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If you determine a patient is a good candidate for hybrid lenses, you can perform a trial lens fitting in the office, or order empirically using keratometry values and refraction. To order a multifocal hybrid empirically, you will also need to know eye dominance and add power.
Hybrid lens wearers will need proper training with insertion, removal and lens care. This new modality is easy for some and difficult for others. If your patient is unwilling to learn about a new lens modality, a hybrid lens may not be the best option. Hybrid lenses have the possibility of flattening the cornea over time, even if the contact lens fit is perfect in the beginning (see case report).
Case ReportNW, a 25-year-old female, presented for a comprehensive eye exam and contact lens fit. She complained of occasional lens rotation OS, which caused intermittent blurry vision. She was currently wearing standard soft toric contact lenses.
Manifest refraction was -4.00 -1.25x180 OD (20/20), -4.00 -1.75x160 (20/20). After trialing two additional soft toric lens options over the course of three weeks, the problem persisted. At this point, I decided to try Duette HD on the OS. Topography showed [email protected] and [email protected] (Figure 2). I felt this patient was an excellent candidate because all her astigmatism was corneal and her complaint of lens rotation should be solved with a hybrid lens. Using the online calculator, I ordered for the left eye: Duette HD 7.7 BC / -4.00 / 8.4 skirt curve.
Practice PointersHybrid contact lenses do work well for many patients, but be careful of potential flattening or altering of corneal shape as outlined in this case report. Frequent monitoring of the patient may be necessary to recheck their vision and eye health. In my personal experience, hybrid lenses have been a huge value to my practice; they satisfy many patients when other lens modalities fail. The optics for their multifocals have proven to be great for patients who may have failed in other multifocals. In other cases, patients do not adapt to the comfort or their vision is still not up to their standards.
I think hybrid lenses are worth having in every practice, because that patient who has failed in every other design may love their vision in a hybrid lens. Since their pricing is competitive with custom toric lenses, hybrid lenses may be the first lens of choice for many practitioners or patients with normal corneal astigmatism.
Having worn gas permeable contacts for over 30 years, I can honestly say that Duette is the most comfortable lens I have ever worn! My vision is as precise as wearing RGP lenses, but it almost feels like I have no lenses in at all. I recently spent a day at the beach where it was windy. with my old lenses, I would have been very uncomfortable. The Duette lenses were comfortable all day!
EyeBrid Silicone contact lenses use next generation technolgy that combines both a last generation RGP material and a Silicone hydrogel material. EyeBrid Silicone lenses therefore offer the visual acuity and crisp vision of RGPs thanks to the RGP center of the lens. As well as great comfort and easy fitting thanks to the Silicone hydrogel soft peripheral skirt.
EyeBrid lenses are the perfect solution for wearers of RGPs with comfort/centration/stability problems or desiring occasional wear, Keratoconus and highly complex irregular corneas, astigmatisms that can potentially be fitted with RGPs, high ametropias as well as Piggyback refits, 1st generation hybrid lens refits and unilateral wear. A wide range of parameters is available, including spherical, bi/back/front-Toric and Multifocal for presbyopia with astigmatism.
Fitting hybrid contacts is done in the same way as standard contact lenses. We will perform an eye exam and trial lens fitting in our office. Afterwards, you may need a few follow-up eye exams to verify that the corneal fit is healthy and your vision is sharp. Hybrid contacts lenses are customized, and sometimes a bit of tweaking may be necessary to give you the best possible eyesight.
Scleral lenses are suitable for people unable to wear regular contact lenses due to irregular corneas or other problems. They're custom-made and improve vision. They can sometimes work better than eyeglasses or traditional contact lenses.
Gas-permeable contact lenses are rigid and made of durable plastic that allows oxygen to pass through the lens. They're smaller in diameter than soft contacts or scleral lenses, covering most of the cornea.
Remember when you had only two choices in contact lenses Hard (rigid gas permeable) lenses were best for crisp, clear vision, but were often irritating and uncomfortable. Soft lenses were the most comfortable but often provided less-than-optimal vision. Now, a technological breakthrough makes having to choose a thing of the past. SynergEyes Hybrid contact lenses offer the best of both worlds. The soft lens offers all-day comfort while the breathable rigid center keeps eyes healthy while providing crisp, clear vision. Even at night!
