Transcript Proper Patient Compliance with Paragon CRT

What To Do
When…?
Ken Kopp, FCLSA
Clinical and Professional
Services Manager
Paragon Vision Sciences
WTDW.. A CRT lens is broken.
Our replacement policy is 30
days from dispensing.
Order a duplicate and return
any lens pieces in the original
vial for credit.
Spare lenses are vital.
WTDW…the suggested lens
is not in my set.
Follow the suggested RZD/LZA combination
and choose the BC closest to what is
suggested.
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The OR will tell you the exact BC needed.
Dispense and follow-up for adequate
centration. Order the correct BC.
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Extended set or order with warranty
WTDW…the lens will not center.
Superior/Lateral or Superior and Lateral:
Increasing the RZD once (25 microns) or twice (50
microns) until centered. Treatment zone will shrink.
Then reduce the sag (RZD/LZA) to complete
treatment.
Increase diameter as last resort.
WTDW…induced cyl is not
eliminated.
If decreasing the sag (LZA/RZD) does not
“squash” the cyl and causes the lens to
decenter, withdraw and start over using a
deeper RZD but less LZA that originally
suggested.
If the topography shows an oval treatment
zone or an incomplete “red ring”, increase
the RZD 25 microns.
WTDW…halos and glare are a
problem.
These are normal adaptive symptoms. They
should disappear after full treatment.
If not, it could be from the pupil dilating
outside the treatment zone or high order
spherical aberration.
Ask the patient to wear the lenses when
halos are experienced. If yes, pupil dilation
is the cause. If not, reduce the sag (LZA).
Alphagan P (off-label)
WTDW…central staining or SPK is present.
Initial staining is common, especially in the higher Rx
(>-4.00). Review proper lubrication techniques and
offer either non-preserved drops or more viscous.
A sag increase (RZD or BC) may be indicated to ease
off the central pressure. Once staining is eliminated,
then return to original parameters.
If the staining is not eliminated, withdraw.
WDTW…a diameter change is
needed.
The normal diameter is 10.5 mm. If the 10.5 lens covers
the entire visible iris, an 10.0mm diameter is indicated.
If a centered 10.5 mm lens displays at least 1mm of visible
iris around the circumference, a larger lens could be worn.
In order to mimic the edge lift with a 10.5 lens and you need
to alter the diameter, decrease the LZA by one degree for a
10.0 lens and increase the LZA by one degree for each .5
mm larger.
Diameter availability range is from 10.0 to 12.0 mm.
The treatment zone size is fixed at 6mm.
WTDW…the patient calls after 3-6
months complaining of VA reduction.
Usually due to a build-up of deposits on the back
surface of the lens.
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Inspect the lenses for deposits.
Dispense a separate GP daily cleaner.
Have the patient use a Q-tip to clean BC.
Soak in Progent. (in-office only)
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Never polish the back surface of CRT.
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WDTW…there are changes at the
annual visit.
If there is no change in OR but the manifest/ centration
has slipped, replace the lenses with the same
parameters.
If the OR has changed to the minus side, flatten the BC
accordingly but keep the RZD/LZA constant.
Don’t try to extend the wearing life of the lenses by
polishing. Micron changes in the lens shape can
cause treatment disorders.
WTDW…the VA of one eye does not
match the fellow eye.
Are the lenses switched?
If not, look at centration. Make necessary sag
changes in order to achieve proper centration.
Verify the OR is correct and hasn’t changed.
If undertreatment is <-1.00, flatten BC by 0.1mm
If undertreatment is >-1.00D, decrease LZA by 1
WTDW…a long term GP wearer wants
CRT.
Pre-fitting data will help. If so, compare current K
readings, topos, and Rx to confirm changes.
If GP lenses were fitting centrally, trial CRT for
positioning and OR. If normal pattern and
OR…continue treatment.
If GP lenses were superior riding, take baseline
map and wait until the cornea stabilizes.
WTDW…a CRT candidate/patient is
pregnant.
Corneal changes usually do not affect wearing or
treatment until the third trimester.
Use common sense. If the patient is
uncomfortable with their vision or wear ability,
withdraw until postpartum is complete.
WTDW…you haven’t seen a CRT
candidate in months.
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Have a staff meeting to re-energize the group
to promote CRT.
Fill all POP materials.
Make sure your DDS doesn’t look like Swiss
cheese (many holes).
Review initial fitting and troubleshooting
techniques.
Thank you for participating!