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CUSTOM SCLERAL LENS

Bilateral Corneal Transplants & Glaucoma Patient Success With Scleral Contacts

Our patient with bilateral corneal transplants and glaucoma arrived for his scleral contact lens dispense today.

As a refresher, he has corneal transplants in both eyes and cannot see well with glasses. He also has a decentered pupil for the right eye and a glaucoma tube in the right eye.

The left eye was so advanced, the Visionary Optics team had to carefully design his custom scleral lens to safely vault the transplant but also center well on his eye.

With his Latitude scleral lens, he achieved 20/30 in the right eye (the eye with the glaucoma tube and decentered pupil) and he is seeing 20/15 with the left eye!

The patient was so thrilled and said, "Wow I need to look in the mirror to see what I actually look like! I haven't seen this well in over 5 years!"

Thanks again to Dr. Saboori and Dr. Kostanyan for trusting us with this patient's care.

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Can Scleral Lenses Help Patients with RK Scarring?

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.

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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!

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OCT – OD

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OCT – OS

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Corneal Transplant Patient Looking To Improve Vision

Thank you for the kind referral from Dr. Tami Le!

49 year old African American male came to us looking for a way to improve his vision. The patient has had corneal transplants in both eyes due to severe keratoconus diagnosed in 2013. His entering visual acuity was 20/200 right eye, and 20/200-1 left eye.

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After 3D sMap images were taken, it was discovered that the patient had almost 507 microns of scleral toricity in the right eye! The sMap is a special instrument in our office that takes a 3D scan of the patient's eye to determine the shape of the eye. For comparison, a normal scleral toricity is about 125 microns and he has over 500 microns! When someone has a very unique shape, such as this patient, we usually recommend a custom scleral lens right off the bat to minimize the amount of remakes and improve overall success of lens fitting.

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The patient was fit into Custom Latitude Scleral Lenses in both eyes.

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OCT OS Latitude central clearance 300um

The lab designed the lenses and shipped them to our office.

The patient came in for his dispense and with the lenses on and an adjusted over refraction, the patient was able to obtain 20/20-2 right eye and 20/25+1 left eye! What a huge improvement in his vision in both eyes! This patient will not only achieve better vision but now he is legal to drive! The functionality of his vision is going to be spectacular!

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When we inserted his scleral lenses, he was so excited to be able to see clearly for the first time in years! This is always such a joy to experience in the office.

We are so excited that his vision improved so much and we cannot wait to report his findings from his follow up visits! Keratoconus patients are so rewarding, and it is such a pleasure to help them see better!

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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Live demonstration of an EyePrint Prosthetic

In this video, join Dr. Stephanie Woo for a live demonstration of the EyePrint Prosthetic on a real patient.

This patient suffers from poor vision as a result of prior eye surgery. She had radial keratotomy surgery (also known as RK surgery) in the early 1990’s. This surgery was a popular option for patients looking to eliminate their glasses or contact lenses.

Watch EyePrint Demo

RK surgery involved the surgeon making small cuts onto the cornea in a spoke-like pattern, hence the name “radial.” Making the incisions allowed the cornea to reshape and become flatter in the center. This changed the shape of the eye, which reduced the need for glasses or contact lenses.

Most RK patients saw well for many years, but as time has progressed, there have been many issues.

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RK scarring in the cornea

RK patients suffer from blurry vision, distorted vision, ghosted vision, shadow-y vision, double vision, and other visual complications.

This patient also has a corneal transplant. This was due to the enormous amount of scar tissue in the center of the cornea.

Due to her very irregular cornea, we decided to fit her into an EyePrint Prosthetic.

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The Eyeprint procedure is painless and take less than 3 minutes

Step-by-step instructions:

  • First, the tip is placed at the edge of the impression material and locked into place.

  • Next the trigger is squeezed, which allows 2 separate materials to combine in the chamber of the tip.

  • The mixed materials are placed into a small plastic tray.

  • We wait for 40 seconds for the material to set.

  • Then, the patient looks at their fixation target.

  • Quickly, the impression is inserted under the upper eyelid and then the lower eyelid. This is the most important part. You must get the lids out of the way.

  • Let go.

  • The patient continues to look at their fixation target for about 90 more seconds so the material can set.

  • Then, the impression is removed.

