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EYEPRINT

Keratoconus Patient Referred To Us For Contact Lens Consultation

Thank you Dr. Wellish for your kind referral of your patient to our clinic!

We had a very nice 48 year old patient referred to us for a contact lens consultation.

He was diagnosed with keratoconus in his 20’s, but his corneas remained stable throughout the years, and he was able to get by with spectacles.

Over the last 2 years, he noticed a huge decrease in the vision in both eyes. He was seen by Dr. Abrams, who inserted Intacs in the right eye, and then later Dr. Wellish performed corneal crosslinking on the left eye to stabilize the vision.

Intacs OD OS cornea

NaFL 1 od Nafl os 2 (2) NaFl OS 2

He complains that his vision is very poor and distorted and also his left eye suffers from extreme dry eye. He uses Oasis tears in both eyes, along with autologous serum in the left eye. He also uses Restasis in the right eye twice per day to help with dry eye syndrome.

With glasses, he can see 20/60 “double” in the right eye and 20/150 “distorted” in the left eye.

Due to his highly irregular corneal issues, we decided to proceed with the EyePrint Prosthetic with each eye.

pachy od intacs

topo od

topo os

We took an impression of the ocular surface in each eye and then fit him with a diagnostic scleral lens to check his vision potential. With an over-refraction, he could see 20/40 in the right eye and 20/30-2 in the left eye. He also noticed his left eye felt much less dry with the scleral lens on!

We send the impressions to the lab and we will see him in 1 week for his dispense and training. He will continue to use his Restasis drops as recommended, and he will fill the bowl of the scleral lens with autologous serum and Nutrifill. He will also use Tangible Clean MPS.

We are looking forward to helping him 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.

OS cornea

OS pachy over scar

OS scar (3)

OS topo

sMap scleral elevation OS (1)

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.

Bruce+potter+RK+scars+OS

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.

Eyeprint+checking+for+tackiness

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?

Stevens-johnson treatment options

Steven’s-Johnson is a rare, but very serious disease. Stevens-Johnson Syndrome (also known as SJS) is unpredictable and can happen to anyone. It is caused by a reaction to a medication or infection. It starts off with flu like symptoms, but then spreads throughout the body in the form of a painful rash and blisters. Mucous membranes are affected, which is why eye doctors become involved.

SJS is a serious condition which requires hospitalization. After being released from the hospital, the patient usually works with a team of doctors to manage different parts of their body.

SJS patients usually have extremely dry eyes, inflamed eyes, and severe eye pain. Many patients wear very dark sunglasses indoors and outdooors. Often times, the pain is so bad, they keep their eyes closed the entire day and night. Their quality of life can be very poor.

We are fortunate to work with some of these special patients.

A 79 year old female arrived at the office last week for a consultation. She had SJS 30 years ago, and still suffers from a variety of issues. Regarding her eyes, she stated her eyes were incredibly painful all the time. She has to put preservative free artificial tears in her eyes every few minutes, around the clock! Her eyes are red, swollen, and highly sensitive to light.

You can see in the photo that her eyes are very swollen. She wears dark sunglasses all the time due to her severe light sensitivity. She keeps her eyes closed majority of the day because they hurt when she opens them.

For these types of patients, I highly recommend the EyePrint Prosthetic. This is due to the fact that we only have a very small eyelid fissure to work with. For SJS patients, they can’t keep their eyes open even for a few seconds, so it makes fitting their eyes very difficult.

By taking an impression of the surface of the entire eye, the lab is able to design a specialized custom lens. This is the best option for SJS patients, in our opinion.

We were able to take multiple impressions of each eye and send those to the lab to be fabricated.

She arrived to our office for the dispense and we inserted the lenses for her. She was thrilled with the vision and the comfort of her eyes. She wore them over the weekend and when we saw her for her follow up, she said, “You’ve given me a new lease on life!”

You can see in the photo that her eyes are much less swollen and much less red when she has the lenses in her eye. This is because the scleral lens is filled with a preservative free saline, that bathes her eye all day. This also forms a protective barrier between her delicate eye and the outside environment. Scleral lenses can be life changing for these patients. We are honored to work with these special patients – we love seeing their eyes heal and get another chance on life!

Stevens johnson treatment options 1

Stevens johnson treatment options 2

Stevens johnson treatment options 3

 

Corneal Transplant and Aniridia

Saw one of our favorite patients today!

We fit her right eye with a custom scleral multifocal (this eye is normal), and we’ve been patiently waiting for her left eye to heal up from her most recent corneal transplant.

Her left eye suffered a trauma, which resulted in multiple surgeries and multiple corneal transplants. A corneal transplant requires an invasive surgery in which the patient’s cornea is replaced with a donor cornea. The most recent corneal transplant was performed earlier this year by Dr. Casey, and it has been healing perfectly the past few months.

Each time he sees her, he removes some sutures and a few weeks ago he finished removing all of the sutures and gave her the ok to be fit with a contact lens. She sees Hand Motion with the left eye currently.

She also has a large fixed pupil from the trauma, so she is very light sensitive. You can see in the photos that her pupil does not have a normal round shape. This is due to the fact that some of the muscle fibers within the iris were damaged during the trauma. Because the iris fibers are damaged, her pupil is an irregular shape and it is very large. Her pupil is stuck in this shape forever, so her pupil cannot constrict when there is a lot of light. This results in extreme light sensitivity called photophobia. Patients with iris defects, irregular pupils, or aniridia are very sensitive to light. Many of them must wear very dark sunglasses, even indoors. Luckily, there are custom prosthetic contact lens options that can create an artificial pupil. The artificial pupil not only helps the eye look more normal from a cosmetic stand point, but it can also limit the amount of light that enters into the eye. This results in much less light sensitivity, which can be life changing for a patient.

