English - final copy.pdf - Coopervision-training.com

issue 6 2008
The XR highpower
lenses issue
Fitting highprescription
toric lenses
Understanding
high-power lenses
The expert’s view
Contact lenses
for all
Proclear ® launches extended range offering
monthly lenses to fit higher prescriptions
The hidden
benefits of fitting
higher powers
Meeting the
changing needs
of the contact
lens wearer

Offer all day
comfort to more
of your patients
Proclear ® contact lenses
NOW AVAILABLE IN OVER 500,000
DIFFERENT PARAMETER COMBINATIONS;
• NEW Proclear ® Toric XR;
monthly disposable toric lens with cylinder powers up to -5.75DC
• NEW Proclear ® Multifocal XR;
monthly disposable multifocal lens available in +/-20.00DS with Add powers up to +4.00D
• NEW Proclear ® Multifocal Toric;
monthly disposable toric lens with cylinder powers up to -5.75DC and Add powers up to +4.00D
Specification
Proclear ® Toric XR
Water content: 59%
Base curve:
8.8mm
Diameter:
14.4mm
Spherical powers: +6.00 to -8.00DS
(0.50 steps after -6.50)
Cylinder powers: -2.75 to -5.75DC (0.50 steps)
Axis:
5˚ to 180˚ (5˚ steps)
Dk: 25
Orientation mark: 1 marker at 6 o’clock
Wear indications: Daily wear
Modality:
Monthly disposable
Pack size:
3 pack
Trial lens:
Available in all parameters
Specification
Water content: 59%
Base curve:
8.7mm
Diameter:
14.4mm
Spherical powers:
(for Add powers: +1.00
to +2.50)
Spherical powers:
(for Add powers: +3.00
to +4.00)
Add powers:
Lens type:
Proclear ® Multifocal XR
+4.25 to +20.00,
-6.25 to -20.00
(0.50 steps after +/- 6.50)
+20.00 to -20.00
(0.50 steps after +/-6.50)
+1.00 to +4.00 (0.50 steps)
Distance (D) and Near (N) lens
Dk: 25
Wear indications: Daily wear
Modality:
Monthly disposable
Pack size:
3 pack
Trial lens:
Available in all parameters
Specification
Proclear ® Multifocal Toric
Water content: 59%
Base curve:
8.8mm
Diameter:
14.4mm
Spherical powers: +20.00 to -20.00DS
(0.50 steps after +/-6.50)
Cylinder powers: -0.75 to -5.75DC (0.50 steps)
Axis:
5˚ to 180˚ (5˚ steps)
Add powers: +1.00 to +4.00 (0.50 steps)
Lens type:
Distance (D) & Near (N) lens
Dk: 25
Orientation mark : Markings at 3 and 9 o’clock
Wear indications: Daily wear
Modality:
Monthly disposable
Pack size:
3 pack
Trial lens:
Available in all parameters
For further information contact your local Area Business Manager or to place an order:
(t); 0870 9000 055 (f); 0870 9000 056 (w); order online at www.coopervision.com

Understanding
high-power lenses
– the expert’s view
Chris Davison, Lathing Business Unit Manager at CooperVision, explains the
varied methods used at CooperVision to manufacture its exhaustive range of
high-power lenses.
Before looking at the technical
detail of how you manufacture highpower
lenses, could you give a short
explanation of what high-power
lenses offer the practitioner
CD Put simply, CooperVision is able to
present the practitioner with more options
for those needing higher powers than any
other manufacturer. For the optician, this
offers the advantage of a bigger product
portfolio with the widest range of lenses and
powers on the market as well as the greatest
variety of modalities to suit the wearer.
What methods are used in
producing high-power lenses
CD There are two basic methods. Firstly,
the traditional fully lathed process
whereby lenses are lathed on both the
back and front surfaces. Secondly, utilising
a hybrid process in which the base curve
and often the edge are pre-moulded, and
only the front surface is lathed.
The traditional method of fully lathing
is used on our stand-alone ranges, all
of which are marketed as conventional
lenses. The hybrid process is used on the
range extensions and these products are
sold as monthly lenses.
After wet processing, in which the lenses
are placed in their final packaging,
they are autoclaved. Unusually for a
manufacturing site we also label, carton,
and despatch most of our product.
What challenges do you face
CD We are growing hugely in what we
produce and what we offer; for example
we currently make 13 different products
with almost as many different processes!
Because of this, we have initiated
many engineering projects to find
common manufacturing methods that
will standardise the process as well as
continue to improve quality and service.
