Thank you Dr. Isozaki for sending us this fun case!
34 year old Asian male was seen at UCLA by my good friend and classmate, Dr. Veronica Isozaki. He has a long history of corneal gas permeable lens wear, since he was about 10 years old.
After a very thorough case history, and after examining his current lenses, he mentioned that his last eye doctor in New York was attempting "orthokeratology daytime lenses." I didn't know what he meant until I saw the lens fit on his eye and the topographies.
The lenses both showed central bearing with midperipheral pooling (not a classic orthokeratology pattern, but I can see what he meant by 'daytime orthokeratology lenses." The left eye also shifts during blink which causes a chance in his vision.
We reviewed a variety of lens options extensively, and we decided to attempt an oblate scleral lens for now. I could attempt to redesign lenses based on his current topography, but the artificial shape might cause me to chase the lens fit over and over again. I recommended starting fresh with a scleral lens and we can monitor his corneal "unmolding" and if he truly wants to go back to the corneal gas permeable lenses, we will have a much better baseline.
The over-refraction was not attempted due to the autorefract data being -22.25 in the right eye and -22.75 in the left eye.
With an oblate design and also adjusting the base curve, we were able to decrease the power to about -16.00.
The first lens will be sort of a custom diagnostic lens. He knows that the shape of his eye and potentially the power will need to be adjusted as things progress. Will keep you posted on his results!