Keratoconus

Irregular Cornea
Post Graft

PRACTITIONER’S
FITTING GUIDE
Four lens designs
to fit all corneal shapes...
One simple systematic approach to fitting

Featuring
Easy-to-fit using a simple systematic approach for all designs.
Simple to use flexible Edge Lift system.
Aberration control aspheric optics providing outstanding acuity, reduced flare and glare
and minimum lens mass (ROSE K2, ROSE K2 NC, ROSE K2 IC, ROSE K2 Post Graft).
Advanced fitting options* including:
• Toric peripheral curves.
• Asymmetric Corneal Technology or ACT.
• Front, back and bi-toric design.
Extensive diameter and base curve range.
Fits all corneal shapes, sizes and stages of keratoconus because of the unique design that
changes as the base curve steepens.

ROSE K2 ROSE K2 NC ROSE K2 IC ROSE K2 POST GRAFT

PRIMARY Oval Keratoconus, Moderate and steep Nipple Pellucid Marginal For patients who have
Nipple Keratoconus. Cones. Degeneration, undergone penetrating
APPLICATION Keratoglobus, LASIK keratoplasty.
induced Ectasia and
Post Graft.

SECONDARY Early Pellucid Marginal All Nipple Cones. Oval Keratoconus. Oval Keratoconus, Nipple
Degeneration. keratoconus and Lasik.
APPLICATION

PARAMETERS BASE CURVE BASE CURVE BASE CURVE BASE CURVE

4.30 mm to 8.60 mm 4.3 mm to 7.70 mm 5.70 mm to 9.30 mm 5.70 mm to 9.30 mm
AVAILABLE DIAMETER DIAMETER DIAMETER DIAMETER
7.9 mm to 10.4 mm 7.6 mm to 9.0 mm 9.4 mm to 12.0 mm 9.4 mm to 12.0 mm
POWER Any POWER Any POWER Any POWER Any
EDGE LIFT EDGE LIFT EDGE LIFT EDGE LIFT
Standard, standard flat, Standard, standard flat, Standard, standard flat, Standard, standard flat,
standard steep. standard steep. standard steep, double flat, standard steep, double flat,
More lifts are available More lifts available double steep. double steep.
- see section on Edge Lift. - see section on Edge Lift.

ADVANCED 1- Toric Peripheral curves (TP).

FITTING 2- Asymmetric Corneal quadrant specific.
3- Toric: back, front and bi-toric surfaces.
OPTIONS * Note: Advanced fitting options not currently available on ROSE K2 NC design.

TRIAL SETS 26 lenses ranging from 5.10 25 lenses from 4.6 to 7.4 mm 14 lenses ranging from 6.50 22 lenses from 6.00
to 7.60 mm in a variable in variable diameter from to 8.60 mm in an 11.4 mm to 9.00 mm in an 10.4 mm
diameter from 8.5 to 9.2 mm, 8.1 to 8.9 mm with variable diameter, with variable diameter, with variable
with variable power to approxi- power to approximate power to approximate power to approximate
mate the final lens power. the final lens power. the final lens power. the final lens power.

2
 FLEXIBLE EDGE LIFT SYSTEM
The peripheral fit is the single most important fitting factor for a successful, comfortable GP fit. Rather than
a complicated series of radii and diameters, all ROSE K2 lenses use a simple value referred to as Edge Lift
to determine the optimal peripheral configuration. From the trial lens, an Edge Lift value referred to as
standard, increased lift (flat) or decreased lift (steep) can be ordered (see illustrations A, B, C).
The final lens is automatically compensated (base curve and power, no calculations are required), so the
change in Edge Lift (which alters the sagittal height) does not affect the central fit!

With ROSE K2 lenses, 85 % of all lenses dispensed use either the standard edge, standard flat (increased)
or standard steep (decreased) Edge Lift to achieve the desired peripheral fit. However, other Edge Lift
values can be specified in 0.1 increments ranging from -1.3 decreased (steep) to +3.0 increased (flat)
(see illustration D1).

