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KERATOCONUS SURGERY

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

Keratoconus patient sees clearly 2

Keratoconus patient sees clearly 3

Keratoconus patient sees clearly 4

Corneal Transplant Patient sees 20/25 with a Scleral Lens

Today we saw a patient kindly referred by Dr. Ochiltree from Mohave Eye Center.

A 69 year old white male arrived to our clinic for a contact lens consultation. He has a full thickness corneal transplant in each eye from keratoconus. He wears spectacle glasses, however, he was looking to further improve his vision.

Prior to the corneal transplants, he wore gas permeable lenses, and he complained that they popped out of his eyes.

After reviewing the images with him, along with an evaluation of his eye health, we suggested trying a diagnostic lens on in office, to check his vision potential. Often times, if I am concerned with the best potential vision or if the patient has concerns, we will try on a lens and perform a quick over-refraction to check the visual acuity, visual quality, and overall comfort of the lens. Then, we can all make an educated decision whether or not to move forward with the fitting process.

The astigmatism in the right and left eye both look fairly regular, so it is possible that he might do well in a traditional bitoric corneal gas permeable lens. However, with the limbus-to-limbus astigmatism in the left eye, he may experience frequent lens dislodgement. The right eye looked like a better candidate, but the elevation maps showed a huge difference, and I worried about the lens dislodgement issue again.

We tried on an Ampleye Scleral lens 4400 sag in each eye. Both lenses showed corneal touch, so I removed those lenses and we inserted the 4800 sag instead. The central clearance looks acceptable and with a quick over-refraction, he was able to achieve 20/25 vision, and he was thrilled with the comfort of the lenses.

Since he decided to proceed, we continued the fitting process by letting the lenses settle for 20 minutes, and then took external images of the fit and OCT images. All information was sent to the lab and the consultants helped us design his lenses. Looking forward to seeing him at the dispense visit!

Dr. Woo’s tip of the day: If you are concerned with the potential vision or comfort (or the patient is), use a diagnostic lens and perform a quick over-refraction to gauge the patient’s best corrected visual acuity.

Corneal Transplant Patient Fit With Custom Scleral Lens

We had the pleasure of seeing one of our keratoconus patients today for a specialty contact lens fitting for his right eye.

This patient has advanced keratoconus in both eyes. Last year, Dr. Stafeeva performed a corneal transplant on the right eye due to the advanced keratoconus disease. Many patients who have scarring on the front of their eye from keratoconus require a corneal transplant. She was waiting for the transplant to heal up on the right eye so she could perform cataract surgery (he had a visually significant cataract on the right eye as well).

In the meantime, we were focusing our efforts on his left eye to help improve the vision and the fit of the scleral lens. He has advanced keratoconus in the left eye with central scarring. He was fit with a scleral lens from another clinic, but when he saw us, the cornea had changed shape, and he advanced to the point where the cornea was touching the inside of the scleral lens. It is not safe for the scleral lens to touch the cornea, so it was important that we re fit him into a safer scleral lens design. He had a standard intraocular lens from cataract surgery in the left eye, as well as a scleral buckle from a prior retinal surgery. Since his eye was a very complicated case, we recommended a more custom scleral lens. A more custom fit scleral lens helps with lens comfort and can decrease redness.

We saw him in the summer of 2020 and ended up fitting his left eye into an EyePrint Prosthetic. With that lens, he was able to achieve 20/60 vision.

Today, we decided to fit his right eye into the Latitude scleral lens. We felt that because of his corneal transplant, along with the toric IOL in the right eye, a custom scleral lens would be the best option for him. With an over refraction of +2.00-3.50×116, he ended up achieving 20/15 vision! The Latitude scleral lens is a great choice for him because the custom fit of the lens will help to center and stabilize the optics of the scleral lens. This will allow for the best possible vision.

We are very excited for his Latitude scleral lens to arrive! With the amount of astigmatism, we did educate him that it could take 1 or 2 additional lenses to center the optics, but we do feel very good about the fact that he will be able to achieve such great vision.

Thanks for Dr. Stafeeva for thinking of us for this fun case!

Keratoconus patient with scar tissue achieves 20/40 vision!

We had a very pleasant patient with keratoconus kindly referred to our office for a specialty contact lens consultation.

He’s had keratoconus for years, and over time, he has developed corneal scars in both eyes. The right eye scar is much more dense and central than the left eye. Due to the limited vision potential (20/150) in the right eye, Dr. Debry recommended a corneal transplant for the right eye and a specialty contact lens for the left eye.

The left eye also has some scar tissue centrally, but we decided to try a diagnostic scleral lens in office to see what the potential vision could be. He sees 20/80 with his glasses in the left eye. With a diagnostic Europa lens, he achieved 20/40 vision, even with the corneal scar!

