 and young colleagues. It's a pleasure to be with you today. Okay, it's a pleasure to be with you. It's always a pleasure to be with you. And there aren't too many at this great Moran Eye Center do anything with contact lenses who are MDs. You see one of them right here in Kim Taylor's, the other. And let's just talk about it. And I'd like to have you after this hour or even a little less with the paper that I'm handing out and what you'll see and what I'll tell you here able to go into contact lens fitting and do a pretty good job of it because it's just chancey right now. You just sort of you get one like you saw somebody else get one and sort of put it on somebody and let's make it a little better than that. A little bit of general information. When you think about contact lenses, maybe the first ones are what they call scleral contact lenses. Those were used in care to conus and they were glass lenses. They called them scleral because they fit on over the wide of the eye. Of course, they fit on the conjunctivus of sclerals have done name but anyway, they were big. I mean, I don't know what they fill them with. Maybe normal saline, they get this bucket of normal saline in this lens. It's a lens of power and they sort of figured out what might work and for starters, maybe it's a trial lens and they'd bend over and put it on the eye and the care to conus patients were thrilled to have something help. I talked to a friend who said one of the early stockbrokers to come to this part of the country and maybe he wasn't a stockbroker. He was doing that and was with the old Edward L. Burton company. He'd come to the office and he'd read the financial page. You want to know how he read the financial page? He read the financial page like this. He had the paper right on his nose and his forehead and that's the only way that somehow cut it. Nobody told me what he had but I didn't have to be told. He had care to conus. I think care to conus came to the inner mountain west with those early fine there as they brought it. Are you aware that we have more care to conus here than elsewhere generally? Have you heard about that? I was talking to an ophthalmologist in Florida once. He said, boy, you sure have a lot of care to conus there. I thought, well, that's interesting and I didn't think too much about it and then Claes Dolman was giving a talk and one of the resorts around here and we had him here for a visiting instructor and he was talking about his main subject and he said, well, by the way, let's talk about care to conus for a while. He showed the operated care to conus when corneal transplant was the thing done. One thing got out of control and you couldn't see well with contact lenses anymore. He showed all the surgery at Massachusetts Eye and Ear Infirmary. I just sat and watched and I thought, Joe Hatch is doing more corneal transplants than the Massachusetts Eye and Ear Infirmary. Either I'm a crazed surgeon or we've got a lot of care to conus and I submit to you that I think it's the latter and so it's interesting stuff but beyond that kind of lens, it gave people a little help for an hour or two. The next one was polymethylethacrylate and that's a plastic lens. Everything's made out of these days, mostly inside of your car. That's polymethylethacrylate. That lens didn't breathe. No gas exchange through it. You had to blink and oxygen in the tears to get to the corneal and you do pretty good and they weren't bad. They were around for a long time. They may have started, I don't know, maybe in the 1940s. There certainly wasn't a lot of use before then with that type of lens. A big uptake was when the rigid gas permeable lenses came along and that's polymethylmethacrylate plus silicone. You think if you make those two together you'd have a bunch of glop. It wouldn't be good for anything but by golly it was a material that could be clear and you could cut a lens and it still works very well for hammered corneas and keratoconus, things like that and the soft contact lenses. Of course, these lenses show us for most of the general optical improvement type of contact lenses. Physicians haven't been fitting contacts for a long time. When I took my oral boards, the examiner looked me in the eye and he said, okay, how about a minus 1.75 mile in each eye comes in, says she wants contact lenses. What are you going to do? Well, I said as well, I think maybe I'd see if she liked glasses in a nice, attractive frame. They're kind of sexy. Maybe that would work out pretty good. He said what if she said I want contacts and I don't want anything else, then what would you do? I said I'd fit her with contact lenses and he looked alarmed when he looked back at me. Like you're going to compromise your standards or something? Well, it wasn't my standard. I was fitting some contact lenses and I thought well, there's always next year I'll try the oral boards again, but happily he didn't swing enough weight to bury me. That's how some of this is. A few things about contact lenses. On the rigid ones, I tell people once they're well set with a rigid lens to get a spare pair, always have a spare pair. If you lose or break one lens, replace it and get a new replacement so you still have a spare pair because there's nothing more disenchanting. Have somebody come and say a little bag of lenses and all these little boxes and all these lenses. Well, take it from me. Those lenses are probably warped and scratched and they're a mess and you're not going to find anything there that will answer it. If they come into me and don't have any contact lenses at all in their possession, but I know what their last prescription was, I simply order the last prescription and treat them as trial lenses, get them in. Well, I think Moran orders out of Minnesota. I