KeratoconusNipple Cone

Irregular CorneaPost Graft

PRACTITIONER’SFITTING GUIDE

ROSE K2™

ROSE K2 NC™NIPPLE CONE

ROSE K2 IC™IRREGULAR CORNEA

ROSE K2 PG™POST GRAFT

FeaturingEasy-to-fit using a simple systematic approach for all designs.Simple to use flexible edge lift system.Aberration control aspheric optics providing outstanding visual acuity, reduced flare and glareand minimum lens mass (ROSE K2, ROSE K2 NC, ROSE K2 IC, ROSE K2 PG).Advanced fitting options including: •Toricperipheralcurves. •AsymmetricCornealTechnologyorACT. •Front,backandbi-toricdesigns.Extensive diameter and base curve range.Fitsmostcornealshapes,sizesandstagesofkeratoconusbecauseof the unique design that changes as the base curve steepens.

ROSE K2

PRIMARYINDICATION

SECONDARYINDICATION

PARAMETERSAVAILABLE

ADVANCEDFITTINGOPTIONS

TRIAL SETS

ROSE K2 NC ROSE K2 IC ROSE K2 PGOvalkeratoconusNipplekeratoconus

26 lenses from 5.10 to 7.60 mm in a variable diameter from 8.50 to 9.20 mm, with variable power to approximate the final lens power.

Early Pellucid MarginalDegeneration

1-ToricPeripheralcurves(TP)2-QuadrantspecificAsymmetricCornealTechnology(ACT)3-Toric:back,frontandbi-toricsurfaces

BASE CURVE4.30 mm to 8.59 mmDIAMETER7.90 mm to 10.40 mmPOWER Varies with materialEDGE LIFTStandard, standard flat,standard steep.More lifts are available

Moderate and steep nipple cones

25 lenses from 4.60 to 7.40 mm in variable diameter from 8.10 to 8.90 mm with variable power to approximate the final lens power.

All nipple cones

BASE CURVE4.30 mm to 7.69 mmDIAMETER7.60 mm to 9.00 mmPOWER Varies with materialEDGE LIFTStandard, standard flat,standard steep.More lifts available

Pellucid MarginalDegeneration,keratoglobus,LASIKinduced ectasia andpost graft

18 lenses from 6.00 to 8.40 mm in an 11.20 mm diameter, with variablepower to approximate the final lens power.

Ovalkeratoconus

BASE CURVE5.70 mm to 9.30 mmDIAMETER9.40 mm to 12.00 mmPOWER Varies with materialEDGE LIFTStandard, standard flat,standard steep, double flat, double steep

Forpatientswhohaveundergone penetratingkeratoplasty

22 lenses from 6.00to 9.00 mm in an 10.40 mmdiameter, with variablepower to approximatethe final lens power.

Ovalkeratoconus,nipplekeratoconusandLASIK

BASE CURVE5.70 mm to 9.30 mmDIAMETER9.40 mm to 12.00 mmPOWERVaries with materialEDGE LIFTStandard, standard flat,standard steep, double flat, double steep

Four lens designs...One simple systematic approach to fitting

Theperipheralfitisthesinglemostimportantfittingfactorforasuccessful,comfortableGPfit.Ratherthana complicated series of radii and diameters, all ROSE K2 lenses use a simple value referred to as edge lift to determinetheoptimalperipheralconfiguration.Fromthetriallens,anedgeliftvaluereferredtoasstandard,increased lift (flat) or decreased lift (steep) can be ordered (see illustrations A, B, C).Thefinallensisautomati-cally 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 standardsteep(decreased)EdgeLifttoachievethedesiredperipheralfit.However,otheredgeliftvaluescanbespecified 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 periph-eral fit. Other edge lift values are available in 0.1 increments ranging from -1.5 decreased to 3.0 increased (see illustration D2).

With ROSE K2 IC and ROSE K2 PG lenses , the flexible edge lift system is available in 5 different values: stan-dard, standard steep (decreased), standard flat (increased), double steep or double flat (see illustration D3).

Illustration A:OptimalEdgeLiftwillgive a fluorescein band of 0.5 mm to 0.7 mm with no excessive lift or peripheral seal at any point.

Illustration B : When the fluoresceinpattern indicates edge lift in excess of 0.5 mm to 0.7 mm, a standard steep edge lift value is recommended.

Illustration C: When the fluoresceinpattern indicates an edge lift lessthan 0.5 mm to 0.7 mm, a standardflatedgeLiftvalueisrecommended.

FLEXIBLE EDGE LIFT SYSTEM

AVAILBILITY

Peripheral fit zoneIllustration D1

Illustration D2

Illustration D3

ROSE K2

ROSE K2 NC

ROSE K2 ICROSE K2 PG

85% of all ROSE K2 lensesutilizeeitherthestandard,standard flat or standardsteep edge lift values.

85 % of all ROSE K2 NC lenses utilizeeitherthestandard,standard flat or standard steep edge lift values.

5 different edge liftvalues are available to fitall of your patients.

MaximumFlatLift+3.0

MaximumFlatLift+3.0

DoubleFlatLift

MaximumSteepLift-1.3

MaximumSteepLift-1.3

MaximumSteepLiftStandard Steep Lift -0.5

Standard Steep Lift -0.5

Standard Steep LiftStandard Lift +0.0

Standard Lift +0.0

Standard LiftStandard Flat Lift +1.0

Standard Flat Lift +1.0

Standard Flat Lift

ACT ASYMMETRIC CORNEAL TECHNOLOGY

AVAILABILITY

TORIC PERIPHERAL CURVES

AVAILABILITY

Bynature,thekeratoconiccorneaisasymmetric, where the inferiorquadrant is frequently significantlysteeper than the superior portion,causing the GP lens to lift off at6o’clock(seeillustrationE).ROSEK2lensesincorporatingACTare designed to accommodate thisasymmetry (good edge fit at 3, 9and12o’clockbutliftat6o’clock).Theinferiorquadrantofthelensis steeper than the superiorquadrants, providing a moreaccuratefitat6o’clockmakingthelens more comfortable and stable(seeillustrationF)andoftenprovidingsuperiorvision.ACTisindependent of the primary basecurveandEdgeLiftvalueandisavailable for ROSE K2, ROSE K2 NC,ROSE K2 IC, ROSE K2 PG lensdesigns.

Atoricperiphery(TP)iswheretheopticalzoneisspherical and approximately the last 1 mm of the peripheral curve is toric although this is variable dependent on the overall diameter of the lens. With Keratoconus, the tight areas, usually within 20degreesof180°(3and9o’clock),willbeeliminatedwithaTPdesign(seeillustrationG).In PMD there is often significant against-the-rule astigmatismmakingthelenstightat12and6o’clockandlooseat3and9o’clock.Alensthatistightat12o’clockcausesdiscomfort,soaTPdesign is often useful here.

TheTPdesignisavailableonROSEK2,ROSEK2 NC, ROSE K2 IC, ROSE K2 PG lenses will greatly enhance lens fit, stability, comfort, visionand wearing time.

ACTisquadrantspecificandallowsthesteepening of the inferior quadrant only

E: A spherical ROS E K2 lens(symmetric) fitted on thisasymmetrickeratoconiccorneafitswellat3,9and12o’clockbut causes the lower edge toliftoffat6o’clock.

G: With R ose K2 standardperipheral toric

No peripheral toric

F:IncorporatingACTintothedesign improves the fit at6o’clock,makingthelensmore comfortable and stableand providing superior vision.

ACT GRADE #1 (0.7 mm)S light edge stand off withpoolingatoraround6o’clock(between5and7o’clock).Specify:ACTgrade#1

ACT GRADE #2 (1.0 mm)Moderate edge stand off withpooling and possible bubble at oraround6o’clock(between4and8o’clock).Thetearmeniscusmayalsostarttobreakuponblinking.Specify:ACTgrade#2

ACT GRADE #3 (1.3 mm)S ignificant edge stand off or liftoff(tearmeniscusbreaksup)ataround6o’clock.Specify:ACTgrade#3

The3and9o’clockmeridians are flattenedwhilethe6and12o’clockmeridians are steepened.A standard toric peripherywill create an 0.8 mmdifference in meridians.Other values areavailable between0.4 mm to 1.3 mm.

12

3

Note:othergradesofACTareavailable(0.4mmto1.5mm),please call us at 800-253-9364 for more information.

9

6

Systematic Approach to FittingRecommendationsTheuseofdiagnosticlensesistheonlywaytoproperlyassessthecorrectfitandfinallenspower.Topicalcornealanestheticisrecommendedfornewfitstoreducetearingformoreaccuratefittingassessment.ToricperipheralcurvesandAsymmetricCornealTechnology(ACT)areavailableonalllensdesigns.

INDICATIONS Oval Keratoconus,Nipple Keratoconus

Nipple Cone only Pellucid MarginalDegeneration,Keratoglobus,LASIK-inducedEctasia and Post Graft

Forpatientswhohaveundergone penetratingkeratoplasty

ROSE K2 ROSE K2 NC ROSE K2 IC ROSE K2 PG

•ForKreadings7.1mmandflatter, select first trial lens0.2mm steeper than the meanK reading.•ForKreadingsfrom6.0to7.0mm, select the first trial lens equal to the mean K reading.•ForKreadings5.9mmandsteeper, select the first trial lens 0.4mm flatter than the mean K reading (less predictable).

Smaller diameters are required for central cones and larger diameters for decentered cones. A larger diameter is often required for early cones and will alsotendtomakethelensridehigher.Thelensshouldhangoffthe top lid and be well clear of the lower limbus.

Ignore peripheral fitat this stage.A Evaluate central fitimmediatelyafterblinkwhen lens is centered.B A light, feather touch atthe apex of the cone is desired.(See fluorescein images section).

NB:Thisisonlyaguideasthekeratometeronlymeasuresthecentral 3 mm along the line of sight.

Onceoptimumcentralfitisachieved,assessEdgeLift.Lookforanevenfluoresceinbandof0.5mmto0.7mminwidth.Orderincreased(flat)ordecreased(steep)EdgeLiftaccordingly.ForasymmetricEdgeLiftwheretheliftisexcessiveat12and6o’clockandinsufficientat2and9o’clock,considertoricperipheralcurves(TPdesign).Forsignificantedgestandoff/liftoff,atoraround6o’clock,considerACT.

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

It is common to leave low amounts of R.A. uncorrected, or tocompensate spherically for it (see table). It is rare to see R.A. amounts over this level;whenitis,toriclenses(front,backorbi-toric)areusuallyneeded.

Spherical compensation ofR.A.R.A. -0.25 to -0.50,add -0.25 DR.A. -0.75 to -1.00,add -0.50 D

•Formildtomoderatecases(where mean K reading is flatter than 6.0mm), select a first trial lens 0.2mm steeper than mean K.•Foradvancedcases(wheremean K measures between 5.1- 6.0mm), select a first trial lens equivalent to the mean K reading.•Forseverecases(wherethemean K reading is steeper than5.0mm), select a first trial lens0.3mm flatter than the mean Kreading.•If using a corneal topogra-pher, select the first trial lens based on the 3.0mm sim K’s.

Small, steep Nipple Cones oftenrequire a smaller diameterapproximately 8.3mm onaverage. As a rule flatter NippleCones go larger on diameter,steeper Nipple Cones go smallerondiameter.Lookformovementonthetheblinkof1.0to1.5mm.

Ignore peripheral fitat this stage.A Evaluate central fitimmediatelyafterblinkwhen lens is centred.BLookforsimilarorslightlygreater central touch thanwith the conventionalROSE K2 design.(See fluorescein images section).

PMD AND GLOBUS.Select the first trial lens0.3 mm flatter than steepestcorneal meridian.POST LASIK AND GRAFT,refer to ROSE K2 PG section.

Thestandarddiameteris11.2mm. Increasing the diameter will helplenslocation/centration.Makesurethelensisnotimpinging onto the uppersclera.

Ignore peripheral fitat this stage.A Evaluate central fit immediatelyafterblinkwhenlensiscentered.B FOR PMD AND GLOBUS, alight feather touch is desired.FOR POST LASIK,lookforcentral pooling of 0.2 mmto 0.3 mm.FOR POST GRAFT, refer toROSE K2 PG s ection .(See fluorescein images section).

Select the first trial lens0.3 mm steeper thanaverage K reading.

Thestandarddiameteris10.4 mm. Increasing the diameter willhelplenslocation/centration.Makesurethelensisnotimpinging onto the upper sclera.

Ignore peripheral fitat this stage.A Evaluate central fitimmediatelyafterblinkwhen lens is centered.BLookforcentralpoolingof0.2 mm to 0.3 mm in earlyflatter grafts; alignment to0.1 mm flatter in more maturegrafts.(See fluorescein images section).

INITIALBASE CURVESELECTION

CENTRAL FIT

PERIPHERALFIT

ASSESSPOWER LAST

RESIDUALASTIGMATISM(R.A.)

ASSESS THEDIAMETER

1

2

3

4

5

6

CORNEAL TOPOGRAPHY

CORNEAL TOPOGRAPHY

ROSE K2

ROSE K2 NC

ROSE K2 IC

ROSE K2 PG

Corneal topography is a very useful and effective tool in determining irregular corneas and different coneshapesandsizes.Theimagesbelowrepresenttypicalconesandirregularcorneasencounteredin a practice along with the recommended ROSE K2 lens design for optimal fit.

LargeOvalCone

Optimum fit immediately afterblink.

11.4 mm diameter lens on PMD. Proper central touch and edge lift.

Optimum fit.

Nipple Cone. Optimum fit.

Optimum fit a few secondsafterblink.Don’tjudgefitinthis downward location.

11.4 diameter lens on PMD.Proper central touch,insufficient lift.

Early graft - good location and central fit, excessive edge lift.

Nipple Cone.Excessive edge lift.

Good fit centrally - looseperipherally.

11.4 mm diameter lens on PMD. Proper central touch, too much edge lift.

Good central fit, tightperiphery.

©2012MENICONAMERICA,INC.ROSEKISATRADEMARKOFMENICONCO.,LTD.CORPORATIONJAPAN3-21-19,AOI,NAKA-KUNAGOYAJAPAN460-0006

NippleConeTightedgelift.

Steep centrally - good fitperipherally.

11.4 mm diameter lens on Nipple Cone. Proper central touch, excessive lift at6o’clock,ACTgrade#1recommended.

Early Graft - steep centrally,loose periphery.

NippleConeLowlocation.

ROSE K2ROSE K2 PG

ROSE K2 NC ROSE K2 ICROSE K2 PG

ROSE K2 ICROSE K2 PG

ROSE K2 ICROSE K2 PG

Small Nipple Cone KeratoglobusPellucid Marginal

DegenerationLASIK-Induced

Ecstasia