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Medical Forum / General / Vision / March 2008Superior decentration of GP contacts
Anyone have any hints on solving issues with superior (high) decentration? information to keep in mind: pupils are around 8-8.5mm in mid dark conditions. so this limits the minimum size of my contacts. prescription is -2.25 and -2.5. very slight astigmatism in my right eye and none in my left. Slightly dry eye but good tear film. My lenses are centering very high, even with fairly large lenses I am consistently looking through the transition area at night (and in the day to some extent). When I push my lenses down using my eyelisds just a bit they "snap" into position over the center and my vision is perfect, even at night. At least until I blink the next time. Then the lid attach is re-established and they get pulled up and out of the center. My lenses have been getting progressively larger with the optic zone gettng closer and closer to the edge, but no real improvement (in fact it might be slightly worse). What do you all think? > Anyone have any hints on solving issues with superior (high) > decentration? [quoted text clipped - 22 lines] > > What do you all think? Try a semi-scleral or cornea-scleral lens. Those cannot become decentered. > > Anyone have any hints on solving issues with superior (high) > > decentration? [quoted text clipped - 25 lines] > Try a semi-scleral or cornea-scleral lens. Those cannot become > decentered. How is lens comfort on the semi-scleral type lens? So far the larger my lenses get the more uncomfortable they are even with what shows to be a perfect fit (combo of edge awareness and dry eyes). Thanks for the advice, I will be trying another set of lenses in a couple days and will ask about the sclerals. > How is lens comfort on the semi-scleral type lens? So far the larger > my lenses get the more uncomfortable they are even with what shows to > be a perfect fit (combo of edge awareness and dry eyes). The comfort is as good and sometimes better than soft lenses. I prescribe them quite often these days and just published a paper on them in Eye & Contact Lens. > prescription is -2.25 and -2.5. very slight astigmatism in my right > eye and none in my left. > What do you all think? Soft contacts? -MT, OD > > prescription is -2.25 and -2.5. very slight astigmatism in my right > > eye and none in my left. [quoted text clipped - 4 lines] > > -MT, OD I get about 4-5 hours before they become incredible uncomfortable. Tried.. I would guess 15-20 different types. Silicon hydro (o2optix and oasis), acuvue, pro something along with a ton of other lenses. The best was the oasis, but the quality of vision was poor compared to rgp. I could read something if I looked at it long enough, if that makes any sense, but nothing was "sharp". Just always kinda fuzzy. With the RGP lenses, while they are centered, everything is rock solid and super easy to see, better than my glasses even. > > > prescription is -2.25 and -2.5. very slight astigmatism in my right > > > eye and none in my left. [quoted text clipped - 14 lines] > With the RGP lenses, while they are centered, everything is rock solid > and super easy to see, better than my glasses even. now that it is clear that you were describing the fit your your RGP's in your initial posting as opposed to SCL (right?) I will chime in and try to help. Asumming we are talking about RGPs, if I was the doc trying to refit you to get better centration of the lens, I would put you in as small a lens as possible, with a steeper base curve than the pair you were describing. Larger RGPs, and ones with flatter base curves, tend to fit just as you describe-- "lid-controlled" which characteristically has the lens stuck-up under the upper lid and moving with it when you blink. So without examining you, that's my $0.02 cents. What does your doc say? It really isn't rocket science to a decently-trained optometrist. On Mar 19, 11:18 pm, p.clar...@gmail.com wrote: > > > > prescription is -2.25 and -2.5. very slight astigmatism in my right > > > > eye and none in my left. [quoted text clipped - 30 lines] > > - Show quoted text - Understood, they are making another set right now but I don't know what the specs are though I did tell her how a previous set was much more comfortable at a smaller size, though that could also have been because they were made with a good distance between the edge and the optical zone. The newer ones I am now wearing have a fairly narrow space there (basically they made the OZ as large as possible without making the lens much larger supposedly). They are currently making another pair which should be here today or tomorrow and I asked that centration be the major fix. As for why it cant be small they have been keeping it a bit larger than normal due to my large pupils, demonstrated some issues there before, though that could also have been centration issues. You know how it is, when you are a patient you don't know enough to be able to accurately communicate the issue. I saw glare around everything at night but I didn't know what to look for to give a better idea of my specific issue. Now I can describe the issue quite a bit better so hopefully the solution will be coming shortly. Dr. Leukoma: Thanks for the response, I very much appreciate it. I'll let my doctor know about your article and we will see. (hah.. *cough*... gotta love the bad puns.) > Dr. Leukoma: Thanks for the response, I very much appreciate it. I'll > let my doctor know about your article and we will see. (hah.. > *cough*... gotta love the bad puns.)- Hide quoted text - Well, he won't find it under "leukoma" but he will find it under Gemoules. The fitting of these lenses is not very widespread, so don't expect your fitter to leap at the suggestion. For that he would have to acquire a fitting set, and then basically start from scratch. I have quite a few large pupil patients and this is how I have learned to deal with their issues after basically doing everything else. Based on a cost-benefit analysis you might very well decide that you will accept some tradeoffs rather than go through so much trouble and expense. > > Dr. Leukoma: Thanks for the response, I very much appreciate it. > > I'll let my doctor know about your article and we will see. (hah.. [quoted text clipped - 11 lines] > accept some tradeoffs rather than go through so much trouble and > expense. Is the article available on-line anyplace? Either way, can you give us a title? By the way, are your patients able to wear these lenses happily for a full day in most cases? -- > Is the article available on-line anyplace? Either way, can you give us > a title? A Novel Method of Fitting Scleral Lenses Using High Resolution Optical Coherence Tomography Eye & Contact Lens: Science and Clinical Practice (formerly the CLAO Journal), March 2008. Wolters Kluwer/Lippincott Williams & Wilkins publisher > By the way, are your patients able to wear these lenses happily for a > full day in most cases? In most cases. Not all cases.
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