EyeWitness Summer 2010 - 31

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Reader Response
I don’t believe you should settle for less comfort. The fact that your patient is wearing his lenses despite his decreased comfort level shows his commitment to this option. In my experience there is always an explanation for RGP comfort issues. With this type of complaint, I would do the following in this order: 1. Obtain a corneal topography. I think that this will provide you with a wealth of information. Sometimes, large quantities of astigmatism are found in small areas. Remember, when we take “K” readings, we are measuring a small area of the central cornea (roughly 3mm). Knowing how large the astigmatic “bowties” extend may solve the problem for you. Sometimes, they extend over a large area of the cornea, and other times they are compact (within a 6mm to 8mm zone). If they are compact, then you may need to simply decrease the diameter of the RGP to extend just beyond the “zone of astigmatism”. This will, of course, decrease the sagittal depth, and therefore allow the lens to align better on the cornea. If this solves the problem, then you need not worry about SAM/FAP and you should note an increase in vision and comfort. If the “bow-ties” are large, then flatten the BC of the lenses until an acceptable fit is reached, keeping in mind SAM/FAP. 2. If number 1 didn’t work, then I would be curious about the palpebral conjunctiva. Just because someone has no known seasonal allergies, doesn’t mean that there isn’t an underlying eye allergy that is aggravated by a mechanical irritant such as a contact lens. If signs of seasonal allergies are present, then I would address that issue and resolve it before reintroducing contact lenses. 3. If 1 and 2 fail, then check the quality of the patient’s tears. If they are found to be deficient, then you might try switching to a material with a lower wetting angle and encourage the patient to use preservative free artificial tears. 4. If all else fails, then the patient may be RGP intolerant. I have had just a hand-full of these cases, but they do exist. It is apparent that he wants the vision that a RGP offers. If this is the case, I would recommend a corneoscleral over a hybrid lens. Hybrids tend to tighten over time and I usually see an increased incidence of neovascularization with this lens style. The other issue is the patient’s age and extracurricular activities. You mentioned that he participates in karate, a high impact sport. Young males typically have poorer hygiene than young females. For this reason, a corneoscleral will offer a more simple care regimen for this young man. Additionally, protecting him from neovascularization will increase his chances of being a LASIK candidate when he comes of age. As far as karate is concerned, these larger lenses will be less likely to pop out of his eyes while practicing. I hope that this letter offers you a different viewpoint from your own. Thanks much, Corey Dickson, COA, ABOC, NCLEC, RLC, CLO, CLT Refractive Center Coordinator/Contact Lens Specialist Tulane University Medical School Department of Ophthalmology

Stay Tuned
The summer edition of EyeWitness does not include a new case history. Stay tuned for a new interesting case in the Fall edition of EyeWitness. Please feel free to continue to send responses to this case or the case presented this past Spring to ledonna@cox.net. The EyeWitness Team loves hearing from the readers!

EyEWitnEss summEr 2010

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EyeWitness Summer 2010

Table of Contents for the Digital Edition of EyeWitness Summer 2010