SOURCE

Dr. Edward Boshnick maintains a cutting edge practice devoted to the restoration of vision and comfort lost as a result of refractive eye surgery (including LASIK and Radial Keratotomy), keratoconus, corneal transplant surgery, pellucid marginal degeneration, extreme dry eye, corneal dystrophies, corneal trauma and Stevens-Johnson Syndrome.

Specializing in contact lens care, children's vision, orthokeratology and vision care for the partially sighted (low vision). Dr. Boshnick has been a clinical investigator for both the FDA and several major contact lens manufacturers for over 20 years. Dr. Boshnick has also lectured extensively and authored a number of professional articles dealing with contact and scleral lenses and orthokeratology.


Treatment for Post-Surgical Vision Loss

How best to treat a patient who has suffered vision loss due to LASIK, RK or some other surgical procedure depends on a number of factors. Some of the symptoms and issues facing the doctor and patient included but are not limited to the following:

  • Reduced best corrected visual acuity
  • Irregular or distorted corneas
  • Open wounds and/or weakened corneal flap
  • Higher order aberrations
  • Decentered optic zones
  • Corneal ectasia
  • Extremely dry eye
  • Ocular pain and headaches
  • Vitreous floaters
  • Reduced contrast sensitivity
  • Dramatically reduced night vision
  • Visual phenomena such as glare, flare, halos around lights, starbursts
  • Overcorrection of the pre-surgical refractive error
  • Emotional issues due to many of the above factors

At the present time there is no cure for many of the above. However, there are a number of specialized lenses now available that will allow post-surgical patients to function on a much higher level with a much greater level of comfort. While there are a number of soft lens and gas permeable lens designs included in the "specialized lens" category, I have come to rely on two major lens designs to address the vision and comfort issues that most post-refractive surgical patients are facing. These lens designs are the new Synergeyes Post-Surgical Lens and Post-Surgical Scleral Lenses.

 

Synergeyes Post-Surgical Lens on Left Eye Synergeyes Post-Surgical Lens on transplanted cornea with two RK procedures followed by cataract surgery Synegeyes Post-Surgical lens on post-RK cornea

Synergeyes Post-Surgical Lenses are "hybrid" lenses. This lens consists of a highly oxygen permeable central area "married" to a soft periphery. The geometry of the lens is designed to fit over the irregular cornea without irritating the compromised corneal tissue. The soft peripheral portion of the lens gives superior comfort while at the same time creating a stable fit. Unlike previous hybrid lenses, the interface or juncture where the soft and rigid portions meet is extremely resistant to tearing or damage. In addition, the Synergeyes Post-Surgical lens is hundreds of times more oxygen permeable than it's predecessors.

 

Scleral lens on post-refractive surgical cornea.

Scleral lenses are large gas permeable lenses which vault over the compromised cornea and rest on the white portion of the eye (the sclera). Comfort and vision are extremely good. A special liquid fills the space between the back surface of the lens and the front of the cornea. This type of lens, when fit correctly, very often allows the dried cornea to heal. Often, traumatized corneal tissues don't heal due to the blinking action of the eyelids and various irritants in the environment (air conditioning, dust, allergens etc.). Scleral lenses protect the compromised corneal tissue allowing the eye to heal while providing vision that no other type of lens can provide.

There is no way of knowing before hand which type of technology will work best. Very often I will fit a post-surgical patient with both types of lenses at the initial session. If a patient has a weakened Lasik flap or if there is incomplete healing, a scleral lens may work out best. To save time and reduce the number of follow-up office visits, I will very often order both types of lens designs and evaluate both at the dispensing visit.

The above lens designs provide superior vision due to the fact that there is a rigid material in front of the pupil and along the line of vision. They essentially replace the cornea as an optical surface. Soft lenses, while providing good comfort, take on the same shape as the irregular cornea. Crisp, sharp vision, therefore is not possible with soft lenses. In addition, soft lenses lie on top of the dried-out, distressed cornea, very often making matters worse by drying out the tissue and preventing the tissue from regenerating.

