One of most successful scleral lens patients arrived to the office for her annual contact lens evaluation.
She is an 80 year old female who had radial keratotomy (RK) surgery years ago. She did quite well for many years, but then her vision started to decline. She ended up having some corneal epithelial splitting issues due to the RK incisions, and Dr. Wellish had to fix those areas and then stitch them (you can see the stitches in the photos).
She also has 3+ nuclear sclerotic cataracts. When I saw her a year ago, I thought the vision potential was meek, due to her scar tissue from the RK surgery, the irregular corneal shape, the stitches on the cornea and the dense cataracts.
If you asked me to guess what the patient's best corrected vision would be, I would have said, maybe 20/50-20/80 if I had to bet money on it.
For cases like this, I always put a diagnostic scleral lens on and perform a simple over-refraction to see what the vision potential is. To our surprise, she was able to achieve 20/30 in office with a diagnostic scleral lens. She had a very large amount of against the rule astigmatism, which is to be expected in a patient who has dense cataracts.
We decided to proceed with a custom scleral lens called the Latitude. To design this lens, we needed to take 3D images of her eyes using the sMap 3D instrument. Then, the lab uses special software to design custom scleral lenses for each eye.
When we dispensed the Latitude scleral lenses, she was seeing 20/25 and 20/20 in each eye! This was shocking to everyone, and we were so happy for her. The lenses fit her eyes perfectly and she's done well for the past year.
She arrived today for an annual evaluation of the contact lenses with no complaints. Her vision was 20/25 on the right eye and 20/20 on the left eye. The lens fit remained excellent for each eye, and the surface of the contact lenses were unremarkable. She will follow up with Dr. Wellish as directed, and we are so happy her vision and lens fit have remained stable!
OCT - OD
OCT - OS