Fitting Guide Minutes-to-Fit 2.0 by SynergEyes Moving Vision Forward
Minutes-to-Fit 2.0 Everyday success made easy! Thank you for making Duette HD, by SynergEyes, a part of your contact lens practice. We appreciate your business and loyalty. Table of Contents PRODUCT OVERVIEW AND PATIENT CANDIDATES... page 1 DUETTE HD FITTING FLOW CHART... pages 2-3 DUETTE HD FITTING GUIDE... page 4 DUETTE HD DISPENSE & FOLLOW-UP GUIDES... page 5 DUETTE HD TROUBLESHOOTING GUIDE... pages 6-9 RECOMMENDED SOLUTIONS... back cover CONTACT INFORMATION... back cover Empirical Ordering Lenses may also be ordered empirically by calling Consultation at 877.733.2012, option 2, Monday-Friday 9:00 AM - 8:00 PM (EST).
Duette HD is the perfect contact lens for exceptional vision! Your patients will say Wow! when they experience the consistently clear vision of Duette HD contact lenses. The Duette difference. Uncompromised Optics Rigid lens center and optimized tear layer deliver precise acuity and excellent vision, even at night The asphericity of the rigid center inherently provides greater depth of focus Stable Vision Throughout the Day Rotationally symmetric hybrid platform keeps optics in place Comfort by Design New skirt design promotes all-day tear exchange and movement Comfort similar to a soft lens Patient Candidates Duette HD is a great lens for any patient who want to see better than they ve ever seen before. Reach for Duette HD for your patient with: 1.50D or more of corneal astigmatism Emerging presbyopia with up to 1.00D add needs A prescription greater than +/-4.00D with or without astigmatism HD spectacles who is interested in contact lens wear Unsuccessful soft lens wear history due to unstable vision, less than optimal acuity or poor late day or night vision 1
Duette HD Minutes-to-Fit 2.0 Flow Chart SELECT & VERIFY: No Fluorescein Required SELECT BASE CURVE use mid-k to select base curve from the chart below INSERT LENS fill the lens with solution and insert medium skirt in one eye and flat skirt in other let lens settle 10-30 minutes VERIFY FIT assess lens VERIFY movement SKIRT and choose the FLATTEST skirt that provides up to 1mm of movement if movement not ideal 2 Base Curve SELECTION (up to 3.00D of corneal astigmatism only)* Mid-K (in Diopters) Base Curve 41.00D - 42.00D 8.1mm (41.75D) 42.25D - 43.25D 7.9mm (42.75D) 43.50D - 44.25D 7.7mm (43.75D) 44.50D - 45.50D 7.5mm (45.00D) 45.75D - 46.75D 7.3mm (46.25D) 47.00D - 48.00D 7.1mm (47.50D) *If corneal astigmatism is below 1.00D or over 3.00D, find a base curve that is between +0.50D and +1.50D steeper than the Flat K to create the optimal tear lens. (Tear lens = RGP base curve (in diopters) minus the flat K.) excessive movement or edge wrinkling: steepen skirt if no movement, refer to troubleshooting guide
FINALIZE & DEMONSTRATE if movement ideal over-refract due to the tear lens, lens power is expected to be 0.50D to 1.50D more minus than the sphere power of the spec Rx* if patient is happy with vision SHOW VISION demonstrate vision and order lenses if patient is not happy with vision if excessive lenticular astigmatism present check for uncorrected cylinder in the over-refraction patient not a candidate *Over-refraction may need to be adjusted for power of diagnostic lens. Fitting Philosophy: Fit the rigid center like an RGP, and fit the soft skirt like a soft lens. Fitting Objective: Fit the flattest skirt that provides both comfort and centration to maximize tear circulation through maximum edge lift. 3
Duette HD Minutes-to-Fit 2.0 Fitting Guide SELECT BASE CURVE For corneas under 3.00D of astigmatism, determine the mid-k and use the chart provided. (The mid K is the K value halfway between the flattest K and the steepest K.) If the corneal astigmatism is below 1.00D or over 3.00D, find a base curve that is between +0.50D and +1.50D steeper than the Flat K to create the optimal tear lens. (Tear lens = RGP base curve (in diopters) minus the flat K.) Fitting Philosophy: Fit the rigid center like an RGP, and fit the soft skirt like a soft lens. Fitting Objective: Fit the flattest skirt that provides both comfort and centration to maximize tear circulation through maximum edge lift. Start with a medium skirt in one eye and a flat skirt in the other eye. Fill the bowl of the contact lens with solution when inserting and allow the lenses to settle for no less than ten minutes and up to 30 minutes. Assess movement and patient comfort and choose the flattest skirt curve that provides: Lens movement up to 1mm (at straight ahead and upward gaze) Good centration No wrinkling at the skirt edge At this stage, there may be awareness of the flatter compared to the steeper skirt, which is acceptable. Differentiate between discomfort and mild awareness. Mild awareness is not a concern as adaptation by wearing the lenses will eliminate this sensation. There is no need to try the selected skirt curve on the opposite eye in patients having similar Ks OU. Perform a distance over-refraction, utilizing the over-plus refractive method, to protect against inadvertent over minusing. Due to the tear lens, the final lens power is expected to be 0.50D to 1.50D more minus than the spherical portion of the spectacle refraction*. (Do not adjust for the cylinder correction of the spectacle Rx.) If the final lens power is greater than 1.50D more minus than the spherical portion of the spectacle refraction, order the next flatter base curve and add +1.00D to the over-refraction. 4 INSERT LENS VERIFY FIT Over-refract SHOW VISION Demonstrate vision and order the lenses in the selected parameters, making sure to adjust the power of the lens for vertex distance if the power is over +/-4.00 diopters. *Over-refraction may need to be adjusted for power of diagnostic lens.