think that's where the ones that I would get at Mid Valley would come from. When they come in, I do a spherical over refraction and if they see well and it's fine, that's good. If not, I find out what power I want to order and order that and then tell them to get a spare pair exactly like this or if I'm only changing one, get another one like this. I say throw away every contact lens you have because these people scroll away contact lenses all over the place. They're stocking drawer and they're everywhere. So you get rid of every one and they'll save you a lot of grief. A few other little details that are kind of important. Some kind of lenses might be time consuming or somebody goes to Google and they find this super special lens for character quality. This is the one I want. Well, if you're not fitting lots of contact lenses, really making your way of life, you might want to refer that one off to your colleague who does find somebody who will handle it because a lot of those lenses, when they come in, they cost $100, $150, $200 per lens and you bought it once you get there. It's not a trial lens. It's yours and if you can't use it, it's yours for junk. So you might want to send certain things off and that's quite all right and it's good. I think it's wise to choose your fee. Tell the patients this will do for three months. If you have to come back a time or two, we'll of course take care of it. We'll do re-evaluations as necessary and exchange trial lenses and they like that too. They like to know what's going on. There are a lot of different contact lens solutions. These are Boston solutions. That's one of the good ones. By the way, I have a handout here. I advise you to be sure you get one and if you don't get one at the end of the talk, these are Boston solutions. This is the old kind. It has a cleaner and a wetting solution. The problem with that is sometimes people mix up with two and they use the cleaner and then they put it in their eye and that is an owie immediately and it is just terrible. So Boston, they call it Simplis, S-I-M-P-L-U-S. It's Simplis because there's only one and it does whatever cleaning it might do but it also is a wetting solution. There are so many kinds and they will usually provide starter kits. I've won this Boston Lohman once at Alcon for soft contact lenses. There are a lot of solutions and my advice on solutions is to get a kind you like and stick with it unless you feel that it's irritating your eye or giving you a problem and okay, go ahead and make a change but make it too complicated. Okay, we talked about the, when I fit rigid gas permeable lenses, I only fit spherical lenses. I never do a back-torque. I never have and I haven't had any trouble. I have so many patients who do so well. That rigid back-torque, a lot of special treatments on making rigid contact lenses that you sort of have to crimp the lens or do other things. I want to lens so that patients say this is the most wonderful lens I've ever had in my life. I sure hope I treat it well. Well, I like to know that the lab can make another one if they make it by crimping it and sort of working it. The chance of getting that exact and the subsequent time is kind of unlikely. The protein buildup on the PMMA lenses, the older ones, is a certain number of years. It takes a long time for the protein buildup and it's not very toxic and the way it bothers people most is that when they clean it, they have something slightly gritty on their fingers that will cut a little canyon in the film of protein and they feel both sides of the canyon and when they have more and more of those, they feel worse and once you clean one of those, they say, wow, this is so nice. You get all the protein off, the lab will do it, but actually in cleaning lens, especially the rigid gas permeable, there are a lot of techs within the Moran system that do this so the patients can come in and they have to have that done at least once a year and some patients have to have it every six months. So either the lab or one of our wonderful techs, something like that. This is what you need to order. We'll get into this also a little later, but when ordering a rigid gas permeable lens, you've got to know what the power will be and I often work mine out of my trial set. I build up the trial set over the years, but if you're going to be involved in rigid gas permeable and fitting care to comas, call the lab and get in touch with somebody there and say, okay, how about a trial set? Mine's a 10 and mine's well with 20, 30, 40 lens or something like that. They can fix you up and you can match the base curve and the diameter and hope you'll be near the power. If you base curve the diameter about the same, you put it on the high, then all you have to do is do an over refraction and add that algebraically to the power of the trial lens you used and you know what power to order. You need a base curve and I'm going to show you the diopter slash radius of curvature table. That's the wonderful thing. You get the radius of curvature from the a keratometer or a corneal topography that you need to put down the power. You need to put down the base curve you want and the diameter and the chart on that's one. There wasn't one that was very good when I started out. I used something but I've adapted it and I have a darn good one and it's in the notes. So it'll be easy to find what diameter you want. The little color thing it's nice because if they're working over a towel or over the sink and they drop a lens, it's nice if they can see it and they have very light colors. It doesn't really change the color of the eye much but it might enhance it a little. They come in blue and brown and gray and green and the hazel kind of likes green and the blue blue and the brown brown and the