History

This is one of our interesting specialty contact lens cases of a female, age 28. She presented with a history of Marfan syndrome and subsequent lens dislocations in both eyes for which she received anterior chamber intraocular lenses as a young child. Due to the anterior chamber IOL’s, both eyes developed increased intraocular pressure which was managed with bilateral iridectomies.

She also reports three separate occasions of experiencing retinal detachments in the Left eye, after which a vitrectomy was performed. Unfortunately, she later suffered a branch occlusion which resulted in dramatic loss of vision in the Left eye.

Topography

After consultation, we decided to proceed with Rigid Gas Permeable lenses. The image below shows the Medmont E300 topography map of the right cornea.

Medmont topography of the right eyeThe next image shows the Medmont topography map of the left cornea.

Medmont topography of the left eyeThe left cornea presented with an unusual ectatic point at the 5 o’clock position due to the multiple surgeries the left eye had undergone, which made the lens design a bit more tricky.

Designing the Lens

Based the Medmont E300 composite maps I designed two EyeSpace Bespoke Bitoric Gas Permeable lenses using the EyeSpace contact lens software. The video below shows EyeSpace with the completed lens designs which were ordered from the lab through the software’s build in Shopping cart.

Calculating the Bitoric lens ends up easy using EyeSpace. Using the corneal topography data and entered spectacle prescription, EyeSpace automatically calculates the correct Back Vertex Power (BVP) of the lens.

The Optical Analysis Tab shows the calculated Ideal Back Vertex Power, Vertex Spectacle Power and Tear Power over the 180 degree meridian of the cornea.

Image of EyeSpace Optical Analysis Page

Dispensing two weeks later

The Sodium Fluorescein images show the 1st pair of virtually designed EyeSpace Bitoric lenses fitted on the right eye.

The next set of images shows the Sodium Fluorescein images of the 1st pair of virtually designed EyeSpace Bitoric lenses fitted on the left eye. Considering the irregularity of the cornea, they look really good.

The Right Eye slit lamp images show the complete new optical system comprising of the iris-claw anterior chamber intraocular lens and the EyeSpace Bespoke gas permeable lens fitted on the cornea. Notice the iridectomy at the 12 o’clock position to facilitate the flow of aqueous to the anterior chamber.

The lens parameters of the lens fitted:

EyeSpace Bespoke BC 8.25 x 7.75 / OZ 6.6 / Toric aspheric AC / Diam 9.60 mm.

BVP: -1.00 / -2.75 x 180.

BCVA: 0,80.

The Left Eye slit lamp images show the angle-supported phakic intraocular lens and the EyeSpace Bespoke gas permeable lens fitted on the cornea.

The lens parameters of the lens fitted:

EyeSpace Bespoke BC 8.20 x 7.65 / OZ 6.6 / Toric aspheric AC / Diam 9.40 mm.

BVP: -5.75/ -3.00 x 180.

VA: 0,25.

Follow Up

After contact lens handling and cleaning instructions, the patient is sent home with the lenses and a two week follow up appointment is scheduled.

More information

For more info on EyeSpace products visit www.EyeSpace.com.au.