We've already addressed the best solutions for your soft contact lenses, but for those patients wearing  specialty contact lens options, finding good information about how to care for your lenses can be quite difficult.  Synergeyes contact lenses are a unique "hybrid" option; one part soft lens and one part hard (or rigid gas permeable) lens.  The hard lens center allows for improved vision in patients with high astigmatism or irregular corneas (like those found in keratoconus).  The soft lens skirt of the lens allows for superior comfort.  These lenses last for 6 months of wear, but can easily tear or build up deposits if not cared for properly.  You can always find more information on the best way to care for your lenses at the Synergeyes website, but here is a breakdown of what I recommend.

SYNERGEYES DUETTE

The Duette lens is the company's latest design which has superior optics for "regular" corneas and up to 4 or 5 diopters of astigmatism. A multifocal design is also an option.  The company has performed studies to see which solutions operate best to keep the lens moisturized but still clean.  Click here to see a more thorough post on their findings.

1) CLEANING

The best options to clean your lens are Biotrue multipurpose solution and Aquify multipurpose solution. These two solutions provide the moisturization that the soft contact lens portion of your lens needs to prevent dryness, especially as the lens ages.  Previously Clearcare was the top recommendation, but in a large percentage of patients, the Clearcare solution will cause white deposits on the soft portion of the lens, preventing proper moisturization.  Clearcare can be used for intense cleaning, but I no longer recommend it on a nightly basis unless my patients have severe depositing issues.

2) FILLING THE LENS

Before you insert the lens into your eye, you should fill the lens with the correct saline solution to provide better fit and comfort.  I usually recommend Unisol 4 sterile saline for this purpose.  You want the solution that you fill your contact lens with to be preservative free, since preservatives can be toxic to the cornea with prolonged contact.  Preservative free artificial tears are sometimes also recommended.



SYNERGEYES CLEARKONE, SYNERGEYES KC, SYNERGEYES A

1) CLEANING
For this lens, I solely recommend Clearcare.  Synergeyes Clearkone is made for correcting the vision of patients with keratoconus.  The company also offers products like Synergeyes A that are made to correct for higher astigmatism.  These products are made with a hydrogel soft lens skirt (versus Duette which is a higher oxygen permeable silicone hydrogel), and this material responds better to the intense cleansing ability of Clearcare.


2) FILLING THE LENS
Unisol 4 saline is still a great option for filling the bowl of the lens.  Again, you really want to avoid preservatives if you are using this solution against your cornea all day.  In some cases, a thick preservative free tear like Celluvisc has even been used to help with comfort in patients that are just learning to use the lenses.  Long term the  thicker Celluvisc is usually replaced with a thinner solution to improve visual quality.

Synergeyes Duette is a RGP in the center for great optics, surrounded by a silicone hydrogel skirt for comfort

You can probably tell from my previous posts (here, here, and here) that I have really been incorporating the new Synergeyes Duette lenses into my practice.  Unfortunately, they haven't always been the easiest lenses to fit.  I was seeing patients back 3 or 4 times (or more!) over a period of 2 months to get the vision and fit comfortable for some patients.  The lens would look great, I was following the fitting guide, but my patients were getting variable results.

Then came the break through.

If you are going to fit Synergeyes Duette lenses, don't follow the fitting guide.  At least, not the one they gave you initially.  I was told earlier this week that the fitting guides are being changed and redistributed, so if you have a trial set in your office this new information will be available soon.  The original fitting guide had you fitting lenses based on flat K, over refracting, and then maybe going to a steeper skirt curve if the distance vision still didn't seem sharp enough.  Sometimes it worked; sometimes it bombed.The new fitting technique is straight forward and makes a lot of sense.

Step 1:  Get the Patient's K readings and find the average K value.




You can use a topographer (left), your autorefractor, or a (gasp) keratometer for your K readings.  If you are fitting this lens, the cornea should be pretty regular, so using the autorefractor K's should be good enough in most cases.









Step 3: Round your Base Curve to the nearest available Synergeyes Base Curve (they only offer 7.90, 7.70, 7.30, and 7.10)

Step 4: Insert the trial lens in the Median Skirt curve and Over Refract -- make sure you are within +/-1.00D of the spherical glasses correction!  Remember, you need less than 0.75D of residual astigmatism (just like any other RGP) to make this lens work.  I have been told it can handle up to 4.00D of cyl, but I haven't tried that high.  If your over refraction isn't within that 1.00D target, your base curve probably needs to be adjusted.  Just SAMFAP to tell you which direction to go.

Step 5: Order.  You can still adjust skirt curve for comfort (steep and flat options are available).   And in the multifocal lens you can use a large (better for distance vision) or small (better for near vision) add zone to improve vision.  I will say that basically every lens that I put on a patient looks like a good fit, so using fluorescein hasn't been that helpful.  Judge going steeper or flatter based on patient complaints.  Also, there is very little movement of the lens if the fit is too steep, so make sure to check that out. Little tweaks from your original fit should be all that is needed!