gray and the grays are nice but actually I fit that one time the gray was the main color they had and I fit a lot of people that way and on the Ritchie Gasper Mibble I like the Boston lens. By the way I'm telling you what I like that doesn't represent what the university likes or what Moran likes I have no financial interest in any of these things but Boston I like the Boston lens the one called the EES and the only time I use other Boston lenses is if they come in with a different Boston lens and they're wearing them and I can refract through them and see what they have and see if they need a power change. I'll say with the one they've been in that's fine when you get your lenses if you've ordered to pair this place on the eyes and check how the fit is see if they're too loose or too too tight we'll talk a little bit about that and they need some instructions on how to use the solutions and they're not all that complex this one Boston solutions the one you put in your case the same one you rinse the lens with clean with your fingers and I two solutions I hate are saliva and water it's spitting on your lenses I just I can't tolerate that people do it and a lot of people get away with it well you can get away with something for a long time then get nailed so saliva is no choice and water you're running the chance of acanthamoeba and all you need to scratch under your cornea and give it to acanthamoeba a chance you may have something a lot tougher than what you want and they need some instruction and most of the texts at least around here are good at that and if they aren't you begin to learn how to tell them how to put them in and take them out I used to do that myself a lot it's not all that tough and people who are wearing rigid gas permeable lenses can learn how I've one of my doctor friends said you know there's a consensus that women are better with these because they have delicate little fingers and so on he said I think the men who work on the carburetors and who they who do the exciting detailed mechanical stuff are equally capable told you about the spare pair for the backup and a spherical trial lens of rgp contacts is a great thing to have and I have one it's in a box that used to contain that kind of box contains 35 millimeter slides but it also you can slide the lens case in there have separate little book they'll tell what's in every one of those stations I love that okay fitting a cone you need a cone trial set and there must be several kinds of cone trial sets and when I got one Dr. Joe it wasn't Dr. Joe's over Mr. Joe Soper an optician in Texas he developed a cone trial set and it's really nice that there are others there's one call I think them a gill and some others and find a trial set and that's not all that tough and all like that's my trial sets 10 lenses this is a Soper pterodactyl is diagnostic set and all you have to do is order the Soper number you order this lens if I want a Soper 6 because I've put it on the eye and that works well well that's a minus 1250 I refract through it it sits low it doesn't have an air bubble I algebraically add the over refraction to the minus 1250 in order and they'll do it take care of all the rest of it the sagittal depth is the depth between the back of the contact lens and the table it's sitting on that this that distance right there and if you have a little bit of sagittal depth you're not likely to be sitting right on the cone and squashing it you know when I'm fitting off the trial set I pick one that I think's right and if I'm seeing what the steepest curve is I'll take a look and if I think well maybe something like this 52 might do it they all have a 45 further more peripheral corneal curve but for the central corneal curve it's this 48 52 56 60 that one you can see they repeat and if you put it on there's an air bubble take it out and put the next flatter one on if that still has an air bubble the next flatter one it takes a little time and once you get one there's no air bubble it looks like it stays there and doesn't want her too much then you're right there order that and you you're in business the finishing of the lens edge is an ARP it's not a technical detail it's not something you set a machine on it soon it's the one that you set that wonderful lab tech in your contact lens manufacturing system to do the bevel because when you when they cut it goes right to a sharp edge so they've got to cut off that sharp edge of it around the periphery and that leaves other sharp edges you have to keep blending when you find you blend it so they're on any sharp edges and that's good I will take patients who have a brand new lens they see well with it it sits there it looks good they say doctor this doesn't feel good I've had contact for it doesn't feel good it's probably the edge problem and so I send it back I say check the edge blender the edge is too sharp and if it sounds like a dumb question I don't care if it sounds like a dumb question guess what comes back very often a better lens the one the patient likes and it so there are subtle things like that and if they think they have good quality control it's hard maybe to know how good that edge is you sort of trust that technician and also if they send another one back and they say oh I still bought it oh no it's not good I just say make another their trial and the free trial lenses and the companies will work with you pretty good on that at least the one we have now that I deal with the brand does okay soft contact lenses I already mentioned protein buildup is slower or half I haven't mentioned it's six months to a year on a rigid gas permeable is two to four weeks on a soft contact but protein buildup seems to be toxic here so non-infectious keratitis is a possibility we see this here I see it when