Patient Videos from Dr. Edward Boshnick's website

  1. POST-LASIK ECTASIA PATIENT WEARING SCLERAL LENSES
  2. CORNEAL TOPOGRAPHY EXPLAINED
  3. SYNERGEYES LENS DESIGN EXPLAINED
  4. CORNEAL TRANSPLANT AND KERATOCONUS PATIENT WEARING SPECIALTY LENSES
  5. PATIENT WITH CORNEAL TRANSPLANTS WEARING SCLERAL LENSES
  6. PATIENT WITH STEVENS-JOHNSON SYNDROME WEARING SCLERAL LENS
  7. PATIENT WITH VISION LOSS DUE TO LASIK WEARING SYNERGEYES LENSES
  8. PATIENT WITH VISION LOSS DUE TO MULTIPLE REFRACTIVE SURGICAL PROCEDURES
  9. PATIENT WITH ADVANCED KERATOCONUS WEARING ROSE K AND SCLERAL LENS (SPANISH)
  10. PATIENT WITH ADVANCED KERATOCONUS WEARING SCLERAL LENSES
  11. PATIENT WITH ADVANCED KERATOCONUS WEARING SCLERAL LENSES
  12. PATIENT WITH ADVANCED KERATOCONUS SPEAKING IN CREOLE
  13. EXTREMELY FAR-SIGHTED PATIENT WEARING SPECIALTY SOFT LENSES
  14. PATIENT WITH ADVANCED KERATOCONUS WITH HYDROPS WEARING SCLERAL LENSES
  15. PATIENT WITH ADVANCED KERATOCONUS WEARING ROSE K LENSES
  16. PATIENT WITH ADVANCED KERATOCONUS WEARING ROSE K LENSES
  17. PATIENT WHO UNDERWENT 2 R-K PROCEDURES FOLLOWED BY 2 LASIK PROCEDURES WEARING SCLERAL LENSES.
  18. PATIENT WITH ADVANCED KERATOCONUS WEARING ROSE K LENS AND A SCLERAL LENS.
  19. PATIENT WITH ADVANCED PELLUCID MARGINAL DEGENERATION WEARING SCLERAL LENSES.
  20. PATIENT WITH POST-LASIK CORNEAL ECTASIA WEARING SYNERGEYES POST-SURGICAL LENSES.
  21. YOUNG BOY WITH ADVANCED KERATOCONUS WEARING ROSE K LENSES (SPANISH).
  22. PATIENT WITH BILATERAL CORNEAL TRANSPLANTS WEARING SCLERAL LENSES
  23. PATIENT WITH ADVANCED KERATOCONUS WEARING A SCLERAL LENS AND A ROSE K LENS.
  24. PATIENT WITH ADVANCED KERATOCONUS WEARING ROSE K LENSES.
  25. PATIENT WITH A HIGH VISUAL ERROR IN ONE VERY DRY EYE WEARING A 1-DAY MOIST ACUVUE LENS.
  26. PATIENT WITH POST-LASIK CORNEAL ECTASIA WEARING SYNERGEYES POST-SURGICAL LENSES.
  27. PATIENT WITH PELLUCID MARGINAL DEGENERATION WEARING SCLERAL LENS.
  28. PATIENT WITH ADVANCED KERATOCONUS WITH INTACS (WHO ALSO UNDERWENT COLLAGEN CROSS-LINKING THERAPY) WEARING SCLERAL LENS.
  29. PATIENT WITH ACHROMATOPSIA (SEVERE COLOR BLINDNESS) WEARING SPECIALLY COLORED SCLERAL LENSES. (SPANISH).
  30. PATIENT WITH POST-LASIK CORNEAL ECTASIA WEARING 1-DAY ACUVUE MOIST LENSES.
  31. PATIENT WITH ADVANCED KERATOCONUS WEARING SYNERGEYES LENSES (SPANISH).
  32. PATIENT WITH ADVANCED KERATOCONUS WEARING ROSE K LENSES.
  33. POST-LASIK CORNEAL ECTASIA PATIENT WEARING SYNERGEYES HYBRID POST-SURGICAL LENSES.
  34. KERATOCONUS PATIENT WEARING REVERSE-GEOMETRY SOFT LENSES.
  35. ADVANCED KERATOCONUS PATIENT WEARING SYNERGEYES HYBRID KERATOCONUS.
  36. PATIENT WITH HIGH MYOPIA (NEARSIGHTEDNESS)WEARING CRT (CORNEAL REFRACTIVE THERAPY) LENSES DURING SLEEPING HOURS ONLY .
  37. ADVANCED KERATOCONUS PATIENT WEARING SYNERGEYES HYBRID KERATOCONUS DESIGNED LENSES (SPANISH).
  38. ADVANCED KERATOCONUS PATIENT WEARING SYNERGEYES HYBRID KERATOCONUS DESIGNED LENSES.
  39. ADVANCED KERATOCONUS PATIENT WEARING MENICON GAS PERMEABLE LENSES (SPANISH).
  40. NEARSIGHTED(MYOPIC)PATIENT WEARING CRT(CORNEAL REFRACTIVE THERAPY) LENSES ONLY DURING SLEEPING HOURS.
  41. ADVANCED KERATOCONUS PATIENT WEARING SCLERAL GAS PERMEABLE LENSES.
  42. PATIENT WITH SCARRED IRREGULAR CORNEA DUE TO CORNEAL ULCER WEARING SCLERAL GAS PERMEABLE LENS.
  43. EXTREMELY ADVANCED KERATOCONUS PATIENT WEARING SCLERAL GAS PERMEABLE LENS.
  44. PATIENT WITH ADVANCED KERATOCONUS WEARING ROSE K GAS PERMEABLE LENSES.
  45. PATIENT WITH POOR VISION AT FAR AND AT NEAR WEARING ACUVUE BIFOCAL DISPOSABLE SOFT LENSES (SPANISH).
  46. PATIENT WITH EXTEMELY HIGH VISION ERROR WEARING MENICON GAS PERMEABLE LENSES.
  47. PATIENT WHO UNDERWENT TWO SEPARATE R-K PROCEDURES FOLLOWED BY TWO SEPARATE LASIK PROCEDURES SUCCESSFULLY WEARING SCLERAL GAS PERMEABLE LENSES.

