MC Case Study.pdf - UltraVision Group

www.kerasoft.co.uk
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History
MC Clinical Notes
MC is a 38 year old man who was diagnosed with keratoconus 20 years ago. He has worn RGP contact
lenses since diagnosis but has never achieved good vision binocularly and more notably with his right eye.
MC regularly attended an NHS Eye Hospital department. In mid 2009, the acuity in the left eye dropped to
below 6/12 rendering him below the visual standard for driving. Alternative lens fittings were attempted by the
hospital without success in improving his acuity. Both RGP lenses exhibited a flat fitting. Although better
physiological fits were achieved, the visual acuity with these lenses was reduced. He was therefore advised
by his Consultant Ophthalmologist, to have both corneas grafted to be followed by phakic implants in order
to reduce his myopia. It was anticipated that the procedures would take approximately 5 years in total to give
him stable vision.
At this stage, MC decided to explore other contact lens options before going ahead with the grafting option.
Initial Findings
MC presented wearing RGP lenses to the following design.
Rose K RE: 6.10/8.70/-10.75 VA 6/36 LE: 7.10/8.70/-11.50 VA 6/18
He wore his RGPs for up to 16 hours per day, even though they caused him discomfort and photophobia. He
was not comfortable wearing spectacles as they were a high minus prescription (thus causing visual
distortion) and the acuity was insufficient for his work (as an Accountant).
Slit Lamp examination showed flat fitting lenses, mild diffuse staining and mild paracentral scarring on both
eyes. Both RGP lenses were clearly lifting off inferiorly.
RE
LE
His lenses were easily dislodged due to the flat fitting which led to the habit of moving his head rather than
his eyes.
UltraVision International Ltd, Commerce Way, Leighton Buzzard, Beds, LU7 4RW
UK Freephone 0800 585115 or +44 (0)1525 381112
email: info@ultravision.co.uk web: www.ultravisiongroup.com
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MC Clinical Notes Cont’d
Rationale for KeraSoft ® fitting
MC had heard of KeraSoft ® lenses and wished to see if he could achieve sufficient levels of vision to avoid
undergoing corneal graft surgery. He had been informed by his hospital practitioner that no rigid lens type
would offer him sufficient visual acuity to enable him to continue driving.
Topography/Simulated Keratometry readings
RE
LE
Central: 5.44 X 31/4.92 x 121 6.38X 103/6.02 x 13
Flattest: 8.14 7.45
Initial Fitting Lenses
KeraSoft ® IC SiH
RE: 8.20/14.50/STD/-14.00/-4.00 x 45 VA 6/9 LE: 8.20/14.50/STD/-14.00 DS VA 6/6
When the flat fitting RGP lenses were discontinued, it was expected that the cornea would become steeper,
as it went through the demoulding process. The patient was advised that he may require steeper KeraSoft ®
IC lenses to be fitted at subsequent visits as the cornea settled.
MC decided to go ahead with the fitting as the improvement in his acuity was better than he had anticipated.
The above KeraSoft ® IC lenses were supplied. After 2 days wear, he reported a significant reduction in
photophobia, a considerable increase in comfort and achieved 18 hours wear comfortably. MC kept in
contact during the following weeks and his acuity was regularly checked to ensure he did not fall below the
driving standard whilst his corneal shape fluctuated during the “demoulding from RGP” process.
3 month follow up
Both lenses now appeared tighter than at initial fitting but movement was still acceptable and the left lens
rotated 15 degrees clockwise (CW). MC reported vision had reduced slightly but was still better than with his
previous RGP lenses.
Visual Acuity
RE: 6/9 - No over refraction
LE: 6/18 - OR -2.25DS VA 6/7.5 pt
UltraVision International Ltd, Commerce Way, Leighton Buzzard, Beds, LU7 4RW
UK Freephone 0800 585115 or +44 (0)1525 381112
email: info@ultravision.co.uk web: www.ultravisiongroup.com
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MC Clinical Notes Cont’d
Topography
RE
LE
Slit Lamp
Corneas were clear, eyes quiet and white, no neovascularisation and no staining with fluorescein.
Fit Assessment
As the corneas remained healthy, the lens fit was left unchanged as it was expected that the cornea would
continue to undergo shape fluctuations. The left lens power was updated in accordance with the over
refraction found at this time.
9 Month Follow Up
Comfort remained excellent and MC was wearing lenses all waking hours.
Slit Lamp
Both eyes white and quiet. Corneas clear, no staining with fluorescein.
Over Refraction on Current Lenses
RE: 6/15 OR Plano/-2.00 x 140 6/12 – 6/8 variable
LE: 6/12 No over refraction gave improvement
Topography
Corneal shape had now changed significantly, so a new fitting assessment was made.
RE
LE
UltraVision International Ltd, Commerce Way, Leighton Buzzard, Beds, LU7 4RW
UK Freephone 0800 585115 or +44 (0)1525 381112
email: info@ultravision.co.uk web: www.ultravisiongroup.com
Page 3 of 4

®
MC Clinical Notes Cont’d
Final Fit
RE: 7.60/14.00/FLT2/-17.50/-5.50 x 13 VA 6/8
LE: 7.60/14.50/FLT2/-16.00/-5.75 x 4 VA 6/6 -2
Summary
RGP wearer 20 years with poor vision – hospital advised grafting as acuity improvement not possible with
RGP lenses.
Patient went from:
15 hours uncomfortable wear, poor vision, photohobia and continuous lens displacement with his original
lenses:
Rose K RE: 6.10/8.70/-10.75 VA 6/36 LE: 7.10/8.70/-11.50 VA 6/18
To:
18 hours comfortable wear, good vision and no photophobia with KeraSoft ® IC lenses:
RE: 7.60/14.00/FLT2/-17.50/-5.50 x 13 VA 6/8
LE: 7.60/14.50/FLT2/-16.00/-5.75 x 4 VA 6/6 -2
The patient’s quality of life has improved hugely and he no longer needs to consider corneal grafting surgery.
UltraVision International Ltd, Commerce Way, Leighton Buzzard, Beds, LU7 4RW
UK Freephone 0800 585115 or +44 (0)1525 381112
email: info@ultravision.co.uk web: www.ultravisiongroup.com
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