Advanced Ortho-K Technology. Proudly brought to you by. Australian Contact Lenses

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1 Proudly brought to you by Australian Contact Lenses Advanced Ortho-K Technology Are your patients looking for crystal-clear vision without surgery? Are you looking to grow your practice and enhance patient satisfaction? Emerald & ACL offers you a brilliant solution. Emerald features advanced Ortho-K technology enabling quick and easy fitting with a remarkable record of first time success. Fit Emerald and you ll be the gleam in your patients eyes!

2 Australian Contact Lenses Pty. Ltd. Unit 6, 2 Lace Street, Doveton, Victoria, Tel: (03) , Toll Free: , Fax: (03) Street bigpond.net.au Unit 6, 2 Lace Street Doveton 3177 Phone Fax Unit Toll Free 6, 2 Lace 1800 Street Doveton Phone Fax Toll Free Emerald Outstanding Results, Clearly Visible Why Emerald? Emerald delivers consistent, predictable results, time after time. And it is FDA approved as Overnight Ortho-K lens. Emerald Outstanding Results, Clearly Visible It offers a remarkable first-fit success rate and significantly reduced chair time when Emerald fitting patients delivers without consistent, trial lens predictable in the approved results, time range. after In time. a recent And it study, is FDA 83% approved of the as participants Overnight required Ortho-K lens. only 1.3 lenses per eye to achieve successful results. That s exceptional clinical performance! ld Outstanding Results, Clearly Visible It offers a remarkable first-fit success rate and significantly reduced chair time when fitting Emerald patients takes the without guesswork trial lens out of in Ortho-K the approved - and there range. is no In simpler a recent fitting study, procedure. 83% of the ivers consistent, participants Only Spec predictable Rx, required HVID, results, only Topography 1.3 time lenses after Sim per time. K s eye and And to E achieve it values is FDA successful are approved required results. to achieve That s rtho-k lens. exceptional success; no calculators clinical performance! are needed. It s fast and easy. Emerald Each lens takes is designed the guesswork to fit the out individual of Ortho-K patient s - and there cornea is no and simpler is available fitting procedure. with complete arkable first-fit success rate and significantly reduced chair time when Only flexibility Spec on all Rx, parameters. HVID, Topography This will allow Sim you K s to and get the E values best possible are required fit on each to achieve cornea. without success; Emerald trial lens lenses in the no calculators are made approved are of needed. quality range. Boston In a It s fast and XO recent easy. material. study, 83% of the quired only 1.3 lenses per eye to achieve successful results. That s inical performance! Each ACL is lens holding is designed a large to stock fit the range individual appropriate patient s for cornea the majority and is of available patients with for complete next day delivery. flexibility on all parameters. This will allow you to get the best possible fit on each cornea. the guesswork ACL Emerald & out Emerald's lenses of Ortho-K are made experienced - and of quality there consultants Boston is no simpler XO are material. ready fitting to procedure. guide you through your first, HVID, fittings Topography and are Sim committed K s to and your E success. values are required to achieve lculators ACL are needed. is holding It s a fast large and stock easy. range appropriate for the majority of patients for next day delivery. esigned to ACL fit the & Emerald's individual experienced patient s cornea consultants and is are available ready to with guide complete you through your first parameters. fittings This and will are allow committed you to to get your the success. best possible fit on each cornea. s are made of quality Boston XO material. a large stock range appropriate for the majority of patients for next day 1

