Onefit Spotlight Case Report: Improving Comfort of Scleral Lenses
By Linh Chieu, OD
State University of New York, College of Optometry’s Cornea and Contact Lens Resident, 2020-2021
State University of New York, College of Optometry, Class of 2020
A 30 year old male presented for contact lens evaluation with moderate keratoconus OD and mild keratoconus OS. The patient has a history of crosslinking OD, strabismus surgery at age 1, and a longstanding right exotropia causing headaches and eyestrain. He habitually wore soft contact lenses OU prior to transitioning to a corneal RGP OD lens for improved vision.
In 2016, due to RGP intolerance, the OD eye was re-fit with a scleral lens. He has struggled with overall lens awareness, discomfort, and poor VA resulting in only 4 hours of wear every other day. Despite this, he remains highly motivated to continue wearing his scleral lens as it dramatically minimizes his eyestrain and headaches.
Current scleral lens OD, provides 20/80-1 V/A. Upon initial evaluation the Landing Zone (E) appeared well aligned to the scleral asymmetry 360⁰. Patient states he still has lens awareness and discomfort.
Upon closer evaluation, leakage was observed, and patient’s comments of lens discomfort were confirmed despite multiple toric haptic alterations to the lens. Mild stromal thinning OD>OS consistent with Keratoconus was observed, but otherwise the lens and eye appeared unremarkable.
Oculus Pentacam was utilized for profilometry mapping and CSP imaging revealed an extremely irregular scleral profile indicating a need for a quadrant specific landing zone (E) to better align to the eye’s scleral asymmetry.