A Case in Point

I won’t bore you with another ‘myopia reduction’ or ‘white eye’ silicone hydrogel case as these are rather passé by now.

I will however share a case where we do have that ‘wow factor’ we all seek…

This concerns a lady whom I’ve seen for a number of years: A high myope, she was referred to me by a local ophthalmologist with a history of corneal injury from a mascara brush followed by epithelial debridement and stromal puncture. She had a history of contact lens intolerance and was unable to wear her lenses. It was also subsequently found she suffered from a corneal dystrophy in the form of an epithelial basement membrane disorder [EBMD]. I suspect that the mascara brush injury was aggravated by this condition.

Various treatments were tried including debridement and various lubes and drops. We tried daily disposables but her eyes were dry and she continued to suffer chronic recurrent corneal erosion. Poly Visc nocte did not solve the problem.

I discussed the possibility of a more ‘permanent’ bandage lens, in the form of the then relatively new silicone hydrogels. The potential benefits were high Dk providing an EW option as well as the low water, (hence lower evaporation) that Purevision provided. Separation of the tarsal conjunctiva and regenerating corneal epithelium - allowing the recurrent erosion to heal while bandaged overnight – was what I hoped to achieve. The patient and co-managing ophthalmologist were amenable to this approach and we subsequently embarked on a trial.

It proved to be a great success.

She wears the lenses three to four nights on EW then has an overnight break, stores in OptiFree and then repeats the cycle and replaces lenses monthly. She returns for regular aftercare and is always enthusiastic about her ability to successfully and comfortably wear lenses. Additionally she reports that her eyes are no longer sore every morning and all day as they were with spectacles and regular contact lenses. On examination her corneas show no sign of recurrent erosion and there is only minimal evidence of the EBMD and the corneal debridement/mild scarring.

She is now in her seventh year of 4N EW wearing Purevision, Rx;

R 8.6/14/ -5.75 6/7.5

L 8.6/14/-7.50 6/7.5

She reports only occasional need/use of lubricants and notes that if she discontinues EW for more than two or three nights her symptoms return. Interestingly I discovered that her mother also suffers from EBMD when she consulted me on referral from her enthusiastic daughter.

That’s what we want isn’t it?

Enthusiastic patients following successful resolution of complex conditions and resulting referrals from patients and fellow eye care practitioners.

This case would represent one of the very early uses of silicone hydrogels as bandage lenses for this type of problem and would probably be one of the longest in duration thus far, on the silicone hydrogel road of discovery.