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GAS PERMEABLE

Patient Looking For New Rx For Her Multifocal Gas Permeable Contact Lenses

Thank you for this fun referral from Dr. Casey at NVision!

63 year old female was looking for a new prescription for her multifocal corneal gas permeable lenses. She has been wearing GP lenses since she was a child and has always found it difficult to find a well-fitting lens that was coupled with great vision. During our testing, we discovered this patient has a moderately high minus prescription with about 4 diopters of limbal to limbal corneal astigmatism in the right eye and almost 5 diopters in the left. Her manifest Rx was OD: -4.25 -6.00 x 179 (20/30+1) and OS: -5.25 -6.00 x 001 (20/40+1). She also wanted to try to eliminate all need for glasses since she has been using OTC readers on top of her habitual multifocal contact lenses for near work.

Since she wanted to stick with corneal GP lenses, we discussed options for adding in near optics. Our patient stated that she had some success with the MF lenses and that she would like to see if an increase in add power would help with near work.

Due to her high amount of with-the-rule- astigmatism, we fit her in Valley Contax bitoric MF corneal GP lenses. We explained that this type of lens should allow for functional vision without OTC readers for about 70% of her daily routine.

After about 15 minutes of settling, her DVA was 20/20-2 OD, 20/20 OS, and 20/15 OU, and her NVA was 20/40-2 OD, 20/20-2 OS, and 20/20 OU. Both OD and OS lenses fit wonderfully with apical alignment, mild midperipheral bearing and moderate edge lift. The patient reported good comfort and vision and was so incredibly ecstatic in the office! She pulled her Kindle out and stated that it was the first time she could see the 12 point font without readers in years!

OD topo

OS topo1

Are Hard Contact Lenses Still Useful?

Are hard contact lenses still useful?

With the invention of scleral lenses, corneal gas permeable lenses may seem like a thing of the past. However, corneal gas permeable lenses still remain a very effective option for many patients.

We have the pleasure of seeing a patient with keratoconus. He was used to wearing a corneal GP lens for keratoconus, and wanted to remain in the same lens modality. His lens was 5 years old, however the fit still looked ok. There were some scratches and deposits on the lens surface, and there was some excessive touch on the apex of the cone.


Patient’s habitual contact lens (unknown parameters)

Based on the topography, we decided to try the Rose K 2 lens. This corneal gas permeable lens is great for patients with nipple cones and oval cones. He falls into the mild/moderate category of keratoconus, so we thought this was a good lens to try first.

topo+OS+axial
The topography shows a mild/moderate keratoconus with a nipple/central cone

Based on the fitting guide, we chose the base curve that we equal to his average K. The average K was 6.96mm so we selected the 6.9mm lens in the Rose K 2 fitting set.

When we placed the lens on the eye, it looked great! We were super happy with the fit and he was able to see 20/20 in this lens. Usually, we need to try several lenses on to get the perfect fit, but we really lucked out today! The lens was very well centered with good edge alignment. There is a very light feather touch on the apex of the cone, which is visible with the wratten filter.


The Rose K 2 lens was very well centered.

Stay tuned for his dispense!

NEXT: WHAT IS KERATOCONUS?

Keratoconus patient switched from corneal gas permeable lenses to scleral contact lenses

Kind referral of a Keratoconus patient from Dr. Starlin!

▪️Keratoconus patient who has been wearing corneal GP lenses for the past 20+ years.

▪️His vision has been great over the years, as well as comfort, but over the past 3 years he has noticed that the lenses keep dislodging from his eyes and he has to replace them 4 times per year.

▪️After reviewing his case and taking measurements of his eyes, we decided to try scleral lenses in office. Scleral lenses are a great option for patients who have issues with lens dislodgment. Since scleral lenses are tucked under the upper and lower lids, they do not dislodge from the eye like corneal GP lenses do.

▪️With the Ampleye scleral lens, he was able to achieve 20/25 in the right eye and 20/20 in the left eye! The central clearance was excessive, so we altered the sag in each eye by 200 um.

