Topography And Wave Training Program with Technical Support

• QA - When do I use Average Astigmatism and not use Average Astigmatism when designing a     Wave Contact lens?

  ANS - Click HERE for short video

• QA - What happens when I can not find a previously ordered or missing Wave Contact lens in the Keratron Scout software program?

   

  ANS - You should be able to find a copy of the ordered Wave lens in the Documents Wave folder in the WaveFiles. Click HERE to view a short video.

   

• QA - How do I delete a Wave Contact Lens Order once it has been sent to the Internet Order Status System?

   

  ANS - If you need to cancel an order, you must do so as quickly as possible to avoid charges. Right click on the IOSS icon located in the system tray, various options are presented. Select the Check IOSS option to directly enter the IOSS web site.  Click HERE to view document.

   

• QA - How do I get the Wave icon to appear in Keratron Scout? When I open up the Keratron Scout program the Wave icon is missing from the Keratron Scout icon bar.

   

  ANS - There is a spot to enter your ID and password when you register. If you miss this, your Wave icon button will not show on the Scout icon bar. Click HERE to view document.

   

• QA - How to make additional changes to a previously ordered Wave Contact Lens before reordering.

  ANS – You will need to start a new design with the previous settings. Click HERE to view a short video.

• QA - What is the best starting point in creating a Hyperopic / Presbyopic Ortho-K Lens?

  ANS - A custom configuration definition like the one attached to this message is a very good place to begin with your hyperopic/presbyopic patient. For this to function properly, you MUST first place a check next to the B indicator and have dialed in +.05 for an S value. Only AFTER those two items have been set, apply the custom configuration.

   

   After about one week, if near is good but distance is blurred, reduce both the oz and ic by about 0.20. If, on the other hand distance is clear but near is blurred, increase both the oz and ic by about 0.20.

   

   

   

  

• QA - How does the new edge angle feature help with large lenses?

  Have a patient for whom I would like to increase the angle.  I guess that will mean the very edge will be lifted slightly.  I can see the edge angle when I hover over the black ball.  I tried clicking the up arrow on both that ball and the 2nd from the right and no change in edge angle was shown.  Am I doing something wrong, or perhaps I don’t understand this feature like I thought I did?

   

  ANS - This video shows me making a large diameter lens. The moral of the story is that it takes lots of microns to make one degree of change. Click HERE to view video.

• QA - What does the “B” (blending) option do?

   

  ​

   

  ANS - All Wave lenses blend the junction. The default blending is a soft and gentle. But with some     (ortho K) designs the designer may wish to introduce a harder, more aggressive blend by checking the  B option.

   

  If you select the B option with ortho k designs, also do so before beginning the Custom Configuration for your ortho k design. Custom Configurations calculation the design to create the apical clearance, peripheral alignment and edge lift specified in the selected definition. The results of those calculations can be different if the B option is selected or if it is not.

   

  If you intend to use the B option and use Custom configuration to do the rest of the design adjustments, the result is more accurate if the B option is activated at the time custom configuration does its calculations and not after. The difference can be only a micron here and a micron there, but the difference in fit can be noticeable.

   

  Watch this video for more details.

• QA - How can I use older Wave Designs to design a new Wave Contact Lens?

  ANS - An example would be when you have 5 Wave lens designs and you want to do a re-design from lens # 3. Normally when you do a re-design the Wave program will only allow you to start from the ( previous ) # 5 lens.

   

  There is a work around to this issue which involves manipulation of the data files by export / import and renaming the files. Click HERE to view video.

• QA - Should I "check the B box" for blending in Ortho-K designs as recommended in the videos?  How does blending (more abrupt curvature changes) affect treatment...better or same outcomes? It depends. There is no easy answer to this. Try it on one eye, and not the other. See what happens.

   

  ANS - The "B" actually stands for "MINIMAL blending", NOT "blending", is that not correct, Jim? Both slopes of the reverse curve are less steep (more blended, less abrupt transition to TZ and AZ) when the minimal blend box is unchecked. Both slopes of the reverse curve are much steeper (less blended, more abrupt transition to TZ and AZ) when you check the minimal blend box. Not only will minimal blending increase the TZW (treatment zone width), but it increases the AZW (alignment zone width) as well, which can help in centration. Both will help to minimize halos, but if myopia control is the chief goal, then you want the TZW to be slightly smaller than the pupillary diameter to create peripheral myopia from the highly plus powered RZ (return zone) ring being slightly inside the pupil.

