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17 EW SHOW DAILY ASCRS•ASOA Symposium & Congress, Los Angeles 2017 you can get material under these lenses, including foreign bodies and debris, Dr. Ciralsky said. "Although RGPs work well for many patients, there are a lot of failures," she said, noting that there are original but also new designs for RGPs. The next lens type she spoke about was soft contact lenses. The role of soft contact lenses has changed significantly. There are new designs, new material, and use of complex mathematics to fit irregular corneas. Many soft lenses are specif- ically designed for keratoconus, Dr. Ciralsky said. The next type of lens she described was a piggyback lens, which is a combination of two lens systems. It's a soft contact lens with a hard contact lens over it. You get the comfort of the soft lens and the vision of the hard lens, as well as better centration, Dr. Ciralsky said. "But with two lenses on top of each other, you do have to watch out for hypoxia." Then, she mentioned hybrid lenses, which are similar to piggy- back lenses, but the soft and hard lens are together in one lens with a rigid center and soft peripheral skirt. The pros are that this type of lens has the optics of an RGP lens and the comfort and stability of a soft contact lens. However, there may be some difficulty fitting this type of lens on decentered cones. They can also tighten on the eye and create irritation, Dr. Ciralsky said. The last type of contact lenses she discussed were scleral lenses, or large-diameter gas permeable contacts that are scleral based. These provide stability and vault over the cornea, she said. The tear reservoir bathes the cornea, provid- ing comfort, and debris cannot get underneath. However, Dr. Ciralsky noted that these lenses require a complex fitting and may be difficult to insert and remove. Additionally, mucous or debris may be trapped underneath, which would require replacement. EW Editors' note: The physicians have no financial interests related to their comments. good visual acuity, have good tear exchange, have good oxygenation of the cornea, there are low rates of in- fection, and they are easy to handle. However, cons include the fact that (RGP) lenses. These have been the gold standard of contact lens correction for ectasia for more than 50 years, she said. The pros are that they mask irregular corneas, have Dr. Ciralsky speaks about contact lens options available for keratoconus patients. Indication LOTEMAX ® GEL (loteprednol etabonate ophthalmic gel) 0.5% is indicated for the treatment of post-operative infl ammation and pain following ocular surgery. Important Safety Information about LOTEMAX ® GEL • LOTEMAX ® GEL is contraindicated in most viral diseases of the cornea and conjunctiva including epithelial herpes simplex keratitis (dendritic keratitis), vaccinia, and varicella, and also in mycobacterial infection of the eye and fungal diseases of ocular structures. • Prolonged use of corticosteroids may result in glaucoma with damage to the optic nerve, defects in visual acuity and fields of vision. If this product is used for 10 days or longer, IOP should be monitored. • Use of corticosteroids may result in posterior subcapsular cataract formation. • Use of steroids after cataract surgery may delay healing and increase the incidence of bleb formation and occurrence of perforations in those with diseases causing corneal and scleral thinning. The initial prescription and renewal of the medication order should be made by a physician only after examination of the patient with the aid of magnification, and where appropriate, fluorescein staining. • Prolonged use of corticosteroids may suppress the host response and thus increase the hazard of secondary ocular infection. In acute purulent conditions, steroids may mask infection or enhance existing infection. • Use of a corticosteroid medication in the treatment of patients with a history of herpes simplex requires great caution. Use of ocular steroids may prolong the course and exacerbate the severity of many viral infections of the eye (including herpes simplex). • Fungal infections of the cornea are particularly prone to develop coincidentally with long-term local steroid application. Fungus invasion must be considered in any persistent corneal ulceration where a steroid has been used or is in use. • Patients should not wear contact lenses when using LOTEMAX ® GEL. • The most common ocular adverse drug reactions reported were anterior chamber inflammation (5%), eye pain (2%) and foreign body sensation (2%). Please see brief summary of Prescribing Information on adjacent page. ®/™ are trademarks of Bausch & Lomb Incorporated or its a liates. © 2015 Bausch & Lomb Incorporated. All rights reserved. Printed in USA. US/LGX/15/0041(1) Down, Boy. Help Tame Postoperative Ocular Inflammation and Pain With LOTEMAX ® GEL

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