Superior decentration of GP contacts

Discussion in 'Contact Lenses' started by obsrving, Mar 17, 2008.

  1. obsrving

    obsrving Guest

    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?
     
    obsrving, Mar 17, 2008
    #1
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  2. obsrving

    Dr. Leukoma Guest

    Try a semi-scleral or cornea-scleral lens. Those cannot become
    decentered.
     
    Dr. Leukoma, Mar 18, 2008
    #2
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  3. obsrving

    obsrving Guest

    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.
     
    obsrving, Mar 19, 2008
    #3
  4. obsrving

    obsrving Guest

    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.
     
    obsrving, Mar 19, 2008
    #4
  5. obsrving

    Dr. Leukoma Guest

    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.
     
    Dr. Leukoma, Mar 20, 2008
    #5
  6. obsrving

    p.clarkii Guest

    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.
     
    p.clarkii, Mar 20, 2008
    #6
  7. obsrving

    obsrving Guest


    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.)
     
    obsrving, Mar 20, 2008
    #7
  8. obsrving

    Dr. Leukoma Guest

    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, Mar 20, 2008
    #8
  9. obsrving

    Charles Guest

    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?

    --
     
    Charles, Mar 22, 2008
    #9
  10. obsrving

    Dr. Leukoma Guest

    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
    In most cases. Not all cases.
     
    Dr. Leukoma, Mar 22, 2008
    #10
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