A Chief's Complaint
Stephanie L. Woo OD FAAO FSLS
A 45-year-old white male visited our clinic as a new patient for a comprehensive eye exam. His chief complaint was double vision in his right eye when he was looking down the scope of his rifle. As a sheriff, he relied on accurate vision day and night. He began noticing the double vision a year prior, but said it was getting worse. His last comprehensive eye exam was over 10 years ago with no significant findings. Currently, he was not using any glasses for distance or reading.
Entering VAs: OD: 20/70, OS 20:40 – distance. Near VA OD: 20/70, OS: 20/40
He stated the vision OD was double when the left eye was occluded. He did not have any comments about his vision OS.
Topography showed keratoglobus OD (picture below) and a large oval cone OS.
MRx: -4.00+7.00x045 DVA 20/50 OD, -3.00+3.25x176 20/25-2 OS
Slit lamp exam revealed Vogt’s striae OD only. Corneal thinning was observed with optic section OD and OS. All other ocular structures were normal.
Scleral Lens Fit
I showed the patient his topography and explained that he had a condition called keratoconus, which was worse in his right eye compared to his left eye. He was shocked that he had developed this disease over time, and we spent 20 minutes together describing the etiology, management options, and prognosis. He stated, “I just thought I was getting older, and that is why my vision was changing each year. I thought my vision was just slowly getting worse over time, and there was nothing I could do about it.” After reviewing all of the treatment options, he elected to be fit with a scleral lens design.
The patient was fit into:
OD: Atlantis/ 7.03/ 16.0/ -2.00/ BXO clear/ drill dot
OS: Atlantis/ 7.34/ 15.5/ +1.50/ BXO ice blue
With these scleral lenses, he can achieve 20/25 vision OD and 20/20 OS. His double vision is resolved, and he feels his vision is the best it has been in years. He has been successfully wearing scleral lenses for 2 years now.
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.