18/12/2025
The patient underwent bilateral corneal transplantation approximately 20 years ago and is currently corrected with spectacles, presenting visual acuity below 10% in the right eye and approximately 20% in the left eye. For the past two decades, the patient has been significantly limited in daily activities due to reduced visual acuity.
Both corneal grafts are highly irregular and ectatic. Slit-lamp examination also reveals nasal pingueculae in both eyes, with the pingueculae in the right eye being particularly significant.
Given this clinical presentation, I initially considered scleral freeform lenses to be the ideal solution. However, after discussing this option with the patient, concerns were raised regarding the associated costs. In light of this, I opted for an alternative approach, using diagnostic trial lenses adjusted according to clinical evaluation at the slit lamp, a methodology I employed for many years prior to the widespread availability of advanced technological support.
Nevertheless, I made use of the technology available, namely the Scansys corneal tomographer and the ESP, which provide significant support in the fitting process. That said, I believe that in this particular case, a comparable clinical outcome could have been achieved even without these devices, reinforcing the notion that while technology is extremely valuable, clinical judgment remains the most critical factor in achieving successful outcomes.
After making all possible modifications to the lenses within the constraints of trial lens customization, we achieved a visual acuity of 80% in the right eye and 100% in the left eye, with microvaults perfectly aligned over the pingueculae, ensuring appropriate clearance and comfort.
The patient is extremely satisfied with the functional and visual outcome, as is the practitioner with the clinical result achieved. Ongoing follow-up will focus on close monitoring of the lens fit and ocular health, with particular attention to the integrity of the corneal grafts.
Undoubtedly, an excellent Christmas gift for both patient and practitioner.MediWorks Eaglet-Eye