Duette HD Dispense Guide 1. Check lens fit for acceptable movement and comfort. 2. Assess visual acuity. 3. As long as fit and vision are appropriate, refrain from making changes at dispense. 4. Have a staff member train the patient on lens insertion, removal and care. Videos are available on FitDuette.com and VisionUncompromised.com. Duette HD Follow-Up Guide A follow-up exam is suggested after the patient has been wearing the lenses for two weeks. The patient should come to the appointment having worn the lenses for a minimum of two hours. 1. Assess Lens Movement and Patient Comfort Verify movement on blink up to 1mm. In the absence of a dry eye diagnosis, patients should get a minimum of 8 hours of comfortable wear with most wearing comfortably between 12 and 14 hours. 2. Evaluate the Cornea Perform a slit lamp evaluation to assess the cornea for signs of insult. Slight bearing is acceptable as long as there is no evidence of damage to the epithelium. If the patient complains of discomfort when wearing the lenses or temporary spectacle blur after wearing the lenses, use fluorescein to check the cornea for SPE and/or assess the lens fit. 3. Check Acuity Visual acuity should be at least 20/25 or acceptable to the patient. 5
Duette HD Troubleshooting Guide Discomfort and Decreased Wear Time Patients should get a minimum of 8 hours of comfortable wear with most wearing their lenses comfortably between 12 and 14 hours. Check for Dry Eye Treat Dry Eye Before Continuing Fit Discomfort & Decreased Wear Time Assess Fit Flatten Skirt If Patient Wearing Flat Skirt, Flatten Base Curve Consider Solution Reaction Recommend ClearCare & Non - Preserved Saline Troubleshooting Lack of Movement Lens should have movement similar to a soft lens after the lens has had a chance to settle on the eye. With Discomfort Flatten Skirt If Patient Wearing Flat Skirt, Flatten Base Curve Without Discomfort Sign of Dry Skirt Instruct Patient to Add Saline Before Removal 6
Troubleshooting Corneal Staining Slight staining is acceptable as long as there is no evidence of damage to the epithelium. Corneal Staining Indicating Epithelial Damage Assess Fit Flatten Skirt If Patient Wearing Flat Skirt, Flatten Base Curve Troubleshooting Vision Distance visual acuity should be at least 20/25 and acceptable to the patient. Confirm Rx is Not Over-Minused Unacceptable Vision Confirm Lens Power is.50d - 1.50D More Minus than Sphere Power of Spec Rx Lens Power Out of this Range: Adjust Base Curve Check for Residual Cylinder in the Over- Refraction Residual Cylinder: Patient Not a Candidate 7
Duette HD Troubleshooting Guide (continued) Troubleshooting Spectacle Blur A certain amount of spectacle blur may be experienced and may last for up to 30-45 minutes. Spectacle Blur Lasts Longer than 30-45 Minutes Flatten Base Curve Troubleshooting Lens Dryness Patients should be able to wear lenses without a dry eye sensation for 8-14 hours each day. Solutions May Recommend ClearCare, Non-Pres. Saline and Lubricant Drop at Insertion Causes of Lens Dryness Fit Flatten Skirt If Patient Wearing Flat Skirt, Flatten Base Curve Dry Skirt (End of Day Dryness) Consider Rewetting Drops and 2-3 Drops of Saline Before Removal 8
Troubleshooting Filming or Fogging Ask the following questions to help troubleshoot filming or deposits that occur after several weeks of wear: 1. Where are the deposits/filming and when do they appear? 2. What solution is the patient using? 3. Is the patient digitally rubbing the lenses each day? 4. Are the deposits removed easily with a daily cleaner? 5. Investigate allergies and medications. 6. Is the patient using make-up on the lid margins or using lotions or hand-soaps containing lanolin or lubricants? Fit Lens Fit Too Tight Causes of Filming and Fogging Environmental Investigate Patient s Daily Routine (Cosmetics, Soaps, Etc.) Solutions and Cleaning Regimen Solutions Reaction & Lack of Care 9
Recommended Solutions We recommend the following solutions for use with Duette lenses: ClearCare * Biotrue AQuify A soft lens daily cleaner should also be used to remove deposits or film from Duette lenses, and an enzymatic cleaner can be added to the care regimen for deposits that cannot be removed with a daily cleaner. To Place Orders Phone: 877.733.2012, option 1 Fax: 877.329.2012 Email: orders@synergeyes.com Online: www.synergeyes.com Customer Care Representatives are available Monday-Friday: 9:00AM to 8:00PM (EST) Technical Consultation is available Monday-Friday: 9:00AM to 8:00PM (EST) Phone: 877.733.2012, option 2 E-mail: consultation@synergeyes.com Lens Handling & Care Videos: www.visionuncompromised.com The Duette Patient Hotline is available 24 hours a day, 7 days a week. 855.5.DUETTE 2012 SynergEyes, Inc. PN 75247 Rev B * In some patients the tear chemistry may react with the peroxide to cause a permanent white ring at the junction of the rigid center and soft skirt. This ring does not affect vision or comfort.