A Case of Rigid Thinking
Gregory W. DeNaeyer OD FAAO FSLS
Corneal scarring can result from trauma, infection, dystrophy, disease or surgical complications. Scar tissue, regardless of location, often results in topographical irregularity that can cause decreased vision even with the best
standard glasses or soft contact lens prescription. Many of these patients can experience visual improvement by being fit with a (R)GP lens that is able to correct ametropia, regular astigmatism, and irregular astigmatism. However, centrally located, dense scar tissue can be a rate-limiting step because the patient isn’t able to see through a dense opacity.
A 28-year-old male patient developed microbial keratitis of his right eye secondary to daily wear of soft contact lenses that resulted in corneal irregularity and a significant central corneal opacity (figures 1 and 2).
Manifest refraction was OD -7.00 20/30 and OS -6.50 20/20.
The patient was interested in returning to contact lens wear.
His right eye was diagnostically fit with a large diameter (R)GP lens: Dia. 11.5mm, BC 8.1mm and power -4.37 20/25 (figure 3).
The left eye was empirically fit with a standard (R)GP lens: Dia. 9.4mm, BC 7.84 and power -5.75 20/20 (figure 4).
The patient successfully wears his (R)GP lenses full-time and is satisfied with both the comfort and vision.
Figure 3 left (OD) and Figure 4 right (OS)
Refitting this patient into (R)GP lenses maximizes the best-corrected vision of his right eye. The patient was successfully fit with a large (R)GP design, achieving good comfort and vision. Large diameter lenses tend to be more stable than smaller lenses in cases of corneal irregularity. A scleral lens could also have been successful and would have been the second choice design had the patient failed in the large diameter lens. A scleral lens may have been the first option if the patient’s irregularity had been more severe. The patient sees remarkably well considering the location and density of his scar. A slightly larger or denser scar may have necessitated a corneal transplant.
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 a boardmember 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.