Bausch & Lomb Boston Multivision GP Contact Lenses - Manual (Page 2)

tear film establishes a baseline against which the practitioner can compare any changes resulting from contact
lens we a r.
FITTING GUIDE FOR THE BOSTON® MultiVision (enflufocon A) CONTACT LENS
CAUTION: Federal Law Prohibits Dispensing Without a Prescription
Background Information
The BOSTON MultiVision (enflufocon A) Contact Lens consists of a back surface aspheric design intended to
provide distance and intermediate correction with a reading addition of +1.50D. The base cur ves range from 7.3
mm to 8.3 mm, in 0.1 mm steps, with an overall lens diameter of 9.6 mm. The lens parameters and lens design
were chosen to maximize the ease of fit.
Fitting Principles
Although these lenses may be empirically fit, the best success has been found when they have been fit using
diagnostic (trial) lenses . There are no conversion requirements or special techniques required for fitting this mul-
tifocal design. The following guidelines have been provided to maximize the fitting success of the lens.
Initial Base Cur ve Selection:
If the patient’s corneal cylinder is less than or equal to 1.50D, then the initial base curve selected should corre -
spond to the patient’s flat K reading. If the patient’s corneal cylinder is greater than 1.50D, the initial base curve
selected should correspond to 0.1 to 0.2 mm steeper than the patient’s flat K reading. In general, the goal of the
fit of this multifocal design is to achieve good centration of the lens over the pupil, although superior central posi -
tion may also be acceptable. The lens must translate well with the blink (1-2 mm) ensuring that the reading por-
tion of the lens moves over the pupillary area upon down gaze. The patient should be instructed to keep their
head erect while moving their gaze to an inferior position (much like progressive addition multifocal spectacle
lenses) to maximally utilize the reading portion.
Example:
B. Step one:
Measure central corneal cur vature and identify the Flat K (lo west dioptric power)
B. In this example – K = 42.75/44.75 @ 90;Flat K = 42.75D (7.90mm)
The “Flat K”is used as a reference point from which the Base Curve Radius is Chosen.
B. Step two:
Calculate the corneal astigmatism (difference between the flat and steep K).
B. In this example – K = 42.75/44 .75 @ 90;Corneal Astigmatism = 2.00D
B. Step three:
Calculate the Base Cur ve Radius.
B. In this example – K = 42.75/44.75 @ 90;
Flat K = 7.90D
Corneal Astigmatism = 2.00D
Lens Diameter = 9.6 mm
Initial Base Curve:
Flat K 42.75D 7.90mm
+ Corneal Astigmatism Fa c t o r 0 . 5 0 D steeper than Flat K
= Initial Base Cur ve 43.25D
Base Curve Radius 43.25D 7.80 mm
You may use the above method to select your initial base curve or you may refer to the chart below:
Note: Corneal astigmatism greater than 1.50D should be evaluated with a 0.1 mm steeper lens . Greater than
2.50D of corneal astigmatism may require a 0.2 mm steeper lens.
Determine Flat K Select Base Curve
Recommendation (mm)
Range (diopters) Corneal Corneal
Astigmatism Astigmatism
< 1.50D > 1.50D
40.00 - 40.25 – 8.3
40.50 - 40.75 8.3 8.2
41.00 - 41.25 8.2 8.1
41.50 - 41.75 8.1 8.0
42.00 - 42.25 8.0 7.9
42.50 - 42.75 7.9 7.8
43.00 - 43.50 7.8 7.7
43.75 - 44.00 7.7 7.6
44.25 - 44.50 7.6 7.5
44.75 - 45.25 7.5 7.4
45.50 - 45.75 7.4 7.3
46.00 - 46.50 7.3 –
With this initial base cur ve selection evaluate the following:
A. Lens Movement:
The lens MUST move freely with the blink. Poor translation will not place the reading portion of the lens in front
of the pupillary zone upon down gaze. If the lens does not translate well, try a flatter base curve. The greatest
effect of the add is achieved when the lens interacts with the lo wer lid in down gaze which will facilitate upwa r d
t ra n s l a t i o n .
B. Lens Centration:
The lens should center o ver the pupil in primary gaze and translate upward in down gaze. The greatest effect of
the add is achieved when the lens interacts with the lo wer lid in down gaze which will facilitate upward transla -
tion.If the lens is not well centered over the pupil in primary gaze (straight ahead) try a steeper base curve.
C. Fluorescein Pattern:
In evaluating the fluorescein pattern, divide the pattern into three zones: central, intermediate and peripheral.
The ideal fluorescein pattern is one that demonstrates an aligned to slightly bearing central zone, an aligned
intermediate zone and a peripheral zone that demonstrates a slightly high edge. This slightly high edge lift or flu -
orescein pooling, is normal as long as there is not a excessive amount of edge lift, i.e., creating bubble formation
at the edge or causing the lens to be unstable.
The presence of the UV-absorber in the BOSTON® MultiVision (enflufocon A) contact lens may require equip-
ment enhancement to visualize fluorescein patterns adequately. A simple, inexpensive approach is the use of an
auxiliary yellow Kodak Wratten #12 filter in conjunction with the cobalt blue filter of the biomicroscope.
Slit Lamp Application:
1. All customary light intensities and filter settings (Cobalt Blue) are left in place.
2. The Kodak Wratten Filter #12* (yellow) is secured on the patient side of the slit lamp microscope with a small
piece of adhesive tape.