The other big challenge we face due
to our tremendous growth is training
enough new staff in time to cope with
the volume increases. Our headcount
was 250+ by year-end and the volumes
will be over two million custom lenses
during our next fiscal year.
Is there technology that is specific
to producing high-power lenses
CD We use state-of-the-art computer
controlled lathes designed to produce
complex geometries directly on a lens.
Some of these lathes have ‘Oscillating
Tool’ technology that allows us to directly
cut toric zones or prismatic or dynamic
stabilisation curves. We are also able to
specify aspheric curves for products such
as multifocal lenses. These lathes have
air bearings and can repeatedly produce
to a very high level of form accuracy and
surface quality.
How do the methods differ from
normal-power lenses
CD There are two main differences.
At CooperVision, the majority of lenses
are cast moulded and produced to stock
in lots of many thousands. However,
lathing produces lenses on a made-toorder
basis. Each order may be a single
lens each for right eye / left eye, or a
three or six pack for each. Offering
made-to-order lenses widens the
available range of parameters beyond
what is economically possible by the
cast-moulding process. For those patients
whose vision correction requirements
are not serviced by the standard ranges,
the practitioner can specify exactly the
parameters required. These custom made
lenses, in conjunction with our standard
products, give the practitioner a wide
range of options.
How do the challenges differ
from normal-power lenses
CD In lathing, we can produce a lens
of extreme power as easily as we can a
plano. The hard work is done before the
launch of a new product when the lathe
is programmed and validated for the
new design.
The demand for a product dictates
whether the lens is cast moulded or if it
is lathed. When the demand is large, it
makes economic sense to mould but as
the volume demand drops away we can
offer wider ranges of products to our
customers by lathing outside of the bell
curve, the higher prescriptions.
Are there any differences to the
lens wearer
CD The lenses should be totally
equivalent in terms of comfort, visual
acuity and fit as those made by cast
moulding or any other method, such as
spin casting. The patient would not know
what process has made his or her lenses
because lenses may perform differently
by material and design but not by
manufacturing methods.

Meeting
the changing
needs of the
contact lens
wearer…
Understanding how contact lenses are currently worn and what wearers would
like to get from their lenses in future is a key factor in the development of new
products and the market. By meeting wearers’ needs we can keep them in
lenses for longer and therefore grow the market by reducing the current dropout
rates. In the second year of our continuous research project, CooperVision
questioned around 3,000 wearers in 13 European countries to gain a better
understanding of their habits and desires.
Contact lens wearers for life,
not just a few years
One of the first things we see is that
wearers are staying in lenses for longer
with 20% having worn lenses for over 10
years and 5% for over 20 years. This
increase in long-term wearing has been
brought about by the advancement of
disposable lenses. This increase also raises
questions about the long-term impact of
increased lens wear. Long-term wearing
has created the need to ensure that the
wearers are regularly upgraded with newer
materials and lens designs that will have a
better long-term benefit for the eye. It is
also important to keep in mind that the
incidence of presbyopia will be increasing
within the wearer population and
therefore the ability to successfully fit
presbyopic lenses will be important in
keeping these wearers in contact lenses.
15%
22%
5%
28%
30%
Fig.1: How long have you
been wearing contact lenses
Up to 2 years 2-5 years
5-10 years 10-20 years
Over 20 years
The respect of the professional
Yet again, CooperVision’s research has
highlighted how much respect the wearer
has for the practitioner. An amazing 37%
of wearers state they leave the choice of
brand purely to the optical professional.
Additionally, another 27% attribute
discussion with the practitioner as one of
the main reasons for choosing their
specific brand. So overall, 64% of wearers
are heavily influenced in their choice of
product by their practitioners. The research
also highlighted that, when measured
among wearers of CooperVision products,
this figure increases to 72%. Even in the
information-saturated modern world,
contact lens wearers across Europe still
look to the practitioner as the most
important source for making their lens
and brand selection.
Upgrading to increase
satisfaction
One of the main advantages of market
research is in discovering what wearers
would like from their lenses to make the
experience even more enjoyable. Currently,
we found around 16% of wearers sleep
overnight in their lenses with two thirds of
these doing this for just a few days a
week. However, when asked if they would
like to sleep overnight in lenses around
70% said “yes” with over half of these
just wanting to sleep in their lenses a
couple of times a week.
Overall lens performance is high, yet
wearers can still easily identify areas
needing improvement. The most common
problem reported was “increased levels of
dryness” (46%), highlighting a move away
from discomfort to one of lens awareness
on the eye. Closely followed in second
place (43%) was the desire for “healthier
lenses for the eyes”, which reflects an
underlying concern for those who have
been wearing lenses for a longer period.
