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Keratoconus Patient Wore Gas Permeable Contacts For Many Years

Thank you Dr. Ochiltree for this kind referral!

73 yo female has worn gas permeable lenses for many years due to keratoconus.

Keratoconus patients are not able to wear traditional contact lenses or glasses due to the irregular shape of their eye. Many times, corneal gas permeable lenses, hybrid lenses, custom soft lenses or scleral lenses are needed to improve their vision.

Over the past 8 years, we have successfully managed her with corneal gas permeable lenses.

In the last few months, she reported that the lenses were starting to slip and move around with increase in discomfort. She reported a long history of dry eyes with excessive mucous strands and her primary care optometrist (Dr. Ochiltree) told her that her gas permeable lenses had protein and deposits building up on the lens surface.

Upon our examination, she had several areas of dellen, SPK with staining, corneal neovascularization and pannus. We also found that her gas permeable lenses had heavy protein and lipid deposits and scratches.

At this point, we reviewed some of the options. The first option is we could keep her into the same corneal gas permeable lens type of lens. We also discussed some of the pros and cons of other lens designs such as hybrid lenses and scleral lenses. After discussing all designs, she chose the custom scleral lens.

Due her dry eye syndrome, corneal neovascularization and high scleral toricity, we felt that she would be most successful in a custom scleral lens.

Patients with dry eye may benefit from scleral lenses. This is due to the fact that there is a layer of liquid that bathes the eye all day. Gas permeable lenses rest directly on the cornea, so they can rub and irritate the eye surface. Scleral lenses do not touch the cornea at all, and rest on the white part of the eye, which has significantly less nerve endings. This results in a very comfortable lens for many dry eye patients.

With the help of Visionary Optics, we were able to design custom scleral lenses using 3D technology.

Switching between GP lens wear and scleral lenses can take some time to get used to. The patient was surprised at the stability of her vision when she looked toward her right and left. She could see 20/20 at distance out of each eye and she was happy with the comfort! Overall, she has been very happy with the change! We are excited to see how she progresses over the next few weeks.

OD corneaOS cornea

OD pannus at 800OS cornea and temporal conj irregularity

cornea OD

cornea OS

Latitude® Custom Scleral Lenses

OD OCT central clearance 152

OD OCT nasal edge

OD OCT temp edge

OS OCT central clearance 165

OS OCT nasal edge

OS OCT temp edge

Scleral Lenses Help Dry Eye Patient

Thank you Dr. Landin for this kind referral

36 yo HF who has a history of PRK at age 15 and reports that it may have resulted in a scar OS and dry eyes. She prefers soft CL wear over glasses but feels discomfort with the lenses due to her dry eye symptoms. She has tried various artificial tears and lid scrubs with no improvement in comfort.

Her vision in her soft contact lenses were 20/30 OD and 20/80 OS.

She currently wears Biofinity XR toric lenses due to her high prescription.

From her slit lamp evaluation, her corneal scar looked elevated and was surrounded by areas of superficial punctate keratitis. We suspected her dry eye signs to have been exacerbated with the Soft CL mechanically rubbing the elevated area.

From her evaluation, she seemed like a great scleral lens candidate especially with the goal of achieving clearer vision and better comfort with lens wear from her dry eye symptoms.

We dispensed her Europa Scleral lenses and was able to achieve 20/20 vision with both eyes. She reported better comfort in comparison to her habitual lenses. With the scleral lenses vaulting over her cornea, the area of elevation will not be further aggravated and will allow the cornea to heal.