Custom Contact Lens News & Views from Art Optical Contact Lens, Inc. 
eissue 14/Summer 2013
Mark your calendar and join us at an upcoming meeting:

Vision Expo West
Oct. 3, 2013 - Oct. 5, 2013
Booth #MS9057
Las Vegas, NV


East West Eye Conference
Oct. 3, 2013 - Oct. 5, 2013
Booth #204
Cleveland, OH

American Academy of Optometry
Oct. 23, 2013 - Oct. 25, 2013
Booth #803
Seattle, WA

2013 Michigan Optometric Association Fall Seminar
Oct. 29, 2013 - Oct. 30, 2013
Booth #6-7
Lansing, MI

Click the show name for more information.
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The Rose K Product Line Has Much to Offer
by Mike Johnson, FCLSA
Director of Consultation Services
Art Optical began manufacturing the Rose K and Rose K2 family of GP designs for irregular corneas in November of 2012. Our Consultation Department has gained valuable experience over this period of time and has found that its versatility and simplified 5 step fitting approach lives up to the worldwide distinguished reputation the Rose K brand has achieved.

In the articles below, our consultants discuss how practitioners can benefit from the simplified trial fitting approach and how our consultation staff can assist you along the way. We also provide some insightful "Do's and Don'ts" when working with the Rose K2 series. I am certain you will find value in these featured articles, and in expanding your awareness of the multitude of conditions this product line allows you to successfully manage in your practice.
Keys to Specialty Lens Success:
Trial Lens Fitting & Art Optical Consultation
by Keith Richards, NCLEC
Fitting Consultant 
Often when you come across patients with keratoconus, pellucid marginal degeneration and other irregular corneal conditions our consultation staff will recommend sending you a trial set to assist in fitting your patient. The purpose of the trial set is to simplify and expedite the fitting process for you and for the patient. One aspect that sometimes gets overlooked is your ability to contact our consultation department while you are going through the fitting process, specifically, while the patient is still in your chair. By contacting us while the patient is still in your office we are able to recommend what additional trial lenses may be needed to ensure you are getting the best possible fit and acuity from day one. This helps eliminate the need to make further unnecessary adjustments since we will already know how a flatter or steeper trial lens performs on the patient's cornea. Having the trial lenses in office definitely gives us a leg up in the fitting process, but if enough lenses are not trialed initially, then we may still end up needing additional remakes to get to a successful final fit. 

The Rose K family of lenses is known for its' high rate of first fit success. The fitting guide that is provided along with the trial fitting set will walk you through the easy 5-step trial fitting process. However, If you come across something you are unsure of or does not line up with what you would expect using the fitting guide, please contact our consultation department so we can suggest what additional lenses to try while the patient is still in your chair.

By offering specialty lenses, patients who need your services sometimes travel a considerable distance for their contact lens evaluation and fitting. By doing all you can on the initial visit, you are simplifying things for the patient by limiting their travel back and forth to the office for additional visits that may have been avoidable. Your patient will appreciate the extra work put in on the initial visit to get them into a successful pair of custom lenses as soon as possible. You will also appreciate having to spend less chair time in the long run to ensure a satisfied patient.

Through our website,, we offer an online order form where you are able to attach corneal topographies or photos and videos of a trial fit to further assist us in the fitting process. When you utilize our online order form we not only receive your information instantly, but also in a secure, HIPAA compliant transfer. Our ultimate goal at Art Optical is to make fitting specialty lenses as easy as possible. Our success is directly tied to your success with your patients. Please never hesitate to contact us while your patient is still in your chair if you have questions about the fit or visual acuity you have received through the fitting process. Our consultation staff is available for live fitting assistance Monday through Friday from 8:30 am to 5:30 pm EST.
Rose K Fitting: The Do's & the Don'ts!
by Adrian Johnson, NCLEC
Fitting Consultant
We have been working with the Rose K2 family of lenses for a while now and we've learned quite a bit about the designs. Tips are offered here to help everyone become a part of the 85% first fit success rate statistic associated with the Rose K product line.

It may be noted that from here on out I only mention the attributes of the Rose K2 designs and do not mention the standard Rose K design. This is because it is only the Rose K2 designs that have the advanced fitting options available that have so much to do with the first fit success rate. The Rose K2 designs are also generally more comfortable than standard Rose K, and because of aspheric back optic zones, the design will have greater aberration control, which will provide patients with better visual acuity and reduced flare and glare. We are aware there are many offices out there that only have the original Rose K fitting set. Although we do have the ability to manufacture the standard Rose K lenses, we will always encourage an upgrade to the Rose K2 design, which can be ordered without the need to adjust any parameters from a standard Rose K fitting set.