▪️The topography looks a bit strange in the left eye, but that is likely due to his habitual corneal GP altering the true corneal shape.

▪️Looking forward to his dispense next Friday! All of the new Cornea and Contact Lens Residents will be able to witness his dispense live, so it will be very exciting!

#unidospelaoptometria #eyeexam #optometria #optometrylife #optometrists #ophthalmology #keratoconusawareness #eyeclinic #medicine #keratoconusucks #eye #optometrist #doctor #womeninoptometry #eyecareprofessionals #ilovespecialtycontacts #eyes #optometrista #scleralens #scleralcontacts #keratoconus #eyecare #eyedoctor #customcontacts #eyehealth #vision #gaspermeablelenses #helpingeyesonescleralatatime #givemeallthekeratoconus

Keratoconus Patient Fit With Scleral Lens

Thank you Dr. Ortiz for your kind referral of this keratoconus/dry eye patient!

OD+Central+corneal+transplant+w+pterygium

This patient suffers from a corneal transplant as well as a pterygium

A hispanic male presented to the office for a contact lens consult. He was diagnosed with keratoconus years ago, by another eye doctor. Keratoconus is an eye disease where the cornea, the front part of your eye, changes shape and becomes thinner and steeper over time. The danger of the eye becoming steeper and steeper and thinner and thinner over time means that the vision can become more distorted and blurry. It can also lead to eye issues such as corneal hydrops and possibly issues that would lead to a corneal transplant. Common treatment options include glasses, hard contacts, gas permeable contacts, hybrid contact lenses, and scleral lenses. Corneal crosslinking should also be considered for keratoconus patients.

This patient had corneal crosslinking in the right eye a few months ago and he is scheduled for the left eye in 2 months. Cross linking helps to stabilize the cornea and prevent it from worsening, or help slow it down. Cross linking is highly recommended for many keratoconus patients and should be considered. There are 2 types of cross linking, epi-on and epi-off. This patient has an epi-off crosslinking procedure called Peshcke cross linking.

A corneal transplant is not something that should be considered in the early days of keratoconus. Most of the time, corneal transplants are reserved for patients who have issues that cannot be resolved with traditional treatments such as eye drops, glasses, contacts, soft contacts, hybrid contacts, gas permeable contacts, hard contact lenses, or scleral contact lenses. If patients cannot see clearly with any of the aforementioned items, a corneal transplant may be warranted.

Corneal transplants also come with risk. Many times, the patient will be on medicines and eye drops for a very long period of time, and in some cases for the rest of their life. There is also a risk of a rejection. Also, 30% of corneal transplant patients end up with glaucoma, which is an incurable eye disease. If we can prevent a corneal transplant, we will.

This patient he was fit into corneal gas permeable lenses by another eye doctor many years ago. He claims that his vision is quite good with the lenses, but they are very uncomfortable. Especially in dusty and windy environments.

He does have some central scarring on the right eye and some scarring inferior/temporal on the left eye. The scarring is likely from his corneal gas permeable lens being a bit too flat for his eye and/or the keratoconus worsening.

He also has severe dry eye, which Dr. Ortiz has been managing. He has been using Oasis tears every hour with and without his contacts. He also had punctal plugs inserted by Dr. Ortiz to help with his severe dry eye.

After evaluating the eye, we discussed the different options. I did make a strong recommendation for a scleral lens compared to a corneal gas permeable lens to try and prevent the scar tissue from worsening. The scleral lens will also provide better comfort for him and hopefully help with his dry eye syndrome too. Since scleral lenses are filled with non-preserved liquid, it can act as a barrier to the outside world and lubricate the eye all day. Many patients are actually fit into scleral lenses who have extreme dry eye.

eyeprint 3d scanning

The EyePrint Pro uses a 3 D scanner to create a perfectly fit scleral lens

Eyeprint mold after setting

An impression of your entire eye is taken to design a custom fit lens

Due to the keratoconus, corneal scarring, pterygium and severe dry eye, the patient opted for the EyePrint Prosthetic. The EyePrint Prosthetic is a lens that is custom made specifically for a patient’s eye. An impression is taken of the entire ocular surface, which takes about 3 minutes in office. The impression is then sent to the lab in Colorado, where the impression is scanned with a 3-D scanner. After that, the lens is fabricated and then shipped back to the doctor.

