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Never too old, even at 83

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Damien Fisher & Mark Hinds

 

CM, an 83-year-old female and a long-standing patient at QUT Optometry Clinic, suffers from Fuchs’ Dystrophy. She is comanaged by a variety of ophthalmologic and optometric clinicians.

In 2006, she had a left full-thickness penetrating keratoplasty and IOL implant. In 2007, she was diagnosed with a left epiretinal membrane with pseudohole formation (Figure 1).

CLF 10 Fisher & Hinds Figure 1 - Web

Figure 1. OCT image of L macular epiretinal membrane and pseudohole

In 2009, she underwent a right lamellar endothelial keratoplasty that had complications and ensuing right trabeculectomy.

The graft was rejected and she currently takes Maxidex gtt mane and Hycor ung nocte for this in the right eye.

From 2012 to 2013, her spectacle visual acuity dropped from R 6/18 L 6/12 to R 6/38 L 6/30.

We offered her the option of fitting her left eye with a mini-scleral lens to vault the graft and corneal irregularity. Corneal sag was calculated by both topography and optical coherence tomography (OCT) using a five-line anterior raster scan. A suitable trial lens could then be placed on the eye to examine lens fit and over-refraction.

The final contact lens script was L 8.6/13.75/12.5/18.5/+7.00 (BCOR/haptic radius of curvature/OZD/OD/BVP). Visual acuity of 6/7.5 was achieved with slight distortions noted due to the epiretinal membrane.

Lens clearance was examined with slitlamp and OCT. The use of an OCT allows a quantitative analysis and is useful in tracking corneal thickness after lens wear (Figure 2).

Once a good fit had been obtained, she was trialled initially on four hours wearing time. This was gradually increased to eight hours. Progressive spectacle lenses were prescribed to use with the contact lens.

CLF 10 Fisher & Hinds Figure 2 - Web

Figure 2. Anterior OCT image of contact lens, lens clearance and corneal thickness measurements



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