A Very Good First Impression
- Using Impression Technique Scleral Lens Fitting -
Stephanie L. Woo OD FAAO FSLS
A 78-year-old white female presented to our office for a possible contact lens evaluation for the left eye. She had been referred to us by her retinal specialist.
The patient reported having extremely poor vision for about 15 years in each eye. See table 1 (below) for an overview of her ocular health situation.
Although a very difficult case, I was willing to try any contact lens possible that might improve this patient’s vision OS (for OD there was no potential for vision improvement). Topography could not be performed on either eye.
20/ Hand Motion
PK with running suture x 10 years
PK with interrupted sutures x 15 years
Bleb with shunt
Bleb with shunt
Wet Macular Degeneration
Dry Macular Degeneration
Potential for improved vision
First, I trialed some corneal gas permeable lenses in a variety of diameters, base curves, and reverse curves. Every lens resulted in a large bubble centrally and dislodged easily due to the sunken-in center of the corneal transplant. I next attempted a few scleral lenses, but each persisted with a similar problem.
I referred the patient back to her corneal surgeon for suture removal with the hope of altering the corneal shape to help with the contact lens fit. I saw the patient about three weeks later and attempted the following lens options:
- Corneal gas permeable lenses
- Reverse geometry gas permeable lenses
- Post transplant gas permeable lenses
- Piggybacked corneal gas permeable lens with high plus soft lens
- Intra-limbal gas permeable lenses
- Scleral lenses
- Custom soft lenses for irregular corneas
All contact lenses failed due to poor fit and lens dislodgment. Scleral lenses would not work due to the large bleb at 2 o’clock.
At this point, I knew the only option for this patient would be the EyePrintPRO, in which an impression technique is used to create a transparent scleral cover shell designed to match the exact contours of the cornea and sclera. The patient returned for the impression process (Fig 1), during which a mold of the eye is taken and sent to the lab for fabrication.
The patient returned for dispensing of the EyePrintPRO. Upon insertion, she could immediately see 20/50! The impression technique lens was perfectly positioned and in place. The bleb did not look altered in shape at all (Fig 2). The patient and her husband were so thrilled with the vision, they were in tears in the exam room. For a patient that had only seen shapes and shadows for many years, this was truly life changing.
Of course, I monitored the patient very carefully; every day for two weeks I checked her vision, which remained at 20/50 with no over-refraction. Her IOP remained around 10 mmHg or 11 mmHg at each visit.
Impression Technique Scleral Lens Fitting
For difficult to fit corneas/scleras, the EyePrintPRO is an amazing device. Because an impression of the ocular surface is taken, it leaves no guesswork when designing a lens. The result is a precise fit and great vision. This device is an excellent option for many patients, and in my opinion it is the new gold standard for eyes that have challenging anterior surface shapes.
Dr. Stephanie L. Woo graduated from the Southern California College of Optometry and completed a Cornea/Contact Lens residency at the University of Missouri - St. Louis.
She is a Fellow of the American Academy of Optometry and a Fellow of the Scleral Lens Education Society.
She is a contributing author for the American Optometric Association Contact Lens and Cornea section, and she is the author of the "GP Expert" column for Review of Contact Lenses.
She is also the Public Education Chair for the Scleral Lens Education society and is an Advisory Board member for GPLI. She currently practices at Havasu Eye Center in Lake Havasu, AZ.