SynergEyes Hybrid offers a wide variety of hybrid contact lenses to meet your visual needs. Whether you have Astigmatism, need vision correction for distance, close up, reading, or to help correct keratoconus, SynergEyes contact lenses will provide you with a comfortable and crisp vision all day long.
Before hybrid contact lenses, patients with keratoconus often had to wear small diameter gas permeable lenses in order to achieve good vision. In spite of the better vision, patients often could not tolerate the poor comfort associated with gas permeable contact lenses. Hybrid contact lenses were an attempt to solve this problem and were patented in 1977. Hybrid contacts gave patients a more comfortable alternative to gas permeable lenses without sacrificing vision.
Keratoconus specialists used piggyback lenses to treat patients with keratoconus before hybrid contacts were available. Piggyback lenses gave patients the benefit of good vision from a gas permeable lens while still providing good comfort. Fitting a gas permeable lens on top of a soft contact lens is called a piggyback lens. This combination gave pretty good comfort and vision. Piggyback lenses are rarely used now since hybrid lenses and scleral contact lenses both provide better vision, comfort, and ocular health.
The early generations of hybrid contact lenses were plagued with durability problems due to the difficulty in bonding the soft skirt to the gas permeable lens in the center. The first few generations of hybrid contact lenses were known to tear easily at this junction. The original SynergEyes contact lens, which gained FDA approval in 2005, was the first hybrid lens to significantly improve the durability problem. While the SynergEyes lenses are not nearly as durable as scleral contacts, gas permeable lenses or even soft contacts tearing is not nearly the problem it used to be. The original SynergEyes lenses are available in a few variations.
A significant drawback to the original SynergEyes lens is its thick, low oxygen permeable skirt, because of this the Ultrahealth hybrid contact lens was developed. If the cornea does not get enough oxygen it will grow blood vessels to make up the deficit. The lack of oxygenation to the cornea is called hypoxia. These blood vessels tend to grow into the peripheral cornea (limbus). The limbus is where the cornea meets the white part of the eye (sclera). These limbal blood vessels are called neovascularization.
The UltraHealth hybrid contact lens is the newest version of the SynergEyes keratoconus family. It differs from the original SynergEyes hybrid lens by adding a high oxygen permeable (SiHy) soft lens skirt in addition to an ultra-high oxygen central gas permeable lens. Thus improving on one of the disadvantages of the original SynergEyes design. Because of this, when a hybrid contact lens is indicated, most keratoconus specialists tend to choose the Ultrahealth hybrid contact lens over the original SynergEyes lenses. Keratoconus patients tend to have high contact lens wearing times, therefore high oxygen permeability is especially important.
The Ultrahealth FC uses all of the same high oxygen permeable technology as the Ultrahealth hybrid contact lens for keratoconus. The FC lens, however, is designed to treat patients that require a lens after eye surgery. Patients that have had eye surgery often require a post-surgical contact lens to achieve their best visual acuity. Some eye surgeries that may be treated with the SynergEyesUltraHealth FC hybrid contact lens are;
While not used in the treatment of keratoconus, the SynergEyes Duette hybrid contact lenses rely on the same high oxygen permeable technology found in the Ultrahealth hybrid lenses. The Duette hybrid lenses lack the extra steep center found in the SynergEyes UltraHealth keratoconus hybrid lens designs. The Duette hybrid contact lenses were designed to give patients that find a gas permeable lens uncomfortable; however, they need the vision only found with a gas permeable lens. SynergEyes Duette hybrid contact lenses are available for high astigmatism, high refractive error, and presbyopia.
Hybrid contact lenses are not as customizable as other contact lens options such as scleral lenses. While a hybrid contact lens typically gives a patient reasonably good comfort, the vision and fit of the lens may not be optimal for patients with advanced keratoconus or highly irregular corneas. Because of this they may not be the best keratoconus treatment option for patients with moderate or severe keratoconus. Patients wearing a well fit scleral lens will almost always experience better comfort and vision than they had with a hybrid lens. Scleral contact lenses have the advantage of being highly customizable thus making it easier for the doctor to fine-tune both the vision and the comfort.
Patients with mild to moderate keratoconus are the best candidates for hybrid contact lenses.2,3 Hybrid contact lenses are not as customizable as scleral contact lenses or gas permeable contacts. Nonetheless, they are often used for patients needing medically necessary contact lenses. 59ce067264
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