I am just now incorporating this method into my office, but so far it seems to make a lot of sense!  Please post if you are having any problems or any advice for other ODs out there fitting this lens.  Overall my patients do really like the vision and comfort in this lens once we get the fit correct.  Hopefully with this new method, finding the right fit will be a lot less time consuming.

Another Synergeyes post! Several visitors to this blog have started reading to find out more information regarding these new hybrid lenses, and because they are so new, information on the web is very limited.  I just got an email from my Synergeyes rep with important new information regarding what contact lens solution is best with this lens.  Note: results are based on a study performed by the Synergeyes company and independent of any company making contact lens solutions.

I have had some interest in my experiences with the Synergeyes Duette lenses, so now that I have had more patients wearing the lenses and returning for follow-up I thought it was a good time to share.  If you are interested in my original post, please click here.

For those who may not recall from my previous post, Synergeyes Duette is the hybrid lens that combines a rigid gas permeable (or hard lens) center with a soft contact lens skirt that surrounds the lens.  The soft lens skirt provides added comfort and also helps deliver oxygen to the eye via the new silicone hydrogel material (in comparison to the original Synergeyes lens that had poorer oxygen transfer). It is a great choice for patients experiencing poor quality vision through soft contact lenses, especially in patients with astigmatism or those needing multifocal correction.

Synergeyes contact lens: notice the darker colored  hard lens (RGP) in the center to provide sharp, clear optics

If you are a patient interested in trying the Synergeyes lenses, here are some things to know:

1) The lenses are quite large and can be hard to get used to at first.  A lot of my patients request to try them, but when they see the size difference compared to their soft lenses they aren't as keen.  For best comfort you will fill the contact lens bowl up with solution before inserting it, to provide added moisturization.  To insert the lens patients often need to lean forward over a mirror placed flat on a table, and then insert the lens straight up towards the center of the eye. Due to this insertion method, it is not a great lens choice for a first time wearer due to the learning curve involved with inserting a lens of this size.  Most patients have no trouble after a short course of practice.

2) There may be some dryness and lid awareness, especially early on in the fitting experience.  Lid awareness should resolve with proper fit and adaptation time, but I have had patients with dry eye complaints prior to trying this lens notice their dryness seems worse.  This dryness issue is not affecting all of my patients, but I am still working on how to resolve the complaints. Right now my efforts are centered over adjusting the fit to ensure that adequate tear flow is present under the lens.  As far as solutions, I have been told by reps that the Revitalens solution is highly recommended with Synergeyes wear to improve comfort, though many other multi-purpose solutions can be effectively used.  Personally I have had great success with Aquify and Clearcare solutions with this lens.  Of course, I just love Clearcare in general, but that is another post, hah.

UPDATE:  The above information is now very outdated, and I recommend seeing this post for better information.  Suffice it to say that Revitalens is NOT what the current data supports even though the initial lens launch recommended this product.  BioTrue is the solution of choice for Synergeyes Duette, with regular cleaning with an additional build up remover like MiraFlow.

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3) The multifocal lens (Synergeyes Duette Multifocal) isn't going to be perfect.  I have patients seeing 20/20 with this lens that aren't happy with the quality of their vision. Some of this is inherent in the lens design and I do try to tell patients exactly what their expectations should be. The design of this lens is called "simultaneous vision," and what that means to the wearer is that you are seeing both distance vision and near vision information "simultaneously."  That's a lot for the brain to process.  It can take 1-2 weeks of wearing time to know if this lens design will work for you.   If you are a doctor fitting this lens, to increase distance vision you need to switch to a larger add zone, or consider going to a steep base curve skirt.  To improve near vision, the add zone size needs to be small.  

4) There is a major price tag on these lenses.  Patients should expect to pay a higher contact lens fitting fee because your fit is going to include several visits to perfect your lens parameters.  The lenses themselves are also expensive, typically around $200-$300 for a set of lenses.  Keep in mind that each lens will last only 6 months, so you will need 4 lenses in total for a year's supply (that puts these around the $400-$600 range for your year!).  This is different from traditional RGP (hard) contact lens wearers that may sometimes be able to use their lenses for 1-2 years.

If anyone has stories to share about these lenses, I would love to hear them!

Soft contact lenses offer wonderful comfort and vision for the large majority of patients needing vision correction, but some patients (due to corneal shape or refractive error) just can't achieve satisfactory vision with a standard soft contact lenses.  Rigid gas permeable (or hard) contact lenses are still available largely because of this fact.  Lately I have had the privilege of working with a new lens design that combines the optical quality of a rigid contact lens with the comfort of a silicone hydrogel (or highly oxygen permeable) soft lens: the Synergeyes Duette.

Picture courtesy www.synergeyes.com

An ideal Synergeyes fit (courtesy Contact Lens Spectrum): Fluorescein staining should show even central clearance under the RGP (rigid) central portion of the lens