  • After, we proceed with a diagnostic scleral lens fitting to determine what power to add into the EyePrint.

Watch EyePrint Pro Demo

After several impressions are obtained, we send them to the EyePrint lab in Colorado. Next, the lab uses a 3-D scanner and captures over 3 million data points using information from the impression. This information is then used to design a perfectly custom scleral lens. The lens is then fabricated in the lab and then shipped to us for dispensing.

When the EyePrint arrives, we will call the patient and schedule her for a scleral lens dispense.

We were able to achieve 20/20 vision with the EyePrint with this patient. Looking forward to seeing how her next visits go!

Next: Does Insurance Cover Scleral Lenses?

What Are Custom Scleral Lenses?

The sMap is such a cool instrument, and it tells us a lot of information.

Normal topographers map the corneal surface only, and give little (if any) data about the shape of the sclera. Since scleral lenses rest on the white part of the eye (the sclera), it makes sense that a scleral topographer could help improve our scleral lens fits. Scleral topographers are expensive, which is why most eye doctors do not offer this technology in their office. It would only make sense for clinics that are fitting scleral lenses at a high level to invest in this equipment.

This particular patient has severe keratoconus in the right eye (K max of over 70 diopters). He complains that a traditional scleral lens does not fit his eye perfectly and he has issues with redness and irritation. With the slit lamp, we observe a small area of elevation inferiorly and a slight area of increased elevation nasally. The nasal elevation is a result of a small pinguecula.

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Corneal topography showing a keratoconus patient

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A small pinguecula on the sclera can cause issues with a scleral lens fitting.

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A small area of elevation is seen on the sclera (white part of the eye) . This was easily detected with the sMap.

The sMap images take 3 D images of all areas of the eye, and the information is used to create a custom fit scleral lens. We instill a drop of sodium fluorescein and have the patient look up, down, and straight ahead. Then, the sMap software stitches the images together to give us a 3D image of the shape of the sclera.

Notice how the 3:00 and 6:00 position are slightly "warmer" colors compared the the rest of the sclera. This is due to the elevation of the pinguecula nasally and the small area of elevation inferiorly.

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sMap images of a patient looking up, down and straight ahead.

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Notice the 3:00 position and the 6:00 position have more of a teal and yellow color compared to the other colors on the map.

This information will be used to create a custom scleral lens, which should vault over those areas perfectly. This results in an extremely accurate scleral lens fit.

So grateful to have this special technology in our office!

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The end result is a beautiful scleral lens fit

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The scleral lens fit is perfect.

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Damage to Eye from a Burning Building

Super interesting case from Dr. Schorr from New Eyes!

We saw a 19 year old boy for a consultation today. He suffered a trauma from going into a burning building and when he opened the door, the door flew open and the padlock hit him in the right eye. According to the patient, he left the burning building but then his boss told him to go back in. When he went back in, he opened the door, and (probably due to backdraft), the door slammed into the right side of his face and the padlock went right into his eye. He was a child when this all happened.

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Large, dense corneal scar which goes right through the center of his eye.

He had a globe perforation to his eye that had to be repaired quickly.

His crystalline lens could not be saved, so he is aphakic in that eye. He has severe corneal scarring. There is also a dense amount of scar tissue that attaches the posterior cornea to the anterior iris. You can see in the OCT image below that the back side of the cornea attaches to the front side of the iris.

He also has an artificial pupil and iris defect both nasally and inferior nasal.

His main goal of today’s visit was to see if a specialty lens could improve his vision. He sees count fingers at 4 feet and complains of diplopia in the right eye.

When I looked at his eye, I had little hope that any vision improvement would be possible, due to the severe scar tissue and lack of a normal entrance pupil.

We tried on a diagnostic Europa scleral lens to see if any vision improvement was possible and with a +8.00 over refraction, he could achieve 20/50 and he stated his double vision was gone.

Due to the ocular condition, he must be eccentrically viewing out of his artificial pupil inferiorly. We are going to attempt a scleral lens for him to see if it helps improve his vision, diplopia and balance. Stay tuned for updates!

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This image shows us that the back side of his cornea is attached to the iris

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The topography of the right eye shows irregularity

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We placed a diagnostic Europa scleral lens on his eye and he could see 20/50!

