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SCLERAL LENSES

High myopia patient fit into scleral contact lens

Thank you Dr. Isozaki for sending us this fun case!

34 year old Asian male was seen at UCLA by my good friend and classmate, Dr. Veronica Isozaki. He has a long history of corneal gas permeable lens wear, since he was about 10 years old.

After a very thorough case history, and after examining his current lenses, he mentioned that his last eye doctor in New York was attempting “orthokeratology daytime lenses.” I didn’t know what he meant until I saw the lens fit on his eye and the topographies.

The lenses both showed central bearing with midperipheral pooling (not a classic orthokeratology pattern, but I can see what he meant by ‘daytime orthokeratology lenses.” The left eye also shifts during blink which causes a chance in his vision.

We reviewed a variety of lens options extensively, and we decided to attempt an oblate scleral lens for now. I could attempt to redesign lenses based on his current topography, but the artificial shape might cause me to chase the lens fit over and over again. I recommended starting fresh with a scleral lens and we can monitor his corneal “unmolding” and if he truly wants to go back to the corneal gas permeable lenses, we will have a much better baseline.

The over-refraction was not attempted due to the autorefract data being -22.25 in the right eye and -22.75 in the left eye.

With an oblate design and also adjusting the base curve, we were able to decrease the power to about -16.00.

The first lens will be sort of a custom diagnostic lens. He knows that the shape of his eye and potentially the power will need to be adjusted as things progress. Will keep you posted on his results!

Young keratoconus patient tries scleral lens

We completed a scleral lens fitting on a great 19 year old boy with Keratoconus!

▪️He was originally fit with a piggyback system (soft contact lens with a corneal gas permeable lens on top) and had to wear glasses on top.

▪️He had corneal cross linking surgery on the right eye and then was referred to us for a new contact lens fitting.

▪️He didn’t have a great experience with the piggyback system and complained of many corneal abrasions and difficulties. He also has a scar in that central temporal pupil.

▪️I wasn’t exactly sure what the vision potential would be, but we proceeded with a scleral lens fitting.

▪️We used the ampleye scleral lens, and with an over refraction, he was seeing 20/20! His mom was shocked and they were thrilled! There was some blanching at 12 and 6 and we need to adjust the sag by 200 um but it should be a straightforward order!

▪️Thank you Dr. Ortiz for trusting us!

#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 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.

#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

What to expect during a scleral lens fitting

What to expect during a scleral lens fitting:

Full video on YouTube:

https://youtu.be/C-igXQ_J_KY

▪️Your Doctor will take several images and measurements to determine the best lens for your eye.

▪️Then, a series of scleral lenses may be placed on the eye.

▪️The Doctor will evaluate the fit with the microscope and other imaging to determine if any changes are needed.

▪️They will then check your vision to determine what power to add to the lenses.

#eyeexam #optometria #optometrylife #optometrists #ophthalmology #eyeclinic #medicine #eye #optometrist #doctor #womeninoptometry #eyecareprofessionals #ilovespecialtycontacts #eyes #optometrista #scleralens #scleralcontacts #keratoconus #contactlenses #eyecare #eyedoctor #customcontacts #eyehealth #vision @oculus_usa @optovueoct @scleralsociety

Scleral Multifocal Follow Up

Our 55 year old scleral multifocal patient arrived for her follow up today.

▪️As a refresher, she is a post LASIK patient with dry eyes and seeking a multifocal option. She has high demands at intermediate and near.

▪️She states her right eye feels uncomfortable near the superior temporal area of her eye. Left eye has no discomfort issues.

▪️Her distance vision is “great” but computer and reading are lacking at work.

▪️No issues with insertion and removal.

▪️Distance vision was 20/20 in each eye and 20/30 “double” at near.

▪️She did accept a +0.50 at distance in each eye with loose lenses. At near, she accepted +1.00.

▪️Slit lamp exam showed great central clearance and to me, the edges looked great. However it concerned me that she was having some discomfort in the right eye in the superior temporal area.