The longer interviewees had been wearing
lenses, the more likely they were to
highlight these areas for improvement.
50%
40%
30%
20%
10%
0%
33%
Reduced dryness
17%
15%
14%
21%
Fig.2: How long would you
like to leave lenses in for
1 night Few days
1-2 weeks
Month or more
Would not wear overnight
More healthy
Up to 2 years 2-5 years
Over 5 years
Longer wearing times
Reduced risk of infection
Ability to wear overnight
Fig.3: What three areas would you
like to see improved Shown by time
wearing contact lenses
In Summary
Market research helps to drive the product
development process at CooperVision as it
highlights the key areas for improvement
as cited by current wearers. As a
practitioner it can also help to drive your
contact lens strategy by allowing you to
align new products to the changing needs
of wearers. A process of continual
upgrading is normal in life as, for example,
we are always looking to upgrade our
mobile phones, cars, computers and even
our spectacles.
For CooperVision, continual upgrading has
led to the development of Biofinity, our
silicone hydrogel lens. We have also
developed the Proclear 1 Day lens to offer
the comfort benefits of Proclear to the daily
disposable wearer. The latest product
innovation is the XR range for the Proclear
monthly lenses that offers those needing
higher prescriptions the clinical advantages
of a monthly lens.
Many practitioners always wonder how
often they should upgrade a wearer and
the key guidance would be to suggest they
do this as their needs change. However,
making the basic assumption that there
should be no change to a lens unless there
is a clinical issue or concern is misplaced.
With the continuous advancements in
contact lens technologies, a process of
gradual upgrading will ensure that your
wearers are gaining the best experience
from their contact lenses. In terms of
pricing, the research shows that over 90%
of wearers would accept an upgrade
costing 10%, though this drops to around
60% for a 20% increase.
The key to success is understanding the
wearer’s needs and proactively
encouraging them to reveal how they
would really like to wear their lenses.
From that point it is possible to explain the
benefits of different lenses and how these
meet the wearer’s individual needs. For
example, if they would like to wear lenses
occasionally overnight, then telling them
about a lens like Biofinity and how the
higher oxygen flow makes it more suited
to overnight wear ensures that they are
using the right type of lens for their own
personal situation.

Contact
lenses for all...
CooperVision launches the Proclear ® XR range to offer monthly lenses to
fit higher prescriptions
“it has a very high affinity for water,
making any device containing PC
material highly resistant to dehydration“
CooperVision has launched a new range of monthly contact
lenses which will make over 500,000 different parameter
combinations available to practitioners and patients. The
Proclear ® XR range includes the world’s first monthly disposable
multifocal toric lens, making healthy, comfortable contact lens
wear accessible to more patients.
Currently, many contact lens wearers with high or more
complex prescriptions remain unable to take advantage of
the benefits that wearing monthly disposable contact lenses
provide, with some patients not able to wear contact lenses at
all. The monthly disposable modality provides an established
collection of benefits for the patient, which include more
convenient lens care, more comfort and, most importantly,
reduced risk of health-related issues.
An important part of the development of the extended range
of contact lenses was to identify the best material technology to
employ. The Proclear ® material which utilises PC Technology
has long been established as the standard for providing the best
in healthy comfortable daily wear, therefore providing the obvious
choice of material with which to develop the Proclear ® XR range.
About PC Technology
PC can be defined as the primary natural substance found
in all cell membranes which allows adjacent cells to live in
harmony without provoking a biological response. Besides being
non-reactive, it has a very high affinity for water, making any
device containing PC material highly resistant to dehydration.
CooperVision incorporates a totally synthetic copy of PC into the
entire range of Proclear ® lenses.
Thanks to the patented PC Technology, CooperVision’s entire
range of Proclear ® lenses is highly resistant to protein and lipid
deposition, and gives the material its 59% to 62% water content
and low dehydration rate. This in turn sustains the oxygen
permeability throughout the day; offering a healthier lens which
more than adequately achieves the Holden and Mertz criteria for
safe all-day wearing in the standard monthly spherical form † .
The Proclear ® XR range includes extended parameters in the
Proclear ® sphere*, Proclear ® Toric and Proclear ® Multifocal, allowing
you to fit patients with up to a ±20.00 sphere power, -5.75 cylinder
power or a +4.00 add. As part of the Proclear ® XR development
process, the very first monthly disposable multifocal toric has been
developed and will now provide a more flexible option for the
growing number of presbyopics that also require a toric prescription.