ROSE K2 NC presents a very rapid peripheral flattening with also a high percentage of all lenses dispensed using either
the standard edge lift, standard flat (increased) or standard steep (decreased) for optimum peripheral fit. Other Edge
Lift values are available in 0.1 increments ranging from -1.5 decreased to 3.00 increased (see illustration D2).

With ROSE K2 IC and ROSE K2 Post Graft lenses, the flexible Edge Lift system is available in 5 different
values: standard, standard steep (decreased), standard flat (increased), double steep or double flat
(see illustration D3).

Illustration A: Optimal Edge Lift will give Illustration B: When the fluorescein Illustration C: When the fluorescein
a fluorescein band of 0.5 mm to 0.7 mm pattern indicates Edge Lift in excess pattern indicates an Edge Lift less
with no excessive lift or peripheral seal of 0.5 mm to 0.7 mm, a standard steep than 0.5 mm to 0.7 mm, a standard
at any point. Edge Lift value is recommended. flat Edge Lift value is recommended.

AVAILABILITY
Illustration D1 Illustration D3
Peripheral fit zone
ROSE K2 ROSE K2 IC
ROSE K2 POST GRAFT
85 % of all ROSE K2 lenses
utilise either the standard, 5 different Edge Lift
standard flat or standard values are available to fit
steep Edges Lift values. all of your patients.

Maximum Flat Lift +3.0 Double Flat Lift

Standard Flat Lift
Standard Flat Lift +1.0
Standard Lift
Standard Lift +0.0
Standard Steep Lift -0.5 Standard Steep Lift
Maximum Steep Lift -1.3 Double Steep Lift

Illustration D2

ROSE K2 NC
Maximum Flat Lift +3.0
85 % of all ROSE K2 NC lenses
utilise either the standard, Standard Flat Lift +1.0
standard flat or standard steep Standard Lift
Standard Steep Lift
+0.0
-0.5
Edges Lift values. Maximum Steep Lift -1.5

3
ACT ASYMMETRIC CORNEAL TECHNOLOGY TORIC PCS
By nature, the keratoconic cornea is A toric periphery (TP) is where the optical zone is
asymmetric, where the inferior spherical and approximately the last 1 mm of the
quadrant is frequently significantly peripheral curve is toric although this is variable
steeper than the superior portion, dependent on the overall diameter of the lens.
causing the GP lens to lift off at With Keratoconus, the tight areas, usually within
6 o'clock (see illustration E). 20 degrees of 180° (3 and 9 o'clock), will be
ROSE K2 lenses incorporating ACT eliminated with a TP design (see illustration G).
are designed to accommodate this In PMD there is often significant against-the-rule
asymmetry (good edge fit at 3, 9 astigmatism making the lens tight at 12 and 6
and 12 o'clock but lift at 6 o'clock). o'clock and loose at 3 and 9 o'clock. A lens that
The inferior quadrant of the lens is tight at 12 o’clock causes discomfort, so a TP
is steeper than the superior design is often useful here.
quadrants, providing a more The TP design is available on ROSE K2, ROSE
accurate fit at 6 o'clock making the K2 IC, ROSE K2 Post Graft lenses and will
lens more comfortable and stable greatly enhance lens fit, stability, comfort, vision
(see illustration F) and often and wearing time.
providing superior vision. ACT is
independent of the primary base
curve and Edge Lift value and is
available for ROSE K2, ROSE K2 IC,
ROSE K2 Post Graft lens designs.

ACT is quadrant specific and allows the

steepening of the inferior quadrant only

G: With Rose K2 standard No peripheral toric

peripheral toric

E: A spherical ROSE K2 lens

(symmetric) fitted on this
F: Incorporating ACT into the
design improves the fit at
AVAILABILITY
asymmetric keratoconic cornea
fits well at 3, 9 and 12 o'clock
6 o'clock, making the lens
more comfortable and stable
AVAILABILITY
but causes the lower edge to and providing superior vision. 12
lift off at 6 o'clock.

