Interesting case today sent by Dr. Malik.
56 year old black male with a history of keratoconus in the right eye. The left eye has been blind since birth, due to toxoplasmosis. When a patient only has vision in one eye, the case becomes a lot more complicated, because if anything happens to the good eye, they could go blind. When patients only have vision in one eye, we have to examine the situation a bit differently and take an extra amount of caution with everything we do.
For years, he has been successfully managed with corneal gas permeable lenses, but as his cornea got steeper, gas permeable lenses would not fit properly on his eye. As keratoconus progresses, the shape of the cornea becomes more and more steep, resulting in more and more of a pointed shape. As the front of the eye becomes more pointy, the contact lenses are more difficult to fit. Imagine the lens like a teeter-totter. As the shape becomes more pointed, the lens can shift and become unbalanced. This can result in the lens popping out of the eye more frequently, and more lens awareness.
He was switched into scleral lenses 2 years ago, due to the advancing keratoconus. He has had success with a scleral lens for the past 2 years. However, as the cone has advanced even more, the lens no longer fits properly. You can see that the lens has excessive bearing, and the diameter is way too small for him too (see the superior image).With his habitual scleral lens, he sees 20/60 "double."
We refit him into the Ampleye scleral lens today with 5000 um of sagittal depth, and the fit looks a lot better. With an over-refraction, he achieved 20/25 vision, despite the corneal scarring.
We ordered the lens today, but warned the patient that as the cornea goes back to its shape, the vision will likely decline and we may need to adjust the fit and prescription. He understands and we are holding off on a corneal transplant for as long as we can, due to the fact that he is monocular.
Looking forward to his dispense
