Case No.1:

33 YOWM presents with complaints of blurry VA with right contact lens for several months...Left lens is fine. VA with glasses fine. Age of lenses = @ 1 1/2 yrs.   Cleaning regimen:  Any cleaner....digital cleaning in evening Allergan Wet n Soak Enzymatic tabs q month or so.  Comfort is good. Average wearing time is all day.

VA CL:
OD 20/200
OS 20/30
 

Illustration 1 This is the Right lens in white light. I didn't capture this with fluorescein but I would describe it as flat centrally surrounded by pooling. There was heavy mid-peripheral bearing and fair edge-lift.

Illustration 2a		Illustration 2b
Fluorescein patterns of left lens

Thoughts???
Now remember, he feels his vision is fine OS.

Lens parameters verified:

Topographies:
 

Illustration 3
 

Illustration 4

 
How would you refit?

Suggestions?


Final lens design: Conforma Labs.

	BC	BVP	D/OZ	PC
OD	41.00/44.50	+4.50/+1.75	9.0/7.5	9.7 secondary with HPC.65
	(8.23/7.58)
OS	41.25/44.25	+3.75/+1.00	9.0/7.5	9.7 secondary with HPC.65

 

Illustration 5		Illustration 6
Final lens OD		Final lens OS

 

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Case No. 2:

20 YOWF presents wearing Biomedics 55% 2 week disposable lenses. Lenses are comfortable but vision with the lenses was never great. Vision with glasses much clearer. Her previous doc told her, "This is as good as it gets." Uses ReNu with no problems. No enzyme. Replaces q 2 weeks.

VA with lenses:
OD 20/25
OD 20/25

Manifest refraction	Keratometry
OD -1.75 - .50 x 95	43.50 sph
OS -1.75 - .50 x 90	43.25 sph

What would you do???



Final lenses - Boston ES

PANOFOCAL FRONT SURFACE!

	BC	BVP	D/OZ
OD	7.80	-1.50	9.3/8.0
OS	7.85	-1.50	9.3/8.0

Patient sees 20/20 in each eye and is very happy. It took a while (@ 2 weeks) to overcome the initial "lid sensation" but the improved acuity was a very motivating factor.

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