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Patient PT

Female

Age: 29


History: PT was diagnosed with keratoconus 13 years previously at which point she started to wear RGP contact lenses. Gradually, she was unable to see through spectacles and RGPs began to be very uncomfortable. She was forced to resort to piggybacking (RGP worn over disposable soft lenses) in order to continue with contact lens wear.

As her keratoconus continued to advance, she consulted an ophthalmologist who recommended Collagen Cross Linking (CXL). She had treatment on her left eye in December 2008 and was advised to be fitted with a soft contact lens so as not to adversely affect the cornea as it was settling. She also needed to be able to achieve reasonable vision in the treated eye before she could have CXL on the right cornea. PT had no spectacles, as vision was too poor to be of any use.

Vision: R: Count Fingers ½ m L: Count Fingers ½ m
Spectacle Rx: R: -12.00/-5.00 x 20 VA 6/36 L: -15.00/-7.00 x 7 VA 6/24+2
Keratometry: R: 7.21 x 25/ 6.69 x 115 L: 6.81 x 4/ 6.10 x 94

Current contact lens system:
RE: RGP piggybacked onto daily soft lens VA 6/9 (current contact lens information not available)
LE: no contact lens

Topography: RE                                                             LE

Patient PT Topography

Keratoscopy: RE                                                           LE

Patient PT Keratoscopy

Slit Lamp: R cornea showed central thinning and Vogt’s Straie whilst left cornea manifested significant corneal haze due to CXL treatment 6 weeks previously.

PT was asked to return 1 week later to reassess left cornea by which time the corneal haze was reduced.

Lens type fitted:
RE: KeraSoft®IC SMC LE : KeraSoft®3
Both by UltraVision produced in Contamac Definitive™ Silicone Hydrogel material

R: KeraSoft®IC SMC 8.40/14.50/FLAT1/STEEP3 Flat periphery between angles A1 – A2=10 – 170; Steep periphery between A3 – A4= 220- 320 with Blend angles of 50.
Power: -9.25/-3.25 x 20 VA 6/9
L: KeraSoft®3 8.40/14.50/-13.50/-4.50 x 170 VA 6/12+

This level of acuity is quite normal for 7 weeks post CXL

Wearing time: All day comfortable wearing time of 16 hours was achieved. The KeraSoft®3 allows the left cornea to settle after cross linking without causing any undue physical pressure. Settling can take up to 6 months. The KeraSoft®IC SMC was worn in the right eye awaiting CXL treatment and was to be used within 2 weeks of cross linking.

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