Another summary of a case we started in May 2015.
5/19/15 CRT screening: AR’s parents were concerned that her vision was getting worse and was referred to our clinic through a current patient’s referral. It was determined that she would be a candidate even though there was almost 2 Diopters of corneal astigmatism. I explained to her parents that she might need a dual axis lens.
5/26/15 CRT Consultation: AR has long beautiful lashes that sometimes get in the way of us taking topographies. Also, because she’s never worn contact lenses before, I knew that it would take time for us to get comfortable with her insertion/removal process. Her mom volunteered to help her get started by doing all of this.
We trialed diagnostic lenses on her eyes to demonstrate to AR and her parents how the lenses look/feel/handle. AR and her parents are committed to try to stop her myopia and signed up for our program.
6/2/15 Day of training and dispense: We started with training AR’s mom to insert and remove the lenses so that we can get up to speed faster with the actual molding of AR’s eyes. We knew that air bubbles upon insertion or occasional lens manipulation after they are inserted can cause variations to the results the next day. AR’s mom was up the the task and we confidently dispensed the lenses and scheduled a follow up the next day.
6/3/15 Day after dispense: AR’s vision was 20/60 and 20/50 the next day. AR came in wearing an older pair of glasses. Mom said it took about 30 minutes to insert the night before. There was some expected keratitis on both eyes. There was some irritation inferior from the lens removal process in the morning in the left eye.
I reassured the parents that the results are typical and to continue with the program. Patient will get more comfortable with the insertion/removal process and the insertion time will reduce and vision will improve. A 1 week follow up was scheduled.
6/9/15 1 Week follow up: Mom said that it was still time consuming with insertion/removal. There was not a consistent pattern that she could pinpoint if it was one eye that took longer than the other. AR was seeing 20/40 and 20/25. She came in without wearing any glasses. AR’s mom said that she had a new sense of confidence where she could see things in the distance in the car and point them out to her parents. AR had no complaints about her vision, except the occasional glare but we knew were on the right direction with this program. AR was dispensed a bottle of Ortho-K Thin. I told AR’s parents that I will consult with the lab to design a new pair.
6/14/14 Broken lens: AR’s father contacted me in the morning to tell me that the right lens dropped on the floor and it was accidentally stepped on amidst the anxiety. We ordered a new one on Monday morning and provided a spare from a prior lens design so that she wouldn’t miss a beat. A replacement lens was picked up on 6/16 in the PM and we were back on track.
6/30/15 2 week Post Dual Axis OD and 1 Month post CRT: We ordered a dual axis lens for her right eye and this is a 2 week progress report. Based on the maps from the last visit, the right eye needed more fine tuning and it was not centered correctly so we had to go with a dual axis lens. The left eye was doing great, so we didn’t have to make any big changes. AR’s vision was 20/30– and 20/20. We reviewed insertion/removal with mom and AR. We were getting good results, but wanted to slowly integrate AR into doing this herself. I consulted with the lab and a new pair was also ordered.
7/28/15 2 week f/u for the new OD and 2 month f/u for the OS: AR was seeing 20/30 for the right eye and 20/20 for the left. We did some training for AR today with insertion/removal. The topography maps looked fantastic. Mom reported that it was becoming routine and there was less anxiety with the insertion/removal program. She reported occasional dryness a few days out of the week where artificial tears or Ortho-K Thin was used. I consulted with the lab and they asked for another data point to make sure there wasn’t any variation of the results caused by insertion techniques.
8/13/15 1 Month f/u on dual axis OD and 2+ month f/u for CRT OS: AR was seeing 20/20 on each eye on this visit. There was no corneal keratitis and the topography maps still look well centered.
We are pretty close to going on the extended 3 month progress evaluations for AR. We plan to get another data point in 2 weeks to see if there is any variation to the fit and vision of the lenses. We also just plan to bring AR back to try to assist her with insertion/removal so that she can be independent by Fall Break.