I'm lucky I'm at the VA at a time when one comes in I just love to see him take a look it is so hard to get a history out of these people these people if you say how long do you hold your lenses before you throw them away they'll say oh four weeks I say do you keep your lenses for a while maybe maybe four months before you throw them away then they say oh no I always throw away by three months well it's a two week lens so and I phrase the question of do you ever sleep in if I say do you ever sleep with your lenses and they all say no if I say do you ever sleep with them day and night day and night on and on for three months they say oh heck I I don't think I've gone over six weeks doing that well one night's terrible time seven is bad business well seven times the six weeks so and we put out a white paper for LDS missionaries and some of them pay attention some don't those that don't get into the non-infectious keratitis it's so hard to diagnose non-infectious keratitis in Hong Kong on the telephone but I have mighty high strong suspicions and the most important thing on that is to stop wearing the lens a lot of patients are given a an antibiotic that needed that doesn't necessarily do any good but the antibiotic if it makes you feel good it's okay with me the thing that really works in non-infectious keratitis is steroids and they got so well they know they're better in a day or two days and so teaching to throw the way that the lens is the way it's recommended we talked about the treatment the best way to work with them after they've had non-infectious keratitis and absolutely insist that they never wear on the two-week lens I'm soft on that I'll let it work in four weeks but the two-week lens well if they say that they never wear it before in four weeks and they say they never sleep in them give me daily lenses so they wear lenses one day throw it away that night and just make them promise on a stack of rifles they will always throw it away that night that'll help you you can tell the movement by looking at the patient on the slit lamp and seeing kind of looking at the conjunctival vessels and the edge of the lens and get some idea there's some colored soft contact lenses we won't get into that that's more about there's some crazy ones people like to wear it Halloween so once you want to get in that a little bit okay with caution we talked about solutions this is really a nice idea find find a friend or a lab consultant and if you can deal with the big company they say you just call this number and we'll take care of you all our people are capable I tell them I'm just one person I want to talk to oh it's the same could we do that there's any possibility they'll usually help you and I do have such a friend it's been very very helpful very bright person it's not a lot of them optometrists not an ophthalmologist that sees a lot of lenses come and go and they know which ones are failing and they'll send you a free if you're going in detroit contact lenses it's really nice or multifocal bifocal contact lenses they'll send something to you and they'll kind of guess what you might want that's very very helpful also when you have a lens with the sphere in the cylinder in it you do a refraction of the sphere and cylinder on top of that which is the kind you do not just sphere the sphere and cylinder you add those two together professor worson white put all of that in one of these for me I don't know anybody else in the world had that kind of thing that is wonderful for me to add them together it was about the time that the companies were getting better it's all in their computer now they can do it for you you don't have to worry about doing that but they do have to add it and that friend will take care of that I'm saying you new trial lenses in the new power and it's so often it's great with one try okay let's talk about oh multifocal rigid contact lenses they're hardly ever done anymore my wife is wearing these so at one time and she also had toric lenses in rigid lenses I'd find her sometimes on the couch kind of watching television like this those track lenses are weighted so that they hang down and they have a worry at your cylinder she was looking at it like this I said well dear house of picture I'm pretty good I don't know how on earth would that be good because she's rotated her axis 90 degrees but I love her just the same okay this is climber once again I ran I said her University of Utah Joe hatch don't care what you use I will tell you something you can start with change the anything you'd like no problem and I told you I like the material of Boston ES now you order a base curve that is right on the flattest K reading if the central colonial curve is two diopters you'll ask just order the flattest one that's number one above two diopter cylinder order a base curve halfway between the 2k reading so if you have a 42 diopter and 45 halfway between is 4350s everybody agree order 4350 for your base curve and of course you convert it into millimeters when you when you order it and I'll show you the chart that does that and above four diopter cylinder order a base curve steeper by two-thirds the difference between the 2k readings if you have a 38 and a 44 two-thirds the distance toward the steeper 42 you agree with that okay by the way I had to develop this on my own but I did but it's right it's good I didn't ever see that written anywhere and then you use the chart to convert diopters to millimeters radius curvature order the spherical power that you want I told you about the lens now if I haven't told you about lens no matter I'll show you a chart we have it I'll show you the chart on that but that's four bullets on there one more is color that light little color so you can tell the difference from the lens