The Proclear ® XR monthly disposable lenses really increase the
choices available to you and your patients. XR lenses available
from CooperVision include:
Proclear ® monthly disposable & Proclear ® XR*
Specification Proclear ® Proclear ® XR
Base curve:
Diameter:
Spherical powers:
+/-10.00DS
(0.50 steps after +/-6.50,
+0.25 not available)
Proclear ® Toric & Proclear ® XR
8.6mm
14.2mm
+/-10.00 to +/-20.00DS
Specification Proclear ® Toric Proclear ® Toric XR
Base curve:
Diameter:
8.8mm
14.4mm
Spherical powers: +6.00 to -8.00DS (0.50 steps after -6.50)
Cylinder powers: -0.75, -1.25, -1.75, -2.25DC
-2.75 to -5.75DC
(0.50 steps)
Axis: 10˚◦ to 180˚◦ (10˚◦ steps) 5° to 180° (5° steps)
Proclear ® Multifocal Toric
Specification
Base curve:
Diameter:
Proclear ® Multifocal Toric
8.8mm
14.4mm
Spherical powers: +20.00 to -20.00DS (0.50 steps after +/-6.50)
Cylinder powers:
Axis:
Add:
Lens type:
Proclear ® Multifocal & XR
-0.75 to -5.75DC (0.50 steps)
5˚◦ to 180˚◦ (5˚◦ steps)
+1.00 to +4.00 (0.50 steps)
Distance (D) & Near (N) lenses
Specification Proclear ® Multifocal Proclear ® Multifocal XR
Base curve:
8.7mm
Diameter: 14.4
Spherical powers:
(for Add powers
+1.00 to +2.50)
Spherical powers:
(for Add powers
+3.00 to +4.00)
+4.00DS to -6.00DS
(0.25 steps)
N/A
Add: +1.00 to +2.50
(0.50 steps)
Lens types:
†Holden BA, Mertz GW. Critical oxygen levels to avoid corneal edema for daily and extended wear contact lenses. Invest Ophthalmol.Vis.Sci. 1984;25:1161-7.
*Available from Summer 2008.
Distance (D) & Near (N) lenses
+4.25 to +20.00DS,
-6.25 to -20.00DS
(0.50 steps after +/-6.50)
+20.00 to -20.00DS
(0.50 steps after +/-6.50)
+1.00 to +4.00
(0.50 steps)

The hidden benefits of fitting higher
powers: Danish opticians Martin Iversen
and Hans Bleshoy discuss the benefits and
techniques behind higher-power lenses.
Fitting high-prescription toric lenses
John Rogers, European Clinical Affairs Manager at CooperVision UK, and Henk Molenaar, Professional Services
Manager at CooperVision Netherlands, provide you with top tips on fitting high-power toric contact lenses.
In your opinion, what constitutes
‘high-powered’ lenses
HB The official definition of ‘highpowered’
lenses in Denmark is anything
above +/-16.00D or a cylinder of more
than -5.00D. In practice, however, we
think of high-powered lenses as more
than +/-8.00 to 10.00D and a cylinder of
-4.00 or above.
MI Any spherical power not available in
my trial sets qualifies as what I would
call a ‘high-powered lens’. Also, any
cylindrical power not available in a
‘standard’ toric range.
Do you generally prefer to
approach the fitting by using
diagnostic lenses or empirical
ordering
HB Both methods are practical. Trial lenses
have the advantage of showing the effect
of lens bending and tear fluid power on
the eye. Consequently it is more accurate
to calculate the final power. Empirical
fitting is faster and, on many occasions, it
may not be possible to use trial lenses.
MI I always prefer empirical fitting because
you have a ‘trial’ lens that is very close to
the best fit and power (and in many cases
you really don’t need to refit). I think for
the contact lens fitter it’s a matter of habit
that is the determining factor.
Which CooperVision lens do you
most commonly use for high powers
and why
HB The Proclear Rx range is my firstchoice
lens. No doubt the silicone
hydrogel lenses will become the first
choice but due to present limitations
in parameters and powers, this is not
possible. Oxygen permeability is of prime
importance and the choice of parameters
is necessary in order to provide the best
possible physiologic and visual result.
MI The Proclear Rx range is my
preferred choice.
Many practitioners would say that
fitting these lenses is time consuming,
complex and costly. What would your
response be to them
HB All new and not straightforward
matters require more time and expertise.
With the cost side of things, it is very
much up to the practitioner to work out a
fee structure that takes time and materials
into account. If this happens, I don’t see
any problem with this area of CL fitting.
MI Fitting high-powered lenses is of course
not like fitting a daily disposable -1.00DS.
It does take a bit more time, but it is time
well spent. It’s a big misunderstanding that
it’s much more complex. A new fit with
high-power lenses normally takes one or
two extra check ups but that’s it.
