Optometrist Perspective By Harvey Yamamoto, OD

Harvey Yamamoto, ODAhhhh, the fresh smell of spring is now upon us.  Spring is one of my favorite times of the year.  I extend a very happy spring season for my readers.

SOFT CONTACT LENSES:  GP Specialists launched a new lens which is called YamaKone™ IC at the Global Specialty Meeting in Las Vegas during the last week of January.  The YamaKone™ lens is a family of specialty lenses with the keratoconic patients in mind.  My long time readers will know that fitting specialty contact lenses is one of my passions in life.  I find them stimulating and challenging.  Yes, they do take some chair time but the end results often bring about very happy patients who become very loyal and great for referrals. Every GP lab around the country has focused their attention to the development of their own brand of scleral lenses.  Some say that the growth of GP lenses can be directly linked to the rebirth of scleral lenses.

By now, I’m sure that I’ve whetted the appetite of most of my readers about soft cone lenses.  What? Why? For what reason?   I have a very large Keratoconus practice which grew over a period of 49 years.  I have run into patients that eventually became so advanced that they no longer were able to tolerate gas perm lenses.  Scar tissue also became an obstacle as the descemet’s membrane would tear and scar over.  It was my lifelong belief that we could develop some type of soft lenses that would help these patients improve their quality of life.

Most of these patients were very myopic so anything that would give them even 20/100 acuity would be considered an improvement that would allow these patient’s to live more comfortably.

With the advent of Silicone Hydrogel buttons, this allowed our lab the ability to make lenses much thicker in design to help mask the highly irregular surface and still provide adequate oxygen to reach the cornea.  Our team developed our small initial cone fitting set consisting of 8 lenses: 5.0, 5.5, 6.0, 6.5, 7.0, 7.5, 8.0 & 8.5.  The fitting set was designed to fit beginning cones to advanced cones.  The base curve consisted of 5 conical spheres with an aspherical front curve giving the lens a very smooth transition from the base curve to the periphery.

We selected one of our worst cone patients whom we had fitted with the gas perm YamaKone™ design.  We also used fluorescein dye made for soft lenses to help evaluate the fit along with the Cirrus OCT.  Soft lenses are much more forgiving than its gas perm counterpart.  We encountered no bubbles as we had with the gas perm equivalent.  The patient reported immediate comfort with the 7.0mm B.C.  We allowed the lens to equilibrate on the eye for 15 minutes.  The lens had a front slab for stabilization with markings @ 270 degree’s.   We noted a slight CC rotation = 10-12 degrees.  The acuity with the lens = 20/40 and 20/100.

This particular patient was 68 years old and had suffered a stroke some two years ago.  That was then that he stopped wearing his gas perm cone lenses which we had made.  He had lost all interest in life and fortunately his daughter found him lying on the floor in the living room where he had laid for several days. She brought him home from Fresno to Southern California to nurse him back to health.  After nearly 2 years of tender loving care, he regained the use of his arms and his smile returned to his face.

Today, he is living on disability which we helped him obtain so our entire staff decided to fit him pro bono.  He had been a loyal patient since 1964.  We worked around the clock testing many various soft lens designs for him.  Finally during the last quarter of 2012, we called “Eddie” to tell him that we had a soft lens for his eyes.   His daughter drove him to our office from Huntington Beach.  Eddie smiled broadly as I greeted him.  It took him some time to master inserting the large soft cone lenses.  Once he had inserted the lenses, his face shined like the sun.  The smile was a dead giveaway that Eddie was once again happy.  We took a wild stab at his Rx = -15.00 OU.  The same powers of his YamaKone™ GP lenses which he wore for years. The powers were right on the money and Eddie kept wiping tears that were streaming down his face.  Eddie wanted to pay but our staff was instructed not to charge him for these lenses.

Eddie calls each week to remind us on how very happy he is that we have given back his life.  We are so happy to have brought him out of his state of depression.  I can only imagine going about life not being able to see 2 inches from my nose.  We thank GP Specialists for manufacturing these wonderful life saving lenses for a patient so well deserving.

With each new patient that comes into our practice, we learn more and more about our multifocal lenses.  Each parameter can be custom ordered to meet the demanding needs of our patients.  It’s hard to believe that it is already 8 months since GP Specialists helped us design these wonderful lenses, iSight MCL.  Finally, we have a multifocal lens that we feel extremely comfortable in fitting.  Each patient has different needs.  We have the ability to ask for customized OZ’s that fills the needs of our patients.  It takes only 3 patients to become an expert fitter.  One patient wanted her multifocals with the distance power in the center of both lenses.  She drove long distance thus her distance vision was important.  She was able to read clear enough to see her manifest.  2 months later she had us make her a near center lens for her left eye so she could read at night.  This is a fun lens to fit!  Fun because we can alter so many facets of these lenses to satisfy the needs of each patient.  We finally feel like we are back in the driver’s seat.  If you haven’t tried these lenses then you owe it to yourselves to see what our staff is so excited about.  The iSight MCL is the world’s first multifocal lens where we can alter all of the parameters.

GLAUCOMA:  We have been fascinated with this disease for many years.  Thanks to the development of the many hi-tech machines to help us clinicians diagnose this disease, this disease is under control once again.  The most important facet of this disease is to catch it soon enough.  Find it, treat it.  Preventing blindness is our protocol.  When we see a suspicious ONH, we advise the patient to have the OCT test performed.

Yes, we all know that this disease can come in many different forms.  I know a colleague who has studied glaucoma for over 30+ years.  He has developed an interesting program of testing his patients for sleep apnea.  He realized that vision was lost when Ganglion cells were lost? Why? How come?  Cerebral perfusion pressure?  Think about it & it makes for common sense.

Here is his simple theory:  Diastolic pressure minus IOP = 50 = Glaucoma.  i.e.:  80 (diastolic pressure) – 30 (IOP) = 50 = glaucoma.  I like his theory and will begin to implement it into my regimen.

Second:  Check for sleep apnea.  When a person sleeps, IOP can increase which means the blood pressure decreases causing ONH damage which leads to glaucoma.  Sleep clinics can help to determine whether a patient is suffering from sleep apnea.  Also check the CCT (central corneal thickness).  There are a lot of theories to glaucoma. It’s something to think about.  Have fun my friends.

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