GP Lens Case Grand Rounds Troubleshooting Guide – 03

Corneal Neovascularization: John M. Rinehart, OD

Background

38 year old male entered the office wearing toric, nondisposable contact lenses. His current lenses are three years old and he has recently lost his left lens. He is very pleased with this particular prescription. He has not worn lenses for three weeks and he has no spectacles.

Test Procedures/Fitting & Refitting Lens Designs & Ordering

Unaided Visual Acuity (Distance):

OD 20/250
OS 20/200

Manifest Refraction:

OD -7.00 -0.50 x 100 20/20
OS -4.50 -2.25 x 180 20/20

Keratometry:

OD 46.00 @ 180; 47.00 @ 090 mires clear
OS 44.75 @ 180; 46.75 @ 090 mires clear

Biomicroscopy:

Grade 3 neovascularization (see photo) is present in the right eye. The left eye exhibits Grade 2 neovascularization, primarily ghost vessels.

The patient was fit with gas permeable (GP) lenses in order to increase the amount of oxygen to the cornea and to eliminate any physical irritation of the limbal vessels.

To achieve an apical alignment fit it was necessary to fit the right lens somewhat flatter than “K”. The final base curve radius was: OD 0.75 D flatter than “K”; OS “on K”.

Patient Consultation and Education

Considerable time was devoted to discussing the risks to vision by allowing the blood vessels to continue to grow further into the cornea. The importance of timely examinations and monitoring was emphasized as neovascularization causes no discomfort and is not something the patient can monitor himself.

Follow-Up Care/Final Outcome

The lenses were dispensed and the patient was instructed in placement, removal and care of the lenses. He began by wearing the lenses five hours the first day and increased two hours per day after that. Appointments were scheduled one and three weeks after lens dispensing. By the three week appointment all the blood vessels in the cornea were empty. The patient was scheduled to be followed again in four months in order to monitor the blood vessels.

Discussion/Alternative Management Options

The options discussed with this patient were to switch to glasses or to be fit with gas permeable lenses. There was no other practical option. I would not consider any of the then available soft toric lens options to be of value to this patient. Even with a thinner disposable lens there could have been continued hypoxia and continued growth of the blood vessels. It is possible that today’s silicone hydrogel toric lenses could be an option if the patient were seen today and I would consider this treatment option.

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