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| FEATURE CASE REPORT | ||||||
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*Click images for values |
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Right
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Note degree of regularity in the 3.00 mm central zone |
Left
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Note degree of irregular astigmatism in the central zone |
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The patient is a 53 year old white female presenting with poor distance and near vision 15 years after undergoing radial keratotomy in both eyes. It was not possible to verify her preoperative prescription. Her medical and family histories are unremarkable. She is not taking any medications. She does not exhibit any clinical signs of dry eye and shows no ocular signs of GPC or other eyelid anomalies. Uncorrected visual acuity is 20 / 80 and 20 / 200 right and left eye respectively. With a glasses correction of +1.75 - 0.75 x 085 and + 2.50 -1.00 X 045, she is able to see 20 / 20 and 20 / 30. However, she is not satisfied with the quality of her vision in spectacles and desires better vision near and far. Topography is noted in each eye. Right Eye Left Eye Note the degree of regularity in the central Note the degree of irregular astigmatism in the 3.0 mm zone central 3.0 mm zone. An attempt was made to fit the patient in 8.4 BC, +1.50 and + 3.00 Focus Night and Day contacts. Vision was fair with 20 / 25 distance and 20 / 70 near and the contacts were extremely comfortable, but the patient was most dissatisfied with lack of visual quality near and far. An attempt was made to fit the patient in aspheric rigid gas perms. Using a 9.6 diameter Boston Equalens, visual quality was greatly improved, but centration was an issue with the left eye. Comfort was also an issue, especially with the left eye. An attempt was made to fit the patient in 10.5 diameter Z-Wave RGP's in Boston XO. Vision was best of all the options, but patient was constantly bothered by lack of comfort in the left eye. It was thought that the interpalpebral design was just too bothersome. Indeed, the patient was also dissatisfied with having to wear glasses for near and didn't like the reduction in visual quality with monovision. An attempt was made to fit the patient in 14.0 diameter Z-Wave RGP's in Boston XO material using a bifocal design. Vision was crisp 20 / 16 and 20 / 20 right and left eye with 20 / 25 near vision. Comfort was best of all the designs and provided stable vision throughout the day. Patient needed some coaching on the nuances of insertion and removal with the bigger lens, but adapted well and has tolerated the lenses beautifully. Assessment: Stable Fit Observations: This is a classic example of not giving up on the fit. This patient had a multitude of problems, including overcorrection from previous radial keratotomy, visual variability, poor distance quality with near and far vision, and dissatisfaction with glasses. It is interesting to note that the patient did not want to wear reading spectacles even though she had previously been suffering from greatly reduced distance vision and had been tolerating readers for a 2 year period of time. Such a case represents a daunting challenge for any practitioner. This patient has been visually happy now for 2 months. To submit an article,
contact lens or surgical case case report, please email |
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| DOCTOR QUESTIONNAIRE ON POSTOPERATIVE CARE | ||||||
| s How do you diagnose dry eye in postrefractive patients? 1) Clinical signs, including shallow tear lake and punctate staining 2) Clinical tests, including Shirmers 3) Combination of all 4) Other 5) None of the above Please click here to answer the above poll. s |
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| REFRACTIVE EYE CARE NEWS | ||||||
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s Lasik enhancements - A comparison of lifting to recutting the flap. Elizabeth A. Davis, et. al. Ophthalmology: Volume 109: Issue 12 (December 2002) Pages 2308-2313. This retrospective
case-control study involved two hundred twelve consecutive eyes undergoing
a LASIK enhancement procedure at a single surgery location during a
5-year period. Outcome measures utilized were uncorrected visual acuity,
best-corrected visual acuity, refractive error, complications. While
there were no significant differences in early visual outcomes between
the two groups. At 1 year patients had significantly better uncorrected
vision if the flap was lifted rather than recut and the flap lift group
had a significantly more stable refraction at 1 year than did the recut
group. More |
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| SPOTLIGHT PROFILE | ||||||
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Dr. Hartzok's appreciative audience at our NYC Support Group Meeting. View Dr. Hartzok's presentation on RGP Lenses Following Refractive Surgery. Future Profiles to follow from Top Doctor Posters on our Bulletin Board: Greg Gemoules OD, David Hartzok OD, Grant Mason OD, W Trattler MD, Gregg Russell OD, Ken Minarik OD, Frank Holly PhD, Ophthinfo MD, James Salz MD, Clint Hoxie OD, Tracy Lynn Swarz, OD, Donald F. Ezekiel OD, Cornea Doctor MD, Steven Lee OD, Sam Omar MD, Alejandro Tirado OD, Demetrian Dornic MD, Ricardo Trigo MD, Arthur Epstein OD, Chris Marmo OD, Hollis Stavn OD, Eirit Yonatan OD, Paul Klein OD, Robert Bard OD, Neal A. Sher MD, Dan Reinstein MD, Jim Dillard OD, Gregg Feinerman MD, Steven Shum OD, Richard Bursua OD, Jason Jedlicka OD, Mark Ventocilla OD, Barrie Soloway MD, Carlton Chan OD, Jack Miller OD, Brian Boxer Wachler MD, Ken Maller OD, Joe B. Goldberg OD, Bruce Butts OD, Kraig Abe OD, Paul Blaze OD, Frank Goes MD, Bill Berke OD, David L. Davidson OD, Joe B. Collins OD, James Stevenot OD, Jeffrey Martin OD, Johnathan Christie, OD. s |
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| FEATURED POSTINGS from SE's BB | ||||||
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Welcome
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