of water drop and the last thing is dot the right lens with the white dot that way they always put the right lens and right eye if the lenses are almost identical I say always put the right lens and right eye anyway because someday we may change you so that it won't be that identical so get good habits to start with okay this chart is wonderful this is part of Tyler's quarterly it's a little magazine that comes out every three months it has about everything about every contact lens in it if someone comes in you're not too sure what it is but they do know the name and details of the lens you can see things about it and it might help you in your future border I don't get into this very often I don't get into encyclopedia Britannica very much either Google or whatever but when I get in I'd like to find something but this chart begins with the 20 diopter base curve goes up to 60 on the front of the cornea and for every one of those base curves and this starts here and this is a little steeper this little steeper little steeper little steeper little steeper this gets down to the steepest but if you've got a 40 diopter in front of the cornea which is quite flat let's try something 45 that's kind of mid-range you'd order a 7.50 I only go to two points past a decimal point but that that's a wonderful chart that's in Tyler's quarterly okay the flattest charitometer for the lens diameter you're only interested in the flattest k this just determines how wide the lens how big a lens so well let's go back if you have your flattest charitometer reading 45.50 over 9.3 these are a little bigger lenses and I used to fit my patients like the bigger ones I found out as I widened them about two tenths of a millimeter I'll even fudge it up another tenth I wouldn't go the other way toward the smaller ones check the lens fit if the lens is rocking and they're popping out all the time fit it steeper and go on back on this chart go a half diopter steeper so what if you have a lens it's a 46 and I say it's coming out all the time well the 46 go to a half diopter steeper 46 we go to a 46.50 7.25 instead of a 7.3 the larger the number the flatter the curve 7.3 is a larger number than 7.25 so the smaller the number the shorter that radius of curvature also if it's loose you can order a larger diameter lens the cornea isn't just one curve the cornea has a slope then a curve and then the slope the further out you fit toward the slope with a larger lens the type more like a cookie cutter at fifth because it's off to where the slope grad you becomes more gradual so you can go larger by two tenths of a millimeter and see if that will help out now when you do make the contact lens steeper or flatter you have to remember there is a lens in the tears between the lens and the cornea I'm not talking about that frontier film that has no power which you've been taught it has power forget that part but you are really changing that lens you find you're going you have to go steeper and you want to go a diopter steeper you made a stronger plus lens so you have to counter that if you have the if you already have the power right you're only working on the not slipping so much then take that one die for more plus lens and put minus one in the power of the contact lens and you'll still have the same power in front of the eye if they seem tight it's just the opposite cut back to a flatter contact lens a larger radius of curvature or smaller contact and we just mentioned the tear lens power there is a tear lens there it's real and we talked about soft the edges okay soft spherical contact lenses for plane just a cosmetic fitting for revision I like actually OASIS OAS YAS is the way they smell it and here are the details they're all they're all on the box they're only two base curves 8.4 is for steeper caratometer readings such as 46 diopters 47 48 up through there 8.8 is for flatter ones 45 44 so depending upon what the flat the flattest caratometer readings the flattest caratometer reading is you know if it's above 46 or below 46 and you know whether the 8.4 series of lenses the 8.8 they're all 14 millimeters diameter it's their only refraction over the free trial lens and you add that algebraically to the you add the over refraction to the lens power and that way you know what power you want there is an inside out laser mark 1 2 3 on the lens that little tiny dots of 1 2 3 if you see a backward 3 2 1 you understand backward on the eye virtually never see that somehow the patients know when they've got it when they've put one inside out they're taught how to see how it's cupped maybe try to cup it a little more like you fold a taco it's that taco fold goes toward each other then then you're right you've got the cup the way you want it if you try to fold it like a taco and it flares out better turn it over it's probably inside out okay next step if you have a stigmatism there is an acutal view oasis for stigmatism and by the way i very frequently use others because that's what my friend my lab consultant has told me so i've been into cooper lenses and other things that's where you want that person because they know which lenses are getting ordered which ones seem to be satisfied for which ones that seem to fail they have a sense of that they see it in a in a larger number of cases in one's individual practice but this lens only has one base curve it's 8.6 it only has one diameter 14.5 have someone send you a free torque torque trial lens and if you don't have that you might try the just sending in your usual refraction findings and let the lab guess for you and send you a trial lens that still works because you over refract over that and you can get right on it again be with your consultant it's very soon over refraction the one two three on the lens edge you