Solving Centration & Rotational Stability Challenge

Courtesy of Dr. Aaron Wolf, OD, FAAO, FSLS, FIAOMC, Austin Optometry Group, Austin, TX

Patient: 24 WF, with keratoconus OU, post corneal collagen cross-linking OU and severe HOAs OU.

Minimal scleral toricity evident on corneo-scleral profilometry from both Eaglet Eye Surface Profiler (Netherlands) and Oculus Pentacam AXL WAVE with CSP Pro (Germany) showing less than 100um of scleral toricity at a common 15mm chord, with no prominent geographical features.  Due to the severe HOAs of ~2.0um HOA RMS (normal being 0.3um and severe being 0.6um), there was critical need for custom HOA correction to restore maximal quality of vision. However, with less than 100um of scleral toricity at the center of the scleral lens (SL) landing zones there would be too much risk of likely rotation in a standard commercial SL design.

Instead, to assure the greatest chance of rotational stability and optic zone centration, the Gaudi Hypergeometric SL with freeform landing zones was chosen as the best option for the lens to closely follow any geographical elevation changes available.  By adjusting the Fit Factor down to 10, and using high quality, high reliability profilometry maps, a perfectly centered and rotationally stable lens fit was achieved, thanks to the Gaudi practitioner-based desktop design software.  From here, custom HOA optics from Ovitz reduced the HOAs by almost 10 times! This patient now enjoys 20/20 vision out of this eye with no perceivable glare around lights and is free to live their life unencumbered by the stress and disruption that keratoconus so often causes. 

Figure 1. OD GAUDI QS

Figure 2. OD GAUDI Design 3D

Figure 3. OD GAUDI Design Meridian View

Figure 4. OD HOA Summary Comparison (OVITZ xwave)

Figure 5. OD HOA Wavefront Map Comparison (OVITZ xwave)

Figure 6. OD Profilometry Pentacam CSP Pro

Figure 7. OD Profilometry Eaglet Eye ESP