Tackling a 10-mm Pupil with Post-LASIK Glare

30th May 2024

I have no idea what LASIK (laser eye surgery) surgeons are thinking when they perform surgery on engineers with large pupils, let alone engineers with 10-mm pupils when dark adapted (Figure 1). Figure 1. 10-mm dark adapted pupil. Such an engineer sought out our office for a scleral fitting...

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Slit Lamp Series – Oblate Cornea

02nd April 2024

In the second instalment of the Slit Lamp Leries, Martin Conway looks at Oblate Cornea. You can read the previous article which examined Demodex Mites here. This month’s image from Marco Tovaglia won the BCLA Diane Gould Photo Contest in 2021. It very clearly illustrates the flattening of the...

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Scleral Lens Management of Soft Contact Lens Induced Limbal Stem Cell Deficiency

03rd November 2023

Introduction Limbal stem cell deficiency (LSCD) results in dysfunction and/or loss of the stem cells in the basal limbal area. These cells are responsible for maintaining and replenishing the corneal epithelium. This change in corneal tissue composition results in conjunctival epithelial ingrowth, persistent epithelial defects, chronic inflammation, and neovascularization.1,5 There...

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Type 1 Lattice Corneal Dystrophy Status Post Penetrating Keratoplasty: A Scleral Lens Success Story

31st August 2023

Background Type 1 lattice corneal dystrophy (LCD1) is a rare hereditary bilateral disorder of the cornea. This is a result of an autosomal dominant mutation of the TGFBI (transforming growth factor beta induced) gene which leads to accumulation of amyloid deposits in stroma1 Variable clinical appearance depends on the...

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Managing Bilateral Penetrating Keratoplasty-Related Rim Ectasia and Astigmatism

31st August 2023

Introduction This patient is a 51 YO female who had bilateral Penetrating Keratoplasties around 30 years ago in Rotterdam. Her grafts have become ectatic over the years and now exhibit signs of Rim Ectasia. This presents itself as a thinning of the host cornea leading to a tilting of the graft and a significant...

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Avoiding a Corneal Transplant in a Young Patient

23rd June 2023

Background Corneal opacity is the fifth leading cause of blindness worldwide¹. A common cause of corneal opacity is infectious keratitis. In developed countries, contact lenses are the leading cause of infectious keratitis while in developing countries it is from corneal trauma during agriculture work¹. The most common organism responsible...

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Using a Customized Soft Lens

28th February 2023

Introduction The vast majority of the lenses we fit in contact lens practice are soft lenses. The amount of attention that goes into ‘fitting’ soft lenses is limited in contrast to the focus on scleral lens fitting, corneal lens fitting, and orthokeratology, for instance. This case shows how taking...

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The Changing Face of Contact Lens Fitting

30th November 2022

In the October 2022 edition of Contact Lens Spectrum, Ed Bennett’s report on the GP and Custom Soft Annual Report 2022 provided a comprehensive insight into the prescribing habits of top US practitioners. Scanning the list of subscribers, they are mainly Key Opinion Leaders and researchers, so this may not necessarily...

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Comfortable Customizing

23rd March 2022

Never a dull moment in our industry. Although this past period will surely be remembered as ‘the COVID era’, there are so many new and exciting developments going on that maybe in the future, all of these technological advances may outweigh the negative vibes of COVID for our industry....

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Haunted by Ghosting: HOA Correction in Keratoconus

25th March 2021

Scleral lenses have an astounding ability to provide patients with the gift of sight, often allowing them to regain their lives. With keratoconus (KCN) being the most common indication for scleral lenses, patients often experience a significant improvement in visual function with wear.1 It is well-understood that, by providing...

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