The specialty lens-fitting optometrist has a variety of lenses in the arsenal to choose from for the simplest to the most complex patient. Armed with patient goals in mind, increasing options can push ODs to aim for the “troubleshooting” tool without a reason to consider the simpler solution.
Many times customized gas permeable (GP) lenses or scleral lenses are the only fix, but taking a step back can yield a creative solution using standard designs. This article will highlight several such cases.
Case 1: Goldilocks of lenses
A 71-year-old Caucasian male, JZ, presented to our office after previously wearing keratoconus-specific aspheric design GP lenses, customized soft lens for keratoconus, and most recently a mini scleral design. See Figure 1 for his topography.
He complained that the GPs were uncomfortable, the customized soft lens did not yield great vision, and he had difficulty applying and removing the scleral.
In spectacles, he was correctable to OD -5.50-2.75 x 148 with visual acuity (VA) of 20/50, OS -0.75-3.25 x 095, VA of 20/30+, and preferred glasses to contact lenses. He had discontinued lens wear several years prior.
Initial evaluation was undertaken utilizing Biofinity Toric XR lenses (CooperVision): OD 8.7 mm base curve, 14.5 mm diameter, -5.50-2.75 x 150, and OS 8.7 mm base curve, 14.5 mm diameter, -0.75-3.25 x 095, yielding 20/25- vision OU.
Though the rigid lenses produced better vision, JZ stated that he felt more comfortable physically with soft lenses and would wear the soft toric lenses full time. He reported glare with the right eye, the eye with the bigger cone; nevertheless, JZ ultimately had better success with the XR toric lenses and has been wearing them full time.
This case demonstrates that soft toric lenses may be an option when best-corrected spectacle VA is acceptable to the patient.
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