▪️You can see with the OCT images, there is a clear difference between the 11:00, 12:00 and 1:00 positions. There is excessive limbal vault and the transition to landing is harsh in that area.

▪️Once again, Keri from Blanchard Contacts helped me design some new lenses. We are adding +0.50 to each lens and also increasing the near power to +2.75 to try and help improve her intermediate and near. For the right eye, we are decreasing the limbal vault by 125 um and steeping the edge.

▪️Will keep you posted on her next dispense!

#unidospelaoptometria #eyeexam #optometria #optometrylife #optometrists #ophthalmology #eyeclinic #medicine #eye #optometrist #doctor #womeninoptometry #eyecareprofessionals #ilovespecialtycontacts #eyes #optometrista #scleralens #scleralcontacts #Lasik #eyecare #eyedoctor #customcontacts #eyehealth #vision #gaspermeablelenses #multifocalcontacts

What Do You Do If Your Scleral Lens Is Stuck On Your Eye

How do I remove my scleral lens if it is stuck?

  • First, make sure the small plunger is toward the periphery of the lens, not directly in the center of your eye. If the plunger is in the center of your eye, it will be difficult to remove.
  • You can also try a twisting motion as you pull the lens out to break the suction.
  • You can also apply some artificial tears to your eye, gently massage your eyelids with the eye closed, then attempt removal again.
  • If you have tried all of these but you still have major difficulty removing the lens, it may be a sign that the fit of the lens may need to be adjusted. Please see your eye doctor for help with this.

#eyeexam #optometria #optometrylife #optometrists #ophthalmology #eyeclinic #medicine #eyeglasses #eye #optometrist #doctor #womeninoptometry #eyecareprofessionals #ilovespecialtycontacts #eyes #optometrista #scleralens #scleralcontacts #keratoconus #ophthalmologist #eyecare #eyedoctor #customcontacts #eyehealth #vision

Scleral Lens Stand Helps With Insertion

dalsey+adaptivesDo you have EXTREME difficulty inserting your scleral lens?

  • Patients having difficulty inserting their scleral lenses with traditional devices may consider using a scleral lens stand.
  • Place your scleral lens on the plunger, which will be held up with a stand.
  • This allows full control of your eyelids from both hands!
  • Fill the scleral lens with non preserved saline and simply lower your eye to the scleral lens.
  • This is a great option for patients who have difficulty controlling their blink reflex, among other patients (patients with Parkinson’s or other Neuro disorders, or patients with one arm, etc.)

This has been an incredibly helpful tool in my office to assist patients with scleral lens insertion!

#sclerallens #scleralcontacts #sclerallensinsertion #howtoinsertaclerallens #ilovespecialtycontacts #helpingeyesonescleralatatime #keratoconus #keratoconuscontacta

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!

@scleralsociety #sclerallenses #scleralcontacts #ilovespecialtycontacts #helpingeyesonescleralatatime #gaspermeablelenses #complicatedcontactlenses #photophobia #aphakia #eyeinjury #irregularcornea #cornealscar #scleralsrule #eyeprintpro #eyeprintprosthetic #exotropia #prostheticontactlens

Scleral lens insertion with a dental ring

You can insert a scleral contact lens with an o ring, or dental ring (orthodontic band)
▪️For patients who have difficulty using a plunger to insert their scleral lens, the use of an o ring or orthodontic band can be helpful.
▪️Simply place the O ring or orthodontic band on the tip of your index finger. Then, place your scleral lens on the device. Fill with non preserved saline, and apply the lens to your eye.
▪️This technique helps many patients who prefer to use only one finger to balance their lens. It also allows the other fingers on that hand to control the lower eyelid.
▪️O rings can be found at any hardware store (the cost is usually around 10 cents) and a pack of orthodontic bands can be found online (pack of 100 bands for around $7).
▪️This is a cheap and effective method to helping scleral lens wearers apply lenses!

@nkcforg @scleralsociety @keratoconusgroup #sclerallenses #scleralcontacts #ilovespecialtycontacts #helpingeyesonescleralatatime