The two photos below are of the left eye of a patient who suffered significant trauma to his body, face and left eye in a car accident. This patient’s upper left eyelid was severed from flying glass. His left cornea had numerous particles of glass which nearly perforated his cornea, but did create a purulent corneal ulceration. Two months ago reconstructive surgery was performed on this patient’s left upper eyelid. One month ago I fit this eye with a scleral lens to protect it from the environment and the blinking action of the eyelid. 7 days ago I refit this eye with a very thin gas permeable scleral lens made with a highly oxygen permeable material that is FDA approved for wear during sleep. Because this patient is unable to close his left eye completely, I asked him to wear this lens during sleeping hours as well as during the his waking hours. He has been wearing this lens all day while taking short breaks during the day to remove the lens, rinsing out his eye with saline solution, cleaning the lens and reinserting it. Look carefully at the photos below. The first photo was taken one month ago when I first met this patient and placed a scleral lens on this eye. Note the inflammation, mucous formations and the opaque, cloudy cornea. At the initial visit, this patient’s best corrected visual acuity was finger counting. The 2nd photo was taken yesterday. Note how much clearer his cornea is. In the 2nd photo you can see his pupil which is barely visible in the first photo. Also note the improved appearance of his upper eyelid in the 2nd photo. With this very thin highly oxygen permeable scleral lens, this patient’s corrected visual acuity is now 20/150. The oculoplastic surgeon who I share this patient with was as surprised as i was at the degree of improvement in such as short period of time. Three months before I met this patient, he was told by a very prominent eye specialist that this eye needed to be removed. Fortunately he and his family decided to obtain another opinion. This patient’s story, his eye and his scleral lens “journey” with me has to be one of the most unforgettable experiences of my career.
The Wavefront Scleral Lens
The corneal irregularities created by refractive surgeries, such as LASIK and RK, are responsible for ghosting, halos, starbursting, and loss of contrast sensitivity. These "higher order aberrations" may exist on both the anterior and posterior. With aberrometry, the defects of the entire optical system can now be corrected by a scleral lens.
Dry eye conditions are among the most challenging conditions faced by refractive surgery patients. With autologous serum, blood is spun down to plasma, forming an eye drop that helps rehabilitate the cornea.
See Dr. Boshnick and Dr. Morris Waxler (former FDA chief research scientist on refractive surgery) talk about bad LASIK
Optimum Infinite Gas Permeable Material
I am happy to announce that our Global Vision Rehabilitation Center will be designing and fitting all of our “high need” patients with the Optimum Infinite gas permeable contact lens material. The Optimum Infinite material is the most oxygen permeable material ever to be approved by the FDA. In addition, this newly FDA approved material includes a UV lens blocker. Now for the first time, with certain patients, wearing a scleral lens made with the Infinite material under extended wear conditions can be considered.
Last year we introduced an exciting piece of technology that has allowed us to custom design a scleral lens much more accurately. It is the SMAP 3D, which is a computer attached to a dedicated camera that allows us to obtain a 3 dimensional image of the entire front surface of the eye, including the cornea and the surrounding white portion of the eye (the sclera). Up until now there has not been any technology that would allow us to measure
the ocular curvatures outside the cornea. The SMAP allows us to do this.
EyePrintPro technology creates a scleral lens based on a mold of the cornea. The molding is accurate to 1 or 2 microns and fits perfectly because it exactly mirrors the irregularities of the individual corneal surface. The technology is well suited for post-Lasik, Keratoconus, RK, eye injury, and corneal transplant patients. Read More in this PDF about EyePrintPro Scleral Lens Technology