We obtained an impression of the right eye in the office today and then placed a diagnostic lenses on his right eye. We then placed a diagnostic scleral lens onto the eye with 8.04 base curve and -8.00 power. With the traditional scleral lens, there was some compression at 3:00 and 9:00, especially where the pterygium was. This will not be an issue once the Eyeprint PRO is designed. With the diagnostic lens, he was able to achieve 20/30 vision. This is typical for patients who have central corneal scars.

The lens was designed and ordered today and should arrive here soon!

Thanks again Dr. Ortiz for your kind referral! It is always a pleasure managing keratoconus patients together!

Keratoconus patient and scleral lens

Another great referral from @wellishvisioninstitute!
▪️Young Hispanic female with Keratoconus presented for a scleral lens consultation.
▪️She had corneal crosslinking with Dr. Wellish in January 2020 for the right eye and early June 2020 for the left eye.
▪️Both corneas show steeping and central striae.
▪️She doesn’t currently use any glasses or contact lenses.
▪️Without correction she is 20/400 in the right eye and 20/400 in the left eye .
▪️We fit her right eye today with the Ampleye scleral lens and got her to 20/30 vision!
▪️Ordered the lens today and we are super excited for her dispense!
▪️We will fit her left eye with a scleral lens after her eye is healed from the cross linking surgery and Dr. Wellish gives her the ok.
▪️So grateful to be a part of this patient’s journey to great vision!
▪️Thank you Dr. Wellish for trusting me to care for this patient!

@keratoconusgroup @scleralsociety @nkcforg #keratoconus #keratoconusawareness #keratoconussucks #ilovespecialtycontacts #gaspermeablecontacts #specialtycontactlenses #gplenses #helpingeyesonescleralatatime #hardcontacts #scleralsrule

Radial keratotomy and scleraL lenses

Update on our 79 year old patient!

▪️If you recall, our RK patient (with moderate cataracts OU and sutures OD) returned for her 2 week follow up after her dispense.

▪️With her Latitude custom scleral lenses, she was able to achieve 20/25- in the right eye and 20/20- in the left eye (despite the air bubble in the lens).

▪️She had adequate central clearance in each eye and the edges were still perfectly aligned.

▪️She had a few issues in the beginning with insertion but after the first 4 days she became proficient.

▪️We reviewed her lens care system and she was following the prescribed protocol perfectly.

▪️She is incredibly happy with her vision with the lenses, and she has recently started to make jewelry again.

▪️She saw Dr. Wellish the day prior, and he was pleased with the state of her eyes too!

▪️Grateful to be a part of this patient’s vision rehabilitation journey!

#rkscarring @scleralsociety #irregularcornea #radialkeratotomy #ilovespecialtycontacts #gaspermeablecontacts #specialtycontactlenses #gplenses #helpingeyesonescleralatatime #hardcontacts #scleralsrule @contactlensinstitute

How often should you replace your contact lens case?

cosmetic contact lens storage case 1

▪️Your contact lens should be discarded and replaced around every 90-100 days, or per your doctor’s instruction.
▪️Most manufacturers of contact lens solution recommend that the case is thrown away every 90-100 days.
▪️Typically, every time you purchase a new bottle of contact lenses solution, it will come with a new contact lens case.
▪️Be sure to throw away your old contact lens case everyone time you purchase a new box of solution or when your doctor recommends, whichever is soonest.
▪️Contact lens cases harbor lots of bacteria, which can result in serious eye infections.
▪️It is highly important to discard your contact lens case on a frequent basis!