AVAILABILITY
ACT GRADE #1 (0.7 mm)
Slight edge stand off with
pooling at or around 6 o'clock
(between 5 and 7 o'clock).
Specify: ACT grade #1 The 3 and 9 o’clock
meridians are flattened
while the 6 and 12 o’clock
meridians are steepened.
ACT GRADE #2 (1.0 mm) A standard toric periphery
Moderate edge stand off with will create an 0.8 mm
difference in meridians.
9 3
pooling and possible bubble at or
around 6 o'clock (between 4 and Other values are
8 o'clock). The tear meniscus may available between
also start to break up on blinking. 0.4 mm to 1.3 mm.
Specify: ACT grade #2

ACT GRADE #3 (1.3 mm)

Significant edge stand off or lift
off (tear meniscus breaks up)
at around 6 o'clock.
Specify: ACT grade #3

Note: other grades of ACT are available (0.4 mm to 1.5 mm),

please call us 6 for further information on +44(0)1604 646216. 6

4
 Systematic Approach to Fitting
Recommendations
The use of diagnostic lenses is the only way to properly assess the correct fit and final lens power.
Topical corneal anesthetic is recommended for new fits to reduce tearing for more accurate fitting assessment.
Toric peripheral curves and Asymmetric Corneal Technology (ACT) are available on all lens designs.

ROSE K2 ROSE K2 NC ROSE K2 IC ROSE K2 POST GRAFT

INDICATIONS Oval Keratoconus, Nipple Cone only Pellucid Marginal For patients who have
Nipple Keratoconus Degeneration, undergone penetrating
Keratoglobus, keratoplasty
LASIK-induced
Ectasia and Post Graft
INITIAL • For K readings 7.1 mm and • For mild to moderate cases PMD AND GLOBUS. Select the first trial lens
flatter, select first trial lens (where mean K reading is flatter Select the first trial lens 0.3 mm steeper than

1 BASE CURVE
SELECTION
0.2 mm steeper than the mean
K reading.
• For K readings from 6.0 to
than 6.0mm), select a first trial
lens 0.2mm steeper than mean K.
• For advanced cases (where
0.3 mm flatter than steepest
corneal meridian.
average K reading.

POST LASIK AND GRAFT,

7.0 mm, select the first trial lens mean K measures between 5.1- refer to ROSE K Post Graft
equal to the mean K reading. 6.0mm), select a first trial lens
section.
• For K readings 5.9 mm and equivalent to the mean K reading.
steeper, select the first trial lens • For severe cases (where the
0.4 mm flatter than the mean K mean K reading is steeper than
reading (less predictable). 5.0mm), select a first trial lens
0.3mm flatter than the mean K
NB: This is only a guide as the reading.
keratometer only measures the • If using a corneal topogra-
central 3 mm along the line of sight. pher, select the first trial lens
based on the 3.0mm sim K’s.

CENTRAL FIT Ignore peripheral fit Ignore peripheral fit Ignore peripheral fit Ignore peripheral fit

2 at this stage.
A Evaluate central fit
immediately after blink
at this stage.
A Evaluate central fit
immediately after blink
at this stage.
A Evaluate central fit immediately
after blink when lens is centered.
at this stage.
A Evaluate central fit
immediately after blink
when lens is centered. when lens is centred. B FOR PMD AND GLOBUS, a when lens is centered.
B A light, feather touch at B Look for similar or slightly light feather touch is desired. B Look for central pooling of
the apex of the cone is desired. greater central touch than FOR POST LASIK, look for 0.2 mm to 0.3 mm in early
(See fluorescein images section). with the conventional central pooling of 0.2 mm flatter grafts; alignment to
ROSE K2 design. to 0.3 mm. 0.1 mm flatter in more mature
(See fluorescein images section). FOR POST GRAFT, refer to grafts.
ROSE K2 Post Graft section. (See fluorescein images section).
(See fluorescein images section).

