CORNEAL GPs are an excellent tool for visual correction of regular and irregular cornea conditions, although sometimes discomfort may be an issue. It may be related to poor design or an ocular condition such as dry eye. In these cases, scleral lenses are a helpful alternative.

History

A 36-year-old female patient who has high myopia originally presented to our office in 2013 claiming she had tried to be fit with corneal GPs in another clinic without success. Ultimately, we successfully fit her with aspheric corneal GPs.

In 2017, she reported discomfort whereupon we observed a low tear meniscus height, measured by tear breakup time (TBUT) (OD 6 seconds and OS 8 seconds) with Schirmer’s test at OD 16mm and OS 11mm.

Contact Lens Fitting

Initial GP fitting was planned based on trial lenses analysis.

Corneal GPs parameters (Figures. 3 and 4) were:

OD: base curve (BC) 41.00 D (8.23), power  –7.50 D, overall diameter (OAD) 10.0mm, optic zone (OZ) 7.5 mm, Dk of 100, and visual acuity (VA) of 20/20.

OS: BC 41.00 D, power –7.75 D, OAD 10.0mm, OZ 7.5 mm, Dk of 100, and VA of 20/20. 

In 2016, she came for a follow-up with a complaint of discomfort in both eyes. We proceeded with a new corneal GP fitting based on trial lens analysis. We observed a thin tear meniscus height, then measured TBUT (OD 6 seconds and OS 8 seconds) and Schirmer’s test of OD 12mm and OS 8mm, which were lower values compared with 2013. We discussed with the patient about the benefits of scleral lenses and ultimately she was fit with sclerals of 17.7mm diameter in both eyes. (Figures 5 and 6). 

Conclusion

Corneal GPs can be used in mild to moderate evaporative dry eye but when the condition worsens, scleral lens may provide an excellent option to solve the patient’s issues.