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Presbyopia Patient Looking For Alternative To Eyeglasses

Sharing a case we recently worked on with custom soft lenses.

50 year old female was looking for an alternative to glasses that would also allow her to see up close and far. She reported that she first wore glasses when she was in 1st grade and has a history of high astigmatism. During our exam, we found that she had limbal to limbal corneal astigmatism and her manifest Rx was :

Right eye: Plano-3.00×016 (20/20)
Left eye: +1.75x-4.25×165 (20/20)

Based on our findings, we felt that she would benefit from several different lens options between monovision or multifocal GP lenses, hybrids, sclerals, or custom softs. Due to her history of previous soft contact lens wear and finances at this time, the patient opted for a custom soft contact lens.

We fit her into monovision Specialeyes in both eyes. Specialeyes is a company that makes custom soft contact lenses. This will work much better for patients with higher amounts of astigmatism, compared to traditional soft contact lenses. The patient reported good comfort and was excited to be able to see her cell phone without any glasses on! She was able to achieve binocular 20/20 distance and 20/20 near!

OD specialeyes CL

OD cornea

OS cornea

topo OD crop

topo OS crop


Keratoconus Patient Fit With Scleral Lens

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


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!

What to expect during a scleral lens fitting

What to expect during a scleral lens fitting:

Full video on YouTube:

▪️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.

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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!