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There are thousands of patients in the US with disfigured eyes, yet only 5% to 10% of these patients are being treated with prosthetic lenses.1 This leaves an opportunity for eye care professionals to help the 90% to 95% of patients who could improve their appearance and even the function of their eyes. It only takes a minor effort to learn about prosthetic technology and fitting, but this small effort has the potential to reward your patients with significant, life-changing benefits. The first step is to understand the conditions that may be suitable for prosthetic soft contact lenses.
Prosthetic conditions
Prosthetic lenses can be used to treat several conditions of diseased or disfigured eyes, and functional or non-functional eyes. The tables below outline these conditions.
Corneal Leukoma
Non-Functional Eyes1
| CONDITION |
MANIFESTATION |
BENEFIT OF PROSTHETIC LENS |
| GLOBE ABNORMALITLES |
| Phthisis bulbi |
|
Cosmesis |
| Buphthalmos |
|
Cosmesis |
| Trauma (opacity) |
Opacified |
Cosmesis |
| CORNEAL |
| Congenital leukoma |
Opacified |
Cosmesis |
| LENS |
| Dense Cataracts |
Opacified |
Cosmesis |
| VITREOUS/RETINA |
| Retinal (detachment) |
Photophobia |
Light blocking, comfort |
| Macular aplasia |
Photophobia |
Light blocking, comfort |
| Hypoplasia |
Photophobia |
Light blocking, comfort |
| Iris |
| Aniridia (non-functional) |
Photophobia |
Light blocking, comfort |
Functional Eyes1
| CONDITION |
MANIFESTATION |
BENEFIT OF PROSTHETIC LENS |
| Corneal |
| Leukoma |
Opacity |
Cosmesis |
| Bullos keratopathy |
Opacity |
Cosmesis |
| Band keratopathy |
Opacity |
Cosmesis |
| Micro cornea |
Iris size decreased |
Cosmesis |
| Keratorefractive surgery |
Scars |
Cosmesis |
| Lens |
| Aphakia |
Lens absence |
Photophobia |
| Pseudophakia |
Lens absence |
Photophobia |
| Subluxated lens |
Lens absence |
Photophobia |
| Vitreous/Retina |
| Maculopathies |
|
Photophobia |
| Color deficiency |
|
Photophobia/filtering |
| Cone dystophy |
Rod saturation |
Photophobia/filtering |
| Iris |
| Aniridia |
Iris absence |
Glare, photophobia |
| Colobomas |
Iris loss |
Glare, photophobia |
| Polycoria |
More than one pupil |
Glare, photophobia, diplopia |
| Heterochromia (uveitis) |
Pigment variation |
Cosmesis |
| Iridectomies/iridoplegia |
Iris loss |
Glare, photophobia |
| Posterior synechiae |
Pupil enlarged surgically |
Excessive glare |
| Trauma/muscular |
| Diplopia> |
Double vision |
Total occlusion (patch lens) |
| Amblyopia |
“Lazy” eye |
Total occlusion (patch lens) |
Other conditions that may benefit from prosthetic lenses include iris translucency, photophobia, refractive error, decreased visual acuity, oculocutaneous albinism, which includes nystagmus and photophobia found in patients with albinism, aniridia, sector iridectomies, rod monochromatism, code dystrophy, retinitis pigmentosa, and colobomas.
The next step is to develop and follow an easy fitting procedure to integrate this specialty into your practice.
Prosthetic fitting procedure
Fitting a prosthetic lens is much like fitting a regular soft contact lens with a few extra considerations depending on the patient’s needs.
Setting proper expectations with your patients is the first step. It’s important that they understand what the results will be (functional vs cosmetic).
Other steps include:
- Evaluate clinical history and make sure that the underlying condition is stable or resolved.
- Keratometry readings and corneal topography may be difficult to measure, so it may be helpful to take readings of the fellow eye as a guide for diagnostic lens selection.
- Don’t forget the refractive error. Remember that prosthetics come in spherical and toric powers.
- To determine the correct iris color, use a diagnostic lens. CIBA Vision offers a 9 lens diagnostic kit, as well as the two underprint diagnostic lenses.
- How to Order
- To determine the correct iris size, the visible horizontal iris diameter should be measured in the undamaged eye.
- To determine the correct pupil size, measure the undamaged pupil in normal to bright lighting with a millimeter ruler.
- To achieve the best centration, stability, and movement, start with a clear trial lens to determine the base curve needed. Select the optimal base curve as indicated by the keratometry readings and corneal topography of the undamaged eye. Selecting the optimal base curve is vital to preventing a lens with excessive movement, which is more noticeable in patients with cosmetic needs.
Lastly, it’s highly recommended that patients come in for regular follow-up visits to help minimize possible complications that arise from contact lens wear. It is also recommended that every prosthetic patient be evaluated thoroughly with a post-wear biomicroscopy with sodium fluorescein, as some eyes are not able to wear the lens. Also, some conditions may aggravate due to lens wear.
Final Prosthetic Appearance
Prosthetic lens options
Prosthetic lenses are available in a broad range of colors, designs and powers, and in several choices of hard and soft lens materials. Soft lenses are usually used because they are able to fit a wider range of corneal conditions with excellent comfort and results.
Regardless of the material and parameters needed, all prosthetic lenses are made-to-order for each patient. For the widest range of colors, patterns, and parameters available, look to the CIBA Vision Special Eyes Program. The Special Eyes Program also donates to vision care education and offers discounts for indigent patients.
Choose a lens that CIBA Vision Specialty Lens Group offers for prosthetic: Durasoft® 2 Prosthetics and Durasoft® 3 Prosthetics
References
- Bator KK, Salituro SM. Prosthetic contact lenses and you. Eye & Contact Lens: Science & Clinical Practice. 31(5):215-218, September 2005.
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