Download Balancing Sight and Safety with a Non

Balancing Sight and Safety with a Non-Complaint Specialty Lens Patient
Kelly Voltz, Eva Duchnowski, OD
INTRODUCTION:
Contact lenses are a safe and effective method of visual correction and
are a well-documented treatment option for corneal disease.1 Recently,
there has been a resurgence of specialty lenses due to the evolvement of
lens materials and oxygen transmissibility capabilities. Despite their
improved clinical performance, specialty lenses’ complexities and
possible adverse effects are not yet well understood. Existing literature
provides some cases of infection, while hypoxia and inflammation have
rarely been reported.2 This case study discusses complications in a noncompliant wearer of modern, high Dk specialty lenses.
DISCUSSION:
According to a recent Centers for Disease Control and Prevention study,
nearly 33% of contact lens patients report going to the doctor for red or
painful eyes due to contact lens wear.3 Contact lenses have physiological,
metabolic, and anatomical effects on the eyes, which can manifest on
the eyelids, lacrimal tear film, conjunctiva and throughout all layers of
the cornea.4 In 1995, Tan et al. reported on a total of 517 eyes wearing
low Dk scleral contacts; they found the most common complications to
be neovascularization (13.3%) and corneal edema (7.4%) secondary to
corneal hypoxia. The most common causes of corneal hypoxia are
sleeping in lenses and prolonged wear without removal. It is important
to provide patients with adequate introduction and instructions on
handling, disinfection, and storage of specialty lenses to maintain proper
lens hygiene and protect the anterior ocular surface.
CASE:
CORNEA FOLLOW UP VISIT
INITIAL ENCOUNTER
The patient continued to wear scleral lens OD despite doctors
recommendations of discontinuing for corneal safety. Corneal evaluation
revealed progressive deep stromal neovascularization into the visual axis
ultimately decreasing the best-corrected visual acuity of the right eye.
A 36 year-old Caucasian female with advanced bilateral keratoconus of
unknown duration presented for contact lens evaluation. The patient was
previously fit in corneal scleral lenses OU with appropriate parameters
according to manufacturer fitting guides and practitioner examination. The
patient was lost to follow up for four years until she presented to clinic due to
loss of the left lens.
Ocular History:
Medical History: Asthma
Keratoconus OU, unknown duration
Medications: None
Dacrocystitis OS, one time occurrence, no current complications
Corneal Neovascularization OU secondary to hybrid lens non-compliance
Visual Acuity:
OD c: 20/60
OD s: 20/400
OS c: Unknown, lens lost
OS s: 20/400
Current Contact Lens: ART Optical SoClear® corneal sclerals
OD: -17.00sph BC 6.15 Dia 14.0 Material XO2 Clear Edge 0.5 Flat
OS: -12.50sph BC 6.03 Dia 14.0 Material XO2 Clear Edge STD
Corneal Examination:
Topography:
3
20/40
20/60
20/80
NON-COMPLIANCE INDUCED COMPLICATIONS OD:
15
Missed
appointments
7
Missed referrals to
corneal specialists
Cornea OD Cornea OS
Initial Exam Clear
3 years later 4mm
Clear
4mm
1 year later
4mm*
4.5mm
4 years later 6mm
5mm*
1 year later
5mm*
8mm
4
Years lost to follow
up at one time
Non- Compliance
• Not applicable: no lens wear
• Overwear hybrid lenses OU
• Sleeping in lenses; not filling lenses
• Overwear of hybrid lens OD
• OS lens lost
• Filling scleral lens with generic
Multi- Purpose Solution
• Continues to wear 5 year old scleral
lens OD against doctor's advice
*ghost vessels
CONCLUSION:
SCLERAL LENS FITTING FOR FUTURE VISION OS:
Contact lens compliance plays an important role in the ocular health and
visual outcome of a specialty lens patient. Encouraging specialty lens
wearers to improve ocular hygiene behaviors is a necessary practice that
directly contributes to the longevity of a healthy ocular surface and
overall visual success. When patients fail to comply with doctor
recommendations concerning contact lenses, the results on vision can
be devastating.
Successful lens fitting of the left eye achieving 20/40 vision
REFERENCES:
1. Suchecki, J. K., Donshik, P., & Ehlers, W. H. (2003). Contact lens complications. Ophthalmology Clinics of North America, 16(3), 471-484.
2. Walker, M. K., Bergmanson, J. P., Miller, W. L., Marsack, J. D., & Johnson, L. A. (2016). Complications and fitting challenges associated with
scleral contact lenses: A review. Contact Lens and Anterior Eye, 39(2), 88-96.
3. Cope, J. R., Collier, S. A., Rao, M. M., Chalmers, R., Mitchell, G. L., Richdale, K., ... & Zimmerman, A. (2015). Contact lens wearer demographics
and risk behaviors for contact lens-related eye infections—United States, 2014. MMWR Morb Mortal Wkly Rep, 64(32), 865-870.
4. Collier SA, Gronostaj MP, MacGurn AK, et al. Estimated burden of keratitis—United States, 2010. MMWR Morb Mortal Wkly Rep
2014;63:1027–30.
5. Tan, D. T., Pullum, K. W., & Buckley, R. J. (1995). Medical applications of scleral contact lenses: 2. Gas-permeable scleral contact lenses. Cornea,
14(2), 130-137.
3
Emergency
exams
Management:
A
B
Keratoconus OU: Patient was advised to discontinue OD lens wear and was
refit into new scleral lens OS Proper lens care and handling was reviewed with
patient in detail as she was not filling lenses prior to insertion
Corneal Neovascularization OD: Patient educated to discontinue wear of lens
OD, referred to corneal specialist for corneal evaluation
Lens Parameters: EUROPA® Scleral Lens
OS: -13.75-2.00x007 BC 6.25 Dia 18.0 OZ 9.0 Material Boston XO
CT 0.35 Central Vault 6202 Peripheral Curves 6.11/2.0 10.0/1.0 15/0.5
After receiving a new OS lens, patient once again was lost to follow up .