Paragon CRT®

paragon

No Glasses... No Daytime Contacts... No Surgery!

Paragon Vision Sciences is the manufacturer of Paragon CRT®, a unique rigid gas permeable contact lens designed to temporarily correct myopia (nearsightedness) by gently and reversibly reshaping your cornea while you sleep. Paragon CRT lenses are made from an overnight contact lens material in a special design intended for this purpose.

According to Paragon, Corneal Refractive Therapy is a non-invasive (non-surgical) alternative to Refractive surgery, developed to reshape the cornea while you sleep. This allows you to go throughout the day without any lenses, and without expensive surgery!

"Recent clinical research combined with the latest corneal surface mapping technology, computerized manufacturing and space age oxygen-breathing materials have brought new science to corneal reshaping", states Paragon's website.

Paragon CRT® Inquiries Increase With Recent FDA Hearing on LASIK

Mesa, AZ (Apr 29, 2008) Paragon Vision Sciences, the manufacture of Paragon CRT® for overnight corneal reshaping to temporarily correct nearsightedness, commented today that inquiries have increased by doctors, consumers and distributors worldwide for its non-surgical contact lens. Paragon CRT provides similar visual benefits as LASIK so that patients can go all day long without their glasses or daytime contacts, however, it also provides other significant benefits for both children and adults in that it’s temporary and reversible. These dramatic rise in inquiries is coming quickly on the heels of a Nationwide consumer alert that the FDA convened a special meeting on Friday, April 25, to hear from LASIK surgeons, as well as, disgruntled patients who say their eyesight has been irreparably damaged by the surgery.

