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.

At the beginning of January I was lucky enough to get my own office, and these past few weeks have been a flutter of activity.   My life has been awash in excitement and decision making and new responsibilities.  And every few days I have the great little milestones that invariably result in a little "geek out" moment.  Like the first time my diploma and license went on the wall (luckily someone else hung them for me).  The first time my name went on the door (even though it was in removable sticky letters -- I think that must be standard but stickers do seem so fleeting).  The first time the office letterhead got my name as a standard feature.  The first time I got the stamp that had my signature emblazoned so I don't even have to pick up a pen most days what with electronic medical records and my new tablet!

All my diplomas framed and hung!  It is incredible how big the state license (top right) is when you compare it to an undergrad degree (top left).  I guess the size directly correlates to the amount of stress and tears required.

With all these firsts, I decided it was about time to start making my small office into a nice homey atmosphere to write letters/finish my charts/call RGP companies and reorder lenses...again.  So I embarked upon a little project inspired by Pinterest.

My Inspirations:

Simple bulletin boards are dressed up with picture frame borders.  It's amazing how much better this looks than just slapping a cork board from Wal-Mart on the wall.

Even better, you can cover your corkboard with fabric for a  hanging surface  almost too pretty to use.

My Office Project: Unfortunately I am a notorious spend-thrift (that's the nice word for it), so instead of splurging on expensive frames, I decided to tackle my own "do-it-yourself" project that was fast, easy, and of course cheap.

So this is the wall of my office where I decided to remove the old standard bulletin board and replace it with cork tiles for posting important notes and info.  The hanging files underneath are nailed into the wall and a remnant of the previous OD, so I had to work my design around their positioning.

What I used: 

• Mirror from Target, just $19.99!  This is great for after lunch when you need to check your teeth before going in with a patient.  Or to help your hair after one to many rounds with the BIO.

• Cork Board Tiles from Michael's; set of 4 that are 12 x 12 for $13.  They are about 4 inches thick and made of a dark, rich looking cork but I did have several issues.  They come with sticky adhesives for easy attachment, but within a few days they were falling off the walls.  The issue has since been resolved with my handy glue gun since I don't get along well with nails.  My other complaint is that they leave a brown residue all over the walls, so every time they fell I had to do wall clean-up too.  

I would love to get more ideas about making my small, windowless office more appealing so please post advice!