CASE STUDY I - Dr. Ames

Patient A.S. A 25-year-old seminary student who has never worn contacts.

     Refraction:
          OD -3.25 -1.50x175   20/20
          OS -5.00 -1.00x020   20/20
     Ks:
          OD 46.25/48.25@085
          OS 47.25/48.00@090
     Narrow apertures with good upper lid coverage O.U.
     CL parameters:
          OD 7.20 BC 9.3 DIAM -3.75 stock tricurve design
          OS 7.10 BC 9.3 DIAM -4.75 stock tricurve design

These initial lenses were designed empirically to achieve lid attachment. At dispensing, the lens fit was difficult to assess. The patient was tearing profusely and extremely uncomfortable. I'm sure we have all had unadapted patients whose initial reaction to GPs was intense and somewhat unexpected like A.S. Lens movement was excessive and the lenses dropped between blinks. I would normally see this patient 5-7 days after dispensing to assess fitting and consider changes, but he was heading back to school so I scheduled a recheck the next day. I told him to wear the lenses 4-6 hours the day of dispensing and to insert the lenses first thing the next morning. I saw him the afternoon of the second day.

To my surprise, he was remarkably more comfortable the second day. He reported acceptable comfort but felt the right lens was slightly more comfortable than the left lens. Lens fitting could now be easily assessed, and the right lens was fitting as predicted with good lid-attachment, alignment, and 20/20 VA pl over-refraction. The left lens was slightly steep with a more centered fit. VA was 20/25 -50 over-refraction. A new lens was ordered for the left eye .10 flatter with no power change. The new left lens now fit lid-attached with good acuity.

 
CASE STUDY II - Dr. Ames

Patient K.J. An 11-year-old patient who has never worn contacts.

     Refraction:
          OD +.75-3.00x178   20/20
          OS +1.75-3.00x175   20/20
     Ks:
          OD 42.75/46.00@085
          OS 43.00/46.25@085
     Moderately wide aperture with borderline upper lid coverage
     CL parameters:
          OD 7.90/7.50 BC 9.6 DIAM +1.00/-1.25 minus carrier lenticulation
          OS 7.90/7.50 BC 9.6 DIAM +2.00/-.25 minus carrier lenticulation

The lenses were designed empirically to achieve lid-attachment and at dispensing, the patient was more comfortable than expected and the lens fit was possible to assess with reasonable accuracy. The lenses picked up with blinking but dropped to a centered position quickly. The left lens looked slightly flat and decentered slightly temporal. Acuity was 20/20 OU with no significant over-refraction.

I was concerned that lid attachment would not be achieved and scheduled a recheck in one week. I anticipated changing strategies and having to go smaller and steeper to achieve a centered fit. The patient missed the follow-up appointment due to a family vacation and was seen approximately one month later. At this visit the lenses lid-attached as predicted and provided good vision and physiology.