She also complains that it always feels like there is an “eyelash” in her left eye, which is quite annoying. After discussing the different options, we decided to fit her with the EyePrint Prosthetic. The EyePrint uses a special material to take an impression of the entire eye surface. This allows the lab to design and fabricate a very custom scleral lens.

With a diagnostic scleral lens, she was able to achieve 20/40 vision! She has amblyopia in the left eye, and she was able to see 20/40 prior to all of her surgeries. She also noticed that her left eye felt much better with the lens on, and she noticed a huge decrease in foreign body sensation. Her eyelid was able to open a bit more too, so it looks more aligned with the right eye. Scleral lenses create a barrier between the eyeball and the eyelid, which can help patients who have irritated and sore eyes. In this patient’s case, her eyelids are constantly touching and rubbing the graft of the corneal transplant. Imagine if you had a open wound and someone kept ripping it open. This is somewhat similar when the eyes are suffering from a damaged surface. When we apply a scleral lens to the eye, it can help act as a barrier between the eyeball and the eyelid, resulting in much better comfort. When we inserted the scleral lens onto this patient’s eye, she noticed a huge improvement in comfort right away. Her eye was also able to open a bit more, too!

We will see her in one week for her dispense! Super excited to see how she does with her custom scleral lens. Thanks again Dr. Casey for thinking of us!

EyePrint Prosthetic For Keratoconus Patient

Thank you Dr. Malik for your kind referral!

A 23 year old white male with Keratoconus was kindly referred to us for a specialty contact lens consultation.

With his glasses, he could achieve 20/400 in the right eye and 20/40 with ghosting and double vision in the left eye.

His topographies showed irregular astigmatism in each eye (right eye worse than the left eye). He does have striae and thinning on the right eye and thinning on the left eye. The rest of his ocular structures appeared normal.

After discussing the different options, he and his family decided on the EyePrint Prosthetic for each eye. We performed the impression on each eye in office, and the proceeded to a diagnostic scleral lens fitting to determine the vision potential.

The right eye went from 20/400 to 20/25-2 and the left eye went from 20/40 (ghosted and double) to 20/15-2 and no ghosting or double vision!

We sent the impressions out this evening, so the lab will start working on designing his devices early next week. We are thrilled for him! We cannot wait for his lenses to arrive!

Thanks again to Dr. Malik and his staff at Eyes and Optics for trusting us with his care! It’s always such a pleasure to be a part of a patient’s journey to better vision!

Keratoconus patient fit into EyePrint Prosthetic

Thank you Dr. Malik for your kind referral!

A 23 year old white male with Keratoconus was kindly referred to us for a specialty contact lens consultation.

With his glasses, he could achieve 20/400 in the right eye and 20/40 with ghosting and double vision in the left eye.

His topographies showed irregular astigmatism in each eye (right eye worse than the left eye). He does have striae and thinning on the right eye and thinning on the left eye. The rest of his ocular structures appeared normal.

After discussing the different options, he and his family decided on the EyePrint Prosthetic for each eye. We performed the impression on each eye in office, and the proceeded to a diagnostic scleral lens fitting to determine the vision potential.

The right eye went from 20/400 to 20/25-2 and the left eye went from 20/40 (ghosted and double) to 20/15-2 and no ghosting or double vision!

We sent the impressions out this evening, so the lab will start working on designing his devices early next week. We are thrilled for him! We cannot wait for his lenses to arrive!

Thanks again to Dr. Malik and his staff at Eyes and Optics for trusting us with his care! It’s always such a pleasure to be a part of a patient’s journey to better vision!

Temporally displaced pupil

Awesome complex case referred by Dr. Wellish!

– 71 year old male referred for specialty contact lens evaluation.

– History of cataract surgery 20 years ago and the right eye went well, but the left eye suffered complications. There were some corneal and iris issues that took an incredibly long time to heal.

– He suffers from poor vision all around at distance and near with the left eye.

– He has a displaced miotic pupil temporally on the left eye.

– He does have some corneal irregularity in both eyes, according to topography.

– Best corrected vision was 20/50+ in the right eye and 20/80- in the left eye.

– I put a scleral lens trial on both eyes, just to see if he appreciated the improvement in vision in either eye. The plan was to show him the vision potential in each eye to see if it was worth it to pursue the fitting process.

– For the right eye, we fit him with an Ampleye/4800/ 16.50/8.04 BC and with an over-refraction, he could achieve 20/20 vision!

– For the left eye, we opted for the EyePrint Prosthetic and David from the lab helped me design the lens. The pupil is off axis about 1.36mm temporally and 5 degrees, so we are going to decenter the optics to center over his displaced pupil. With an over-refraction and eccentric viewing, he was able to see 20/25!

– He was thrilled and wanted to order lenses for both eyes.

– Ordered both lenses today, and we are super excited to see how he does at his dispense!

– Thank you @wellishvisioninstitute for trusting me with this very special patient!

Eyeprint prosthetic case

Awesome patient referral from Dr. Murphy from @eyediologylv

– 69 year old male who suffered an eye trauma to the left eye over 30 years ago.

– The trauma involved a nail gun, and ultimately led to a corneal perforation, and dislocation of capsular bag and zonules.

– He ended up aphakic in the left eye, along with a permanent mydriatic pupil.

– He also has an exotropia.

– With glasses he can see 20/400 blurry in the left eye.

– After reviewing all options, he elected the EyePrintPRO.

– With an over-refraction of +14.75, he was able to achieve 20/20 vision!

– Once the EyePrint arrives and he has time to wear it, we will discuss prosthetic lens options to help with the photophobia.

– Thank you Dr. Murphy for trusting us with this special case!

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