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For many years, scleral lens fitters were limited in their ability to fit irregular ocular surfaces based on the parameters of computer software programs. Traditional fitting methods work well for most of the population; however, in eyes with irregular ocular surfaces, these methods fall short. Landing a symmetric scleral lens across an asymmetric ocular surface simply does not work. Furthermore, when lenses do not conform to the shape of the front surface of the eye, problems such as conjunctival impressions, redness, discomfort, lens intolerance, and poor vision can result.
The EyePrintPro prosthetic device (EyePrintPro), which received 510(k) clearance from the US Food and Drug Administration in March, is a game-changer when it comes to scleral lens fitting for both practitioners and patients. The EyePrintPro technology produces a prosthetic scleral shell designed to match every detail on the front surface of the eye in question, within a margin of 1 to 2 µm accuracy. Each EyePrintPro lens is unique to each individual eye, much like a fingerprint. Because it fits the ocular surface to a T, it provides the best comfort and vision possible.
An ideal candidate for EyePrintPro is any patient who requires a scleral lens to mask corneal irregularities in order to achieve maximal visual potential and/or to alleviate dry eye symptoms. Patients who have failed to achieve stable, comfortable vision despite numerous scleral lens fittings are perfect candidates. Examples are listed in the table.
NO FITTING GUIDE NEEDED
The EyePrintPro fitting procedure does not involve the use of diagnostic trial lenses. Instead, a procedure similar to that used by orthodontists is used to make a mold of the ocular surface (Figures 1 and 2). A blue impression material composed of polyvinyl siloxane is loaded onto a specialized tray and delicately slipped under the upper and lower eyelids of the patient’s eye. The impression material does not burn and, in fact, acts as a cushion when on the eye; therefore, no topical anesthesia is required. After insertion of the material, the eye is left in silent darkness as the fellow eye maintains steady fixation on a distant target. Any eye movement could affect the accuracy of the final impression.
From insertion to removal of the impression material takes less than 5 minutes per eye. The only inconvenience to the patient is having to go lens-free for at least 48 hours before the day the impression is taken. This is crucial in order to obtain an accurate impression of the ocular surface in its natural state. Once the impressions are done (Figure 3), they are shipped to the company’s laboratory, where they are scanned with a 3-D scanner. The new lenses, made from a highly oxygen-permeable material, are ready for dispensing within a week or so. EyePrintPro provides all of the tools and equipment necessary to complete the impression process.
The developers of EyePrintPro are Christine Sindt, OD, FAAO, of the University of Iowa, and Keith Parker, NCLEC, of Advanced Vision Technologies in Denver, Colorado. We had the pleasure of hosting Mr. Parker and his associate David Slater, NCLEC, for a day-long personalized workshop on the use of the technology. The company truly wants to make sure that practitioners are comfortable with the impression process. After several failed impressions and a few yanked eyelashes, our team felt comfortable using the impression material to make a perfect first impression. In addition, the EyePrintPro team provides staff training and the necessary documentation for patients to submit to their insurance companies for reimbursement.
ONE AND DONE
In our experience, the first EyePrintPro lens dispensed is the final lens, making fitting these challenging eyes significantly less time consuming than with previously available technologies. The beauty in the EyePrintPro fitting lies in the fact that there is no guesswork. The impression material captures all of the hills and valleys of the eye, and the computer software does the rest.
Case No. 1. A 65-year-old man had been using traditional scleral lenses to correct for post-LASIK ectasia. However, his front-surface–toric scleral lenses failed to provide sharp, stable acuity due to rotational instability. In addition, the patient desired to be less dependent on reading glasses. After fitting with EyePrintPro, he was able to achieve 20/15 vision in both eyes at distance and adequate intermediate and near vision without reading glasses.
Case No. 2. A 53-year-old man had been successfully wearing scleral lenses for his keratoconus for several years. In an unfortunate series of events, he developed a retinal detachment in his right eye and underwent a combined scleral buckle and vitrectomy procedure. A few months afterward, the patient underwent a subsequent vitrectomy due to dislocation of his IOL toward the posterior retina. The combination of surgeries for retinal detachment repair and IOL relocation left the sclera irregular and the conjunctiva chemotic, making it extremely difficult to fit with a stable scleral lens. After fitting with EyePrintPro, he was able to achieve clear and stable vision with excellent comfort.
Case No. 3. This case involves one of the authors (EB). In his own words: “My corneas did not necessarily require the precision of the EyePrintPro technology. However, whenever possible, I try to test a product before recommending it to patients.
“With refractions of +4.00 -3.50 X 085 in the right eye, +2.50 -2.00 × 095 in the left and +2.50 [add], I was never able to achieve adequate distance and near vision with traditional multifocal scleral lenses. A pesky cataract in my right eye left me with about 2.00 D of residual cylinder that had to be incorporated into the right lens as a front surface toric. With these lenses, my vision was not stable, and I was unable to achieve the near focus I desired.
“For a long time, I settled for monovision, with the right eye corrected for near and the left eye corrected for distance. After being fit with EyePrintPro multifocal lenses, I now wear the lenses every day while in the office, and I am amazed at how clearly I can see up close. Wearing the lenses myself also serves as a great marketing tool for this new technology.”
Because EyePrintPro serves such a niche population, only a small percentage of the nation’s eye care providers are trained to fit these lenses. A list of EyePrintPro fitters can be found on the company’s website. For now, EyePrintPro lenses are available with sphere, toric, multifocal, and prism optics. Developers are working on incorporating correction for higher-order aberrations that occur behind the anterior corneal surface. We look forward to seeing what the future holds for this revolutionary technology. n
Edward L. Boshnick, OD
• Global Vision Rehabilitation Center, Miami, Florida
• (305) 271-8206; email@example.com
• Financial interest: none acknowledged
Jennifer Vicente, OD
• Ocular Disease Resident at Omni Eye Services of New Jersey
• Financial interest: none acknowledged