DO - Start with the correct fitting set 
The Rose K2 family consists of five different design options to satisfy almost any irregular cornea: 
Rose K2: This design is meant mainly for oval and moderate to mild nipple cones, but can be used for patients with early Pellucid Marginal Degeneration as well. The diameter on this lens within the fitting set varies depending on the base curve: the steeper the base curve, the smaller the diameter. 
Rose K2 Nipple Cone:
The NC fitting set is useable for all stages of nipple keratoconus. This lens has smaller optical zones and diameters than the standard Rose K2 fitting set, but also has diameters within the fitting set that get smaller the steeper the base curve is.
Rose K2 Irregular Cornea: This lens is for all stages of PMD, keratoglobus and post-LASIK ectasias, but has a secondary application for oval keratoconus. The standard diameter in the fitting set is 11.2, but the lenses can be made smaller or larger as needed. 
Rose K2 Post Graft: This design is for those patients who have undergone penetrating keratoplasty and for those who have oval keratoconus. If you want your post-refractive surgery patient in a Rose K2 design, this is the best design for that purpose. The fitting set comes with a standard 10.4 diameter but, like with the IC design, the diameter can be made smaller or larger as needed.
Rose K2 XL semi-scleral: The newest of the Rose K2 designs, the XL semi-scleral lens can fit the widest variety of corneas. It can be used for nearly all stages of keratoconus, PMD, post grafts, post -LASIK ectasia and any irregular corneal condition that cannot be successfully fit within the limbus. The XL lenses are also good for polluted work conditions, people working or playing in dusty environments, corneal GP intolerance, piggyback intolerance and even just for daily wear. The diameter is standard at 14.6 but can be made larger or smaller if necessary.

Each of these fitting sets comes with a fitting guide that offers suggested starting points and tips on how to follow the easy five step fitting process. The Rose K2, NC, IC and PG fitting sets share a guide but each design has its own section. The Rose K2 XL fitting set comes with its own fitting guide to cover this unique semi-scleral lens. If you decide to borrow a fitting set on loan, please feel free to keep the fitting guide for future reference.

DO - Evaluate the fluorescein pattern when lenses are centered  
An important aspect of evaluating the fit of a Rose K2 lens is assessing the fit when the lens is centered. The fitting guide recommends assessing the fit immediately after the blink when the lens is more likely to be centered. The reason for this is because a lens that is fit perfectly can appear to be a bad fit when decentered and vice versa. Figure 1 shows an optimally-fitting lens immediately after the blink while Figure 2 shows this same lens a few seconds after the blink when it is in a downward location. If the lens drops too quickly to evaluate the central fit it can be pushed up using the lower eyelid.
Fig 1 AJ article issue 14
Figure 1
Fig 2 AJ article issue 14
Figure 2
DO - Use non-preserved saline when inserting the XL lenses
The XL lens, being a semi-scleral design, will need to be filled with solution before it is inserted. We recommend non-preserved saline solution for insertion purposes both in the office and for the patient at home. If a viscous conditioning solution is used it can give an inaccurate fluorescein pattern. Any solutions that have preservatives in them can cause a toxic environment for the cornea as the wearing time lengthens. This can cause SPK-like staining to the cornea and general irritation to the eye. If non-preserved saline is difficult to find, patients can also use preservative-free eye drops that have been approved for use with contact lenses.

DON'T - Be concerned about "mid-peripheral bearing"
The ideal fit for all Rose K2 designs is a feather touch on the steepest portion of the cornea with pooling in the rest, mid-peripheral touch and adequate edge lift. (Refer back to Figure 1 above or see Figure 3 below for an example of an optimally-fit Nipple Cone lens.) At first glance the optimal fitting lens appears to have mid-peripheral bearing, but upon closer inspection fluorescein can be seen getting in and out of the center of the lens. If, looking at a fluorescein pattern, the periphery of a lens has excessive edge lift but the mid-peripheral area is optimal, order a steeper edge lift. When the periphery of a lens looks tight but the mid-peripheral area is optimal, order a flatter edge lift for an improved edge lift 360 degrees around the edge. If you're having difficulty determining whether or not fluorescein is getting underneath the mid-periphery, you can push more fluorescein in under the lens using the lower eyelid.

Fig 3 AJ article issue 14
Figure 3

DON'T - Forget there are advanced fitting options available
The Rose K2 design has an answer for almost any problem that might be seen in the fluorescein pattern. We often hear about edge lift in the 6 o'clock area and one common fix for this will be to go to a smaller diameter, but the Rose K2 designs have a much better fitting option: Asymmetric Corneal Technology, or ACT. ACT steepens just the inferior portion of the lens, which should even out the fluorescein pattern. ACT comes in grades of severity and can be manufactured with any base curve and edge lift value. See Figure 4 for an example of a mid-range edge lift, requiring a Grade 2 ACT.

Fig 4 AJ article issue 14
Figure 4

When a fluorescein pattern shows decent edge lift inferiorly and superiorly but is tight at 3 and 9 o'clock there is the option to do a toric periphery on the lens, where the optical zone is spherical and just the edges of the lens are toric. PMD patients who have significant against-the-rule astigmatism might show a pattern where the lens will be tight in just the 12 and 6 o'clock regions and toric peripheries can be done in this situation as well.

Another common problem with keratoconus patients is residual astigmatism. We will typically do spherical equivalents for low amounts of residual astigmatism, but when the patient is over-refracting more than one diopter of residual cylinder we do have the option to do a front toric design in all of the Rose K2 designs.

DON'T - forget that our Consultation team is here to help!
Even when your patient is in the chair! 800.566.8001