SCLERAL LENS ONE FIT

1. KRISHNA KUMAR DHANKHOTI
OPTOMETRIST

3. WHY SCLERAL LENS?
TO VAULT PROBLEMS!!!!
https://www.eyecareconcepts.com.au/scleral-lenses-melbourne.html

4. Advantanges
• Solves problems other lenses can’t
• Initial Comfort (no lens to lid interaction)
• Sharp Crisp Vision (like GP lens)
• No debris entrapment under the lens
• Masks corneal astigmatism
• Keeps the cornea and ocular surface moist
• Helps restore ocular surface disorders

5. RIGHT CANDIDATES ?

6. Scleral lens design demands
• One design to fit a wider range of ectasias, as well as regular corneas.
• A lens thin enough to allow sufficient oxygen transmission and strength.
• A diameter that simplifies fitting and manipulation
The Onefit™ MED Platform
• A lens that allows full and easy customization of every section (central, mid-
peripheral, limbal and edge)
• A lens that offers web base support to facilitate the fitting

7. The Onefit™ MED
Full customization with four fitting zones:

8. The Onefit™ MED
CENTRAL

9. The Onefit™ MED Parameters
Parameters
SAG range: 3800 µ - 6600 µ @ 50 µ steps
Diameters: 15.6mm - Standard 90% + of your patients 16.0mm,
16.4mm available for larger corneas (12.3mm and over)
15.6 mm

10. Parameters - Fitting Zone Evaluation – Affords Complete Fitting Control
M Value - Mid-Peripheral Clearance
Maximum Amplitude of Change
9.5mm Diameter
Range: -300 to +300 microns
Increase Clearance (+) Decrease Clearance (-)

11. Fitting Zone Evaluation – Affords Complete Fitting Control
L-Value - Limbal Clearance
Maximum Amplitude of Change 12.0mm Diameter Range: -300 to +300 microns
Option: In quadrants
Increase Clearance (+) Decrease Clearance (-)
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12. Fitting Zone Evaluation – Affords Complete Fitting Control
E Value - Edge Alignment
A combination of peripheral curve and tangent lathing technologies
provides enhanced support within the lens peripheral landing zone beyond the limbus.
Range: -300 to +300 microns
Option: In quadrants
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13. Fitting Zone Evaluation – Affords Complete Fitting Control
Edge Alignment - Toric Haptic
Aligns lens to scleral asymmetry for improved lens edge alignment
for better lens centration and for Toric Rx stabilization
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Lenses are etched to indicate
the flattest meridian
Std TPC: +75/-75

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Fitting Zone Evaluation – Affords Complete Fitting Control
Edge Alignment - Toric Haptic
Preferred design option to stabilize Onefit™ MED Front Toric lenses
When prescribing Front Toric lenses, a minimum of 100 microns difference between the two
meridians is needed. i.e., Edge: -50 / +50
Use LARS to compensate for
misaligned axis
Additional marking @ 6:00

15. Fitting Zone Evaluation – Affords Complete
Fitting Control
Oblate geometries
Use Oblate Geometries to reduce minus power or
better align to oblate corneas
▶ CCR-Central Clearance Reduction
▶ 70 microns (+2.00)
▶ 110 Microns (+4.00)
▶ 150 Microns (+6.00)
▶ 190 Microns (+8.00)
▶ 230 Microns ( +10.00)
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16. All these option are open for the fitter
For Summary
SAG VALUE
M
VALUE
L VALUE
EDGE VALUE
OBLATE
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17. For complete control of the design
Onefit™ MED, 4 Zones
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18. •Flat eye
•Average eye
•Steep eye
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- Choose a low sag lens
- Choose a moderate sag lens
- Choose a high sag lens
Initial lens selection - Based on scleral shape
Fitting the OneFit MED

19. Fitting the OneFit MED
Using the UV-Lamp or slit Lamp Check right
after installation:
Good Fitting Air Bubble Touch
Good Corneal and
Limbal Clearance.
Check tear layer
thickness It should be
about 250microns
Reinstall Lens Low sagittal depth,
replace with higher
sagittal lens in at
least 300microns
https://www.fit-boston.eu/downloads/scleral_lenses/A_Guide_to_Scleral_Lens_Fitting_(2ed).pdf
Troubleshooting Tips

20. Scleral Lens Fit Scales
https://www.ferris.edu/optometry/vision-research-institute/pdfs-docs/Scleral-lens-fit-scales_v2.pdf
Ideal 250 to 300µ
Optic Section View
Too thick
Too thin
Troubleshooting Tips

21. Use the laser etching of the trial lenses
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Simplified Fitting Regimen
Mid-peripheral
Limbal zones
Edge

22. Fitting Guidelines
• Tear Layer at highest corneal elevation
• At Insertion 250-275µ clearance
• After 4 hours + Ideal clearance of wear 150-175µ
• Tear Layer at Mid-Peripheral clearance 100-125µ
• Tear Layer at Limbal clearance 50-75µ
Simplified Fitting Regimen
Mid-peripheral
Limbal zones
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23. Fitting Guidelines
Simplified Fitting Regimen
• Edge aligned to the conjunctiva
• Over Refraction
• Flat Axis
• When Toric Rx needed
0°
90°
180°
270°
Flat Axis
Additional
marking
Finish the order using the
Online Fitting Tool!
Available at:
http://blanchardlab.com/produ
cts/onefit-med//

24. The Best OneFit™ MED Fit
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25. Fit the smallest lens possible
•Less fitting parameters to
deal with
•Less blanching and/or indentation
•Fogging is not a problem
•Less conjunctival prolapse
Remember, Small is Beautiful!
https://collaborativeeye.com/articles/july-aug-18/scleral-lens- complications-you-cant-miss/
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26. Online Fitting Tool
http://blanchardlab.com/products/onefit-med//
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27. The Onefit™ MED Difference
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Maximize Oxygen Transmission
for Optimal Health
Thinner lens Thinner tear layer
thickness
Simplified Fitting Process
Across the entire Onefit™ MED
Platform
Easy to Handle Diameter
Comfort comparable to a soft lens
• Complete control of the design
• Fits a wide range of applications:
from regular to MEDically indicated
corneas
• Meets the oxygenation standards
established by the industry
• Easy to use Fitting Calculator.
• A user friendly diameter to simplify both
fitting and handling
Review of Onefit MED Scleral Lens

28. Onefit™ MED Experience at Matrika Eye Center
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We started 3 months from now
Total Eyes (Trail):36
Total Eyes (Dispensed): 18

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My Key Learnings:
 OneFit MED has wide range of customisations
 Give Justifiable Time for your patients
(3-4 hours is minimum)
 Each case is unique
 The More you trail, the more you learn

30. Acknowledgements
- Moodi Kupperman (Cooper Vision)
- Gagan Sahani (Silverline Laboratories)
- All my patients
Thank
You