By Jeffrey Sonsino, O.D., F.A.A.O., Vanderbilt Eye Institute
Shortly after UltraHealth was introduced, I became one of the top fitters of the lens in the U.S. We have a moderately busy keratoconus practice, seeing between 21-35 keratoconic patients per week among other complex anterior segment cases.
When UltraHealth arrived, we jumped on it due to some key design changes.
The redesign of the skirt curves made me breathe a sigh of relief. Our experience with Clearkone was being limited by significant mid-peripheral bearing at the inner landing zone on many advanced cones. Even with steep II skirt curves, it resulted in decreased wear time at the end of the day. The redesign of the UltraHealth skirt curve went a long way to fix this problem. SynergEyes re-engineered the skirt to have a thicker zone right at the junction between hard and soft. This resulted in a very soft landing zone on the cornea and changed the fitting dynamic to require mostly flat skirt curves.
Next, there was the change to a silicone hydrogel skirt material. This was very appealing since keratocones notoriously wear their lenses from waking to bedtime. Patients have commented that their eyes are whiter than when they were wearing ClearKone. Biomicroscopically, we have noticed less limbal hyperemia in seasoned UltraHealth wearers. Some patients complained that when we made the transition from hydrogel to silicone hydrogel skirt, they needed to remove their lenses during the day and reinsert. However, after 3-4 days of powering through this, it resolved and they could wear their lenses all day with comfort.
Then, there is the idea that a corneal contact lens is able to vault the cone. Standard GPs cannot make this claim. It is only by using the soft skirt that the GP portion of UltraHealth is able to vault over the central cornea with minimal impact to the mid-periphery. This is a boon to those who have read the CLEK studies and understand that an apical clearance lens is superior to a three point touch fitting philosophy. UltraHealth lenses will tend to settle after some time on the eye, but you should be able to observe this during the fitting process. I ensure that there is no bearing on the cone as seen with sodium fluorescein and importantly, a Wratten filter (you will be able to see bearing much easier).
Our experience with UltraHealth has been very positive. We have patients for whom this strategy is a game changer. They love the comfort improvement while maintaining the good vision they are accustomed to with standard GPs. Challenges have been that some patients may notice one lens more comfortable than the other, with no apparent physiologic reason. Sometimes a change of skirt curve and/or base curve will equalize the comfort of the two eyes. In patients who remark that in one eye, they are unable to feel the lens at all, while in the other, there is a foreign body sensation, it is tough to solve this problem. With any lens that has set parameters, if the eye fits within the "zone," there will be success.
With the many improvements to UltraHealth over previous generations of hybrid lenses, SynergEyes has finally come up with a lens that works for the majority of keratocones. My patients are grateful for the opportunity to try something newer than their standard GPs. Comfortable lenses that provide good vision is what keratocones want and deserve. It is our responsibility to offer them options that can deliver.