Comfort 15

Comfort 15 is the contact lens for ECP’s looking for an easy to fit, low cost alternative to more complex designs. Comfort 15 offers excellent initial comfort whilst providing outstanding visual acuity - it's easy for patients to handle, too.


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For 'Fitting Guide' presentation, please see 'Fitting Guide' tab (right) >>

 

Introduction

Comfort 15 is the lens for ECP’s looking for an easy to fit, low cost alternative to more complex designs.

Unlike standard RGP’s, Comfort 15 offers excellent initial comfort whilst providing outstanding visual acuity. Contrary to other mini-scleral designs however, Comfort 15’s smaller overall diameter means that it’s easy to handle.

Because mini-scleral lenses fit over the cornea and limbus and land all of their weight on the sclera, keratometry and topography aren’t required for successful fitting. Instead the lens is simply fitted to the sagittal depth of the eye.

 The 15 fitting set contains 13 lenses with depths ranging from 3500μm to 5000μm in 125μm steps. The aim of the fit is to find the lens that exceeds the sagittal depth of the eye by around 100-150μm.

Comfort 15 offers all the benefits of a mini-scleral design. Indications include:

  • First fit for irregular corneas such as KC, PMD
  • Post Graft, Post Lasik, Ectasia
  • Refits for patients wearing RGP’s but looking for better comfort
  • Refits for patients wearing soft lenses but needing improved vision
  • Patients with mild to moderate ocular surface disease and dry eye
  • Patients with high cyls requiring excellent vision and comfort
  • Patients who need to wear lenses in dusty environments


Choosing the First Trial Lens

Comfort 15 cannot be fitted empirically as keratometry and topography do not give a good indication of sagittal depth. However, the first trial lens can be chosen based on the eye condition to be fitted.



Insertion

Lenses must always be inserted full to the brim with saline. Fluorescein must be added to the bowl of the lens prior to insertion as it will not get behind the lens after insertion.

The patient should be bent forward with their nose pointing towards the floor and their chin tucked in. The lens can either be supported on a tripod of three fingers or on a DMV inserter.

    


Ideal Fit

Sagittal depth of the lens exceeds depth of the eye by 100μm
A good fit will show: -

● Low vaulting of the cornea
● No edge lift
● No scleral impingement
● Mid-peripheral clearance
● Limbal clearance

Shallow / Flat Fit

Sagittal depth of the lens is less than the sagittal depth of the eye

A flat or shallow fit will show: -

● Edge lift
● Central bearing
● Discomfort

Action: Remove the lens and insert a lens with a higher sag (a deeper lens)

Deep / Steep Fit

Sagittal depth of the lens exceeds the sagittal depth of the eye.

A deep or steep fit will show : -

● Excessive central NaFL pooling
● Central bubble
● Scleral impingement 

 Action: Remove the lens and insert a lens with a lower sag (a more shallow lens)

Assessing The Edges

To asses the edge of the lens, push the inferior sclera just below the edge of the lens. If the lens flares away very easily, it is flat. If it takes a significant push to get any flaring away of the lens, the edge is tight or the lens is too deep.

  Ideal Edge


  Flat Edge (Fig.2)

  Steep Edge (Fig.3)

Action

  • If the ideal vaulting lens shows edge impingement or scleral blanching (Fig.2) order the lens with a flatter edge option.
  • If the depth of the lens appears correct but the edge stands off (Fig.3) order the lens with a steeper edge.

 

Flat Eyes / Sunken Grafts / Post Refractive Surgery

After a corneal graft or refractive surgery many corneas become flat in the centre whilst the periphery and sclera retain their original shape. This shape, where the eye becomes steeper in the periphery, is known as an oblate cornea.

For corneal grafts or refractive surgery, where the centre of the cornea has become flatter than the periphery, it is possible to modify the shape of the Comfort 15 to give a reverse geometry lens by flattening the central curve whilst keeping the sagittal depth and periphery the same.

The ideal trial lens fit is expected to show bearing in the mid-periphery due to the shape of the eye. The lens matches scleral and limbal shape and sagittal depth of the eye.

Post Surgery

                          



  
  Normal Trial Lens


 

 Reverse Geometry Lens



Ordering The Lens:
The lens should be ordered with a reverse curve option. In the first instance, try 5 dioptres of reverse curve. If the mid-peripheral bearing is very heavy, try 10 dioptres.

Post Surgery, Trial Lens Fit

The trial lens will show mid-peripheral bearing but will match scleral and limbal shape. The amount of touch helps determine the amount of reverse necessary.

     
  
  
     Reverse Geometry Fit


Post Surgery, Ideal Reverse Geometry Ordered Lens Fit

The lens supplied by No7 will have a flattened central curve that should eliminate mid-peripheral bearing. It should have a NaFl pattern similar to the ideal keratoconic or normal fit.

 

Power Of Ordered Lens

The power of the lens will be altered to compensate for the flattened central curve.

Shallow, Flat and Deep Fits

Shallow, flat and deep fits can be assessed in an identical manner as for a keratoconic fit. If there is still significant mid-peripheral bearing, reoder with more reverse curve.

Care Solutions

RGP Solutions are too viscous for use with Comfort 15. Soft lens solutions such as Ote Sensation work well with daily cleaning using Ote Clean.

No7 recommends annual replacement of Comfort 15, please contact us for details.

 

    

 

Fitting Summary
 

1 - Find the correct depth of lens
Determine the fitting lens that gives correct sagittal depth.

2 - Allow the lens to settle
Ideally the lens should be allowed to settle for 60 minutes.
If there is bearing, increase the depth of the lens before continuing.

3 - Assess the edge
If the edge of the lens appears tight, order with the flat edge option.

4 - Perform an over-refraction
Perform a spherical over refraction.
Consider over specs if there is residual cyl.

5 - Assess reverse curve
Order reverse curve to create a reverse geometry lens. In addition whenever there is not a clear band of clearance in the mid-periphery / limbus then a small amount of reverse curve (2.5D in the first instance) is required to lift the lens off the area.

6 - Fine tune the sag
You may add extra sag or decrease the sag in 20 micron steps up to 100 microns.

7 - Order the lens
Order the lens stating the sag, power diameter and any reverse curve required or changes to the edges

Why Comfort 15?

  • No bearing on the corneal surface
  • Fantastic comfort due to scleral landing
  • Simple to fit
  • Excellent value
  • Optimum Extra material for excellent wetting
  • Visual acuity of a rigid lens
  • Available on Lenses for Life planned replacement 

Material:

Optimum Extra (Roflufocon D)
(Blue & Clear) DK 100

Sag:

3.4 to 5.1 in 20 micron steps

Power:

+25.00 to -25.00 (0.25 steps)

Wearing Schedule:

Daily Replacement:

Annual Lens Care Cleaning solutions for soft lenses, No7 recommends:

Oté Sensation & Oté Clean

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