Herpes simplex virus (HSV) can lead to significant corneal scarring and the eventual need for a corneal transplant. Unfortunately, the virus can recur and affect the donor button, reintroducing irregularity and scarring.
A 74-year-old female patient presented with best corrected visual acuity of 20/200 in her left eye. She had a history of corneal transplant and a central scar secondary to a presumed recurrence of HSV. Topography (figure 1) showed moderate-to-severe corneal irregularity.
The patient was without physical disability but had small apertures. She was diagnostically fit with an 11.2mm diameter (R)GP lens design. A lens was ordered that matched the parameters of the best fitting diagnostic lens (figure 2) and the power as determined by over-refraction.
Although the patient was doing well in the lens and eventually achieved 20/40 vision, two attempts were made to improve the fit first by reducing the diameter to 10.8mm and then by manipulating the peripheral curves using quadrant specific technology (figure 3).
The fit changes were coordinated with the consultant by emailing digital photos of each lens fit. Although the final lens fit is still not ideal, the patient is able to wear the lens comfortably for a full day. She was returned to the care of her ophthalmologist.
Corneal scars as a result of corneal infections, especially in cases of HSV, for some reason seem to respond very well to (R)GP lenses with sometimes surprisingly good visual results.
Greg DeNaeyer is a 1998 graduate of The Ohio State University College of Optometry. He completed a hospital based residency at the Columbus VA Medical Center. Greg joined Arena Eye Surgeons in 1999 and is currently the Clinical Director. His primary interest is specialty contact lenses.
Greg is the president of the Scleral Lens Education Society and is a Fellow of the American Academy of Optometry. He is a contributing editor for Contact Lens Spectrum and a contributor to Review of Cornea and Contact Lenses and Optometric Management. Currently his primary research is focused on profilometer designed scleral contact lenses, scleral lenses that correct higher order aberrations, and topical drug delivery devices. He has consulted for Visionary Optics, Essilor, Inspire Pharmaceuticals, B+L, and Aciont.