EYEPRINT PROSTHETIC AS THE ONLY OPTION FOR DIFFICULT PATIENT
Purpose
Corneal disease can be debilitating to a patient’s vision, but when combined with retinal disease and other ocular issues, this creates a particularly challenging situation. Treatments for irregular corneas have ranged from spectacles to soft contact lenses to gas permeable lenses to corneal surgeries. Although infrequent, there are patients who fail in all contact lens modalities and are not candidates for surgery. A possible option for these patients is a relatively new and exciting product called the EyePrint Prosthetic (or EyePrintPRO). The EyePrintPRO utilizes an impression of the ocular surface, which is then scanned with a 3-D scanner to fabricate a unique, custom prosthetic device. The technology of this device yields a perfectly fit prosthesis with excellent vision and comfort.
Case Report
KL, A 78 year old white female, presented to the clinic for a contact lens consultation. Her current ocular status was:
OD: Wet macular degeneration, corneal transplant, glaucoma surgery (bleb), and PCIOL. Her BCVA was 20/HM (15 years), and according to her retinal specialist, there was no potential for vision improvement.
OS: Dry macular degeneration, corneal transplant, glaucoma surgery (bleb), and aphakic. Her BCVA was also 20/HM (20 years), and according to her retinal specialist, there was possible potential for vision improvement.
Topography was extremely difficult, and the images were not helpful. Side profile of her eye showed a flat corneal graft with a sunken center and a large bleb supero-temporal (Fig 1). Her intraocular pressure of the left eye was 12 mmHg. The corneal graft was relatively clear and endothelial count was 1300.
KL was seen multiple times and the left eye was fit with the following contact lenses:
Corneal GP
Reverse Geometry GP
Intra-limbal designs
Post-Transplant GP designs
Custom soft lens for Transplants
Piggyback (high plus soft lens with GP on top)
Scleral lens
The corneal graft prevented any of the gas permeable lenses from centering, even with the high plus piggyback. Scleral lenses were not an option due to the large bleb. At this time, the EyePrintPRO was attempted.
First, an impression of the left eye’s ocular surface was obtained in office. The impression was then scanned and a 3-D image was created (Fig 2). Notice the large area of elevation due to the bleb.
Normally, diagnostic scleral lenses are used during the fitting to obtain a proper over-refraction. However, KL’s bleb was so large that every time a scleral lens was placed on the eye, a bubble formed. There was no useful retinoscopy or subjective refraction, so axial length and estimation of corneal shape from topography was given to the lab to estimate power.
Lens dispense: The technicians at the EyePrintPRO lab were able to create a lens that could vault the bleb, and the lens power was estimated at –0.87.
Upon lens insertion, the patient was immediately able to see 20/50! She had no over-refraction and the lens aligned perfectly with her ocular surface. The bleb was fully covered by the EyePrintPRO (Fig 3). The patient was taught proper insertion and removal techniques along with lens care.
Due to the possibility of unwanted pressure to the bleb, KL returned for a follow up 24 hours later. Her intraocular pressure was 11 mmHg and her cornea remained unchanged.
KL returned for a follow up 2 days later. Her intraocular pressure was 12 mmHg and her cornea remained unchanged.
KL returned for a follow up 1 week later. Her vision was 20/50 and her intraocular pressure was 11mmHg. With the device removed, her cornea showed no corneal staining or edema.
KL returned for a follow up 3 weeks later. Her vision remained at 20/50 and she was very happy with her new-found vision. Her intraocular pressure was 12 mmHg and her cornea showed no staining or edema.
Discussion
Patients with corneal disease can often benefit from the optics from a gas permeable contact lens. However, when patients manifest with other ocular issues, these traditional designs may not work. The EyePrintPRO is a great option for not only difficult patients, but any irregular cornea patient. The impression of the ocular surface truly gives a custom fit. The device fits the patient’s eye like a glove, offering superior comfort and vision. The EyePrintPRO is a revolutionary product, and represents a new product for irregular cornea patients.