Very exciting and fun case today!
We saw a very special glaucoma patient today. Patient’s history: She has always had good eyes and never any eye issues until a few years ago. She was diagnosed with glaucoma, and was put onto eye drops, but her condition quickly declined. The left eye ended up getting so severe, that she is legally blind in that eye. She can only see hand motion in the left eye. Since there is no cure for glaucoma, she will not be able to regain any vision in the left eye unfortunately.
The right eye also has severe glaucoma, but luckily, she still has vision in that eye. She has a tube shunt, which you can see in the photo. This tube shunt is used for patients with severe glaucoma. The tube helps to drain fluid out of the eye, which decreases the pressure in the eye. Decreased pressure is the only treatment for glaucoma at this time. The tube helps to keep her eye pressure low.
Since she only has vision in one eye, we have to tread VERY lightly with this case. Any patients who only have vision in one eye must be treated with extra caution because if anything happens to the good eye, they could go blind.
Over the last few months, her primary care doctor noticed that her ocular surface had become excessively dry. This was causing the patient to have eye pain, redness, foreign body sensation, sensitivity to light, and blurred vision.
With the best glasses prescription, she could see about 20/50 a few months ago, which is still considered functional vision. However, her ocular surface has become more and more dry, which has caused all of the above symptoms to worsen. When she saw me a few weeks ago, she was only seeing 20/400, which is very poor vision. 20/400 vision is the big E at the eye doctor’s office, which is very poor vision.
To further complicate things, she has a very large tube shunt that you can see in the photos. A normal scleral lens cannot vault over this area, so a more custom lens must be used to create a device that is safe for the eye. If you put a regular scleral lens on the eye, the tube creates a speed bump, so the scleral lens cannot align with the white part of the eye (the sclera) properly. Additionally, if a scleral lens presses down too hard on the tube, it can prevent the tube from draining properly, which could cause a spike in her eye pressure, which could be detrimental to her eye health.
Another issue with a scleral lens is that the pressure of a poorly fitting lens could rub the tissue on top of the tube (Called the conjunctiva), and erode that tissue. That would cause a further complication and she would require another glaucoma surgery.
To provide the safest option for this patient’s delicate eye, we decided to try the EyePrint Prosthetic, which is a very custom scleral lens.
We took an impression of the right eye and had the EyePrint team was able to use a 3 D scanner to design and fabricate an EyePrint Prosthetic.
Today, we dispensed the EyePrint device, and she felt immediate relief! Because this type of lens is filled with liquid, it can act as a liquid bandaid, protecting the eye from the outside world. The lens was fitting perfectly too. Since she has the tube shunt, we have to use a special instrument to view the shunt and the tissue between the tube and the EyePrint very carefully. The goal is about 300 microns of tissue between the tube and the contact lens, so this looked great today.
With an over-refraction of +3.75, she achieved 20/30 vision! She was incredibly excited about how well she could see. For the next few weeks, I instructed her to get the stronger power of over the counter cheater reading glasses so that she can see. We will remake the lens with a new power once I see her back and confirm the EyePrint device is fitting well.
Very exciting case, and thank you to Dr. Lin and Dr. Saboori for thinking of me to help.