3 FAQ What are Emerald contact lenses for overnight wear? Emerald lenses are a unique rigid gas permeable contact lens design that temporarily corrects myopia by gently reshaping your cornea while you sleep. You may then be able to go throughout the day without any lenses. Emerald Lenses are made from the approved extended wear contact lens material Boston XO in a special design intended for this purpose. Can everyone wear Emerald? Not everyone can wear Emerald Contact Lenses for Overnight Wear. These lenses are intended for individuals with low to moderate myopia (up to -5 diopters) and moderate astigmatism (1.50 diopters or less). What is needed to fit Emerald? Initial corneal topography readings are essential. Just provide ACL with: Spec Rx, HVID, Topography Sim K s and E values to achieve success. Who should not wear Emerald Lenses for Vision Shaping Treatment? Persons who exhibit any of the following conditions: Inflammation or infection of the eye Any eye disease, injury, or abnormality that affects the cornea or surrounding tissue Any systemic disease that may affect the eye or be worsened by wearing contact lenses Eyes that are red or irritated, or suffer severe dryness Allergic reactions of eye which may be caused or exaggerated by wearing contact lenses or use of contact lens solutions What are the risks of wearing Emerald lenses for Vision Shaping Treatment? There is a small risk involved when any contact lens is worn. It is not expected that the Emerald lenses will provide a risk that is greater than other overnight wear rigid gas permeable contact lenses. Because this procedure is temporary, some patients may notice changes in their vision late in the day. The most common patient symptoms concerned poor distance vision and flare/ghosting (visual disturbances). The incidence of these symptoms tends to decrease over time in Vision Shaping Treatment, and they will go away if lens wear is discontinued. The two most common side effects that occur in general rigid contact lens wearers are corneal edema and corneal staining. It is anticipated that the same side effects will also occur in some wearers of Emerald lenses. Other side effects that sometimes occur in all contact lens wearers are pain, redness, tearing, irritation, discharge, or abrasion of the eye. These are usually temporary conditions if the contact lenses are removed promptly. In very rare instances, infections of the eye, corneal ulcer, inflammation within the eye (iritis), new blood vessel growth into the cornea (neovascularization), and corneal scarring, and resulting permanent decreases in vision may occur. The risk of serious problems 2

4 (such as corneal ulcers and vision loss) is greater when lenses are worn overnight. In addition, studies have shown that smoking increases the risk of corneal ulcers, for those who wear lenses overnight. How long does it take to achieve good vision? Most patients have rapid improvement in the first few days of treatment and have achieved nearly their optimum vision within about 1 month. What steps can be taken until my patient achieves optimal results with Emerald? Since Emerald lenses are designed with the appropriate power correction, the patient may re-insert the lenses if their vision begins to fade late in the day. Early in the treatment period you may wish to provide a pair of disposable soft lenses to compensate for the yet corrected myopia. Ideal Candidates Emerald contact lenses are indicated for temporary reduction of myopia up to 5.00 diopters in eyes with astigmatism up to 1.50 diopters. An ideal candidate is anyone with healthy eyes desiring freedom from contacts or glasses during their waking hours. The ideal candidate: moderate myopia (up to -5 D) and/or astigmatism (up to 1.5 D) normal and healthy eyes good hygiene desire for great vision without glasses and conventional contact lenses not suitable or interested in LASIK almost any age, compliant and motivated has a good understanding of expectations The less than ideal candidate: more cylinder than refractive error poor sleep habits - procedure requires a minimum of 6 consecutive hours to be consistently effective poor hygiene lenses must be cleaned regularly to avoid corneal complications and changes to the lens surface will effect performance. myopia in excess of approved range may result in only partial correction high corneal cylinder may result in residual cylinder and poor centration clinically dry eye patients may have poor results and corneal complications An ideal candidate is anyone with healthy eyes desiring freedom from contacts or glasses during their waking hours. 3

5 Lens Parameters Emerald is approved for the following range of treatment: Approved Treatment Range: Refractive Error Cylinder Keratometry to Diopters < 1.50 Diopters to Diopters Standard Lens Parameters: 10.2 mm, 10.6 mm, Diameter* 11.0mm Power Diopters Center Thickness 0.22 mm selection based on HVID ACL holds 10.6 in stock for quick delivery. Maximum targeted correction is D. Call to discuss your options for patients with refractive error greater than D or 1.50 D of cylinder. Pricing Warranty Per Case $ Per Lens $ Includes Two Exchanges 1 st no charge 2 nd $30.00 Warranty is 3 months from original invoice date. Lenses are not covered for loss or damage. Exchange lenses must be returned. A 50% refund for Unsuccessful Patients (All lenses to be returned). Per case option available on above Treatment Range & Lens Parameters only. Outside of these, only available at per lens price. 4

