Hey all,

I found out recently that optical connection is currently in clinical trials of their FDA approved soft contacts with a wavefront guided correction?(the one specific to each person) on the lenses.

They are currently only doing the trials with lenses that have the pre-made shapes, but the VP tells me that the second phase sometime next year they will have ones based on topography. I actually talked to a Dr. who is part of the clinical test and he says they get rid of his chromatic abberation, whatever that is. In any case, they are a pretty excited about the new contacts since apparently they are working out pretty well, and I've been told by a company representative that they will definitely fit the post-rs eye (ones based on a topography). He also said that they use a system of ballasts on the contacts and have excellent success keeping them stationary (which was apparently crucial to the lenses being functional).

Also, don't want to discourage anyone from RGPs, RGPs are definitely the solution currently, and they can get rid of quite a lot of abberations! But it would be interesting what these new ones will do...

http://www.optom.com/ - dr. thats part of trials

http://www.opticonnection.com/products/wavetouch.html

This has been discussed in many posts on many different threads. You may want to do a search of the archives.

Soft contact lenses in the majority of cases do not fit the post-RS cornea or we would be using them all the time. Soft lenses create their own aberrations, aberrations that fluctuate with blinking. The lack of consistent contouring of the RS corneal surface by soft lenses makes wavefront designed lenses impractical. Most topographic measurements break down past 6 or 7 mm and, typically with post-myopic RS, reveal some relatively steep curvatures that preclude exacting design or stabilization.

While it can be beneficial to talk to company reps and VPs, they typically paint brightly colored pictures for all who are eager for relief. The perspective on this depends on WHEN you jumped into the search for post-RS solutions. Companies thrive on their ability to seemingly re-define optics or re-invent contact lenses but, in the final analysis, it comes down to physical optics and basic mechanics. The FDA does not approve lenses based on a company's clinical claims so much as the safety aspect of wearing them. I don't believe I have ever noted a situation where the marketing failed to exaggerate the performance.

This message has been edited. Last edited by: Dr. DavOD Hartzok,

Thank you for your response on this Dr. I will be honest, I was quite discouraged after reading your post, but if this is the case, then it is better to know before having false hope for something that really won't work. I am quite happy with my RGPs, I suppose it is best to just become comfortable with them rather than chase the pie in the sky etc.

So I must ask to calm my mind, do you think the only real solution for the post-RS eye with GASH is really the custom RGP (which can never be wavefront correcting as they rotate)? And beyond that, based on the "physical optics and basic mechanics", wavefront glasses, synergeyes, and wavefront contacts really have low chances of working for post-RS now or in the future?

Cayeung,

Too often, patients forget that the same kind of hype with which they're bombarded in their quest for a "fix" is exactly what got them into trouble in the first place—over-promising and under-delivering.

If your RGPs are comfortably doing the trick of restoring your vision, you're well advised to stick with them. In the words of Voltaire, "better is the enemy of good."

So far, the only real solution for the post-RS eye with GASH has been a custom fitted RGP prosthetic lens, in much the same way that a patient with a missing limb depends on a prosthetic replacement to restore function.

The benefit from wavefront-generated glasses requires (1) looking through the optical center of the spectacle lens at all times AND (2) maintaining the exact (as measured) vertex distance (the distance between the back surface of the lens and cornea). If you look off center or if your glasses are out of adjustment, the wavefront advantage is lost. There may be some benefit in the asphericity of the lenses. But shaping a lens surface to micron tolerances makes little sense when the simple act of smiling can alter the position of your glasses on your face by 1000 microns. The tolerance of cutting (edging) a pair of spectacle lenses to fit into a frame is about one-half millimeter (500 microns). Measuring the distance between the eyes is to one-half millimeter.

Auto makers could provide odometers to read the distance traveled in feet but what would be the point.

RGPs must move a little and will always rotate a little. Their benefit lies in (1) the inadvertent correction of the peri-ablation refractive error, (2) reducing the oblate post-RS corneal profile and (3) correcting surface irregularities within the ablation zone. Attempting to restore the corneal surface close to pre-surgical optical integrity is pretty much it. Making them comfortable to wear is the challenge.

Synergeyes fails to address the actual post-surgical corneal profile. Vaulting the ablation zone with a plastic dome does not provide crisp optics. There is not enough contouring of the lens to give optimal vision. This doesn't mean a patient with Refractive Surgery Syndrome may not benefit relative to no lens or a poorer design. Everything is relative. But if one is attempting to create the best optics, there has to be more customization.

The real solution for the post-RS eye with GASH is getting the patient to understand that an RGP is not static, that optimizing the optics and mechanical fit is a dynamic process. However one arrives at the initial lens, the key to fitting is in tinkering with the mechanics and the optics - being able to adjust the various factors - AFTER the lens has reached a physical and physiological equilibrium. This takes time and patience. Unfortunately, contact lenses have become commodities in the public's mind. This is why post-RS RGPs, IMO, should be called corneal prostheses. They should be thought of as an ophthalmic appliance. The mindset of the patient AND the prescribing doctor must not be "contact lenses". Post-RS corneal appliances, corneal prostheses - devices used for correcting vision in patients with pathological (e.g., keratoconus), post-surgical (refractive surgery, corneal transplants) and traumatically injured corneas. Save the term contact lenses for vision correcting devices used on normal eyes.

Thank you for taking time to address my issues. I do enjoy close to pre-surgical vision with the RGPs I have now. Again I agree, it is best to stick with them and be happy with the vision they provide.

It is unfortunate (but at the same time fortunate for others), that we are so few in number that the drive for creating solutions to post-RS etc. issues is not quite there. Neither is even the concept in the patients mind. I agree I always viewed them still as contacts, but I suppose the typical solutions no longer apply to us, and that is why these products being released for the mass consumer will continue to dissapoint. I hope though in the future that they do develop some sort of wavefront correcting prostheses for post-RS corneas, but I do see it taking a serious amount of time and patience between the doctor and patient, similar to the fitting of my RGPs to find the right fit. Hopefully the low demand can be offset by simply charging a large premium to the few in need, perhaps that will be a driving factor in their development.