INDICATION: Post LASIK Hyperopic Correction
This case illustrates the use of the sMap3D virtual precision fit software to design a lens to vault over a localized conjunctival/scleral obstacle.
This 35-year-old male patient presented for scleral lens fitting with a history of previous LASIK with a hyperopic under correction. He was unhappy with spectacle correction and drives a truck for which he needs optimal vision. Figure 1 is a clinical photo of the patient’s right eye showing a nasal Pinguecula.
This same area can also be visualized on an sMap3D composite corneo-scleral elevation map (Figure 2a) and a scleral shape plot which can visualize the SAG value (y-axis) vs axis meridian at any diameter from the corneal center; in this case 16mm (Figure 2b). Individual data points can be quantitated on this map to help custom fit a lens for an individual eye.
Figure 3a which is a sagittal view of a virtual fit of this eye with a Europa Scleral lens, illustrates why a standard spherical haptic design would not work on this eye. The Pinguecula (red circle) lifts the portion of the lens adjacent to it off the eye surface (blue circle) causing severe edge lift. These same portions of the eye are highlighted in the scleral shape plot in figure 3b.
Based upon the data from the scleral shape plot, a scleral lens was designed that vaulted over the Pinguecula (Figure 4a) and comfortably precision fit the eye (Figure 4b).