We decided to design a Latitude scleral lens for him, to account for some of the scleral irregularities that you see in the photos.

We will see him next week for his dispense. He is getting his corneal transplant with Dr. Debry early next week and then he will see us later in the week for his scleral lens dispense. Thanks Dr. Debry for trusting us with this patient! We love helping keratoconus patients see better!

Keratoconus patient fit with Ampleye Scleral Lens

18 year old male was referred to our clinic for a scleral lens fit to improve his vision. He was diagnosed with Keratoconus in both eyes two years ago. The first symptoms he noticed was blurry vision that did not improve with glasses. He wore Corneal Gas Permeable lenses which improved his vision but was unable to adapt to the comfort and discontinued wear. He had corneal crosslinking surgery in the right eye about a year ago and in the left eye about 6 months ago. Corneal cross linking is a surgery that is FDA approved to slow down the progression of keratoconus. This patient is very young, so cross linking is necessary to prevent his cornea from worsening over time. Since the surgery, he has not worn any contact lenses and still notices blurry vision and poor night vision.

During our initial evaluation, his vision was 20/60 in the right eye and left eye. His right eye had central corneal scarring and haze while his left eye had some striae. With a diagnostic lens he was able to see 20/30 in the right eye and 20/20 in the left eye. After experiencing the better comfort of the scleral lens on his eyes, he decided to proceed with the fitting! We fit him into the Ampleye scleral lens with optimum extra material.

We recently saw him for his first follow up after dispensing his lenses and found that he was able to achieve 20/20 right eye and left eye even with the central scarring! He shared that he felt much more comfortable with these lenses over his previous lenses.

We love helping keratoconus patients see again!

Keratoconus patient goes from 20/100 to 20/40 to 20/25+ in just a few weeks!

39 year old hispanic male was referred for dry eye in his right eye. He has a history of keratoconus in both eyes. He had corneal crosslinking performed in the right eye only. He has punctal plugs and uses preservative free artificial tears every hour with mild improvement. His current glasses are about 4 years old and his vision is 20/100 right eye and 20/200 left eye. His slit lamp findings showed thin tear meniscus and meibomian gland dysfunction in both eyes. His right eye had a central corneal scar with adjacent thinning inferior central and a nasal pterygium with about 2mm encroachment. The left eye had corneal striae and a temporal corneal scar. Due to his irregular corneal shape and large pterygium, we recommended an EyePrint Prosthetic.

At his dispense, he was able to achieve 20/40 vision in the right eye. The lens was fitting great with no compression over the pterygium. After about a month of wear with some time to adapt to the lens, his vision improved to 20/25+ in the right eye, even with the central corneal scar! In addition to the improvement of his vision, he was comfortable wearing the lens for 16 hours a day.

Corneal scarring can limit the vision potential in keratoconus patients, but we are very excited that he was able to improve to 20/25 in just a few weeks after wearing his new lens! He is thrilled, and we are so happy for him!

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 scleral lens follow up

Great one month scleral lens follow up today!

Our keratoconus patient was fit into the Latitude custom scleral lens in the right eye after cross linking.

At his follow up, he reports excellent vision, improved computer vision, and he is having scleral lens insertion success with the dalsey adaptives see green scleral lens stand.

Average wear time is 13 hours per day. He is using Boston simplus to clean/disinfect the lenses and non-preserved saline to fill the bowl of the lens.

Vision is 20/25+2 and the fit of the lens is beautiful!

His left eye is healing from the crosslinking procedure, but we will fit his left eye once we get the green light from Dr. Wellish or Dr. Ortiz.

Thank you Wellish Vision Institute for trusting us with this patient!

We love managing keratoconus cases with awesome doctors!

Keratoconus patient scleral lens fitting

A young Keratoconus patient was kindly referred to us by Dr. Casey at NVision.

He was diagnosed with Keratoconus a few years ago and was fit into Europa scleral lenses by another eye doctor. He claimed that his vision was great with the lenses but the lenses hurt a lot. He stated that he suffered from several corneal abrasions while wearing his scleral lenses and his eyes were constantly red and irritated. He discontinued lens wearers due to the high amount of discomfort and stress.

During his time with us, we reviewed all of his options such as custom soft contact lenses, corneal gas permeable lenses, hybrid lenses and scleral lenses.

He wanted to insert his habitual scleral lenses to see if we could identify the problem, so we inserted his scleral lenses.

You can see that there is thin central clearance and a significant amount of limbal bearing, which was likely leading to his discomfort. I recommended trying a new lens modality or if we continue with a scleral lens, the Latitude would likely provide a more custom fit. He is going to consider all options and get back to us. He is relieved to finally have figured out what the problem was with his current lenses. His last doctor told him to just keep wearing them and he will get used to them, but with this fit, that would be highly dangerous to the eye.

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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