Much like the shine of a new car or the crispness of a new pair of shoes, new always seems better than a retread. Our profession is no different, especially when it comes to new technologies and the modern design of frames.
New or modern may not always be in the patient’s best interest when what has worked for years and adding a current flair may work as well. You need look no further than the nerdy-chic style or the more modern upgrades to the phoropter. Sometimes no change is needed to something that has worked effectively and flies under the radar.
I am writing this to impart clinical acumen that I learned years ago—contact lens-associated pharmacologically induced kerato steepening or CLAPIKS. I was recently consulted on a case that would have benefitted from some CLAP(iks) back from the managing doctor.
Previously from Dr. Bloomenstein: Managing presbyopia with evolving inlay technology
Imagine you are following a myopic patient who recently underwent a corneal refractive procedure. His scans looked perfect, the thickness was ideal, there was no inflammatory keratitis, all in all a smooth surgery. Yet, he cannot see well at near. Your placid surgical postop patient has a hyperopic correction, indicating he is an over responder. CLAPIKS!
That tiny voice is now asking, “What is he talking about? CLAP-what?”
Related: New correction option for presbyopes
If you lived in the Fayetteville, AR area, then this acronym should not be a surprise. Jay McDonald II, MD, and Allyson Mertins, OD, successfully treated hyperopic over responders following LASIK with the use of CLAPIKS.1 The goal was to provide a more permanent treatment to the incipient hyperopia that some LASIK patients were now enduring.
CLAPIKS is based on keratocyte thickening and thus reshaping a slightly flatter cornea to a steeper profile. The pharmacology involved in this treatment is a non-steroidal anti-inflammatory (NSAID) over a steep contact lens.