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Case 1

New Ortho-K patient gets a helping hand with progressive molding

Data: 51 year old white female glasses wearer for last two years. Wore RGPs before that but was unsuccessful. Glasses work adequately, has some dry eye complaints probably related to medication (anxiety). Wants to go back to contacts.

Unaided OD 20/200 OS 20/200 OU 20/200
RX R -1.00 -1.00 x 100 20/20 Add 2.00
     L-1.25-.75 x 75 ADD 2.00

K's R: 45.50/46.00 x 007
      L: 45.00/46.00 x 157

Most Recent Original Topography Right Eye

Most Recent Original Topography Left Eye

Commentary:
Major obstacles are many:

1. against the rule astigmatism: One diopter or less and some of its corneal
2. dry eye: Not a problem with OK though could be an issue with daily wear
       Can treat this numerous different ways
3. Cl failures previously: Not an issue with OK
4. Mature Presbyopia: Can I get enough reading add?

1. Patient loves the idea of getting rid of glasses and daily wear of CLs
2. Possibility of not needing to wear every night

Commentary: Though the obstacles outnumber the advantages the ability to discard the glasses without wearing daily wear contacts is a powerful incentive. Patient was instructed as to the fact that these lenses are not FDA approved and the vision may not be what we desire due to astigmatism.

Trial fit Contex "E" Series on flat "K" prior to ordering lenses.

First Fit Contex Multi Focal Design
R OK-MF 45.50/-2.00 (.5E) +3.00 BC 7.85 Diameter 10.6 +1.50
L OK-MF 45.00/-1.50 (.5E) +3.00 BC 7.90 Diameter 10.6 +1.00

Contex MF-OK

Commentary: Note unusual pattern to Multi Focal Lens design. (NAFL pattern)
12/28/2006 Follow-up: Patient would like to see better at distance.

OD 20/30 OS 20/40 OU 20/30 Nearpoint J3

Over Refraction
R -.25 -1.00 x 90   20/20
L -.50-.50 x 90   20/20

Change Over Time Right Eye

Change Over Time Left Eye

Commentary: Lens fit was evaluated and decision was made to increase the target power for distance and reading. Patient felt reading was adequate with adequate lighting.

New Lens specs
R: OK-MF 45.50/-2.75(.5E)+3.50 BC 8.04 10.6 +2.00
L: OK-MF 45.00/-2.25(.5E)+3.50 BC 8.04 10.6 +1.75

03/22/2007 Follow-up Distance vision not good enough.

Unaided vision
OD 20/40 OS 20/40 OU 20/30   J3

Over refraction
R: -.75-.50 x 90   20/20
L: -.50-.50x90   20/20

Change Over Time Right Eye

Change Over Time Left Eye

Commentary: Note reduction in against the rule astigmatism in the right eye. Decision was made to increase the target once again in both eyes for best distance vision. Patient was quite satisfied with nearpoint. The target nearpoint add of +3.50 was maintained.

06/05/07 Follow-up Patient complained that Left eye is not seeing as well as right.

Unaided vision
R: OD 20/20 OS 20/40 OU 20/20   J3

Over refraction
R: -.25-.25 x 90   20/20
L: -.50-.50x90   20/20

Commentary: Excellent results for right eye but left eye has not improved at all. Evaluation of fit again lens centered well with blink but lens appears to position low. At this point I decided to again return to our previous fitting of this patient several years ago( See attached Original Topos). These showed that while the right eye was fairly close to the readings the left eye was notably steeper on the older topography. Having a right lens from previous fittings handy I had the patient wear it. So far it seems to be working well and patient has reported excellent vision from both eyes. This problem perhaps could have been resolved earlier if I had paid attention to the patients former data. Note the central flattening of the Corneas in a progressive mold does not look as impressive due to the low amount of ametropia corrected but the steep zone created just outside the central 3mm of the Cornea provides a very useable add.

Original Topography Right Eye

Original Topography Left Eye

Case 2

Hyperopic Molding

17 year old white female. Wears daily wear rigid contacts successfully. Active lifestyle makes it difficult to wear lenses during the day.

Unaided
OD 20/80 OS 20/30 OU 2025

RX
R +3.75 20/20
L +2.50 20/20

K's R: 43.75/44.75
      L: 43.50/44.25

Lens were placed on the eyes from my trial set of Ortho-Plus lenses from Contex.

Intial Lenses
R 43.50/ +3.50(.5E)   BC 6.96   Dia 10.6 power -1.50
L 43.50/+2.50 (.5E)   BC 7.11   Dia 10.6 Power -1.50

Commentary: Well fit Hyperopic Ortho-K design will show central pooling . These lenses matched the K's well and would serve as a good starter set. Trial sets are useful tools when fitting corneal reshaping lenses as they allow you to see right away how a potential lens may fit. A wash out period was prescribed for the patient prior to this fitting so that her eyes would recover from her prior RGP fit. Fortunately we had original topos as a baseline. It can take many months of non wear of RGP lenses before the eyes can recover to pre fitting levels.

HP-OK

01/12/06 Follow-up

Unaided Vas
OD 20/25 OS 20/20 OU 20/20

Over Refraction
R +1.25   20/20
L Plano   20/20

Original Topography

Commentary: Excellent first results. We need more corrective change over the right eye. Lens appears loose. There is to much movemnet. What you see is what you get with Hyperopic OK. Unlikely that further steeepening will occur even if lens is allowed to treat eye over longer period of time.

New Trial Right Lens 44.50/+5.00 (.5E) BC 662 Dia 10.6 Power -3.00

01/28/06 Follow-up

Unaided
OD 20/25 OS 20/20 OU 20/20

Over Refraction
R: +1.00   20/20
L -.25   20/20

Change Over Time Right Eye

Change Over Time Left Eye

Commentary: Our Topos look better but lens is still loose on the right eye. Also still getting some over refraction of note. To tighten lens fit Ill order a lens with less eccentricity.

New Right Contact
R 44.50/+5.00 (.4E) BC 662   Diameter 10.6 Power -3.00

04/22/06 Follow-up

Unaided
OD 20/20 OS 20/20 OU 20/20

Over Refraction
R +.25   20/20
L +.50-.25 x 180   20/20

Commentary: Excellent results were aided by the fact that first attempts at correcting the right eye were aided by having a trial set present.

Full Treatment

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