These are 2 photos of the same keratoconus eye. The first photo is the eye without a scleral lens. The second is with a scleral lens.
The photo below is of an Eye Print Pro Scleral lens on an eye that suffered 2 separate retinal detachments within a 4 month period requiring 2 separate vitrectomy surgeries (surgeries to remove the interior “gel” within the eye known as the vitreous and replacing it with saline). In addition, cataract surgery was done after the first vitrectomy. Several months later, the intra-ocular lens dislodged into the posterior chamber of this eye requiring emergency surgery. For this reason, a 2nd vitrectomy was done along with a retinal surgical repair procedure known as a scleral buckle. Eye Print Pro Scleral lens technology allows us to make a lens from an impression of the front surface of the eye. A very gentle impression material known as Polyvinyl Siloxane is placed on a plastic holder which is then placed on the front surface of the eye and under the eye lids. After a few minutes, the plastic holder with the eye mold is removed and sent to our laboratory where a scleral lens matching the exact contour of the cornea and the white portion of the eye is made. This technology is designed to help patients whose ocular surfaces have been extremely altered due to disease and surgery see clearly once again. In the case of the eye shown in this photo, without the Eye Print Pro, the vision in this eye is less than 20/800. With the Eye Print Pro lens this eye is corrected to 20/20 vision without any distortions. The 2nd photo shows how the impression material appears on the eye. The procedure is fast and painless.
This little girl and her family visited us from Argentina. Last year she suffered a penetrating ocular injury to her left eye which resulted in a torn perforated cornea and significant damage to the internal ocular structures within this eye. She underwent cataract and vitrectomy surgeries in her left eye and in addition retinal surgery for a retinal detachment. Repair of the torn cornea required significant suturing. When she entered our office for the first time the visual acuity in her damaged eye was hand motion at just a few inches from her eye. Because of the irregular cornea and exposed sutures on the corneal surface, we are fitting this little girl with a GVR Scleral lens. It is our hope that this lens will protect the healing cornea and neutralize the visual effect of the distorted cornea. In the near term, we expect this lens to improve her visual acuity to about 20/600 or better and in addition to provide her with some peripheral vision. In the lower left photo you can see the scleral lens over the traumatized cornea. In the lower right photo you can see the scar tissue along with the corneal sutures holding the cornea together. Many months (and possibly years) of exams, office visits and lens changes will need to be done before we can know the final vision her left eye will be capable of.
One year ago this patient suffered a blunt trauma to his right eye. This resulted in a severely damaged cornea and a hemorrhage within the eye. Shortly thereafter, his right eye underwent a partial corneal transplant known as a DSEK. In addition, a vitrectomy was done which involves the surgical removal of the vitreous gel within the eye (done to clear away the blood). This was followed by cataract surgery several months later. Due to the ocular trauma and the multiple eye surgeries that were done, this eye was left with no iris and therefore no pupil. In addition, the transplanted cornea while healthy and clear was extremely distorted. Several weeks ago, in an effort to restore vision to this severely damaged eye, we fit this eye with a GVR Scleral lens. Before placing the scleral lens on this eye, it became necessary to provide this eye with a new pupil. This was done by first placing an opaque black soft lens with an 8 mm pupil on the damaged eye. Over this blackened soft lens we placed our specially designed scleral lens. Without this soft/scleral lens combination, this patient’s best corrected visual acuity is less than 20/200 with significant distortions. With this specialty lens combination this patient is able to see 20/60 without any distortions. The purpose of fitting this eye with a scleral lens was to correct the distorted vision created by the distorted transplanted cornea. The photo below is of me along with this very special patient. Below left is a photo of his right eye without any corrective lens. Note that there is no iris and no pupil. The lower right photo is of the blackened soft lens with the clear pupil. Over this lens can be seen the gas permeable scleral lens. This patient is able to wear the lens combination comfortably with all day wear.
This image shows a scleral lens over a extremely thin (120 microns thick) keratoconic cornea. While this eye never underwent LASIK or any other type of surgery, the purpose is to show how a well fit scleral lens can safely vault over a thinned out cornea. The top 2 lines represent the front and back surfaces of the scleral lens. The thinned out grey structure is the cornea. This patient has been able to successfully wear her scleral lens for the past 3 years. I have never seen a cornea perforated by a scleral lens.