From the point of view of lens
availability, what single thing would
you most wish to see improved or
changed by the industry
HB The newer materials must become
available in an appropriate selection of
parameters. Also research into improved
designs for these new materials is of
significant importance.
MI High-powered lenses have to be made
from more oxygen-permeable materials
in order to ensure corneal health. Optical
quality and lens movement are always
important, and any improvements here are
most welcome. Disposable, high-powered,
tailor-made lenses would be great.
Tip One: Vertex adjustment
Most practitioners will be familiar with vertex adjustment, which
needs to be done for both sphere and cylindrical components
above ±4.50. It is important to keep in mind that these
calculations are done as crossed cylinders.
➢ As an example, take the spectacle prescription -8.00/-
4.00x180 at a vertex of 12mm - the resultant contact lens
power is -7.25/-3.25x180 (sphere and cylinder both decrease).
➢ Another example is +10.00/-3.00x160 - at 12mm this
changes to +11.50/-3.75x160 (here both powers increase).
In order to access a tool to help in understanding vertex
adjustment, please visit the CooperVision website.
Tip Two: Axis rotation
An incorrect cylinder axis positioned in front of the eye can
influence visual acuity (VA). However, depending on the power
of the cylinder there is a degree of tolerance. Up to a -2.00
cylinder a maximum of 10 degrees is acceptable to most
wearers - this is why most monthly disposable toric lenses have
axes in 10º steps. Within the range of -2.00 to -4.00 cylinder
tolerance becomes tighter and must be within about 5º of that
required. Above -4.00 the cylinder axis position becomes critical
at 1º or visual acuity will be reduced. A lens which rotates
outside of these parameters will need to be re-evaluated for
axis position. This is simply done by measuring the number
of degrees the lens is off axis using a slit lamp, determining
whether the lens has rotated in a clockwise or anti-clockwise
direction and adding the number of degrees measured
when clockwise to the originally specified axis or subtracting
the number of degrees if in an anti-clockwise direction. No
adjustments are necessary to the actual sphere or cylinder
powers. Keep in mind that when the new adjusted lens is
placed onto the eye the alignment mark should still be off axis
to the same degree and direction to that originally tried.
Tip Three: Lens design features
Within the Proclear Toric XR range, the design of the higher
powers is the same as for the standard Proclear monthly toric
lenses. The optical zone is constant at 8mm and the edge
thickness is maintained across the range to ensure consistency
between powers and better comfort. At 6.00D the prism in
the lens is 1.36D whereas it decreases to 1.02D at 8.00D to
maintain the overall design profile and lens stability.
Tip Four: Correction of anisometropia
One of the benefits of contact lenses is where there is an
in-balance in the refractive state of each eye creating aniseikonia, a
difference in retinal image size. This can be unacceptable for some
spectacle wearers creating diplopia or double vision. As contact
lenses sit on the cornea, which is almost equivalent to the entrance
pupil of the eye, magnification is unity or nearly zero. If there is a
large discrepancy between each eye then contact lenses are the
only solution, as spectacles would be intolerable.
Tip Five:
Try the lenses and contact CooperVision for any assistance on
optimising the lens performance.

Coming up in the next edition
As the contact lens market becomes
more competitive, developing
your skills can help you to be more
successful in the marketplace.
A new training and development initiative – Stuart Cockerill, European Marketing
Director, talks about the new training tool that CooperVision has launched to help
develop clinical and retail skills online.
Looking at the site – Take a journey through the new online training tool to see how it
can benefit you and your practice.
Trading up wearers – Adapting the right approach to gathering wearers’ needs can
increase the success rate when trialing a new lens.
Overview of the European contact lens market – A brief view of the market and
the trends across the region.
Clinical tips – We address some typical fitting issues that arise day to day in practice.
If you have any comments or feedback please email us at 6.6@coopervision.co.uk
XSM1482
Offer all day
comfort to more
of your patients
Proclear ® contact lenses
NOW AVAILABLE IN OVER 500,000
DIFFERENT PARAMETER COMBINATIONS;
• NEW Proclear ® Toric XR;
monthly disposable toric lens with
cylinder powers up to -5.75DC
• NEW Proclear ® Multifocal XR;
monthly disposable multifocal lens available in
+/-20.00DS with Add powers up to +4.00D
• NEW Proclear ® Multifocal Toric;
monthly disposable toric lens with cylinder powers
up to -5.75DC and Add powers up to +4.00D
For further information contact your local
Area Business Manager or to place an order:
(t); 0870 9000 055 (f); 0870 9000 056
(w); order online at www.coopervision.com