Best lenses for an Aphake
Hi,
Havn't had much experience with aphakic patients.
A patient has just been refracted 3 months after a cataract surgery with no IOL inserted.
As the vision will still be stabalising single vision lenses will be the best option as opposted to multi focials.
My question is what would be the better option in terms of UV protection and protection from bright light
A cr39 with UV coating or a polycarb lens ? or another option.
Your help is much appreciated
Use CR39 (AFAIK specialized aphaik lenses are made only in CR39). The chromatic aberrations caused by other materials will be huge.
Polynomial post-cataract lenses (eliminated ring scotoma, asphericaly corected oblique estigmatism, etc):
- Zeiss Clarlet Aphal
- Essilor Omega Orma
- Rodenstock Perfastar
Use AR coated lenses with UV400 treatment (you can ad tints as well if the client is very sensitive to bright light).
Keep in mind the Corneal Vertex Distance.
Even small differences between refracted C.V.D. and actual C.V.D. will produce large differences in dioptre power experienced by the eye.
Btw, aphakia post cataract eyes often have excellent visual acuity (20/20 and above).
PS: All this info is from the book "Ophthalmic Lenses and Dispensing, by Mo Jalie".
Invest in quality textbooks, having references like that is very useful.
Best regards,
Nikolay Angelov
In terms of cost will this be the best option?
The patient is only likely to have these lenses for 3 months as the prescription stabilizes.
Thanks for the help.
In my opinion.....CR-39 would be your best cost/function option. Tint with a flesh tone 12% tint, and UV400 treat the lens. MED fitting will should be followed for best cosmetic and visual result.
Ummm.....Why would you think that?Originally Posted by bhara
Thanks for your help guys. I will probably go for the CR39 option for the patient then its seems like the best option!
Thanks for the advice.
That is his decision to make. You just give him the options.In terms of cost will this be the best option?
On the other hand, would you live 3 months of Your life with lousy vision?
Well fitted well managed PMMA contacts. Second choice HGP contacts. Very far behind third, Soft contacts.
And yes I have experience with thousands. Been there done that every way posssible.
In spectacles smallest most symetrical thing you can find and patient will only use these to find the bathroom and the contacts.
Chip
I would use a super modular aspheric in single vision. CR-39
Have both eyes been done? Are both eyes aphakic?.. with no IOL? RGP fit would be optimal- but other than that an aspheric lense. Not sure why you would not need a multifocal, I would imagine you would indeed need some ADD power. Someone posted that most aphakic patients have vision close to 20/20; Not without an IOL you don't. Perhaps they meant they are usually correctable to 20/20. I had a pt in recently like this except he only has one aphakic; no IOL- and it was a challenge.
Paula
~Follow Your Bliss~
My mother has been aphakic since she was 12, and she has found that rgp's give her the best vision and the best depth perception, along with allowing her to walk and drive around without puking her brains out. I've tried alot of different lenses as far as glasses go, and she's most comfortable in a basic lenticular. Not sure what name brand or style, but the one that looks like a fried egg. Ditto what chip says as for the frame. Small, round, as little decentration as possible.
Actually the optics are so poor in thick (aphakic) HGP lenses. The flanges are so fragile and the adhesion of lid fluids are so much more of a problem. Not to mention the "oxygen permeablity) is nil on such thick lenses. I will have to maintain that a good well fitted well managed PMMA lens is many times better for aphakes.
Chip
Its just one eye thats aphakik and has no IOL.
I want a spectacle option, not CL, i understand it might not be the best option for the patient.
I took the advice of someone earlier in this thread and was reading Mo Jalies' book which suggested lenticulars such as the Essilor Omega.
However does anyone know if this lens is available as a bifocal?
If you could provide the rx it would sure help. There are many aphakes that have minimum rx after surgery. I have a buddy that was -16.00 prior to surgery and is now -1.50 or so. Everyone assumes that an aphake is going to be +12
The Rx is R +13.50/-1.50 x 55 and a balance for the left eye which is +12.75
Put the man in any spectacle lens and he will have only about 25 degrees of clear vision. Have ring scotomas. Doorways will look so narrow he will doubt his ability to pass through them. Objects will appear about 14% larger than they are.
There are a lot of other good reasons for putting the patient in contacts but these should at least start you thinking and reading.
Chip
This indeed would be a good choice. However the fitter may feels unable to do this particular fit so contacts are avoided.Well fitted well managed ... contacts
I know i can't do it. I wouldn't take a person's money knowing i can't do the job as it should be done (and we don't fit rigid CLs).
I would have sent him for CL fitting/consultation at one of the eye clinics/hospitals around (where they have contactologyst).
If Mr. Anderson was nearby, i would have sent the patent straight to him, and sleep well knowing that a CL expert will do the job right.
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