Post CXL KC

Courtesy of Dr. Joseph DiGiorgio, O.D., Vision Source, Orland Park, IL

We had the pleasure of seeing a 39 y.o. physician with a long history of keratoconus. He had CXL OU in Y2020. He has been a scleral lens wearer for the past several years, but complained of poor comfort and red irritated eyes.

Key findings:

-Crosslinking OU 2020

-KMax: OD 50.2 / OS 59.2OS

-thinnest pachy=463 OD, 338 OS

Based on the nomogram developed and presented by Reinier Stortelder of Eaglet Eye, the patient has a moderately high scleral shape asymmetry and also has a higher sagittal height differential at the chord diameter of the limbus. A decision was made to pursue a digitally designed freeform scleral lens.  We exported the ESP data as a .csv point cloud file and uploaded it into Gaudi software which resides on our desktop.  We designed an initial lens at 16.8 diameter, and set our initial central clearance at 280um. The lens design was uploaded to the EWS cloud hosted by EYEXY, where it was downloaded by the consultants at Valley Contax. Valley Contax used the Gaudi software to generate the manufacturing files and produced the lens according to our design.

When we received the initial lens, we delivered it to the patient, inspected the physical fit via slit lamp with NaFl, and had him back in about 10 days to allow time for the lens to fully settle.  At follow up we did a detailed sphero-cylindrical over refraction and did OCT imaging of central clearance, nasal, temporal, and inferior mid-peripheral clearances, and edge alignments.  We had a very nice haptic alignment heel-to-toe 360 OU. We were seeing mild temporal drift and based on OCT findings, we decided to make small enhancements to optimize our limbal clearance (optional details as follows: same sag, added -0.50D, reduced limbal clearance (LC) a bit Temporally, Sup-Temp & reduced LC inferiorly a bit more @ -200um, and then increased LC a bit nasally).

When we received the revised lens, we had the patient insert with NaFL. It had nice alignment as assessed via slit lamp, with nice central clearance, limbal clearance, and nice haptic alignment heel to toe 360. The patient was very pleased with the comfort and vision. We were very pleased with the result.