Kerasoft IC and K3 Trial

[Lynn White]

Speedy

The KIC stands for KeraSoft Irregular Cornea and as Gareth says, its all in the design. The material is the same as KeraSoft3. Some people have more irregular corneas than others and for those that a regular shaped lens doesn't work, a more customised lens can be made. So these trials are looking at the design - and I was asking for volunteers here because this is where you can find lots of people with eyes that are difficult to fit!

With the KIC, practitioners will be able to fit reverse geometry - centre flat, steep periphery - for corneas that are post graft, post lasik and so on. You can also fit centre steep, flat periphery for PMD and KC where peripheries are flat. A third option will be to have KIC SMC (Sector Management Control) which is basically manipulating the periphery so that there are steep and flat areas on the same back surface.

All of these will be designed with the aid of topography and what I have been doing is looking at topographies and trying different designs based on what they show. What Gareth says is interesting because when I was in Holland, the major scleral fitter there asked why don't UltraVision just do SMC design for everyone and I said well, actually, in some people where you think it would be better (looking at the topography) the original KeraSoft3 works really well, if not better. This may be due to the dynamics of lid pressure, tear volume and so on. This is what happened with Gareth's right eye.

However, on corneas where the cone is displaced to such an extent that RGPs simply won't centre properly, the SMC works really well as it is designed to match the shape of the eye.

Lynn

[Speedy]

My cornea (moderate to advanced keratoconus) is very flat with Intacs now but very sensitive to hybrids (SynergEyes) and sclerals (Falco). Maybe the Kerasoft IC could be a possibility. Currently I am not sure if this soft-lens provides sufficient eye sight improvement.

[Lynn White]

Speedy

Depends on what you call sufficient!! This, for any person with KC, is entirely dependent on the particular eye and often the way in which previous lenses have been fitted. It is possible to get acuity up to RGP standards (say 6/4) with KIC - but not with absolutely everyone, it depends on the state of the cornea and the level of Higher Order Aberrations and many other factors.

Sufficient vision is also very subjective with ANY lens system. If you can get 6/4 with an RGP but can only wear it 3 hours a day and can get 6/6 with, say a scleral, but can wear that 14 hours a day, then the 6/6 is a much better option than the 6/4 if you can only get 6/60 without any contact lenses and can't see through spectacles.

I post on many forums and I see lots of discussions about the relative merits of one lens over another, vision wise. One person may boast they can now see "perfectly" with such and such a system and other people go "Yes!! That's the one I will go for too!". However, I always point out that KC is a designer condition needing designer lenses and what is brilliant for one person is not for another. It is impossible to make any kind of decision based on what one reads - there has to be some sort of trial to see if you are suitable for any kind of lens and to discover what level of vision you will get out of it.

Going back to your post, it is your kind of cornea that the KIC is designed for. Intacs can reshape the cornea in some ways like lasik and grafting, creating a flattish centre, but in other ways unlike those because they tend to have steep peripheries, whereas post intacs can be very peculiar shapes indeed, having even flatter peripheries.

The "traditional" KC contact lenses were designed before intacs were used for KC and all manufacturers are now designing "IC" lenses to take account of new treatments. Some of the hardest corneas to fit with traditional lenses are those who get keratoconus after having lasik. Its like having a bulge on a table top mountain!

Lynn

[pepepepe]

I say,the more contacts for KC the better, and we are quite lucky to have many to choose from if we add them all up in number, if only they can get to where they are needed at a fitting room ! Does anyone know when Kerasofts may be able to be got easily from NHS hospitals ? (the costs of them thus reducing for the patient a lot also) and what are the reasons why they are not ? The reason I ask is because they may be of a good use for those who don't really need or want to be going in to RGPs right away when contact lens wearing is being considered and discomfort issues may play a role in the decision at that time also.

I think I would feel more like I don't have KC in soft lenses ! (can we get disposable ones soon ! and may be ones to change eye colour also !

Pepe

[Lynn White]

Pepe

KeraSoft lenses are already available at lots of NHS hospitals but it is up to the hospital departments themselves what lenses they choose to fit - no-one else has any control over that. Even if a contact lens department has many different fitting sets available, it is then up to the individual fitter what lens he/she fits. Departments do not usually advertise that they fit any particular type of lens so it is up to the patient to discuss lens types with their hospital fitter.

In other words there is absolutely no reason why anyone cannot get KeraSoft lenses through the NHS - but it is entirely up to the individual fitter to decide on what is in the best clinical interests of the patient. It is also theoretically possible, if a local hospital does not fit them but a local optometrist does, privately, for the hospital to allow supply through that optometrist using the HES form - but this is a decision in the hands of the consultant ophthalmologist concerned and possibly the PCT.

Hope this helps!

Lynn

[pepepepe]

So I take it that the use of a lens depends on what options the hospital fitters know of and also their confidence in fitting a particular lens (?) - both of which should be increased where its not holding anyone back (please correct me if I'm wrong or if there are other elements also, which i am sure there may be)

[Andrew MacLean]

Actually pepe, I think you are unfair in your assessment of hospital contact lens clinics: in my experience the optometrists at the hospital I attend are not only skilled in fitting a very wide range of lenses, but also endlessly patient in their efforts to find the right lens for even the most difficult of patients.

I take my hat off to them; they kept me able to see until my eyes became intolerant of any lens and even then they kept trying.

Andrew

[pepepepe]

I wasn't saying that, only what the barriers are, one may be cost, the other may be on top of this a "treatment" seen more as something which is luxury or elective, I was just asking what the reasons may be, was it the lack of fitting skills/experience, a NHS fitter had fitted them but side effects was seen with them/ was not as good as it was thought/ no long term results with a particular lens ? or something else.

[Andrew MacLean]

pepe

Now you have me really confused! For the record, I think that NHS optometry as practiced in my part of the world is absolutely first rate; the optometrists who work in the service are up to date with the latest developments in lens styles and materials and keep people seeing and with healthy eyes.

Well done to them, I say!

Andrew

[private104]

Yea. Me too. I got lenses that fit comfortably; wearing hybrids. Thanx NHS.