Synergeyes as a company has gone through quite a few changes in the recent year, and they are better equipped than ever to meet the needs of the doctors and patients they serve.  With a 90 day warranty period and unlimited no-cost exchanges during that time, fitting Synergeyes lenses is very similar to standard methods used in the RGP contact lens ordering world.  They also have made it easier than ever for doctors to fit their patients in office -- you don't even need a fitting set!

How to Fit the Lens

The lens can be selected empirically for both single vision (Synergeyes Duette) and multifocal needs (Synergeyes Progressive) with just Rx and K values, just like you would order and RGP from your favorite lab.  The lens will be shipped to your office so that the very first lens the patient tries on has a prescription and curvature that would be a best starting place for the patient to wear home that day.  In about 60% of cases, that very first empirically ordered contact lens will be perfect, without any power or curvature changes needed.  But if you do need to change something, don't worry.  You have 90 days of changes if you need to make them.

The true concept of trouble shooting the lens is to fit the soft lens skirt as if it was a run of the mill soft lens. The K values have guided the selection of the central RGP base curve, so it is unlikely that this will need to be changed.  You can change the way the lens fits and moves on the eye by simply adjusting the skirt curve; no fluorescein is needed.  Just like a soft contact lens, you want some movement with blink.  If you aren't getting any movement, the skirt is too steep and you need to flatten the base curve.  Many times the initial lens may be uncomfortable to the patient if it is moving, and a steeper fit would feel better.  But as the day and weeks go on with wear, you want the lens to continue to move with blink, so fitting with movement on the initial dispense is essential. 

The Synergeyes Duette Progressive lens is a new alternative to the Duette Multifocal lens design that is more intuitive to trouble shoot because you aren't dealing with changing add zone sizes to adjust power. If you forgot what a pain that was, just try to read my old fitting guide -- it wasn't exactly intuitive.   The lens comes in traditional add powers: +1.00D, +1.75D, and +2.50D options and is ordered empirically based on Rx and K's.  Just like any multifocal lens you can expect some shadowing and ghosting over the first week as the brain adjusts to the multiple image view it is getting in the contact lens (optimistically marketed as 3D or "simultaneous vision" in the brochures for the lens).  Preparing the patient for this appearance is a huge key to success, just like with any multifocal.  Interested in learning more tips on fitting the Duette Progressive specifically?  The next Synergeyes post will break it down in more detail!

How to Insert and Remove

Remember when you had to fill the contact lens with solution, and use a special inserter to put it on the eye? The good news is that you can properly insert Duette contact lenses on the eye just like you would a regular soft contact lens now, no special solutions or tools needed. The lenses can be placed directly on the center of the eye sitting upright, or if desired a single drop of solution can be placed in the bowl of the lens before insertion.  No need to overfill or bend forward to put the lens on your eye any longer.  Think of putting on this lens as just being normal again.

Removing the lenses is still a slightly trickier endeavor for those used to soft contact lenses, but just remember to aim for the soft skirt bottom, and not the center of the lens when removing.  The hard center part of the lens won't bend under your fingers, so you must get the lens from the very bottom to remove it from your eye. Make sure your fingers are dry before trying to remove the lens to prevent slippage.  If you are having trouble, using a latex or sterile glove or finger cots can create a nice adhesion for the lens to come right off.  

How to Get the Best Results

Patient selection is key to making the Synergeyes lens successful, just like with any contact lens.  If your patient has any of the follwing issues, this is not the right lens for them:

Astigmatism Rx >> Corneal Astigmatism -- Remember this lens is using RGP optics for vision, so if you need a lot of astigmatism correction, you need a cornea with a lot of astigmatism to support it and create that corrective tear lens.  If your K values don't match the cyl in your Rx, the vision will be disappointing and soft contact lenses would be the better route.

Untreated Dry Eye -- Most of my personal failures with Synergeyes have been due to dry eye.  If the patient that you are considering has dryness you will need to adequately control that first before this lens can work. That may mean Restasis or punctal plugs or even just a strong artificial tear regimen.  For patients with excessive dry eye complaints in contact lenses, this would not be the best way to go.

Those Expecting a Time Machine -- While the progressive lens design is effective, if you are over 40 the Duette Progressive cannot give you back the clear and easy range of vision you could see when you were 25.  This lens has all of the normal complaints associated with multifocal lenses -- shadows, ghosting, needing good lighting for near activities.  What it can accomplish is delivering multifocal vision to patients with astigmatism or high Rxes that were otherwise stuck in monovision or with blurry distance vision in soft multifocal contact lenses.  It isn't perfect, but it is much better for those patient groups than their other soft contact lens options.