Dr. Woo shares how sMap3D™ technology helped her provide comfortable, great-fit scleral lenses for a patient who had experienced declining vision for years.
“Even with glasses, the patient’s vision before was 20/100 in the right eye and 20/40 in the left eye,” said Dr. Woo. “The Latitude lenses gave her 20/20 vision in both eyes.”
The Visionary Optics team spoke with Stephanie L. Woo, OD, FAAO, FSLS, at the Contact Lens Institute of Nevada in Las Vegas about how the sMap3D and the Latitude scleral lens dramatically improved the vision of a patient with dense cataracts and irregular astigmatism.
“Learning more about scleral shape has shown us that everyone’s scleral shape is unique, and fitting scleral lenses is not as easy as many people think,” said Dr. Woo. “As I grew my specialty lens practice, I knew I had to stay up to date with the best technology.”
Read about how Dr. Woo used the sMap3D technology to custom-design scleral lenses for a patient with a high amount of astigmatism.
Case Study
The Challenge
A 79-year-old female presented to the clinic for a specialty lens consultation. She received a referral from her ophthalmologist, who had recently performed epithelial ingrowth repair on the right eye in January 2020. The patient had received radial keratotomy (RK) surgery in the 1990s, and she had seen quite well for about seven years before her vision rapidly declined.
For more than 20 years, she had been seeing her optometrist regularly and needing constant updates to her glasses. RK patients are notorious for fluctuating vision, so it is expected that these patients have multiple pairs of glasses.
The patient’s entering visual acuity without glasses was 20/400 in the right eye and 20/70 in the left eye. Her best corrected vision with glasses was 20/100 in the right eye and in 20/40 in the left eye. Both eyes had “double” vision with and without correction.
Slit lamp examination revealed RK scarring in the patient’s right and left eye. The right cornea contained five interrupted sutures due to the epithelial ingrowth repair. Both eyes also had irregular astigmatism and more than three nuclear sclerotic cataracts. Vitreous and retina health in each eye was unremarkable.
The Solution
Having the sMap3D suggest a starting diagnostic lens is huge. It streamlines the process and takes the guesswork out of selecting an initial lens. Also, I love the images – it is great to be able to show the images to patients and explain their exact eye shape. Excellent patient education, tool
For this patient, we performed an sMap3D scan on both eyes. Due to her dense cataracts and her high amount of irregular astigmatism, the vision potential seemed poor, but with the scan information, we fit the patient into diagnostic Europa scleral lenses:
Diagnostic Europa scleral OD: 44.00 BC / 4470um sag / -1.00 sph / 16.0 OAD
SCOR -2.25-1.50×009; (20/30)
Central clearance about 400um. Slight blanching at 3’ and 9; but good centration and comfort; over ks showed no flexure.
Diagnostic Europa scleral OS: 45.00 BC / 4560um sag / -1.50 sph / 16.0 OAD
SCOR -2.75-2.25×166 (20/30)
Central clearance about 400um; slight blanching at 3’ and 9’ but good centration and comfort; over ks showed no flexure.
The Results
The patient was thrilled with her vision in the diagnostic lenses, so we decided to proceed with the scleral lens order. Due to the high amount of internal astigmatism, I highly recommended the Latitude design to align with her sclera and provide great centration. She decided to opt for the Latitude lenses for both eyes. About two weeks later, the patient arrived to pick up her new Latitude lenses:
Latitude scleral OD: 37.37BC / 4716um sag / +3.33 -1.00 x009 / 16.5 OAD
Central clearance about 240um. No significant over-refraction found. 20/20 vision.
Lens well aligned with the sclera; great central and limbal clearance.
Latitude scleral OS: 38.37BC / 4678um sag / +2.38 -2.25 x166 / 16.5 OAD
Central clearance about 200um. No significant over-refraction found. 20/20 vision.
Same result as OD, great fit and comfort for patient.
The patient will be following up in one month, and she is incredibly excited with her newfound vision. I never would have guessed that any lens would yield such great vision in this particular case. Her irregular astigmatism, corneal scarring, sutures, and cataracts were all components that usually lead to degraded vision. The Latitude lens completely exceeded my expectations and made me look like a hero to this patient!
Visionary Optics has been an incredible lab to work with from Day 1. The lenses they design are incredibly well-made, and their customer service is 5-star. The sMap3D has brought my practice to another level. Patients are receiving premium lenses and also learning about their unique eye condition in a way they’ve never experienced before. The consultants are also fabulous. It is easy to send the sMap3D data to VO, and the consultants are excellent at designing lenses.
