BACKGROUND
38 year old male entered the office wearing toric, nondisposable contact lenses. His current lenses are three years old
and he has recently lost his left lens. He is very pleased with this
particular prescription. He has not worn lenses for three weeks and he
has no spectacles.
TEST PROCEDURES/FITTING & REFITTING LENS DESIGNS & ORDERING
Unaided Visual Acuity (distance):
OD 20/250
OS 20/200
Manifest Refraction:
OD -7.00 – 0.50 x 100 20/20
OS -4.50 – 2.25 x 180 20/20
Keratometry:
OD 46.00 @ 180; 47.00 @ 090 mires clear
OS 44.75 @ 180; 46.75 @ 090 mires clear
Biomicroscopy:
Grade 3 neovascularization (see photo) is present in the right eye. The left eye exhibits Grade 2 neovascularization, primarily ghost vessels.
The patient was fit with gas permeable (GP) lenses in order to increase the amount of oxygen to the cornea and to eliminate any
physical irritation of the limbal vessels.
To achieve an apical alignment fit it was necessary to fit the right
lens somewhat flatter than “K”. The final
base curve radius was: OD 0.75 D flatter than “K”;
OS “on K”.
PATIENT CONSULTATION AND EDUCATION
Considerable time was devoted to discussing the risks to
vision by allowing the blood vessels to continue to grow further into
the cornea. The importance of timely examinations and monitoring was
emphasized as neovascularization causes no discomfort and is not
something the patient can monitor himself.
FOLLOW UP CARE/FINAL OUTCOME
The lenses were dispensed and the patient was instructed in
placement, removal and care of the lenses. He began by
wearing the lenses five hours the first day and increased two hours per
day after that. Appointments were scheduled one and three
weeks after lens dispensing. By the three week appointment
all the blood vessels in the cornea were empty. The patient
was scheduled to be followed again in four months in order to monitor
the blood vessels.
DISCUSSION/ALTERNATIVE MANAGEMENT OPTIONS
The options discussed with this patient were to switch to glasses or
to be fit with gas permeable lenses. There was no other practical
option. I would not consider any of the then available soft toric lens
options to be of value to this patient. Even with a thinner disposable
lens there could have been continued hypoxia and continued growth of
the blood vessels. It is possible that today’s silicone hydrogel
toric lenses could be an option if the patient were seen today and I
would consider this treatment option.
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