ONLINE SYMPOSIA:

Case Study for the Oct. 16 Online Symposium, "Post-Surgical Correction with GP Lenses"
with Dr. Grohe & Dr. Szczotka-Flynn

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:

    1. unsuccessful with mini-scleral Jupiter 15.0 mm due to intolerance
    2. unsuccessful with Synergeyes due to severe residual monocular diplopia
    3. unsuccessful with piggyback of Ciba Night & Day with Envision 10.2 mm
    4. 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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    This page was last updated Friday, May 09, 2008.
     
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