August 2008




Tracking eye health with one healthy eye

by Matt Young EyeWorld Contributing Editor 


Case report presents pearls

A scleral lens could be an option for patients with one good eye Source: Robert K. Smith

Eye health clearly is important for vision care specialists, but it’s even more critical in relation to patients who already have one blind eye. Such patients often may be younger, and preserving vision in the remaining eye is of utmost importance. One recent case study yields insight into doing just this. The 38-year-old patient wasn’t doing a good job taking care of herself. She was a smoker with a history of alcohol abuse. What’s more, contact lens wear was getting dangerous. “Clinical examination showed 3 to 4 mm of well-perfused neovascularization with associated pannus in the superior quadrant of her cornea and 1 to 2 mm of peripheral neovascularization in the remainder of the cornea. Mild superficial corneal epitheliopathy was present,” wrote lead study author Muriel Schornack, O.D., Department of Ophthalmology, Mayo Clinic, Rochester, Minn. The study was published in the December 2007 issue of Optometry. Corrective action Dr. Schornack was meticulous in the analysis of the patient and suggested an array of options to both correct her vision and keep her right eye—the one intact—healthy. The patient had undergone a post-traumatic lensectomy in her right eye and enucleation of her left eye in her early teens. She wore a Durasoft 3 (CIBA Vision, Duluth, Ga.) in her right eye and only wore spectacles for occasional tasks. “Her current contact lens was over a year old and was covered with both lipid and proteinaceous deposits,” Dr. Schornack wrote. “The patient reported that she typically wore the lens for up to 16 hours daily and occasionally fell asleep while wearing the lens.”

Dr. Schornack first discussed the risks to the patient’s healthy eye, including chronic hypoxia, smoking, and lack of protection. Dr. Schornack also reviewed contact lens wear options that would reduce her risk. First, Dr. Schornack suggested a rigid gas-permeable lens, but she was fervently opposed to the idea, having tried such a lens in the past without success. “A silicone hydrogel lens would also have provided much better oxygen permeability than her current lens,” Dr. Schornack wrote. A +6.00 DS Focus Night and Day lens (CIBA Vision) was tested, but her visual acuity was only 20/200 with the lens alone. “The patient was not satisfied with that level of vision and did not want to be completely dependent on spectacles worn over her contact to provide adequate visual acuity,” Dr. Schornack noted. Next up was a trial with the Precision UV lens (CIBA Vision). A lens (8.4, +10.00, 14.5) was inserted. “With the contact lens alone, the patient achieved 20/60-2 visual acuity,” Dr. Schornack wrote. “With a +4.25 DS over-refraction, the patient had an acuity of 20/30-2. The lens centered well, covered the cornea completely, and moved appropriately.”

Dr. Schornack also recommended no more than 12 hours of wear daily. She also was given new spectacles and an additional prescription for spectacles that entirely corrected her refractive error. “At the patient’s follow-up visit two weeks later, she reported good vision with the contact lens/spectacle combination,” Dr. Schornack wrote. “She found the contact lens to be more comfortable than her original lens. Corneal findings were unchanged, but the patient actually achieved slightly better visual acuity (20/30+2) with the contact lens/spectacle combination than she had with either spectacles or contacts alone at the initial examination.”

In the future, more oxygen permeable lenses could increase a vision care practitioners’ options for such patients. A scleral lens also might be an option as it would decrease lid sensation with a larger diameter, potentially allowing for more comfortable wear, Dr. Schornack noted. However, it should be noted that another recent study reported that the number-one cause of microbial keratitis is contact lens wear. The study, published in the January 2008 issue of Cornea, was performed “to establish the risk factors, causative organisms, levels of antibiotic resistance, patient demographics, clinical presentations, and clinical outcomes of microbial keratitis at a tertiary hospital in Australia,” according to lead author Matthew Green, M.B.B.S., Gold Coast Hospital, Southport, Australia.

For the study, 253 cases of microbial keratitis were examined in 231 patients, and 22% demonstrated that contact lens wear was a risk factor. This was followed by ocular surface disease (18%), ocular trauma (16%), and previous ocular surgery (11%). Given that microbial keratitis can result in vision loss as a result of such complications as corneal scarring or perforation, contact lens usage in patients only with one eye should be considered only with a very healthy amount of concern.

Editors’ note: Drs. Schornack and Green have no financial interests related to their studies.

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