want it to be correct the two-week lens replacement i've told you four weeks it's okay for me often the soft mold the focus aren't too bad one thing is if you have a given power if you have a tube i have to add on it sometimes it seems like it's about 1.5 or something to the way it works you you chance to over-plussing you're less than under-plussing that the adcubus oasis presbyopia or others there's a lot of good multifocal lenses out there one base curve only that's 8.4 one diameter only 14.5 how do you know those you go to a box on the trial lenses that where the optician is where you are in a clinic and read those numbers off there i put them on on the order but they would if i said i wanted action view oasis for presbyopia i got an eight four base curve and a 14.3 diameter no matter what because that's all they have and you order that power low just low mid or high you don't give them an number lowest 0.75 1.25 mid is 1.5 and 1.75 and high is two to two and a half now it's important to do to find the dominant eye on these because some of the people who make these lenses put a different ad on the dominant eye than they do on the non-dominant you all familiar with you feel comfortable about getting the dominant eye and finding it it's a simple thing have a little triangle keep both eyes open look at it there then close one and close the other as i close one the image jumps a little bit to the right no big importance as i close the left it jumps way to the right the one where the image jumps the furthest from the center is a non-dominant eye work on that little bit that works really nicely because they want to know that work with your consultant that's all great mono vision by the way the percentage of success in uh multifocal lenses is well above 50 60 70 it's this way up there you might have a few of them as but maybe a 70 or 80 and the percentage success on rigid lenses when they were weighted and had the power down in the bottom of theoretically if you look down then your lower eyelid would hold the lens and push the bifocal in place well you all know the anatomy assessment if you look down the lower eyelid goes down too so unless they split it push it up those don't work all that much they're based on a false premise motivation to read or contact with the non-dominant eye power about one and a half over what the distance prescription would be is a good way to go if you want to do that success in monovision however it's around 30 success it's not staggeringly wonderful some patients just put storiders over their contact you know all kinds of storiders you go to the drugstore and you pay 15 20 dollars 10 dollars you go to the dollar store and every pair of glasses there is one dollar well the A the residents keep saying go anywhere you want well tell them about the dollar store too that's easy for those guys i love the acu view too acu view then number two this lens fits a little bit like a rigid lens somehow it has a little body to it i say kind of like it slurps up some of these signatures maybe up to one and a half diopters so if you fit an acu view oasis on some eyes they don't like the leftover cylinder and you put the acu view too on they might like it and it's fine so it's a it's a nice lens do the spherical over refraction which you had then again i think most of the opticians have trial sets of acu view two lenses so you can try one out if you like many low power tour guys do not see with it it has only one base curve a bigger part has to 8.3 for the steeper k's 8.7 for the flatter these numbers a little different from what you see on other lenses but those are the two again based on 48 is the midline less than 48 or more than 48 guide you toward what you want they're all 14 millimeter diameter and they have the laser mark daily disposable soft contacts i like the one day acu view true i there's another one called the one day acu view moist the acu view true i cost a little more it's probably a little better material in the making good patient acceptance when you order those they get enough lenses that they put one in every morning and throw it away every night one base curve 8.5 one diameter 14.2 and if you want guests i like them replaced every day without fail now if you need a one-day lens for a stigmatism repressed opi then you are into the acu view moist they don't the true i doesn't have that ladies and gentlemen i feel with what you've heard today with this paper that i worked over spend a lot of time actually you can see the dates is november 2016 i've worked it and reworked it with that especially the fourth page on which is the intimate details of how you go about it i think you can have success in fitting contacts it can be a lot of fun it's a lot of fun for me now you might think it's kind of tough you might think oh i don't know if i can do it well you can do it even if it seems kind of chancey you reckless bunch skiing and the slash and all that stuff are there any questions i'd like this paper to get out to everyone all the residents who are not here can somebody help with that another i don't know how many there are there were 14 of those do you need more than that or does that cover it if you need any more tell me but if you'd be sure and get them distributed because it's it's reading on there i love contacts they're fun i've kept a lot of people out of the operating room i love corneal transplants this is time one if you failed with contacts and those care to colonize a lot of those people get along with glasses for a while in contact for a while when they fail with that they just can't see and they can't make it then we do a corneal transplant i've kept a lot of people out of the operating room with a good contact lens fit with an rgp lens rigid gas permeable thank you very much