Joe Sicari, President of Paragon Vision Sciences, commented;

"While LASIK has improved the lives of so many people, it is unfortunate that of the estimated 7.6 million Americans who have undergone some sort of laser vision correction that approximately 400,000 have experienced unacceptable outcomes. In some cases this may include permanent vision impairment. We are pleased that Paragon CRT offers a non-surgical and reversible alternative for the freedom from glasses and traditional contact lenses that consumers seek. It is my hope that the Myopia Control research, currently underway with CRT and providing very promising early results, will enable us to nonsurgically halt the progression of nearsightedness. We are also observing expanding indications that CRT is emerging as an answer to dry eye discomfort among soft lens wearers since CRT lenses are not worn during functioning hours providing maximum visual comfort. I would like to think doctors who advise patients against LASIK would consider CRT as an alternative method to vision correction."

While LASIK is a good procedure for many people, most consumers fear eye surgery. After all no one wants surgery. What consumers really desire is the freedom from their glasses and traditional contact lenses. In June 2002, Paragon CRT (Corneal Refractive Therapy) was FDA approved for all ages. CRT allows the consumer to wear a special contact lens ONLY DURING SLEEPING HOURS. Upon awakening, the lenses are removed providing 20/20 vision for one to three days. No Surgery. No Daytime Contacts. No Glasses.

CRT lenses are also used by some surgeons to correct unacceptable visual outcomes following LASIK. The lenses can adjust for small over and under corrections. It is generally accepted by those surgeons that CRT is safer than additional surgery. LASIK surgeons should inform people interested in LASIK about this non-invasive and temporary alternative but, generally, do not. The reasons are varied.

An estimated 4,000 practitioners in the USA already fit CRT lenses and there are well over 200,000 very happy consumers including adults and children.

Paragon Vision Sciences has a history of innovation that spans four (4) decades with many “First” achievements in the contact lens industry including; the First to gain FDA approval for overnight corneal reshaping for myopia with and without astigmatism, the First to secure FDA approval for Plasma treatment of Paragon GP materials and the First to collaborate with NASA to conduct research on gas permeable materials aboard three space shuttle missions spanning almost 10 years. As a result, Paragon’s HDS® technology with the hyper-purified delivery system was used to launch the market leading HDS® and HDS® 100 high oxygen permeable materials that are so widely prescribed today.

Paragon Vision Sciences is a privately held, specialty vision research, development and products company, located near Phoenix in Mesa, Arizona, owned and operated by Joe Sicari, President & CEO and members of his management team. Paragon is the manufacturer of world-renowned oxygen permeable contact lens materials including Paragon HDS®, Paragon HDS® 100, Paragon Thin, FluoroPerm®, and Paraperm® family of materials for a wide range of indications.

For more information about Paragon Vision Sciences GP materials or Paragon CRT® call 800.528.8279.

Data on file – Paragon Vision Sciences - 2008

Paragon CRT® lenses are available throughout North America and are also available Internationally! Please visit Paragon's WEBSITE for this and other information.

The information contained on these pages are not intended to supplant medical advice. As all eyes are different, These lenses may NOT be for you! Please consult your ophthalmologist to see if they are. I've included Paragon's FAQ's below.

 

For Post-LASIK Complications:

synergeyes

  A look at how the technology behind SynergEyes lenses benefits both patients and practitioners

http://www.clspectrum.com/article.aspx?article=13066Contact Lens SpectrumIssue: July 2006

SPECIALTY LENSES

Rigid Optics with Soft Lens Comfort

By Brian Chou, OD, FAAOThe development of SynergEyes (SynergEyes Inc., Carlsbad, CA) exemplifies how technological advances in several areas — material science, manufacturing, lens design and prescribing method — combine such that their sum effect is greater than adding the individual parts, making the trade name appropriately resonate the meaning of "synergy."My office was one of the 23 sites that participated in the initial FDA clinical studies of SynergEyes lenses. Currently, more than 50 patients in my practice are successfully wearing SynergEyes lenses.In this article I'll share some of the relevant information about SynergEyes, giving a technological perspective on what differentiates this contact lens from its commodity counterparts.Figure 1. A SynergEyes hybrid lens.