6 Fitting Emerald Fitting Emerald is Fast and Easy Emerald takes the guesswork out of corneal reshaping - and there is no simpler fitting procedure. Just provide ACL with: Spec Rx, HVID, Topography Sim K s and E values to achieve success. Familiarize yourself with contraindications, troubleshooting, and other information before fitting Emerald Ortho-K Contact Lenses. Recommended Initial Examination Patient History Uncorrected Visual Acuity (VA) Refraction Corrected VA near and far with glasses or phoroptor Keratometry (Ks) Calibrated. Horizontal Visible Iris Diameter (HVID) Corneal Topography Essential Slit Lamp Examination Ophthalmoscopy Intraocular Pressure Dispensing Visit Conduct slit lamp exam without Emerald lens to ensure good cornea health. Over-refract and assess VA with Emerald lens VA should be 20/20 with lenses on. Conduct slit lamp exam and fluorescein evaluation with Emerald lens on eye lens should demonstrate small amount of movement and reasonably good centration. A slightly low riding lens is the ideal position upon dispensing. The lens will then center with the eye closed. Do not make a change unless the lens is chronically low riding with eyelid closed (as demonstrated by topography) or if unacceptable ghosting persists. Follow-up Visits Corneal Topography Essential at all visits! Re-assess patient at regular intervals: - One day - One week - One month - Three months - Six months Assess stability of orthokeratology effect Monitor corneal health Assess lens condition 5

7 Problem Solving Low riding lens Observation: A slightly low riding lens is the ideal position upon dispensing. The lens will then center with the eye closed. Do not make a change unless the lens is chronically low riding with eyelid closed (as demonstrated by topography) or if unacceptable ghosting persists. Cause: The cornea becomes flatter from the apex to the periphery. This degree of corneal flattening is different for everyone, with some corneas having a greater or lesser degree of flattening. If the flattening is too great, the alignment curves will be too steep. Solution: Loosen (flatten) the alignment curves by.50 High riding lens Cause: The high riding lens is usually caused either from the lens being too loose (AC too flat) or from an asymmetrical corneal shape. Solution: If the lens is too loose, tighten (steepen) alignment curve by 0.50 D. Vaulting Observation: Vaulting occurs when excessive bearing is present in the peripheral regions (AC too steep) causing reduced central bearing. This will be observed as central pooling or increased presence of fluorescein under the center of the lens. Cause: The major cause of central vaulting is an alignment curve (AC) that is too steep. The more peripheral from the corneal apex, the more difficult it is to predict the rate of corneal flattening. When the alignment curve is too steep, the central portion of the lens will rise up, preventing it from applying compression to the center of the cornea. A reverse curve that is too steep can also cause central vaulting but is much less common. Solution: Flatten the alignment curves by 0.50 D. The risk is that by loosening the alignment curves too much, centering problems can develop. If the lens is well centered, and does not appear tight in the alignment curve area, flatten the reverse curve by 0.10mm. 6

8 Lens decenters nasal / temporal Cause: Generally caused by a very spherical cornea or a cornea with against the rule cylinder. Solution: Increase the diameter of the lens by at least 0.40mm. The recommended diameter would be 11.0mm. This assumes an HVID of at least 11.8mm. Under Responders Observation: An under-responder is a patient whose myopia does not reduce as anticipated. An example is a 3.00, which was reduced to 1.00 after one month of wear and then remains unchanged for 3 weeks. You will be able to refract the patient, without lenses, to 20/20 or better. Cause: Typically, the under-responder will have vaulting in the center. Some patients will, however, respond slower than others perhaps due to different cell structure of the cornea. You do not want to rush into making a change if the exam figures are correct. Solution: Follow the same solutions for vaulting. If no vaulting is present, recheck the original exam figures. If the fluorescein pattern looks good, wait a while longer, e.g. at least two to three weeks to allow for slow responders. If there is still no further reduction on the unaided visual acuity, increase the target power by 0.50D to 0.75D. Central Islands Observation: Central islands are areas of distortion in the visual axis that are observed with corneal topography. If you do not use a corneal topographer in the follow-up exams, you will observe slightly distorted mires using the keratometer. This condition differs from the underresponder in that you will not be able to refract the patient, without lenses, to 20/20. Cause: Generally caused by the reverse curve being too steep, causing the base curve (BC) to lift off too much from the central cornea. Another cause is excessive astigmatism. With corneal astigmatism present, there are unequal bearing areas where the reverse curve comes into contact with the cornea. Solution: Flatten the fitting curve by 0.05mm to 0.10mm. This action applies pressure that is more central and will smooth out the central region. If the central disturbance is from astigmatism, then flattening the BC will help to correct this. Target the spherical equivalent of the original refraction to be plano to assuming the patient will not have any accommodative symptoms. 7

