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High myopia patient fit into scleral contact lens

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!