1. Fitting Guide: How to fit ArtMost® Flexlens?

2. How do I start the fitting? ArtMost® Flexlens are specialty soft contact lenses. ◦ SMR – Soft Myopia Retard ◦ SPR – Soft Presbyopia Releiving ◦ SEC – Soft Ectasia Control ArtMost® highly recommends using diagnostic fitting approach for prescribing these specialty lenses.

3. Step 1: Preparation & selection of the correct design 1. Comprehensive eye test 1.Ocular Health Check 2.Spectacle Rx, K, and HVID 2. Choose the correct design before trail fitting 1.For myopia control or younger patients, choose SMR 2.For higher reading add demand (>+2.00), choose SPR 3.For high astigmatic cornea, choose SEC

4. Step 2: How do I start the diagnostic fitting? The fitting concept is simple yet scientific! ◦ Know your patient’s “K”  We need to use it to find K-code ◦ Know your patient’s “spec Rx”  We need to use it to find power code ◦ Know your patient’s “HVID”  We need to use it to find LD (Lens Diameter)

5. 2-1 Know your patient’s K! Mean K=(Horizontal K + Vertical K) / 2 Regular lens K-code = 40, 42, 44 Choose the closest K-code to your “Mean K” as for your order (e.g. Mean K = 40.8, K-code will be 40) If you are not sure, use the calculator for suggestion Most common K-code = 42.00D

6. Too Loose/FlatOptimalToo Tight/Steep Increase K-code Decrease LD Decrease K- code Increase LD 2-1 Know your patient’s K!

7. 2-2 Know your patient’s Spec Rx BVS = Best Vision Sphere How do I get BVS from Spec Rx? ◦ BVS = (Spherical error)+(Astigmatism) / 2 ◦ THEN adjust it considering the Back Vertex Distance ◦ Rx on the contact lens = power code E.g. Spec Rx -9.50/-1.50x80 ◦ BVS = -9.50+(-1.50/2)=-10.25D ◦ If Back Vertex Distance = 12mm, BVS=-9.25D ◦ CL Calcs® in iTune App Store or conversion Table

8. 2-2 Know your patient’s Spec Rx If you want to find a more accurate power- code… ◦ Choose your trial lens base on your Spec Rx ◦ Put it on your patient’s cornea ◦ Wait for 5-10 Minute for the lenses to settle in ◦ Over refract  Spherical refraction, if cannot reach 6/7, check if any cyl  Monocularly refract  Binocularly refract ◦ Adjust prescription with considering of Back Vertex Distance ◦ TRIAL FRAMED your patient

9. 2-3 Know your patient’s HVID HVID + 2.8 = Lens Diameter What we want to achieve ◦ Centralized fitting ◦ Very minimum movement: 0~1.0mm Why? ◦ Tear Reservoir underneath the lens to be consistent ◦ Best PVS near vision result

10. Getting to know your ArtMost® Flexlens Lens Design Power Code Lens Diameter K-Code

11. Summary 1. Choose correct design 2. Select K-code 3. Determine Power-code 4. Determine Lens Diameter 5. Go to artmostoceania.com.au, log-in and order on-line 6. Allow 2-3 weeks for the lab (X-cel from USA) to produce your lenses!

12. Practical Example K 43.0 / 43.50 ◦ (corneal astig. = 0.50 D) Refraction: -6.50 ◦ (refractive astig. = 0 D) Spectacle Rx = -6.50/-0.50DC (for calculation purpose) Add +2.00D HVID 12.2 mm

13. Practical Example Age: 58, Male, VDU worker Mean K = (43.00+ 43.50) / 2 = 43.25 ◦ K-code  42.00 (0.00 ~ 2.50 D flatter) Spectacle BVS = -6.50+(-0.50) / 2 = -6.75 ◦ After, consider Back Vertex Distance  -6.25D ◦ Power code  -6.25 (Don’t worry about Add) Lens Diameter = 12.2mm+2mm=14.2mm Rx: SPR / 42.00 / -6.25 / 14.2 mm We know what we are looking for!

14. Trial fitting ◦ Select first trial lens by mean K and power code  SPR / 42.0 D / -5.00 / 14.2 mm ◦ Wait for 10 min for lens to settle BEFORE Over Refraction  Trial Frame Result: -1.25D  No additional vertex adjustment needs  Final adjustment on contact lens: -1.25D Power-code = -5.00 + (-1.25) = -6.25 SPR / 42.0 / -6.25 / 14.2mm Practical Example

15. SPR, SMR & SEC can fit on special corneal conditions but for different purposes Take a few good topo maps for each eye Know what kind of cornea you are facing! Take some useful information from your topo ◦ Sim K ◦ Corneal Astigmatism ◦ Keratoconus or corneal disease indicator (Ref to your topo manufracture) ◦ HVID Topographer is good for trouble shooting, but Trial/Diagnostic Fitting is still a MUST! Fitting Tips

16. Fitting Tips (Part II) If Ast. > 2D, start with SEC design Adjust 0.25D – 0.50D for high near (for hypero) or dist demand (for myo) No need to indicate Add: default PVS mutifocal effect looks after this for you! If not enough Add, make it steeper or SPR Default lens size varies with K-code (know your diagnostic lens so you can fine tuning by ◦ SPR: 40.00/14.4mm, 42.00/14.2mm, 44.00/14.0mm ◦ SMR: 40.00/15.2mm, 42.00/14.8mm, 44.00/14.4mm ◦ SEC: 40.00/15.2mm, 42.00/14.8mm, 44.00/14.4mm

17. Fitting Tips (Part III) Trial fitting is a MUST for Special applications ◦ Post LASIK, Post RK ◦ Early keratoconus Lens movement is a key for good vision Power code determination will be more accurate by over refraction on trial lens May Custom lens size by HVID if too much lens movement! ◦ HVID + 2 mm ◦ HVID + 2.2mm if limbus to limbus astigmatism ◦ Small HVID (High hyperopia) need to order smaller Lens Diameter (e.g. 11mm)

18. If you have any question or need any further information about fitting, please do not hesitate to email our technical consultant Lawrence Kao via admin@artmostoceania.com.au