Material Science

Previous hybrid lenses had a Dk of about 14 and the firm center and soft skirt separated relatively easily. Even though some GP materials now exist with Dk values exceeding 150, until now, no manufacturer successfully developed a high-Dk hybrid contact lens because of the difficulty in bonding hydrophilic skirts to high-Dk rigid materials.The breakthrough in material science is the proprietary Hyperbond technology that allows a strong link between a hydrophilic skirt and a highly oxygen permeable rigid center. The polymer chemists at SynergEyes developed a method to protect the GP material from alteration by the hydrophilic monomers while providing a strong bond. The technology produces intermediate layers that preserve the gas permeability, mechanical properties and index of refraction while producing a multi-zone interface. Each chemically different layer is nanometers thick. The SynergEyes rigid center has a Dk of 145 with a bond to the soft skirt that is substantially stronger than anything before, approximately 10 times stronger than previous hybrid lenses, according to company data.

Manufacturing

Today, contact lens manufacturers frequently use low-cost cast molding to make lenses. Diamond turning lathes and automation also produce precision lenses at a reasonable cost.SynergEyes lenses are manufactured with no-polish lathing. The process utilizes vibration-free computer-numerical-controlled lathes driven by proprietary Pro80 design software. Jim Schwiegerling, PhD, Associate Professor of Ophthalmology at the University of Arizona, developed this software to provide versatility for the hybrid platform extending beyond standard lathe mini-files. Spherical, toric, multifocal and rotationally non-symmetrical optical and structural designs are generated for the hybrid platform.These methods will produce a family of lenses targeted to manage the full continuum of refractive errors. The software-driven polish-free lathed optics are ideal for a platinum standard multifocal, higher-order aberration correcting lenses and lenses for patent-pending Myopia Progression Control. The manufacturing efficiency drives the production cost of the SynergEyes lens to about one-half that of previous hybrid lenses.

Design

Previous attempts at hybrid lenses experienced limitations besides just hypoxia-related corneal neovascularization and frequent separation at the rigid-soft skirt border. The first hybrid lenses were launched nearly 25 years ago. A second-generation hybrid, SoftPerm (CIBA Vision) is still commercially available. These predecessor lenses have one skirt radius for each base curve.The clinical research team at SynergEyes discovered a clear relationship between corneal curvature, corneal diameter and the required base curve and skirt radius needed for a successful lens fit. A plurality of skirt radii for a given base curve radius is necessary to accommodate the geometric diversity from the full range of corneal diameters. The SynergEyes lenses have the patent-pending feature of a series of available skirt radii for each rigid center's base curve.The SynergEyes A and M designs are indicated for correcting hyperopia, myopia, astigmatism and presbyopia, in aphakic and non aphakic eyes free of disease. They are approved for daily wear for correcting up to +20.00D and –20.00D in eyes with astigmatism up to 6.00D; for presbyopia with add requirements from +1.00D to +4.00D. Each design has two available core skirt radii and two available extended range skirt radii.SynergEyes KC for keratoconus patients and SynergEyes PS for post-surgical patients have three skirt radii for each equivalent base curve. These lenses feature an aspheric base curve that is more forgiving on eyes that have high degrees of circumferential and radial irregularity.The plurality of skirt radii, the aspheric base curves and the non-rotational platform are all novel for hybrid lenses, allowing the use of front-surface cylinders and de-centered multifocal optics to center the simultaneous vision features over the visual axis.