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