Once optimum central fit is achieved, assess Edge Lift. Look for an even fluorescein band of 0.5 mm to 0.7 mm in width. Order
PERIPHERAL
3 FIT
increased (flat) or decreased (steep) Edge Lift accordingly. For asymmetric Edge Lift where the lift is excessive at 12 and 6 o'clock and
insufficient at 3 and 9 o'clock, consider toric PCs (TP design). For significant edge stand off / lift off, at or around 6 o'clock, consider
ACT.

ASSESS THE Smaller diameters are required for Small, steep Nipple Cones often The standard diameter The standard diameter

4 DIAMETER
central cones and larger
diameters for decentered cones.
A larger diameter is often required
require a smaller diameter
approximately 8.3 mm on
average. As a rule flatter Nipple
is 11.4 mm. Increasing
the diameter will help lens
location/centration.
is 10.4 mm. Increasing
the diameter will help lens
location/centration.
for early cones and will also tend Cones go larger on diameter, Make sure the lens is not Make sure the lens
to make the lens ride higher. The steeper Nipple Cones go smaller impinging onto the upper is not impinging onto
lens should hang off the top lid on diameter. Look for movement sclera. the upper sclera.
and be well clear of the lower on the the blink of 1.0 to
limbus. 1.5 mm.

ASSESS Perform over refraction in well-lit room. Over refract using ± 1.00D steps initially and refine with 0.50D and 0.25D steps.
5 POWER LAST
ROSE K2 NC: Allow the trial lens to settle for a minimum of 10 minutes before over refracting. Ensure testing room lights are on and
push the plus to blur. It is common to over minus these patients.

RESIDUAL It is usual to leave low amounts of R.A. uncorrected, or to Spherical compensation of

6 ASTIGMATISM
compensate spherically for it (see table). It is rare to see R.A. amounts over this level;
when it is, toric lenses (front, back or bi-toric) are usually needed.
R.A.
R.A. -0.25 to -0.50,
Please consult the Web site at www.davidthomas.com or call +44(0)1604 646216 add -0.25 D
(R.A.) for more information on toric lenses. R.A. -0.75 to -1.00,
add -0.50 D

Care regimen: MeniCare Plus / Progent

0120 - Manufactured by David Thomas CL Ltd, NN3 8RJ, UK
5
CORNEAL TOPOGRAPHY
Corneal topography is a very useful and effective tool in determining irregular corneas and different cone
shapes and sizes. The images below represent typical cones and irregular corneas encountered in a practice
along with the recommended ROSE K2 lens design for optimal fit.
Pellucid Marginal Lasik-Induced
Large Oval Cone Small Nipple Cone Degeneration Keratoglobus Ecstasia

ROSE K2 ROSE K2 NC ROSE K2 IC ROSE K2 IC ROSE K2 IC

ROSE K2 Post Graft ROSE K2 Post Graft ROSE K2 Post Graft ROSE K2 Post Graft

CORNEAL TOPOGRAPHY
ROSE K2

Photos : all rights reserved - Printed in France by Menicon Europe - RCS Nanterre B 722 038 668
Optimum fit immediately after Optimum fit a few seconds Good fit centrally - loose Steep centrally - good fit
blink. after blink. Don’t judge fit in peripherally. peripherally.
this downward location.

ROSE K2 NC

Nipple Cone. Optimum fit. Nipple Cone. Nipple Cone Tight Edge Lift. Nipple Cone Low location.
Excessive Edge Lift.

ROSE K2 IC

DTCL 086/2 2011-05 - www.quelquechoseenplus.fr

11.4 diameter lens on PMD. 11.4 diameter lens on PMD. 11.4 diameter lens on PMD. 11.4 diameter lens on Nipple
Proper central touch and Proper central touch, Proper central touch, too Cone. Proper central touch,
Edge Lift. insufficient lift. much Edge Lift. excessive lift at 6 o'clock,
ACT grade #1 recommended.

ROSE K2 PG

Optimum fit. Early graft - good location and Good central fit, tight Early Graft - steep centrally,
central fit, excessive Edge Lift. periphery. loose periphery.