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Monovision scleral lenses

Monovision scleral lenses

monovision scleral lenses

We saw a 66 year old male with a history of monovision LASIK OU 20 years ago. In the last few years, he began showing signs of ectasia OU and found about 9D of astigmatism. This is a very high amount of astigmatism! For reference, most soft contact lenses can only go up to -2.75D. His right eye (distance) was 20/30 far and left eye (near) was OS 20/ 20 at near but describes ghosting and shadowing. Both eyes, he was seeing 20/25 distance. He felt modest about his vision and was functioning well in his daily activities but wanted to see if he could see better.

With a diagnostic lens, he noticed a significant improvement in his vision and was eager to proceed. He was fit with the Latitude scleral lenses and kept in monovision. This goes to show that the number on the chart (ie 20/20) may not always correlate to the quality of vision. Even if a patient can see the letters on the chart, the letters may still have ghosting or appear doubled. This can be very debilitating for patients.

We saw him a week after his dispensing his new lenses and was thrilled to see how well he was doing with the new lenses! His vision was OD 20/ 20 far, OS 20/ 25+ near and OU 20/ 20 distance. Although he felt that his vision before the lenses were decent, he was most surprised at how much more he was able to see in his daily life. He described noticing the new details of the distant mountains during his daily drives to work.

Thank you Dr. Jenny Wong for your excellent care for this patient and for this update!

We love helping patients like these achieve vision that they haven’t seen in years!

Thank you Dr. Paul Casey for this fun case!

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Are there treatment options after LASIK?

We had a very lovely young lady kindly referred to us from Dr. Wellish!

This patient suffers from extreme dry eye syndrome. She had LASIK eye surgery performed years ago, and she did quite well until having children. She explained to me that her eyes became very dry, painful and uncomfortable after having kids. This could be due to a fluctuation in hormone levels.

Patients who undergo LASIK eye surgery can also be at risk for neurotrophic keratitis, a condition in which the corneal nerves become desensitized and thus causes more corneal issues such as severe dry eye and non-healing defects.

Despite multiple treatments including prescription eye drops, lacrisert, punctal plugs, artificial tears, gels, and Lipiflow, she still remains uncomfortable. Currently, she uses Cequa twice per day, refresh tears every hour or two hours, Celluvisc every 3-4 hours, autologous serum tears twice per day, Lacrisert every week, and gel at night.

She complains that her eyes are very dry and uncomfortable, especially when reading or looking at the computer.

After reviewing all options, we decided to perform sMap 3D imaging to take a 3D scan of her eyes. This information will be used to create a custom scleral lens called the Latitude. Hopefully, the lens will provide a barrier for her eye and the outside environment to provide her some relief. The bowl of the scleral lens is also filled with non-preserved saline, which should also help improve her eye comfort and staining.

I also added Regener-Eyes and Eyesuvis to her current eye care regimen to see if those eye drops can offer any additional relief.

Looking forward to her dispense!

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Custom Scleral Lenses Help Physician to See Better

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.

Scleral Multifocal Follow Up

Our 55 year old scleral multifocal patient arrived for her follow up today.

▪️As a refresher, she is a post LASIK patient with dry eyes and seeking a multifocal option. She has high demands at intermediate and near.

▪️She states her right eye feels uncomfortable near the superior temporal area of her eye. Left eye has no discomfort issues.

▪️Her distance vision is “great” but computer and reading are lacking at work.

▪️No issues with insertion and removal.

▪️Distance vision was 20/20 in each eye and 20/30 “double” at near.

▪️She did accept a +0.50 at distance in each eye with loose lenses. At near, she accepted +1.00.

▪️Slit lamp exam showed great central clearance and to me, the edges looked great. However it concerned me that she was having some discomfort in the right eye in the superior temporal area.

▪️You can see with the OCT images, there is a clear difference between the 11:00, 12:00 and 1:00 positions. There is excessive limbal vault and the transition to landing is harsh in that area.

▪️Once again, Keri from Blanchard Contacts helped me design some new lenses. We are adding +0.50 to each lens and also increasing the near power to +2.75 to try and help improve her intermediate and near. For the right eye, we are decreasing the limbal vault by 125 um and steeping the edge.

▪️Will keep you posted on her next dispense!

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