Fig. 1 OD fit with NaF to show tear lens
Fig. 2 OS fit with NaF in tear lens
Diameter: 14.5 mm Assessment: Very little movement; centered; appropriate edge; good vision ** CIBA Vision has since renamed this lens to Air Optix® Night & Day®
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Due to extreme anisometropia and aniseikonia, DC admits not wearing his glasses that were prescribed approximately ten years prior. Habitual Glasses Prescription • OD: -9.00-5.00x135 • OS: -4.00-3.50x135; +2.50 Flat top bifocal The anterior segment examination showed the following signs: some corneal thinning (pachymetry: 448 µm OD, 406 µm OS), quite obvious Munson’s sign OU, a trace amount of apical scarring centrally OU with a Fleisher ring, Vogt’s striae OU, trace diffuse conjunctival injection, 1+ pingueculae nasal and temporal OU, <1 mm of neovascularization on the cornea 360° and 1+ central corneal staining OU. His puncta were open and without punctal plugs. His previous dilated examination was 6 months prior and was unremarkable, showing no additional ocular health concerns. His annual dilated fundus exam was scheduled for 6 months later. When fitting scleral lenses from this company, keratometry readings are less important data as the lens
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vaults over the cornea. The initial diagnostic lens was chosen based on a quick assessment of the profile of the patient’s cornea. This lens and a few others showed an inadequate fit. When fitting, non-preserved sodium chloride solution is used to fill the lens so that when inserted there are no air bubbles. Upon inserting the fourth lens, it was inserted with staining of the sodium chloride solution with a sodium fluorescein (NaF) strip so the tear lens between the cornea and diagnostic scleral lens would be more prominent for evaluation. The lens was allowed to settle for approximately thirty minutes. The patient was instantly impressed with both the comfort and the visual acuity once the overrefraction was determined. The same lens was used for the initial fit in the OS and also was a successful fit. • • • • • •
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OD: Jupiter® (Essilor Contact Lenses) Diameter: 15.6 mm Base Curve: 6.37 mm Power: -13.00 D Over-refraction: +6.25 D providing 6/7.5 (20/25) Assessment: No bubbles with adequate clearance of ~350 µm centrally and no touch peripherally; well centered; no conjunctival blanching. Subjective: Good vision; good comfort. OS: Jupiter Diameter: 15.6 mm Base Curve: 6.37 mm Power: -13.00 D