This poster was presented at the Global Specialty Contact Lens Symposium 2019 by Tiffany Andrzejewski, OD, FAAO.

Background
INTACs have been used for more than 14 years in keratoconic eyes to reshape the cornea, reduce corneal steepening and refractive error, and avoid or delay the need for a corneal transplant.

INTACs are polymethyl methacrylate semicircular inserts that remodel the corneal contour by acting as spacers between the collagen layers, elevating the midperipheral anterior cornea while flattening the central anterior cornea. However, majority of patients still require vision rehabilitation with contact lenses following INTACs(3).

Nevertheless, contact lens fitting challenges have been reported in literature after implantations of intrastromal corneal ring segments(4,5).

Although sclerals seem like an obvious option as they're designed to vault all corneal irregularity, they may not be optimal depending on the patient’s profession and lifestyle.
These 2 case reports describe patients who were referred for scleral lens fitting and were ultimately refit instead into hybrid contact lenses which improved vision and provided good comfort for all-day wear.

Conclusion
Many different contact lenses can be used after implantation of INTACs. Clinical wisdom within the literature reports that contact lens fitting following INTACs can be challenging due to shape changes arising from the ring segments. This is often why scleral lenses may be preferred as they completely vault all corneal irregularity resting on the sclera eliminating the afore mentioned issues and any concerns of corneal insult and discomfort are avoided.

However, in very active patients whose lifestyle and activities require extremely long wear due to the demands of their profession, the UltraHealth hybrid lens can be a great option because it not only allows high oxygen transmission to promote tear circulation, the GP material also provides enhanced vision for those patients with irregular corneas.

UltraHealth and UltraHealth FC embody ideal contact lens qualities: the soft skirt improves lens centration, as well as comfort; oxygen transmissibility is optimum with the GP center at a Dk of 130, and the SiHy skirt at a Dk of 84. Furthermore, there is UVA and UVB protection. UltraHealth provides a physiologic advantage over scleral lenses in that it allows for a tear exchange rate two times quicker than scleral contact lenses (2.03%/min in hybrids vs 0.02-0.28%/min in sclerals) to maintain corneal health which is an important consideration for longer wear time.