   

   I never checked the "B" box until recently. I like how it cleans up the TZ and RZ rings on the fluorescein patterns and post-tx topos, and patients often seem to get better visual acuity results with minimal blending checked...but sometimes I don't like how the outer slope of the RZ lands so sharply as it begins the AZ landing point, even after trying to fix it, so I'll uncheck the box in those cases. No matter how concisely we try to design these buggers, we don't know, for example, just exactly what size TZW will result from that particular design and if that will be the "be all, end all" lens that will have the patient live happily ever after. With so many design features that Jim has created, we now have a much better ability to troubleshoot when a design isn't producing the result we hoped for, but there is always going to be a "cross your fingers moment" right before you hit the "ORDER" button

• QA - "I've been advised to use tangential mode for all Ortho-k designs to minimize inadequate apical clearance. Your thoughts on this Wavers?"

  ANS - From an experienced user: "I always design in Tangential mode. I would also recommend in this case to design some AZ clearance in the horizontal meridians to promote tear flow under the lens.

   

  Set each horizontal to 50% mode, click up on the BLUE ball to get the inner part of the AZ to be 4-5 microns (for corneal lenses set it to approx 3 microns), then click up on the PINK ball to about 20 microns (10 for corneal lenses). Keep the vertical AZs as parallel to the cornea as possible (to help prevent the induced WTR astigmatism caused by lens rock) while keeping the apical TLT between 0.7-1.7 microns. I also make CT approx 25 mm and ET approx 15 mm.

   

  This thinner edge than most WAVERS design, along with the looser horizontal AZs will help with tear exchange as well as increase the likelihood that the BC will be unimpeded in pressing fully on the apex by horizontal AZs landing "too soon". I also recommend prism for any free form design, especially when you have corneal cylinder.

   

  One last thing. My last step is to make the lift angle at 38 around the whole lens, but then you'll have to go back and readjust the PINK ball slightly."

• QA - "I have been fitting WAVE Ortho-K lenses for about a year and a half now. I find the lenses fit great and patients are happy.  Prior to WAVE, I fit only the Paragon orthoK lenses.   I have a few "Paragon" patients that I feel that I could fit better with WAVE.  However, having them "wash" out in order to get their corneas back to normal for mapping with the Scout sounds like a difficult and blurry process.  Is there any way around this?  Any recommendations from those who have done this before?"

  ANS - "Although it is a hassle for the patient, Turn this into a positive internal marketing venture.  Take them out of the previous Orthok design, supply them with equivalent soft lenses (or glasses) during their wash out period (which I found fairly consistently to be about 1 month) until I would get repeatable topos.

   

  At that 1 month visit ask them just how much they missed their Orthok as compared with their current soft lens/glasses wear they were forced to endure during their self-proclaimed "month of hell."  They almost unanimously vocalize that they had truly forgotten all the "inconveniences and hassles" associated with their pre-Orthok correction choices.

   

  Now that I had their totally focused attention on how wonderful Orthok was, I told them to now go out and tell everybody about their experience with Orthok related to soft lens/glasses wear while I get their new Wave lenses ordered."

• QA - How is the Edge Angle Relative to Lens Vault?

  ANS - Click HERE to view Power Point presentation on how the Edge Angle is Relative to Lens Vault.

             (Requires Adobe pdf reader to view)

• QA - How to adjust Wave Lens Edge Awareness and Comfort

  ANS - When we obsess over the geometry of the edge, we are implying that it comes from the cornea. The cornea is much more sensitive than the lids, so the threshold is much lower there.

   

  The lid attachment idea, is from the same big tear layer at the edge concept when applied to sub 9.0 oad lens designs, which (at that small diameter) are This concept can be applied in the office with a lens modification

  unit. Use an 11.00mm tool and just put about .1 or .2 mm of bevel at the edge, (so you can barely see the width)  then smooth out the edge with polish.

   

  When first started designing ortho-K lenses with 4-5 curve designs (and no topographer), the lab I was using would always do that without my request, because they were "helping" me. I had to specify on the order to NOT add any curves I didn't specify, or they would do it as a matter of routine. They didn't understand that I wasn't designing gp

  lenses to be worn 16 hr/d. These were for overnight, closed eye, orthok, and I found that I got much better results when they didn't "help" me by altering the periphery, even out that far.

   

  Click HERE for a short video about suggestions on how to adjust Wave Lens Edge Awareness and Comfort.

   

  4/28/2015

• QA - How can I work around adding additional Wave designs past the 8 Maximum allowed to be saved?

  ANS - There are two ways to work around adding additional Wave designs past the 8 maximum allowed to be    saved.

   

  1. When you get to the Maximum 8 Wave designs allowed, delete the #1 lens (oldest design) to make room for the newest Wave design to save.

   

  OR

   

  2. You can rename the patient record (Ex. from David Smith to David Smith2).

   

       Then Export the Test to a folder that you create.

   

       After the export  change the patient name back to as it was (Ex. David Smith) in the database.