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What is scleral topography?

The sMap is such a cool instrument, and it tells us a lot of information.

Normal topographers map the corneal surface only, and give little (if any) data about the shape of the sclera. Since scleral lenses rest on the white part of the eye (the sclera), it makes sense that a scleral topographer could help improve our scleral lens fits.

sMap+OD (1)

The sMap takes a series of 3D images to help create a custom scleral lens

Scleral topographers are able to map the white part of the eye, called the sclera. This is important because this is the area that the scleral lens lands on. It would make sense that using a scleral topographer would give us important information about the shape of the entire eye, not just the cornea.

This particular patient has severe keratoconus in the right eye (K max of over 70 diopters). He complains that a traditional scleral lens does not fit his eye perfectly and he has issues with redness and irritation. With the slit lamp, we observe a small area of elevation inferiorly and a slight area of increased elevation nasally. The nasal elevation is a result of a small pinguecula.

The sMap images take 3 D images of all areas of the eye, and the information is used to create a custom fit scleral lens. Notice how the 3:00 and 6:00 position are slightly “warmer” colors compared the the rest of the sclera. This is due to the elevation of the pinguecula nasally and the small area of elevation inferiorly.

scleral+elevation+right+eye (1)

The sMap generates a scleral topography to show us areas of elevation

This information will be used to create a custom scleral lens, which should vault over those areas perfectly. This results in an extremely accurate scleral lens fit.

Good candidates for custom scleral lenses include patients with extreme eye conditions, such as severe keratoconus, graft-vs-host disease, sjogren’s syndrome, extreme dry eye, glaucoma patients, and patients who have difficulty with their current scleral lenses.

We have been able to help thousands of scleral lens patients with this incredible technology.

So grateful to have this special technology in our office! Book an appointment with our office to see if you would be a good candidate for the sMap!

Keratoconus patient sees clearly for the first time in years!

Keratoconus patients are so rewarding!

A 22 year old female was referred to us from Dr. Wellish. She has keratoconus in both eyes. She had corneal crosslinking in the left eye 3 months ago. She will be getting corneal crosslinking in the right eye next month.

She complains of blurry vision, distorted vision, and fluctuating vision. She states her left eye has been a lazy eye for quite some time and she remembers that her vision in that eye was able to achieve 20/40 at one point.

With glasses, she could achieve 20/80 vision in the right eye and 20/200 in the left eye.

After reviewing all of the options, she decided to proceed with the Latitude custom scleral lens. We took 3D images of the left eye and used a diagnostic scleral lens to determine her vision. To our surprise, she was able to achieve 20/20 vision!

We built a trial frame for her and let her roam around the office so she could get a sense of what her new vision would be! She was thrilled and her mom was thrilled too!

Such a fun case, we can’t wait to see her back for her dispense.

Keratoconus patient sees clearly

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Keratoconus Patient fit into custom scleral lens

Thank you Dr. Dadej for your kind referral of your keratoconus patient to our office!

This young man was diagnosed with keratoconus about 5 years ago and was fit into hybrid lenses. The hybrid lenses were not comfortable, so he was switched into scleral lenses a few years ago. Hybrid contact lenses are a lens type that combines a gas permeable contact lens with a soft contact lens. The middle of a hybrid lens is made with a gas permeable lens which is then surrounded by a soft contact lens skirt. Hybrid lenses are used for a lot of different patients. The Ultrahealth hybrid lens is intended for Keratoconus patients. Many patients do well with hybrid lenses.

This patient wore scleral lenses successfully for years.

Dr. Dadej did a great job fitting him into new scleral lenses this year, but because of the severity of his keratoconus, the lenses were still not fitting just right. He developed a corneal scar on the right eye and the left eye, and Dr. Dadej referred him to me right away to help prevent a central cornea scar. Central corneal scars can cause significant vision impairment, and may require a corneal transplant if severe enough.

After discussing the different contact lens options, we decided on the Latitude custom scleral lens. We took 3 D images of both eyes and sent the images to Visionary Optics to help design and fabricate Latitude custom scleral lenses for him. With a diagnostic Europa lens and over-refraction, he achieved 20/20 vision in each eye and he was very happy. I am excited for his dispense!

Thank you again Dr. Dadej for thinking of us to help this special patient!

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