2 MAIN AREAS
- Extreme ectasia / Corneal RGP intolerance / End Stage
- Corneal Neuropathic Pain
- Corneal Hyperalgesia (plus or minus lacosamide depot Tx)
- Ocular Surface Disease
- Chronic Dry Eye
The argument for large diameter RGP contact lenses – Scleral and Mini-Scleral RGPs
- No corneal touch / insult
- Vault very proud /messy ectasias / PK – tilted grafts, graft host junction disease and ectasia
- Large footprint on sclera
- Stable with good centration
- Can not fall out (swimming / bungee jumping/surfing)
- No dust under lenses
- Big tear reservoir
- White eyes – in the absence of atopic and inflammatory eye disease
- No glare – well it is minimised depending on ectasia location relative to optic zone
- No ptosis – better for patients post graft with surgery induced lid damage
- Large corneal clearance = longer lens life = more wiggle room for keratoconus and ectasia progression in the absence of corneal cross linking.
Need to think and calculate in terms of Sag over a chord….. Use topography just to paint a picture and help determine severity.
Touch
Ideal
Too much
Landing Zone is a Tangent with alignment fit
Case – Bilateral extreme (early onset) keratoconus
- 18 yo male advanced keratoconus OS>OD
- BILATERAL Hydrops + neo + scarring
- OD: UAVA 6/CF+ & OS: VA 6/CF-
- CCT OD: 290um / OS: 280um
- Patanol bd OU.
Contact Lens Parameters
- Gelflex mini-scleral RGP in Harmony Plus material
- OD: 7.00/12.50/15.25/18.50/-7.25 CT 220um Sag 5857um (6/12=)
- OS: 7.35/12.50/15.25/18.50/-5.25 CT 220um Sag 6178um (6/15=)
Acute Hydrops in advanced keratoconus: