A 14-year-old Hispanic female was referred for an ocular prosthetic evaluation. She had a history of phthisis bulbi OS due to blunt trauma as a toddler with visual acuity of light perception (LP). A scleral shell was initially tried but was not tolerable. The patient opted for a soft, tinted contact lens. Several commercial lenses were trialed with each lens fluting due to the steeper and smaller globe. A custom soft lens with a steeper base curve (BC) was ordered based on corneal topography.

EXAM FINDINGS

Evaluation of the first trial contact lens showed a moderate air bubble consistently present inferiorly after multiple reapplications (Video 1). Although the patient noted comfort with the contact lens, corneal staining could be seen after removal. A second trial contact lens was ordered with a slightly flatter BC that achieved an improved fit (Video 2). The patient returned one week later with acceptable comfort and fit of the contact lens. A color tint was then applied to the lens to mask the ocular disfigurement.

DISCUSSION

Commercially available soft contact lenses are most practitioners’ first choice when fitting soft lenses. However, when it comes to lens parameter changes, commercial lenses offer little to change other than what is available from the manufacturer. For example, a patient may require a –4.50D cylinder with axis 172, but most commercial torics will not be available in that cylinder power or axis.¹ Custom soft contact lenses offer the practitioner to change the BC (in 0.2mm steps), diameter (in 0.50mm steps), axis (in 1º steps), and extended sphere and toric options to better match the patient’s visual needs (Note: Step changes may vary between manufacturers).² Other options include changing the optical zone, material, and addition of prism.

CONCLUSION

Commercially available soft lenses continue to be a great option for most patients. However, patients who require specific visual needs or who are unsuccessful in traditional soft contacts may benefit from custom soft contact lenses.

REFERENCES

1. Henry VA. Soft Contact Lens Fitting and Evaluation In: Bennett ES, Henry VA, eds. Clinical Manual of Contact Lenses 5^th LWW. 2019 Oct 12:311-329

2. Tyler’s Quarterly Soft Contact Lens Parameter Guide. 2024 Jun;41:24-45.