A very interesting corneal transplant patient arrived today for a consultation.
You can see the double running suture for this corneal transplant patient
He had a herpes scar years ago, which led him to a corneal transplant in the left eye in 2018. After the transplant healed, he was fit into spectacles to improve his vision. He has always suffered with poor vision after the transplant, but claimed he didn't know there were any other options.
I am always surprised when patients tell me that they’ve undergone a corneal transplant, but have not tried any contact lens options to correct their vision. When you get a corneal transplant, it creates a very irregular surface. This irregular surface usually requires a specialty contact lens such as a corneal gas permeable lens or a scleral lens to help smooth out the optical surface. By using a special type of contact lens to re-direct the light entering your eye, the result can be a remarkable improvement in vision.
He sought out another opinion from Dr. Wellish, and Dr. Wellish recommended a scleral lens to improve his vision.
He can see 20/200 "double" with best corrected glasses in his left eye. If you’ve been to the eye doctor, you know that the big “E” is the largest letter on the vision chart. The big “E” represents 20/400 vision, which is very poor vision. As the numbers on the vision chart get smaller, the better your vision is. Hence the term “20/20.” Someone with 20/20 vision has perfect vision. In this patient’s case, 20/200 is also very poor vision.
The transplant has a double running suture, which is what you see in the photo. This technique provides the benefits of a single continuous running suture with the added safety and security of a second continuous running suture. Corneal transplant patients run the risk of hypoxia, and not getting enough oxygen to their transplant. If this happens, patients will need to limit their wearing time with the scleral lens, or change to a different lens modality, such as a corneal gas permeable lens.
The corneal topography for his left eye shows a high amount of irregularity
We placed a diagnostic Ampleye scleral lens: 4400 sag/ 8.04 BC/ -4.00 on his left eye to see what his vision potential could be, and he was able to achieve 20/20 vision with a +4.50 over-refraction! He was thrilled with the vision and comfort of the lens. When patients have an irregular corneal shape, I always place a diagnostic lens on top of their eye to see what their potential vision is. There have been times where the lens does not improve the vision, but it is better to find out now, instead of going through the whole fitting process.
Imagine barely seeing the big E on the vision chart and then improving the vision so that you can see the smallest line of letters! This is such a huge improvement in vision, and it will be life changing for this patient. It’s cases like these that put a huge smile on my face and warms my heart. I love helping patients see better!
We are excited to see him for his dispense in about 1 week.
Thank you Dr. Wellish for trusting us with this special patient!