This is a photo of an eye that underwent Radial Keratotomy (RK) about 30 years ago. Fluorescein dye was instilled on the ocular surface to make the RK incisions more visible. Note the yellow-green dye within the deep RK incisions. This tells you that these incisions never closed. In addition, virtually every post-RK cornea is irregular and dry. Last year this eye underwent cataract surgery. During the surgery, the vertical incision extending downward from 12:00 ruptured forcing the cataract surgeon to suture the open wound. Note the increased staining in the superior portion of this cornea. Without correction, this patient not only has poor vision with this eye but also extreme discomfort (burning, dryness etc.). This patient is now wearing a scleral lens on this eye which is not only protecting this compromised eye from the environment and the blinking action of the eyelids but also providing this patient with clear, stable vision once again. Scleral lenses are now the “standard of care” when it comes to treating post-refractive surgical corneas. That is corneas that have been altered by LASIK, Radial Keratotomy and a host of other harmful, unnecessary surgeries.
The images below are of the same eye that underwent 2 separate Radial Keratotomy surgeries in the 1980’s followed by 2 separate LASIK surgeries about 15 years ago. The first is a photo showing the open RK incisions which look like the spokes of a bicycle wheel. The circular line going around the edge of the cornea is the LASIK flap border. A special dye and filter were used to highlight the corneal defects and make them more visible. These open wounds are permanent and will never close. The 2nd image was taken with a technology known as Optical Coherence Tomography (OCT). This image shows a cross section of the cornea with a scleral lens over it. The 2 curved lines at the top of this image represent the front and back surfaces of the scleral lens. The thick grey irregular structure is the cornea. Look carefully to the right side of this image and you can see the deep, wide open RK incision just below the scleral lens. The last image is a 3-D computer generated image that shows the irregularity of the corneal surface. The red colors represent steep elevations along the corneal surface while the green and blue areas represent corneal depressions. The scleral lens replaces the irregular cornea as an optical surface. In other words, the scleral lens makes the elevations and depressions along the corneal surface irrelevant. This patient is able to see clearly (20/20) and without distortions with the scleral lens in place. Without the scleral lens this patient’s visual acuity is less than 20/800 and cannot be corrected with eyeglasses or conventional contact lenses.
The 3 images below are of the same eye. 20 years ago this eye underwent corneal transplant surgery. For many years this patient was unable to obtain functional vision with this eye due to a high degree of corneal distortion. 3 years ago, in an effort to make the corneal more spherical, her corneal surgeon decided to perform a modified RK surgery on the transplanted cornea. The result of this RK procedure was continuous pain along with a decrease in the patient’s visual acuity. In the first image below, you can see the open RK incisions. A special green dye and filter were used to make this easier to see. In the 2nd photo, which is a profile view, you can see the open RK incision in the lower portion of the transplanted cornea. The 3rd image is a cross section of this cornea taken with a technology known as “Optical Coherence Tomography”. The top 2 curved lines represent the front and back surfaces of the scleral lens. The thick curved grey structure below the scleral lens is the transplanted cornea. Look carefully to the left side of this image and you can see the open RK incision that extends half way through the cornea. With this scleral lens the patient is able to see clearly and comfortably for the first time in 20 years.
This patient had corneal transplant surgery in both eyes a number of years ago. For many years he was unable to see clearly with either eye glasses or contact lenses. Two years ago his left eye rejected the transplant and he needed to undergo another corneal transplant operation. Earlier this year we fit this patient with GVR gas permeable scleral lenses which are allowing him to see 20/25 in his right eye and 20/30 in his left eye. He is able to wear both lenses comfortably all day with stable vision. Because his left eye underwent 2 corneal transplant surgeries, he will need to be monitored very carefully with periodic examinations for several years to come.
What you are seeing in this photo is the third corneal transplant that this eye has had to endure. There is an ulcer in the center of this cornea that has not healed despite many weeks of treatment with antibiotics and other medications. You are viewing a corneal transplant that is in the process of being rejected. The purpose of posting this photo is to enlighten those viewing this image that rejection and infection will always be a risk factor in corneal transplant surgery. This type of eye surgery should never be taken lightly. All non-invasive technologies should be considered before corneal transplant surgery is done.
