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Case Study: Scarred Cornea fitted with a prosthetic soft lens

Miss Tanya Moore completed her Baccalaureus in Optometry in 2013 at the University of the Free State. She is currently practicing at Specs-Savers, Greenacres Link in Port Elizabeth.

Introduction:

I am elated to share the story of how we restored a man’s confidence, who had been living with a very noticeable corneal scar for twenty-two years.

Initial consultation and history: 2nd January 2019

When Mr. Oosthuizen walked through my door, the first thing I noticed was his completely opaque left cornea. It was particularly noticeable because his normal (right) iris colour was dark brown. Thus the contrast between his healthy eye and his injured eye was very high.

Mr. Oosthuizen suffered a severe eye infection with corneal involvement, that eventually lead to the opacification of his cornea. The details of how it got to that point, is vague, as it happened 22 years ago.

It left Mr. Oosthuizen feeling extremely self-conscious.  People would point and stare at the eye.  Everyone he met was curious and wanted to know what happened to his eye.  Over the years, his hopes of having a normal appearance, faded away, since he was told there was nothing that can be done to improve his appearance.

The reason for his visit to me was to get spectacles in aid of his healthy eye, which has now become presbyopic. Herewith the best-corrected prescription:

OD: +0.25 / -0.50 x 125 add +2.00 (VA 1.0)

OS: Balance (No light perception)

Patient needs / wants / goals

As we started talking more about his injured eye, he asked if there is anything that can be done about the appearance of the eye. He understands that it is impossible to improve the vision in the eye using optical lenses, but wishes to improve the cosmetic appearance of the eye. I told him about special tinted contact lenses that could be custom made to match the colour of his normal eye, but that I have not fitted these before. I promised him that I would gather information regarding the fitting and cost of the lens, and get back to him.

Fitting process

At this point, I made contact with the Contact Lens Lab of South Africa and managed to get all the necessary information by the next day.  Bonita Lutzka from CLLSA assisted me with the fitting procedure, including how to work out the base curve, diameter and pupil measurements. She also provided me with an instruction manual detailing how the photographs had to be taken. Photos of both eyes at 30cm indoors and outdoors, with the flash on and off.  She also needed a close-up photograph of the healthy eye on its own.  These would be used to get the colour matched correctly. Furthermore, Bonita advised me that they have diagnostic trial sets available with steeper and flatter base curves, should I have difficulty finding the correct base curve using standard trial lenses.

Mr. Oosthuizen came in again on 4th February 2019.

During this consultation, we took all the necessary photographs and fitted soft contact lenses with different base curves, to get a stable and comfortable fit.  K-readings suggested that the injured cornea was slightly steeper than the norm.  Our second trial lens, with an 8.4mm base curve, was the perfect fit. The comfort was excellent, and the 14.2mm diameter helped to stabilise the lens on the eye. I also measured Mr. Oosthuizen’s iris diameter (12mm) and pupil diameter (3mm) from his healthy eye.

I e-mailed Bonita with all the relevant photographs and measurements.

About ten days later, the prosthetic lens arrived, and I could phone Mr. Oosthuizen with the good news.

Mr. Beldrick Oosthuizen (permission granted)

Mr. Oosthuizen came in on 27th February for his final fitting. The lens was a perfect fit, and we both sat there in total surprise of how excellent the end-result was. We were somewhat skeptical before we started the process and hoped for a 50% improvement in the appearance of the eye.  We both agreed that it was a 100% improvement in the aesthetic appearance of his eye, and it is almost impossible to tell the difference between the healthy eye and the injured eye.

Furthermore, Mr. Oosthuizen coped very well with the handling and cleaning of the lens.  He removes the lens every night before going to sleep, stores it in OptiFree PureMoist solution and inserts the lens again in the morning.  The modality of the lens is conventional so he will keep the lens for about six months, depending on the integrity, comfort, and handling of the lens. 

Conclusion

Despite fearing a complicated fitting process before having all the information, it ended up being a simple and enjoyable, yet educational experience to both the patient and I.  As a result of excellent communication and guidance from Bonita Lutzka of CLLSA, the fitting was successful, and the patient satisfaction exceeded all expectations. 

Mr. Oosthuizen’s friends and family are also overwhelmed by the unbelievable improvement in the appearance of his eye.

Mr. Oosthuizen: “ I have no words.  It changed my whole life.  I have my confidence back after 22 years. “

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