corneal scarring

Patient Referred To Us For Corneal Inflammatory Condition

Thank you Dr. Stafeeva for your kind referral to our office!

A 59 year old patient was kindly referred to us from her corneal specialist, Dr. Stafeeva.

This patient had a corneal inflammatory condition of unknown etiology and has been managed with many eye drops including antibiotics, steroids, and other eye drops.

Although the inflammation has resolved, she is left with a very large corneal scar with pannus and neovascularization.

You can see from the topography images, the K max is over 60 diopters in a small central island. The scleral topography images show some large amount of scleral toricity and irregularity.

Her habitual glasses are about a +4.50 in each eye and she can see 20/20 in the right eye and 20/200 in the left eye. When we don't know the vision potential of a patient, we always trial a diagnostic lens. With a diagnostic scleral lens and a +1.75 over-refraction, she was able to achieve 20/20 vision in the left eye! She was thrilled with the improvement in her vision.

Due to the large amount of irregularity, we highly recommended a custom scleral lens such as the Latitude scleral lens or the EyePrint lens. She is going to discuss with her husband and let us know which lens she wants to proceed with.

Also, we may need to fit her into a soft contact lens for the OD to account for the anisometropia, but we will determine that at the dispense.

She will continue her primary eye care with Dr. Ochiltree and any cornea care with Dr. Stafeeva.

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sMap scleral elevation OS (1)

Contact Lens Options for Corneal Transplant Patients

A very interesting corneal transplant patient arrived today for a consultation.

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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.

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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!

Scleral lenses and eye cancer

Today we saw a very interesting patient for a consultation from Dr. Emily Schorr!

This patient was diagnosed with a scleral melanoma, a rare form of eye cancer on the white part of the eye (called the sclera). She underwent cryotherapy to kill the cancer cells, which was successful.

She also had cataract surgery in both eyes. She also has glaucoma in both eyes, and had ALT surgery years ago. She currently uses dorzolamide-timolol and latanoprost in each eye at night to help with the glaucoma.

Both eyes had multiple stromal corneal scars, likely from a prior eye infection, per Dr. Schorr. She also has a droopy eyelid (called a ptosis) on the left eye, likely due to the multiple eye surgeries she has had on the left eye.

Her main complaint was that her left eye is much blurrier than her right eye, and she wanted to see if there was anything that could be done to help improve the vision.

Due to her complex case and extensive eye history, I felt that it was best to proceed with the EyePrint Prosthetic for the left eye. We took an impression of the entire ocular surface, which will be scanned at the EyePrint lab to design and fabricate a custom scleral lens. With a diagnostic scleral lens in office, the patient went from 20/100 “double and blurry” to 20/25 “much sharper and clearer.”

She is very excited about her new lens, and we are excited to dispense the lens when it arrives. We also used an eye drop called Upneeq to help lift the eyelid and make the eyes appear more symmetrical. Thanks Dr. Schorr for thinking of us!

Check out her before and after photos for a non-surgical eyelid lift.

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Radial keratotomy patient has drastic vision improvement with scleral lenses

We had the pleasure of seeing one of our patients back for a scleral lens fitting today!

We had previously seen this patient in July of this year. He was kindly referred by Dr. Stafeeva for a specialty contact lens consultation. He had radial keratotomy surgery (RK surgery) many years ago, which has distorted his vision over time. Radial keratotomy surgery was a procedure done in the 1980’s and 1990’s to help patients eliminate their need for glasses. It was a type of refractive surgery performed where a small scalpel was used to make tiny incisions onto the front part of the eye, called the cornea. The small incisions re-shape the eye, which corrects your vision and eliminates the need for glasses. RK was replaced by safer procedures such as LASIK and PRK. RK is not performed in the United States anymore.

Many patients who’ve undergone the RK procedure notice problems with their vision. Some of these problems include problems with glare, ghosting, double vision, fluctuating vision, and an overall decrease with vision.

With glasses, this patient can see 20/50 in the right eye and 20/100 in the left eye, and also reports ghosting and double vision in each eye.

We fit this patient into the Ampleye scleral lens to see what kind of vision we could achieve. With the scleral lenses, he was able to achieve 20/25 vision in the right eye and 20/40-2 vision in the left eye. Scleral lenses are filled with a preservative free saline solution, which reshapes the way light enters into the eye, providing much better vision. He also noticed that his double vision and ghosting was much improved with the scleral lenses.

There was a bit of excessive clearance in each eye, which will be adjusted when we order his lenses. He does also have excessive compression on the left eye, which will also be adjusted when we design and order the lenses.

Looking forward to seeing how this patient does at his dispense! Thanks again Dr. Stafeeva for trusting us with this special patient!

Phone & Fax: 702-747-4070 • 9260 W. Sunset Rd, Suite 209, Las Vegas, NV 89148 • info@clinevada.com