– Do not heat the conditioning/storage solution and lenses. Keep them away from extreme heat.
– Always use fresh unexpired lens care solutions .
– Always follow directions in the package inserts for the use of contact lens solutions.
– Use only a chemical (not heat) lens care system.Use of a heat (thermal) care system can warp the
BOSTON® MultiVision (enflufocon A) Contact Lenses.
– Sterile unpreserved solutions, when used, should be discarded after the time specified in the labeling direc-
tions.
– Do not use saliva or anything other than the recommended solutions for lubricating or wetting lenses.
– A l ways keep the lenses completely immersed in the recommended storage solution when the lenses are not
being wo rn (stored). If dry storage is desired to store the lenses for a longer period of time, they must first be
cleaned, rinsed with water and carefully dried by blotting with a soft lint-free tissue prior to being placed in a
clean, dry lens storage case. I d e a l l y, these lenses should be cleaned and disinfected prior to insert i o n .
• If the lens sticks (stops moving) on the e ye, follow the recommended directions on Care for a Sticking Lens.
The lens should move freely on the eye for the continued health of the e ye. If nonmovement of the lens contin -
ues, the patient should be instructed to immediately consult his or her eyecare practitioner.
• A l ways wash and rinse hands before handling lenses. Do not get cosmetics, lotions, soaps, creams, deodora n t s, or
s p rays in the eyes or on the lenses. It is best to put on lenses before putting on make u p. Water-based cosmetics are
less likely to damage lenses than oil-based products.
• Do not touch contact lenses with the fingers or hands if the hands are not free of foreign materials, as micro-
scopic scratches on the lenses may occur, causing distorted vision and/or injury to the eye.
• Carefully follow the handling, insertion, remo val, cleaning, disinfecting, storing and wearing instructions in the
Patient Instructions for the BOSTON® MultiVision (enflufocon A) Contact Lens and those prescribed by the
eyecare practitioner.
• Never wear lenses beyond the period recommended by the e yecare practitioner.
• If aerosol products such as hair spr ay are used while wearing lenses, e xercise caution and keep eyes closed
until the spray has settled.
• Always handle lenses gently and a void dropping them on hard surfaces.
• Avoid all harmful or irritating vapors and fumes while wearing lenses.
• Ask the eyecare practitioner about wearing lenses during water activities and other sports.
• Inform the patient to alert their health care practitioner (doctor) that they wear contact lenses.
• Never use tweezers or other tools to remo ve lenses from the lens case unless specifically indicated for that
use. Pour the lens into the hand.
• Do not touch the lens with fingernails .
• Always contact the e yecare practitioner before using any medicine in the e yes.
• Always inform your employer that you wear contact lenses . Some jobs may require use of e ye protection equip-
ment or may require that the patient not wear contact lenses.
• As with any contact lens, follow-up visits are
necessary to assure the continuing health of the patient’s eyes. The patient should be instructed
as to a recommended follow-up schedule.
ADVERSE EFFECTS
The patient should be informed that the following problems may occur :
• Comfort is less than when lens was first placed on the eye
• Feeling of something in the e ye such as a foreign body, scratched area
• Excessive watering (tearing) of the eyes
If the patient notices any of the abo ve symptoms, he or she should be instructed to:
Immediately remove lenses
If the discomfort or problem stops, then closely inspect the lens. If the lens is in any w ay damaged, do not put
the lens back on the eye. Place the lens in the storage case and contact the eyecare practitioner.
If the lens has dirt, an eyelash, or other foreign body on it, or the problem stops and the lens appears undam-
aged, the patient should thoroughly clean, rinse, and disinfect the lenses;then reinsert them. After reinsertion, if
the problem continues, the patient should immediately remove the lenses and consult the e ye care practitioner.
The patient should be informed that the following problems may also occur:
• Eyes stinging, burning, itching (irritation), or other eye pain
• Redness of the eyes
• Reduced sharpness of vision (poor visual acuity)
• Blurred vision, rainbows, or halos around objects
• Sensitivity to light (photophobia)
• Dry eyes
If the patient notices any of the abo ve symptons, he or she should be instructed to:
Immediately remove lenses
When any of the abo ve problems occur, a serious condition such as infection, corneal ulcer, neovascularization,
or iritis may be present. The patient should be instructed to keep the lens off the eye and seek immediate pro-
fessional identification of the problem and prompt treatment to avoid serious eye damage.
SELECTION OF PATIENTS
BOSTON® MultiVision (enflufocon A) Contact Lens is a rigid gas permeable lens for the daily wear patient who
may require the correction of visual acuity for m yopia, hyperopia, astigmatism or presb yopia.BOSTON®
MultiVision (enflufocon A) Contact Lenses are suitable for patients who ha ve never worn contact lenses, for cur-
rent PMMA wearers, for patients wanting to upgrade their current rigid gas permeable lenses, as well as for
some patients who have been unsuccessful with soft contact lenses .
PRE-FITTING EXAMINATION
A pre-fitting patient history and examination are necessary to:
• determine whether a patient is a suitable candidate for daily wear presbyopic contact lenses (consider
patient hygiene and mental and physical state),
• make ocular measurements for initial contact lens parameter selection,
• collect and record baseline clinical information to which post-fitting examination results can be compared,
A pre-fitting examination should include distance refraction, keratometry and slit lamp evaluation to rule out
a ny contraindications to contact lens we a r. Careful assessment of the cornea, lids, conj u n c t i va and precorn e a l