Links to Case Studies:
Case 1
Case 2
Case 1
By: Dr. Grohe
Refractive Surgery Ectasia
A 56 year old communications executive presents with distorted
vision consisting of halos, spoking and reduced scotopic vision. He has undergone seven
GP refittings in the last ten years with ongoing GP intolerance.
Medical History: adult ADHD
Ocular History: significant for s/p Radial Keratotomy with 3 enhancements for each eye and bilateral cataracts.
CL History: PMMA x 21 years, EWSCL x 3 years & DWGP x 3 years.
Spectacle History: unsuccessful with four PAL.
Medications: Zoloft & Ritalin
Work History: heavy ( 8-10 hours per day ) computer and Blackberry user.
Keratometry: ( with -1.00 D extended range )
OD 33.98 @ 26 x 32.69 @ 112 1+ distortion
OS 37.62 @ 33 x 37.00 @ 115 Tr distortion
Refraction:
OD + 2.75 - 1.25 x 115 = 20/40 with monocular diplopia
OS + 0.75 - 1.00 x 80 = 20/60 with monocular oblique triplopia
Slit Lamp:
OD 8 incision RK with fibrotic recut channels and Tr ASC & 1+ PSC cataracts
OS 8 incision RK with fibrotic recut channels and 1+ ASC & 1+ PSC cataracts
Topography:
OD:
K = 34.80 x 33.00
Eccentricity = - 1.51
CCT = 426 microns
OS:
K = 37.30 x 36.70
Eccentricity = - 1.07
CCT = 453 microns
Diagnostic fitting:
- unsuccessful with mini-scleral Jupiter 15.0 mm due to intolerance
- unsuccessful with Synergeyes due to severe residual monocular diplopia
- unsuccessful with piggyback of Ciba Night & Day with Envision 10.2 mm
- semi-successful with Rose K2 IC ( irregular cornea )
RCL:
Rose K2 IC
Base curve: 9.20 mm ( 36.62 D. )
Power: - 0.75
OAD: 11.2 mm
PC: standard flat
VA: 20 / 40 + 2 ( trace monocular vertical diplopia )
Lens position: Central to Temporal with 2 mm movement
LCL:
Rose K2 IC
Base Curve: 9.25 mm ( 36.62 D. )
Power: - 1.00
OAD: 11.2 mm
PC: double flat
VA: 20 / 50 + 1 ( 1 + monocular vertical diplopia )
Lens position: Central with 1-2 mm movement
Disposition:
Prior to the refitting, a long discussion outlined the benefits and lingering compromises
we would experience with any contact lens. Given the past history of unsuccessful spectacle
and contact lens fittings and the presence of cataracts, it was necessary to re-emphasize the
need to compromise and that no contact lens could provide “perfect” vision. It was also stated
that all day wearing time may be unrealistic given the heavy computer use and anti-depressant
med which together would enhance a dry eye-like state. The patient begrudgingly agreed.
Success in this case was enhanced by the temporary use of Acular LS dosed:
QID x 1 week
BID x 1 week
QD x 2 weeks
Now: PRN
Vision was acceptable and bilaterally resulted in 20 /40 -1 with intermittent
but tolerable ghosting and residual diplopia, especially under scotopic lighting. The patient wears his
GPs 6-12 hours per day, depending on his computer use. He also alternates between two pair of OTC
readers ( + 1.25 or + 2.25 ) for near vision needs.
Case 2
By: Dr. Szczotka-Flynn
Example: Post DALK for KC
Spherical lens:
Post DALK: Piggyback/8.4 N&D
Post DALK: Piggyback/O2Optix
Post DALK: Piggyback/Oasys
Post DALK: SynergEyes A
Post DALK: SynergEyes KC
Post DALK: SynergEyes PS
Post DALK: Rose 2K IC
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