Complex Eye Disorders and Treatment

Fred Lippman: Dr. Kramer you are a contact lens

specialist and an optometrist obviously

so tell me about your field of activity

Dr. Kramer:

I’m also very sub-specialized I

specialize in anterior segment disease

dry eye and I specialize in designing

contact lenses so what that means is you

were talking a lot about you know

patients buying things online

this is not what we do we don’t sell

contact lenses so really design them for

patients some patients can’t wear

contact lenses regular lenses that you

can buy on the market they can’t wear

glasses because they can’t see with them

because they have very irregular shaped

corneas they have irregularities in

their eyes either because they were born

that way they’ve developed a disease

they’ve done surgery in the past and

they end up with something that they

can’t wear normal contact lenses or they

can’t wear glasses and see properly so

what we do is we design contact lenses

for these patients based on the shape of

their eye the shape of their cornea and

every lens that we design is completely

unique and individualize for the patient

that we’re treating doctor Dan was

talking about a condition like neuro

trophic cartography in which patients

don’t feel that their eyes are very dry

because they’ve had you know

cranial nerve palsy so in those cases

what we do is we design what’s called

the scleral lens and the scleral lens is

very specialized type of lens that

doesn’t sit on the cornea which is the

transparent layer on the front surface

of the eye actually sits on the white

part of the eye and it’s filled with

liquid and that liquid can restore and

protect the ocular surface and and so

not only do we correct vision with these

special types of contact lenses but we

can also protect the ocular surface and

restore it for when it’s been damaged

from disease or previous surgery and so

we have a whole host of dry eye

treatments as well that we do in the

office and so we really focus on that

our patients who come to us many of them

are referred from other optometrists who

don’t do this type of work or from

ophthalmologists and we work as a team

and just like dr. Dan was mentioning

with anesthesiologists we work as a team

with other doctors to provide you know

specialized contact lenses or treatments

to help in these refractory cases let me

ask you

simplex the question as I can hear from

the audience right now if if it’s not

something that is already pre stopped

you know whatever it might be and they

have to be customized who actually does

the manufacturing and the customization

what is there a special venue that is

it’s not obviously not done in your

office so that’s a very good question

and I explained this to patients on a

regular basis basically I compared a lot

to having an irregularly shaped foot and

trying to buy a pair of shoes so if a

patient if someone wants to buy shoes

but their foot is shaped weird they

can’t necessarily go to any department

store and buy a pair of shoes off the

shelf because they’ll be very

uncomfortable they may have pain they

won’t be able to walk and so we design

like a special shoe for the specific

shape of this person’s foot it’s very

similar if they they can’t buy regular

contact lens online because it won’t fit

properly

they’ll be uncomfortable they may have

pain they won’t see well and so in those

cases they come to us we take a lot of

different measurements measurements that

are not done in regular optometry

offices we measure the front surface of

the cornea we measure the sclera which

is the white part of the eye we do

specialty refractions and we have

diagnostic lenses in the office that we

put on the eye it’s like if you are

getting a custom suit made you go to a

suit store they put a suit on you and

they they tailor it to the shape of your

body it’s a very similar so we have

diagnostic lenses in the office that we

put in our patients eyes and then we use

all that information and we have various

labs that we work with most of them are

located in the US and we share that

information with the lab and they send

us the product now when we receive that

product we put it on our patients and

then make further changes a lot of the

time many times these lenses have to be

tweaked until we finalize them when

we’ve reached that point where no more

changes have to be made but it’s a

process

and a lot of the time it’s very worth it

for our patients I would assume it’s

your take your capabilities your

techniques within your practice that

enables you to take what is sent to you

from these specialized labs and then in

in essence finesse the product for the

comfort of your patient exactly couldn’t

have said it better myself that’s a

weapon that’s exactly how it happens we

we oftentimes we request something it

comes back well when we put it on

doesn’t fit quite as as we wanted it to

or there’s still some room for

improvement and so then we further tweak

it it’s happened before that it’s you

know the first time it just works but I

would say that most of this time we do

have to make further changes right dr.

Dan we’re back to you you mentioned