contact lens focus

Chemistry Lab Gone Wrong

Using a post-surgical custom lens following a dry ice accident.

JENNIFER HARTHAN, O.D. F.A.A.O.

SHANA BRAFMAN, O.D.

History

A 16-year-old male presented to our clinic at the Illinois Eye Institute for a contact lens fit for his left eye following a full thickness-penetrating corneal accident. Dry ice had entered his left eye during a routine chemistry lab as he was not wearing safety goggles at the time. He was taken to the emergency room where he underwent corneal surgery that day to repair the open wound. He was followed closely by the corneal ophthalmologist until the cornea stabilized.

Exam findings

The patient was left with a large inferior corneal scar and irregular astigmatism (Figure 1). At his initial presentation to our clinic, two corneal stitches remained, and his vision was correctable to 20/30 with a refraction of +4.25 −6.00 × 077. Vision in his right eye was 20/20 with an unknown toric soft contact lens. All other findings were unremarkable.

Figure 1 (left): Inferior corneal scar OS secondary to a dry ice accident that resulted in irregular astigmatism.

Figure 2: Final RevitalEyes Post-Surgical Lens Fit OS

Diagnosis

Based on these findings, we determined the patient needed a post-surgical custom contact lens to achieve acceptable vision. Secondary to the patient’s history of soft contact lens wear and his parents’ concern regarding contact lens comfort, the patient was fit with the RevitalEyes Post-Surgical custom toric lens.

Discussion

Patients who have undergone any type of corneal surgery can be very challenging to fit with contact lenses secondary to the irregularity of the cornea and limited lens modalities available that provide both optimal corneal health and vision. In many cases, small or large diameter GP contact lenses are required to correct the irregularity and provide patients with optimal vision.

Management

We fit this patient with the RevitalEyes Post-Surgical custom lens comprised of Definitive material. With a power of +2.00 −.075 × 075, the contact lens maintained his vision at 20/30 and increased his binocularity. The patient reported stable and comfortable vision throughout the day. The contact lenses were ordered. However, prior to picking them up, his two remaining stitches were removed by the surgeon. This changed the patient’s refractive error to +5.00 −5.00 × 070 with a best correctable visual acuity of 20/50, resulting in unacceptable vision through the initial lens. A new lens was ordered with a power of +3.75 −4.50 × 071, which corrected the patient’s visual acuity to 20/50.

The patient was educated on the proper care and management of the lens and was asked to return in two weeks for a progress evaluation. Now, the patient has been wearing the lens comfortably for 10 hours a day (Figure 2).

Practice benefits

Providing the latest lens design options may enhance practice growth, referrals and increase patient retention secondary to enhanced comfort and the inability to order these lenses online. Fitting custom lenses may involve lengthy chair time, and this should be considered when setting fitting fees. These lenses are typically fit for patients who qualify for medically necessary contact lenses.

By offering custom soft lenses to patients, a practitioner is able to co-manage post-surgical corneal cases with ophthalmologists and primary-care optometrists. Fitting these lenses could be an effective networking strategy with other eye-care practitioners.

The RevitalEyes Post-Surgical reverse geometry custom soft lens in the Definitive Silicone Hydrogel material can be made to order to offer post-surgical patients good vision and comfort while maintaining optimal corneal health. This case demonstrates that custom soft lenses are a viable option for patients who have irregular corneas secondary to surgical procedures. OM

DR. HARTHAN IS AN ASSISTANT PROFESSOR IN THE CORNEA CENTER FOR CLINICAL EXCELLENCE OF THE ILLINOIS EYE INSTITUTE, AND IS CHIEF OF THE URGENT EYECARE SERVICE. E-MAIL HER AT JHARTHAN@ICO.EDU.

DR. BRAFMAN IS CO-DIRECTOR OF CONTACT LENS SPECIALTY SERVICES AT NORTH SUBURBAN VISION CONSULTANTS, LTD., AND ASSISTANT CLINICAL PROFESSOR OF THE ILLINOIS COLLEGE OF OPTOMETRY AND ILLINOIS EYE INSTITUTE. E-MAIL HER AT SBBRAFMA@HOTMAIL.COM, OR SEND COMMENTS TO OPTOMETRICMANAGEMENT@GMAIL.COM.