scleral lenses resolve glare and visual halos following LASIK surgery

CASE STUDY: Post LASIK Surgery
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	This case study illustrates how Biometric Scleral LensesTM addressed a specific patient's vision problems following LASIK surgery.
	The patient is a 24-year old engineer who had bilateral LASIK surgery to correct myopia. Chief complaints included: heavy glare and halos in dim illumination Large pupils > 8.0 mm in dim light Manifest refraction: +0.50 OU VA 20/20 - OD/OS
Corneal Topography
		Corneal topography of the right eye shows a small, superiorly decentered treatment zone. This created a situation in which the contrast dramatically decreased as the pupil became larger in low light and the ratio of unfocused to focused light increased.
Retinal Spot Diagram
		The retinal spot diagram shows the path of light across the area of the pupil. Central rays are somewhat in focus at the fovea, whereas rays hitting the cornea and passing through the pupil more peripherally undergo large amounts of scatter. A measure of the higher order aberrations reveals the magnitude of this light scatter. In this case the higher order total is 3.927 microns, coma is 2.685 microns, and spherical aberration is 2.553 microns. These numbers are extremely high compared to population normals.
HOA Point Spread Function
		The point spread function illustrates how the patient might perceive a single point light source such as a street lamp or car headlight. The extent of the image spread or “smear” goes beyond the illumination and into the area that obscures the grid pattern in the background, essentially filling the right and upper-right side of the visual field.
OCT Anterior Segment Scan
		Scans of each eye were taken with the Visante Anterior Segment Optical Coherence Tomographer. This scan was taken in the vertical meridian through the visual center. Note the very large pupil.
Proposed Scleral Lens Design
		The OCT image was exported to a special software program and a lens design was constructed. All of the design elements have been removed in this image except for the inside surface of the proposed lens shown in red.
Actual Lens
		The lens was manufactured and another OCT image was scanned of the lens on the eye. The inside surface of the actual lens is outlined in yellow. The fit and shape appears to be virtually indentical to the proposed lens.
Fluorescein Pattern
		In this image, the tear layer has been stained with a medical dye called fluorescein and photographed under a blue light. The thicker the tear film between the lens and the eye, the more intense is the green color.
Retinal Spot Diagram with Lens
		This is the retinal spot diagram of the same eye through the contact lens. The higher order total is now 0.495 microns, the coma is 0.177 microns, and the spherical aberration is 0.407 microns. With the contact lenses, the levels of higher order aberrations are similar to the population norms for the same pupil size.
Point Spread Function with Lens
		With the contact lens at night, a point source of light looks like…well, a point source of light.

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