9 Central Staining Observation: This is a complication due to either mechanical irritation or physiological problems. Cause: One major cause of central staining is a coated lens. Because of the steep Reverse Curve (RC), it is difficult to clean the central posterior surface of the lens. This will create an irritating surface, which in turn causes the staining and a tendency for lens adherence. If the BC is too flat, the reduced mechanical pressure can also cause irritation. Reduced oxygen availability can also cause central staining but this is a rare occurrence. Solution: The first thing is to make sure the posterior surface of the lens is clean. Review the cleaning solution used. Make sure there are no dry spots. If the staining remains, steepen the BC by 0.5D. Air Bubbles Observation: Air bubbles are a common occurrence and typically disappear after wear. Only when staining occurs under a persistent air bubble does the lens need to be changed. Cause: Air bubbles form when not enough solution is under the Reverse Curve. Usually the upper lids will compress the lens to the cornea and the bubbles will disappear in the morning. The fitting curve has a steep configuration, which is sometimes difficult to fill with tears. Occasionally, the resultant air bubble can encompass 270 degrees around the RC. Any staining present is due to the air bubble where the cornea is not getting the lubrication or oxygen that it needs. Solution: If the air bubble is less than 45 degrees in length upon insertion, just monitor the next day to see if any staining occurs. If the air bubble is greater than 45 degrees, have the patient remove the lens and fill the concave surface with solution and the reinsert the lens while looking down. If a large air bubble persists, monitor the next day to see if it remains and staining persists. If so, monitor for three days to see if the bubble and staining recede. If both persist, then flatten the reverse curve 0.10mm. This will reduce the steepness of the reverse curve and reduce the air bubble. Air bubbles are usually a selflimiting condition, which require no change. 8

10 Reduced Holding Time Observation: This is when the unaided visual acuity after cornea reshaping does not hold an acceptable amount of time. Cause: Generally caused by a lens that is not centered, with the steep area almost touching the visual axis. When the cornea normally regresses, the visual axis is impacted sooner because there is less distance between the visual axis and the edge of the peripheral steep ring. If some vaulting has occurred, there will be a smaller central visual zone with a corresponding wider concentric steep ring. The cornea can only undergo a limited amount of change. Usually, the more induced change, the faster the cornea will regress. Therefore, if you have reduced 5.00 diopters of myopia, you should not expect the unaided visual acuity to hold all day. As a general rule, the lower the starting amount of myopia, the greater chance of holding for all waking hours. Emerald is not recommended for reducing myopia greater than 5.00 diopters. Solution: If the lens is de-centered, make the appropriate modifications to the design to center the lens better. If vaulting is present, do what is required to reduce the vaulting (see vaulting above). Flattening the BC by 0.50 D can also prolong the holding time by making the cornea change more before a decrease in UCVA is noticed. Flattening the base curve will only be effective for a patient that is able to accommodate the additional correction early in the day. Ghosting at Night Observation: Night ghosting is a normal observation. This usually recedes with time but may always be present to some extent. Cause: The main cause of ghosting is when the reduced illumination at night causes the pupil to become larger than the central correction area of the cornea. This might occur even with a well-centered lens. Patients with smaller pupils will experience this very little or not at all, compared to patients with very large pupils. Another cause of ghosting is a decentered lens. This can present as ghosting reported during the day. Central islands can also give the same subjective complaints as ghosting. Solution: Time is the answer for normal ghosting. If the lens is not centered, then follow the methods described earlier to center the lens. The optical zone of the lens can also be enlarged from 6.2 to 6.5mm. However, this might lead to a decrease in the holding time. It is recommended that you wait 1 month before increasing the size of the optical zone. 9

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