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Patient RA

Female

Age: 30

Diagnosis: Post Lasik Ectasia


History: RA underwent Lasik surgery 7 years previously. Before the surgery she was a -7.00 myope with a spherical prescription and no sign of sub-clinical keratoconus. A year after the Lasik she began to develop astigmatism and her vision became steadily worse until it deteriorated rapidly a year ago.

She returned to the laser company where she got a diagnosis of post lasik ectasia and was fitted with RGP contact lenses. She could not tolerate these at all and was referred for Corneal Cross Linking, undergoing the procedure for the right eye in March 2008. After this her ophthalmologist referred her for contact lens assessment while monitoring the thickness of the left cornea. She was struggling at work (child care) as her vision was variable and ghosting was caused by her irregular corneas. She was also finding it difficult to drive at night due to ghosting and multiple images of lights.

Vision: R: Count Fingers L: 3/24
Spectacle RX: R: -8.00/-4.50 x 87 VA 6/12 L : -2.25/-2.50 x 95 VA 6/9 with severe ghosting
Keratometry: R: 7.70 x 100/7.02 x 10 L: 7.09 x 97/6.56 x 7

Topography:

RE                                                                           LE

Patient RA Topography
Lens type fitted: KeraSoft®3 by UltraVision produced in Contamac Definitive™ Silicone Hydrogel material.

R: 8.40/14.50/FLT1/-6.00 / -3.50 x 87  VA 6/7 L: 8.40 / 14.50.FLT1/ -2.25 / -2.50 x 110 VA 6/7

RE with KeraSoft®3 in situ                                       LE with KeraSoft®3 in situ
Patient RA Keratascopy with KeraSoft3 in situ

After 3 months RA returned for a routine check and felt her vision was deteriorating in the RE and complained of ghosting in both eyes. The VA in the RE had dropped to 6/12 and both lenses gave ghosting due to changes in the RE caused by settling from the CXL procedure and in the LE by progression of the ectasia.

She was refitted with KeraSoft®IC (Irregular Cornea) SMC (Sector Management Control) by UltraVision, produced in Contamac Definitive™ Silicone Hydrogel material.

The KeraSoft®IC lens design allows a customised periphery; one sector is steepened and another is flattened in accordance with information taken from the topography.

R: 8.20/15.00/FLT1/STP2/-6.00 / -3.50 x 87 Sector angles A1 – A2: 0 – 170 for the flatter periphery and A3 – A4: 230 – 300 for the steeper. Blend angles 60 and 60
L: 8.20/15.00/FLT2/STP2/-2.25 / -2.50 x 110 Sector angles A1 – A2: 20 – 150 for the flatter periphery and A3 – A4: 210 – 310 for the steeper. Blend angles 70 and 70

Final VA with the lenses was 6/6 R&L with total elimination of ghosting and increased contrast.
Wearing time was a comfortable 14 hours per day and she could now work productively and drive at night without multiple images and ghosting of lights.

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