   

       Then import your file from your desk top back into Keratron.

   

       Leave the name as is. (EX. David Smith2).

   

       Then right click on the file beneath the patients name.

   

       Next select Change/modify test data.

   

       Then delete all but the last contact lens ,(leave the highest number).

   

       Click Save.

   

       Now you have all your previous designs located in the patient, David Smith and underneath you should have a new patient called, David Smith2 which will only have one design listed – the last one.

• QA - What are the considerations when designing an Ortho-K Wave lens?

  ANS - Considerations When Design an Ortho K Lens

   

  The definitions you see in Wave configurations settings are intended as educational examples of how to use the configuration settings feature and what it can do for you when you use it. None of them, not a single one, are intended as a silver bullet quick fix. None of these definitions have been tested and documented using standard measures with a large group and statistically proven safe and effective over long periods of time. Wave is not making claims about the results you will see using these definitions. When a design is warranted because it fits into the FDA approval for VST, it is because the resultant lens design can be approximately described by the range of designs that were part of B+L's FDA approved system. Exactly HOW you used Wave to end up with a particular design is entirely up to you. You can create a design by manually adjusting each control point in each meridian, or you can use a definition in config settings, or you can use config settings to get a very close starting point and then make minor adjustments manually before ordering a design. Wave is designed to allow you to act on your own knowledge, but without your knowledge, Wave is as dumb as a rock.

   

  I tend to adjust two things about a design according to the Rx:

   

  First the treatment zone size. Larger Rx demand generally works better with smaller treatment zone sizes. I typically will begin to reduce the oz/ic size when I get to about -4. One way to think is to reduce the oz/ic by 0.10 for every 1 diopter of myopia above 4. For example, for a -6, I may reduce the oz/ic from 6.2/6.8 to  6.0/6.6 and a -8 may get an oz/ic of 5.8/6.4 etc. Obviously, there is a practical limit to this step because we typically are not doing myopia control on a -8, just trying to gain functional daytime vision. A smaller treatment zone produces more aberrations than a large treatment zone, so this step has diminishing returns when the treatment zone gets much smaller than the pupil. More about this later.

   

  Second is the target power. We know that the post wear cornea does not match the base curve of our lens. The base curve determines the lens power because the tear lens we create with the base curve must be compensated in the lens power. Up to about -3, a lens power of about +1.25 works pretty consistently. I think of this as a percentage however. The cornea will only go 80% toward the base curve (or something less than 100%) The greater the amount of change I'm trying to make, the larger the amount of difference between base curve and post wear corneal curvature. So as I pass -3, I begin to increase the plus power of the lens because I'm using a flatter base curve. A ballpark rule of thumb would be to increase the plus by .25D per 1.00D of correction above -3. For example a -4 would have a target lens power of +1.50 and a -8 would have a target lens power of +2.50. I personally stop at about +2.50 though because I don't want a super high plus lens on overnight too much because the lens starts getting thicker and thicker.

   

  Back to the treatment zone size. It is darned hard to get a very big treatment zone when correcting for high amounts of myopia. I'm talking about over -7ish. Lots of those patients also have big pupils too, so aberrations (flare and glare) starts dominating the scene. To attempt to address this situation, I use asphericity in the optic zone to try and compensate for the aberration. The definition you referred to includes this asphericity. In simple terms you get a small steep red area in the center of the optic zone when you do this. The treatment zone of the post wear map almost never shows as much asphericity as the base curve of the lens because remember, that the cornea never perfectly matches the lens anyway, and I always try to make sure that the central steep area is as small as possible. I've seen cases where this technique increases the overall treatment zone and improves overall aberrations. It doesn't always work, but then again we are up against a wall with these high Rx situations, so this is when we throw the kitchen sink at the problem.

   

   

• QA - What is best way to start a Hyperopic Wave Ortho-k lens? Can you please suggest your ideal range of patients for example the max distance and near spectacle rx, K’s etc. Any tips about who to avoid would be appreciated.

  ANS - An ideal patient would be a plus 2 with 2 add female patient. Motivation is high, no LASIK options and very forgiving optics.

   

  Avoid the plus 2 with 1.25 cyls or greater. Create more molding centrally in the non dominant eye.

• QA - I'm looking for a template for letter of medical necessity to vision insurance for a post-RK pt now requiring/wearing Wave sclerals.  Suggestions?

  ANS - Coding and Billing Resources - Click HERE to see resources that are available pertaining to medically necessary contact lenses.

• QA - I need to design a Wave Lens for Myopia control.

  ANS - To learn the basics on how to create a Wave Lens for Myopia Control click HERE .

   

  In the video Jim Edwards had created a starting point Wave Template to create the lens. Here are the adjustment points to help you build your own template.

   

  ​                  4/28/2015