Optician India

By GAGAN SAHNI
Director – Professional Affairs Silverline Labs Pvt. Ltd

Introduction
In 2016, a 33-year-old male diagnosed with SJS underwent MMG for the right eye. Sequential trachomatous trichiasis lash removals were performed under topical anaesthesia. Despite these efforts, the patient faced ongoing discomfort and visual challenges. In October 2021, the patient was referred to Silver Line Laboratories for an extensive scleral lens trial. The tailored fitting of the scleral lens not only significantly improved visual quality but also provided unprecedented physical comfort, effectively addressing the patient's long-standing  concerns.Subsequently, in March 2022, the patient underwent mucous membrane grafting for the left eye, followed by PC-IOL implantation. These interventions further contributed to visual enhancement.

Ocular Complaints
The patient's chief complaints encompassed intense ocular pain, extreme sensitivity to light, and discomfort in both eyes. Furthermore, the patient articulated concerns about discharge, eyelid swelling, and a persistent unsettling sensation affecting both ocular regions.

Slit Lamp Examination
Slit lamp exam revealed newly grown eyelashes (epilation), eyelid redness (erythema), and worsening pseudomembranes with epithelial defects in both eyes. Scarring due to conjunctival scarring was seen, leading to potential long-term corneal issues and vision loss. Symblepharon formation was present, increasing the risk of severe dry eye. Corneal scarring, especially in the right eye, resulted from neovascularization. Hazy cornea prevented a full iris, lens, and fundus examination.

Right Eye

Left Eye

Visual Assessment

Corneo Scleral Lens Trial For OU

Remarks
During the initial lens trial, the base curve was chosen according to Scleral fitting guidelines. In both eyes, the lens fitting displayed a smooth and conjunctiva-aligned landing. Remarkably, the optimal fit was achieved on the first attempt. After the subjective refraction was conducted over the lens, a significant enhancement in visual acuity was observed. In the right eye, visual acuity improved from Counting Fingers at 1 meter to 6/36 (Snellen chart), while in the left eye, visual acuity improved from 6/60 to 6/18.  

Right Eye: Vault Clearance

Left Eye: Vault Clearance

Final Lens Parameters For OU :

Management
The patient found the prescribed Corneo Scleral lens comfortable for the right eye. With the lens in place, the patient's Best Corrected Visual Acuity (BCVA) improved to 6/24p in the right eye and 6/18 in the left eye. The patient received thorough instructions on the insertion and removal procedures and was educated about proper lens care and maintenance.

Initially, the patient was advised to wear the lens for 4 hours per day, with breaks interspersed, for one week. Subsequently, the recommendation was to extend the wearing time to 6 hours continuously, followed by a brief half-hour break, and then resume wearing the lens for another 6 hours. A follow-up appointment was scheduled after 4 weeks to assess progress.

Additionally, the patient was provided with a helpline number for tele-consultation in case of emergencies

First follow-Up Visit (After 1 week Of Lens Usages OU)



Management
The corneal scleral lenses exhibited an appropriate vault and provided the patient with comfort in both eyes. However, there was room for improvement in the patient's lens handling and hygiene practices. In response, the procedure was modified to include comprehensive guidelines for proper lens cleaning, care, and maintenance.
The lenses smoothly and conjunctiva-aligned, achieving a proper fit without any impingement. The patient was recommended to maintain the current wearing schedule of 4 hours per day, with breaks, for the following month.

• Second follow-Up Visit (After 1 Month Of Lens Usages OU)

Management

The patient experienced comfort with the corneo scleral lenses in both eyes. The vault beneath the lenses was appropriately fitted for both eyes. The lenses settled smoothly and aligned well with the conjunctiva, without causing any discomfort.The patient received detailed instructions on the correct techniques for lens insertion and removal. Proper care and maintenance procedures were also explained. The cleaning, disinfecting, and deproteinizing process for the lenses involved the use of ProMaster, a rigid lens cleaning system.The patient was advised to gradually extend the lens wear time up to 6 hours continuously in both eyes, with regular breaks. This approach allows the patient to adapt to the lenses while ensuring comfort and proper ocular health. 

BeforeScleralcontactlens

AfterScleralcontactlens

Patient Interview

Summary
The patient was fitted with a pair of Corneo-Scleral contact lenses: in the right eye, a lens with a power of-5.50 DS, a base curve of 7.00 mm, and a sagittal depth of 4580 microns; in the left eye, a lens with a power of-1.50 DS, a base curve of 7.20 mm, and a sagittal depth of 4370 microns. These lenses were crafted from Boston X02, a highly gas-permeable rigid material with an oxygen transmissibility of 141 Barrer. This material was selected to optimize oxygen transmissibility to the eye, provide continuous lubrication to the ocular surface, and safeguard it from external trauma.

Chronic ocular sequelae of SJS encompass conditions such as progressive symblepharon, keratinisation of the eyelid margins, trichiasis, entropion, dry eye syndrome, and persistent epithelial corneal defects. These enduring ocular issues underscore the profound impact of the syndrome.

In addressing these challenges, therapeutic scleral contact lenses prove to be a valuable intervention. By fully enveloping the cornea within a fluid reservoir, these lenses establish an environment conducive to optimal ocular surface health. This approach holds exceptional promise in managing various ocular surface diseases, including those stemming from SJS.