
oIncrease diameter to raise the lens
oDecrease diameter to lower the lens
Regular Cornea - Elipsys STD and Elipsys SE
Step # 3: Evaluate Centering and fluorogram
2. How to Fit Elipsys
Ideal Steep Flat
STEP LENS
Apply the solutions in thisorder
Make BC Flatter
Decrease Diameter
Decrease Optic D Z.
FLAT LENS
Apply the solutions in thisorder
Make BC Steeper
Increase Diameter
Increase Optic D Z.
✓ Uniform distribution of fluorescein
✓ No touch zones
✓ Right edge lifting
✓ Good movement and centered
2. How to Fit ElipsysRegular Cornea - Elipsys STD and Elipsys SE
ElipSYS KC & ElipSYS SE
Diameter BC
9.60 y 9.80 𝐾𝑓𝑙𝑎𝑡+𝑘𝑠𝑡𝑒𝑒𝑝 − 0,102
11.20 𝐾𝑓𝑙𝑎𝑡+𝑘𝑠𝑡𝑒𝑒𝑝 + 0,102
Irregular cornea - Elipsys KC and Elipsys SE
Step # 2: Selection of Base Curve
Select the lens out of the fitting set, with the base curve that is closer to the value obtained
according to the calculations indicated by the table:
2. How to Fit Elipsys
2
49.63 (6.80) @ 180 / 53.57 (6.30) @ 90
𝐾𝑓𝑙𝑎𝑡+𝑘𝑠𝑡𝑒𝑒𝑝 − 0,10= 6.45 mm
𝐾𝑓𝑙𝑎𝑡+𝑘𝑠𝑡𝑒𝑒𝑝
2+ 0,10 = 6.65 mm
1st Fitting Lens: 6.40/-10.75/9.60/FLAT (Elipsys KC)
or
6.70/-8.75/11.20/FLAT 2 (Elipsys SE)
Between 9,80 mm
and DHIV – 1,4 mm
2. How to Fit ElipsysIrregular cornea - Elipsys KC and Elipsys SE
Step #1 Step #2
Irregular cornea - Elipsys KC and Elipsys SE
Step # 3: Evaluate Centering and fluorogram
2. How to Fit Elipsys
1- Static Behavior (holding eyelids and
focusing the lens):
o Movement of the contact lens
without eyelid action (Push Up)
o Static fluorogram (acceptable,
open, closed)
2- Dynamic Behavior (under the action of the
eyelids)
o Movement
o Centering
oIncrease diameter to raise the lens
oDecrease diameter to lower the lens
If the GP Contact Lens provides good AV, comfort and absence of problems, the
fitting is good
o IMPORTANT
o Initially, evaluate the center of the lens
o Make the BC steeper or flatter until getting the ideal
fitting
o Evaluate the lifting of the edge
o Adjust with the eccentricity (see troubleshooting).
2. How to Fit ElipsysIrregular cornea - Elipsys KC and Elipsys SE
Step # 3: Evaluate Centering and fluorogram
STEEP LENS
Apply the solutions in this order
Make BC Flatter
Increase Eccentricity
DecreaseDiameter
Decrease Optic D Z.
FLAT LENS
Apply the solutions in thisorder
Make BC Steeper
Decrease Eccentricity
Increase Diameter
Increase Optic D Z.
✓ Apical light touch
✓ Middle-periphery support
✓ Right edge lifting
✓ Good movement and centered
Irregular cornea - Elipsys KC and Elipsys SE
Ideal Steep Flat
2. How to Fit Elipsys
1
2
3
Slight Apical Touch (feather touch)
Support in the Mid-periphery
1
2 3&
Irregular cornea - Elipsys KC and Elipsys SE
IDEAL adaptation technique in Irregular cornea
Three Support Points
2. How to Fit Elipsys
Lifting of the Edge Solution
Insufficient
(less than 0.5 mm)
Increase Eccentricity
(ei.: MED → MED 2, FLAT o rFLAT 2)
Excessive
(greater than 1 mm)
Decrease Eccentricity
(ei.: FLAT 2 → FLAT, MED 2 or MED)
Irregular cornea - Elipsys KC and Elipsys SE Troubleshooting
If you observe:
2. How to Fit Elipsys
Base Curve Diameter Eccentricity
Dropped Lens Flatten Increase Increase
Lens Riding High Close Decrease Decrease
CentralStaining Close
Staining3 & 9 Decrease Increase
Superior LimbStain Decrease
BlurryVision Value Centered and / or Pupilar Diameter
Poor Vision Flatten
Central Pooling Flatten Decrease
Dimple Veiling(trappedbubbles)
Flatten Decrease
Regular and Irregular Cornea- Elipsys Family (STD, KC and SE)
Troubleshooting
2 . How to Fit Elipsys
Regular and Irregular Cornea- Elipsys Family (STD, KC and SE)
Step # 4 - Power of the Lens
• Perform an Over-refraction.
• Do not forget to apply distometry (vertex distance) for values higher than ± 3.75
• Keep in mind that this design DOES NOT compensate for Internal Astigmatisms
• Ast. Rx = Corneal Astigmatism+ Internal Astigmatism
o Apply rules:
o Make Steeper add negative
o Make Flatter add positive
2. How to Fit Elipsys
Make BC steeper
Meniscus lacrimal positive
Add Negative
Make BC flatter
Meniscus lacrimal negative
Add Positive
Step # 4 - Power of the Lens
2. How to Fit Elipsys
Regular and Irregular Cornea- Elipsys Family (STD, KC and SE)
Step # 5: Order of Final Lens (parameters to be identified):
o Design / Geometry
o Elipsys STD
o Elipsys KC
o Elipsys SE
o Base Curve
o Power
o # LC fitting lens+ Over Refraction (Lab. will apply distometry)
o Definitive lens power (distometry already applied)
o Diameter
o Eccentricity
2. How to Fit Elipsys
3. Elipsys Empirical Calculator
…COMING SOON!!!
o Inicial Lens Calculation
o Keratometry
o Spectacle power refraction
o Corneal Eccentricity – NOT required
o (if Corneal Topographer is available)
o CL Diameter
o Lens Recalculation
o Proven lens Parameters
o Over-Refraction
o Adjustments to apply
o (Rb, Diameter and Eccentricity change)
Possibility of Multifocal Design
o Présbitas patients, users of contact lenses of the Elipsys family, can now enjoy a clear
vision at all distances, regardless of their corneal condition (**) (regular and irregular
cornea).
o Simultaneous Vision Multifocal Design + Translation
o Center - Far (CD)
o Required parameters for your order (empirically):
o In addition to the parameters required to order an Elipsys lens:
Regular and Irregular Cornea- Elipsys Family (STD, KC and SE)
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+
++ - + +
4. Elipsys Multifocal
o Pupillary Diameter
o ADD
o Ocular Dominance
o (sensorial - by fogging test with +2.00 D lens)
(**) We recommend special attention when trying to pass, the cases of very irregular cornea, to a Multifocal geometry, since an accumulation of optical aberrations both corneal and
the same multifocality of the lens, may condition the final visual result.
Regular and Irregular Cornea- Elipsys Family (STD, KC and SE)Possibility of Multifocal Design
o Possibility of Fitting Set with Multifocal geometry
4. Elipsys Multifocal
GRACIAS
