June 15, 2007
Rose K Irregular Cornea Contact Lens
Patient is a 37 year old male accountant with keratoconus OD and clear PKP operated 1990 OS with a history of seasonal allergies for which he uses Patanol bid. He uses Boston soaking solution, Refresh Plus prn and Duratears ointment at bedtime. He experiences frequent discomfort and is photophobic with a foreign body sensation. Patient explains the 10.1 diameter old lens was more comfortable and wears it occasionally.
His lens is a Rose K post graft 2-- specs: 7.3 BC/10.40dia/-8.50D OS
VA @ 20ft OD sc 20/100 OS ccCL 20/25
VA N@16” OD 20/60 OS 20/25
K reading: OS 49.50 X 43.50 @90 1+ distortion
MR: OS -4.75 -4.00 X 90 20/30+ distance and near
SLE: OS lag >1mm, rocks and rides superior
2+ inferior edge lift
2+ central pooling with superior and inferior bearing with corresponding 2+ CL induced
epithelial staining of the graft.
Refit Patient with Rose K Irregular Cornea Lens—specs: BC 7.0/11.4dia/-8.75D/ grey #1/ Optima Extra (Dk=100, WA=4)/standard edge
At one month after dispensing, patient is wearing 12-18 hours per day comfortably.
VA OS ccCL 20/20 N 20/20
rides ½ mm high with minimal edge lift
1+ central pooling
trace superior stain
Patient was advised to use Patanol OU bid daily for 3 months during allergy season and to clean only with Boston cleaner at day’s end and soak in Boston wetting for insertion the next day; Refresh Plus and Duratears ointment discontinued; he should use only Boston rewetting or Blink(AMO) prn for episodes of dryness to preserve the wetting angle.
Patient is now happy and satisfied for first time since PKP in 1990.
Wavefront analysis with and with out Rose K IC:
RMS is 1.440 in the OPD and total aberrations are 10.922 without lens;
with the lens, there is virtually no overrefraction, VA is improved to 20/20, RMS is 0.27 and total aberrations are reduced to 1.290.
The Rose K IC lens is effective in fitting irregular corneas that do not respond to smaller diameter fitting; I have used the Rose K IC lens for post graft, post refractive surgery keratoectasia (reverse geometry lenses are not readily available), pellucid marginal degeneration and large, inferior global keratoconus. The proper use of the Boston cleaning solution at the end of the wearing schedule only preserves the wetting angle and the cornea integrity is protected by using high Dk(Oxygen Permeability) and low Wetting Angle(WA). In conclusion, the Rose K IC contact lens is a welcome addition to the selection of lenses in difficult fits.
John Steile OD, FAAO
Magrabi Eye Center