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Case No. 3: 44-year-old WF first presented to me in April of 97. Her contact lens history is initially of PMMA wear, followed by GPs "somewhere along the line." Her present lenses are 5 years old and they feel "grimy." She used to use Boston Advance with the daily cleaner, no enzyme. She now uses Boston Simplicity solutions and uses the concentrated cleaner once a week. She has a left esotropia, amblyopia OD and was patched as a child.
The lenses were attached to the lid (high riders) and moved only with the blink. There was excellent tear exchange. There were heavy deposits peripherally with some minor ones centrally. The lenses did not wet very well post blink. The fluorescein pattern revealed an alignment relationship overall with some minor 3 and 9:00 intermediate bearing when interacting with the lids. When the lids were released, a central H band was evident in both eyes.
SL revealed some 3 and 9 staining OU. Tear quality was fair, - GPC, and meibomian glands
were subtly blocked.
On follow-up the following was found:
Again, the lenses were attached to the lid (high riders) and moved only with the blink. There was excellent tear exchange. Corneas were clear, no 3 and 9 staining. The fluorescein pattern OD was slightly steep and the left was aligned while attached to the lid. I decided to reorder the right .50 D flatter. She wore these for year. Next Visit The OMD had told her to wear the lenses minimally and use Genteal eye drops QID and to see me. She was now taking some allergy meds and Premphase (progesterone). The lenses were inserted. There was a HEAVY coating of deposits on the periphery of the lenses. Lenses verified:
VA:
The lenses were in a superior-central position, tucked under the eye lids. Fluorescein pattern revealed central alignment, minimal intermediate touch and good edge lift. There is excellent tear exchange. Lenses might be a little larger in diameter than needed. Refraction:
Topography redone: 3-month check Entering acuities with lenses:
The lenses center superiorly and are tucked under the eyelid. The fluorescein pattern is as described before. There is some light buildup at the anterior junction. (The lenses were polished). Refraction:
Topography was redone: Case 4: 37-year-old WF first presents to me in July of 94. Her lens history begins with
PMMA wear as a teenager. About 10 years ago was switched to GPs. She was referred by her
OMD for a CL refit. There is a history of dryness of the cornea . She used to use Boston
rewetting drops. Now she uses Aquasite, but doesn't like it. It's slimy. She has an
allergic history and is taking Seldane D and Entex.
Lenses were Fluoroflex (Cooper) - she had a copy of her CL Rx...I also verified them.
The lens position could be described as central inferior. They came up with the lid on the blink and then released from the lid, post blink. Fluorescein pattern revealed the lightest of a central touch in the middle of apical clearance. The pooling was surrounded by a circular area of bearing in the mid-periphery. There was decent edge lift.
There was surface dehydration.
Using Boston solutions, nighttime cleaning, no enzyme yet (my instructions). VA:
The lenses maintain more of a superior position held up by the lid on the blink. On occasion the lens releases from the lid so I can't really describe this fit as totally lid controlled. Fluorescein pattern reveals a basic aligned pattern with some light bearing in the 2 and 10:00 positions. When you release the lids, the pattern is aligned to slightly flat. The cornea has a similar appearance as before. Although there is no central SPK, there are areas of non-wetting. There still is an appearance of stromal haze with striae present. There is light 3 and 9 stippling OS...much heavier OD.
Lenses were flattened to try to increase lid grad. Why? How do you think the outcome was? (You need to be present for the answer...<g>). A year or so later she wanted to try soft lenses. How do you think this worked out? She wanted to return to GPs again....What was the next design and/or material you would choose? How was her corneal response? |
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What is
your plan of action??
