Quasar K uses the same state-of-the-art CNC lathes and multi-aspheric technology as Quasar and applies it to the keratoconic cornea. A truly junctionless, continuous curve is produced in one smooth cut of the computer-controlled lathe, from the lens centre right to its edge.
Conventional spherical or aspheric lens designs are totally unsuitable for keratoconic eyes. They have inadequate edge-lift to properly align with the abnormal cornea without causing mid-peripheral compression. Existing specific designs for keratoconic patients use either spherical multi-curve technology or high eccentricity conic sections. Both of these have disadvantages.
Spherical lenses with large differences in peripheral curve radii are able to cope with the rapid flattening of the keratoconic cornea from the abnormal centre to the normal periphery, but have very pronounced junctions, which can be a source of discomfort and mechanical insult. Aspheric lenses with rapidly flattening elliptical surfaces have smoother back surfaces, but give rise to induced off-axis astigmatism and poorer visual acuity.
Quasar K uses the same advanced CNC lathes and multi-aspheric technology as Quasar but applies them to the keratoconic cornea. The high-precision, computer-controlled lathe achieves a truly junctionless, continuous curve from the lens centre to its edge in one single, smooth cut. This surface exploits the clinically validated approach of using a smaller B.O.Z.D. with steeper B.O.Z.R.s and higher axial edge clearances for steeper B.O.Z.R.s.
The intention is that the fitting pattern should be similar over the vast majority of different cases presenting in the consulting room, from early keratoconus to well-advanced disease. Whilst the surface is truly aspheric itís polynomial nature is such that it enables you to combine the comfort of a conventional elliptical lens with the visual advantages of a spherical lens without the attendant disadvantage described above.
Computer modelling and consistent results have validated this approach and demonstrated its superiority in terms of the visual result and the improvement of patient comfort.
The optimally fitting lens in keratoconus is only loosely linked to the keratometry readings. Therefore, careful assessment of lens fit with fluorescein is crucial to success. However, an appropriate starting point in early keratoconus will be made by choosing a B.O.Z.R. close to the flattest keratometry reading. As the disease progresses, keratometry readings become increasingly meaningless, but where readings are attainable, a starting point will be the average of the flattest and steepest reading.
It must be emphasised that there is not a substitute for careful lens observation and several trial lenses will probably be required until the practitioner is entirely happy with the fitting.
The table below is for guidance only:
|Keratoconic Stage||Typical K Reading mm||Trial Lens|
|Early Mild||6.80 – 7.80||= Flattest K|
|Moderate||6.00 – 6.80||Average|
|Advanced||5.00 – 6.00||Average|
Desirable Fitting Patterns
Always assess the fitting with the lens centred on the cornea.
Always allow sufficient time for the lens to equilibrate on the eye. Instil fluorescein and ensure that the patient blinks sufficiently for it to penetrate under the central portion of the lens. A well-fitted Quasar K should show 2-3mm of light apical touch. This should be complemented by mid-peripheral touch, as shown in Fig 1. In-between the two areas of touch there will be an annulus of fluorescein, which should be free of bubbles. If no central touch is seen, as seen in Fig 2, then the B.O.Z.R. should be flattened until the correct appearance is seen. Conversely, if there is excessive central touch, as shown in Fig 3, then the B.O.Z.R. should be steepened until only a light touch is visualised.
Figure 1 – Mid-peripheral Touch
Figure 2 – No Central Touch
Figure 3 – Excessive Central Touch
If any part of the lens edge shows
Centration is particularly difficult to control in keratoconus. About 75% of cones are displaced down with regard to the pupil centre and therefore a well-fitted lens will usually centre slightly downwards. A high-riding lens is often too flat or has too great an edge clearance. To improve the optical result with a low-riding lens, it is best to increase the diameter if in other respects the fitting is optimal.
The trial lenses are increasingly negatively powered as the B.O.Z.R. increases. This is to help reduce the magnitude of the over-refraction in more advanced cases. There will, in many cases, be a small residual cylinder, but wherever possible try and optimise the vision using spherical lenses only. Ensure the over-refraction takes place using a trial lens of the same B.O.Z.R. as the final lens as small changes to the B.O.Z.R. can dramatically affect the visual acuity and over-refraction. Ensure that the initial lacrimation has subsided. Obviously, the vertex distance should be taken
Where there is a marked residual cylinder (>0.75) try to dispense
- Junctionless back surface
- Improved centration
- Improved comfort
- Comprehensive trial sets
- Unparalleled technical support
- Choice of lens materials
|Trial Set Radii||5.70 to 8.00 in 0.10mm steps|
|Power||-9.50 to – 3.00D, radius and overall diameter dependent|
|Total Axial Edge Lift||0.421mm – 0.196mm, radius and overall diameter dependent|
|Overall Diameter||8.80 to 9.60mm radius dependent|
Meet every challenge with the Quasar range of RGP lenses. Range includes: Single Vision, Toric and Multifocal.
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