Today we saw a patient kindly referred by Dr. Ochiltree from Mohave Eye Center.
A 69 year old white male arrived to our clinic for a contact lens consultation. He has a full thickness corneal transplant in each eye from keratoconus. He wears spectacle glasses, however, he was looking to further improve his vision.
Prior to the corneal transplants, he wore gas permeable lenses, and he complained that they popped out of his eyes.
After reviewing the images with him, along with an evaluation of his eye health, we suggested trying a diagnostic lens on in office, to check his vision potential. Often times, if I am concerned with the best potential vision or if the patient has concerns, we will try on a lens and perform a quick over-refraction to check the visual acuity, visual quality, and overall comfort of the lens. Then, we can all make an educated decision whether or not to move forward with the fitting process.
The astigmatism in the right and left eye both look fairly regular, so it is possible that he might do well in a traditional bitoric corneal gas permeable lens. However, with the limbus-to-limbus astigmatism in the left eye, he may experience frequent lens dislodgement. The right eye looked like a better candidate, but the elevation maps showed a huge difference, and I worried about the lens dislodgement issue again.
We tried on an Ampleye Scleral lens 4400 sag in each eye. Both lenses showed corneal touch, so I removed those lenses and we inserted the 4800 sag instead. The central clearance looks acceptable and with a quick over-refraction, he was able to achieve 20/25 vision, and he was thrilled with the comfort of the lenses.
Since he decided to proceed, we continued the fitting process by letting the lenses settle for 20 minutes, and then took external images of the fit and OCT images. All information was sent to the lab and the consultants helped us design his lenses. Looking forward to seeing him at the dispense visit!
Dr. Woo's tip of the day: If you are concerned with the potential vision or comfort (or the patient is), use a diagnostic lens and perform a quick over-refraction to gauge the patient's best corrected visual acuity.