We had the pleasure of seeing our patient back for a Latitude custom scleral lens dispense today.
This patient had LASIK surgery years ago, and he had monovision correction. This means that one eye is corrected for distance and one eye is corrected for near. In his case, the right eye was corrected for distance and the left eye was corrected for near.
He was successful for many years, and he was able to function glasses-free.
He was seen by his primary care ophthalmologist, Dr. Paul Casey, for his annual exam a few months ago. Dr. Casey had discovered that this patient developed some highly irregular astigmatism in both eyes, likely due to the LASIK surgery.
Even though the vision was still quite good (around 20/25 both far and near), Dr. Casey wanted him to see me for an evaluation due to a desire to improve vision quality.
This patient saw us for a consultation in February 2021 and he stated that although he saw clearly, some of the images were a bit distorted, and he had a bit of ghosting at night.
When we viewed his topography, we could see why the vision became more distorted at night time. As the pupil increases in size, he starts to see into the midperipheral cornea, which is more distorted in shape.
We also found that he had more than 7 diopters of cylinder in the left eye. Both eyes exhibited irregular topography images.
Dr. Casey has been repeating the topography scans every 3 months and for the past year, the patient has been completely stable.
We decided to put a diagnostic scleral lens on for fun, just to see if it would improve his vision.
With the Europa scleral lens on each eye and an over-refraction, the patient could see 20/20 in each eye and, most importantly, he noticed a huge improvement in the overall QUALITY of vision. This is important because even if someone can technically see 20/20, that does not mean that they have good vision. If the vision is distorted, blurred, has haloes, or glare, it can be very disturbing to the patient. Since he was so happy with the improvement in the quality of vision, we decided to proceed with a scleral lens fitting.
Due to the highly irregular curvature of each cornea, we decided to proceed with a custom scleral lens design, called the Latitude scleral lens. We took 3D images of the eye with the sMap machine, and the laboratory designed a pair of custom scleral lenses for him.
At the dispense, visit, he noticed the vision was very good. He was seeing 20/20 at far and 20/20 at near. The OCT images showed that there was a bit of shallow clearance, but we dispensed the lenses and followed up with him one week later.
At the one week follow up, Dr. Wong noticed that the clearance was a bit too shallow superiorly. Although the patient loved his new vision, we had to re-design his lenses for safety purposes. He also mentioned that when he removes his lenses, they are really stuck on his eye and they feel like champagne bottles popping off his eye. This is not normal and usually means the fit needs to be modified.
Today, we saw him for another Latitude dispense. The lab made some minor adjustments to the lenses to increase the fluid layer underneath the scleral lenses to help improve the fit and help with lens removal.
He mentioned the new lenses were even more comfortable than the old lenses, and we were very happy that the new lenses showed more central and midperipheral clearance.
We feel very honored to have worked with such an amazing patient! Scleral lenses are so rewarding, and it is an honor to be a part of their journey to better vision.
