Keith Parker, Lakewood CO (USA)
EyePrintPRO is a unique gas permeable (GP) scleral, prosthetic, optically active cover shell that incorporates Elevation Specific Design™ (ESD™) Technology. The EyePrintPRO harnesses the unique and irregular characteristics of an individual’s eye to generate a stable platform for advanced optics. With rotationally symmetrical lens designs, prism is allocated to the base down position, but ESD technology allows the scleral device to have prism in any direction.
To make a custom-made device with prismatic correction according to the above-mentioned method, first an impression of the ocular surface is obtained utilizing a special mucous-membrane-friendly polymer. The impression is digitized with a scanning laser, producing a 7-micron-accurate 3-D image of the front surface of the eye that includes tissues, such as the conjunctiva, which are invisible to optical coherence tomography devices.
This data is transferred into the patent pending EyePrint Designer Software™, allowing a virtual lens to be created to match the ocular surface by using ESD technology. The design software allows you to incorporate sphere/ toric, multifocal and prism, all within the same device.
Case Report: 55 YO Asian male
The patient underwent OD retinal detachment repair in 1982, included a laser treatment and scleral buckle, with resulting irregular conjunctival scarring and buckle elevation. Intermittent vertical diplopia was first reported with the onset of presbyopia at age 42, worsening with age. Other ocular history included dry eye s/p punctual occlusion, normal tension glaucoma, and blurred vision. Numerous medications were required daily.
OD - 9.50 =C -2.00 X 179 1.75 ∆ BD +2.25 Add 20/25
OS -10.50 =C -1.50 X 010 1.75 ∆ BU +2.25 Add 20/25+2
44.50/43.25 @ 172 and OS 45.00/44.00 @ 014.
Topographical analysis exhibited a classic with-the-rule regular bowtie image.
Contact Lens History:
Multiple types of corneal GP and soft lenses were worn for 40 years. However, the lenses were either uncomfortable or produced inferior optical images, and glasses were required for diplopia correction and presbyopia. The patient desired scleral lenses for better optics and comfort for his dry eyes, but due to scleral and conjunctival irregularities, he was unable to have a successful fit. He requested to be fit with a custom scleral lens design for alignment of the sclera to improve the dryness. For approximately one year, the patient wore the generated EyePrintPRO Prosthetic Scleral Lenses utilizing over-refractive spectacles with prism to alleviate vertical deviation and as a bifocal.
OD 7.596 -10.25 17.8
OS 7.692 -9.00 -0.75 x 115 18.0mm
* Note: No haptic prism was needed for orientation of the cylinder correction due to the rotational stability of the EyePrintPRO designed with ESD.
Cover test without spectacles over the lenses showed a right hyperphoria at distance and near.
OD Plano 1.75 ∆ BD 20/20-2 +2.25 ADD
OS -0.25 1.75 ∆ BU 20/20 +2.25 ADD
The current wearing time of the lenses was 5 hours, but the patient reported fatigue when not wearing his glasses, so this limited his wear of the lenses. While he reported good distance vision and comfort, he desired to wear lenses without spectacles.
Prism and Multifocal optics
Initially, the lenses were designed with just the prism; however, the patient wanted near vision lenses. Therefore, lenses incorporating both prism and multifocal optics were generated. The EyePrintPRO Multifocal features a spherical distance-center multi-aspheric adjustable intermediate and near zones.
OD 7.596 -10.25 17.8 2.25 ∆ BD +1.75 ADD
OS 7.692 -9.00 -0.75 x 115 1.50 ∆ BU +1.75 ADD
The patient reported no glare and excellent comfort similar to his original EyePrintPRO lenses that did not have prism or multifocal optics. He easily wore this pair for 10-12 hours without any significant problems of vertical diplopia, eliminating the need for additional prism in spectacles.
Both lenses were well-centered, central AC, OD 270 and OS 375 µm. The scleral landing zone was well aligned with the conjunctiva OU. There was no blanching or impingement observed. The edges appeared aligned OU. Corneal evaluation revealed no edema or staining OU.
This reduced the central vault (as measured by OCT on the eye) to 276µm.
OCT image OD showing central corneal clearance (270 micron)
This patient is extremely happy with his comfort and vision with custom EyePrintPRO Prism lenses. He achieves clear, comfortable binocular vision and remains free of prism/ multifocal spectacles to maintain fusion and near focus.
His final VAs were OD 20/20-2 and OS 20/40-2 at distance. Near VAs were OD 20/40-1 and OS 20/20-2 at 40 cm. OU VA was 20/20 both distance and near.
He reported being able to function for most tasks without any near over-correction. He had initially said that having the prism in the lenses was a momentous advancement; now, having the multifocal correction in the lenses appeared to be the icing on the cake. The patient was very ecstatic with his newfound vision free of spectacles.
* a full chronological in-depth documentation of this Case Report can be viewed at www.eyeprintpro.com.
Keith Parker has been involved in the contact lens industry since 1976. His experience in manufacturing has enabled him to be an effective consultant specializing in fitting the irregular cornea.
Currently, Keith is co-owner and President of Advanced Vision Technologies and co-founder of EyePrint Prosthetics LLC.
He has served as the President of the Contact Lens Manufacturers Association (CLMA) and currently still serves on the CLMA Board of Directors.