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KERATOCONUS TREATMENT

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.

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Latitude® Custom Scleral Lenses

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Is there a genetic test for keratoconus?

Many patients ask us about some of the risk factors for keratoconus.

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Recently, a new genetic test for keratoconus launched, and we are incredibly excited to offer this service to patients! AvaGen is available to patients wanting to understand their genetic risk factor for keratoconus and other corneal dystrophies.

The process is very simple, easy, and pain free.

First, you will arrive to the office and answer a few questions about your medical history and family history. Then, you will rinse your mouth with warm water. This will remove any food or other particles from your mouth that may contaminate the test.

Next, the doctor or technician will gently swab the inside of your cheek with a cotton swab. Then this sample is sent to the laboratory for testing.

The laboratory will analyze your genetic sample and generate a report that allows us to view your genetic risk for keratoconus. This information can be very helpful to your doctor so they can manage your specific care at a customized level.

For instance, you maybe have been flagged as a keratoconus suspect in the past, but want to find out what your genetic risk for keratoconus is. If your results come back as “very high genetic risk,” your eye doctor may want to see you more frequently or perform additional tests during your visits.

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Think of it like this: If you have a family history of breast cancer, and your genetic risk factor is also deemed very high, your doctor may want to see you more often to ensure that you do not develop breast cancer. Or if you do develop breast cancer, you can be treated quickly, which is usually the key in stopping or slowing the disease in an early state.

Another example would be if you have keratoconus and you want to find out if your child is at risk. If your child ends up with a very low genetic risk for keratoconus, your eye doctor may feel comfortable seeing them on a less frequent schedule.

This information is incredibly helpful and useful for your eye doctor! If you have keratoconus and want to find out if your family members are at risk, please contact us today to find out more about this test!

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.

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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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Keratoconus patient fit into custom scleral lens

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A nice patient was seen today for a specialty contact lens consultation. He was diagnosed with keratoconus 2 years ago at the age of 34 years old. He wore focus daily soft lenses for years, but 2 years ago, he noticed some changes in his vision, which led his optometrist to perform a topography. The topography revealed keratoconus OD>OS.

He gets Pentacam images every 3 months, and his corneas are both very stable, which is why he has not had corneal cross linking.

He was then fit into different scleral lenses which didn’t feel right (comfort wise) and the most recent lenses made him feel “wonky.” His main complaint was that his eyes suffer from ghosting, especially at night. With the current scleral lens, the ghosting is still apparent sometimes when the lens decenters.

We decided to perform a few tests and see for ourselves.

His scleral topography is interesting because the more elevated areas are at more of an oblique axis, which might explain why the traditional scleral lenses did not fit perfectly. With a diagnostic Europa lens, he still noticed some ghosting and accepted cylinder in his over-refraction. I performed an over topography to check for flexure, and it appears that it is possible that the lens shape could be contributing to the residual cylinder.

After analyzing all of the image, Sabrina from Visionary Optics helped me design a new lens for him. We decided to keep any cylinder out of the first pair, because that will make things more challenging if we need to alter the fit or Rx later. We are going to increase the optic zone to 9.0 mm to help with the ghosting as well. I am hoping that by order the custom Latitude scleral lens, the lens will center much better and will help to decrease or eliminate the ghosting.

Looking forward to his dispense. Thanks to the sMap team for their help with this fun case!

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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!

Comfortable Keratoconus Contacts

We had a nice consultation for a patient who has keratoconus in each eye today!

This keratoconus patient noticed that his vision has declined over the past few months and is in search of a contact lens option to help him see better. He does have a history of hybrid contact lenses, but he had an experience where he could not remove the lens and had to go to the emergency room to get it removed. For that reason, he is seeking other options. Hybrid contact lenses have a corneal gas permeable lens in the center, and then they have a soft contact lens skirt. In theory, you get the vision of a hard contact lens, with the comfort of a soft contact lens.

After reviewing his images from today, we noticed that his retinal health was unremarkable, and his corneas were relatively clear in each eye. For these reasons, we felt a specialty contact lens would be a very good option for him to improve his vision.

Due to his concern for comfort, we decided to fit him into the Latitude scleral lens. The Latitude scleral lens is a very custom lens, made specific to each patient’s eye. First, we use an instrument called the sMap 3D. This device captures the curvature of the entire eye by using a special dye, called sodium fluorescein. The device requires the patient to look up, look down, and look straight ahead. The device captures images in all of the 3 different gazes and stitches the images together to create a 3D image of the surface of the entire eye. The laboratory then uses this information to design an incredibly custom scleral lens.

With a diagnostic scleral lens, he was able to achieve 20/25 in the right eye and 20/20 in the left eye! He also mentioned the comfort was already better than some of the lenses he has tried in the past.

We are looking forward to receiving his lenses and seeing how they fit.

Grateful to be able to help keratoconus patients see better!

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!