Synergeyes case 1 Derek Louie

35 y.o male presented 2009 for gradual progressive distance OD>OS x 5 years. Wears reading glasses to near, but getting worse. VAs SC Near sc PH Right eye 20/200 / / / 20/40 Left eye 20/30 / / / 20/20 OU Current glasses none Manifest here: Manifest sphere cylinder axis Visual acuity Right eye /60 Left eye /20 Near add //+1.25 /,/

Exam findings: – Cornea OD – fleisher’s ring 1+ straie, no scarring – Cornea OS – clear – All other findings WNL Humphery atlas ordered. Keratoconus Dx, OD>>OS – see topography Fit last year with Synergeyes A lens, good correction OD only. Final lens: Synergeyes A/ 7.1 (8.4 skirt)/ / /25 Did well, returns this year with no problems for annual medical exam

Humphery topography 7/2009

Returned for annual exam 10/2010 No problems with vision, good comfort of lens, vision seems stable. 20/30 OD (thru hybrid lens) 20/25 OS (uncorrected) Cornea OD – 1+ punctate staining central inferior, no scarring – All other findings WNL Plan: Refit OD with steeper BC/different lens design

Initial Dx lens: Clearkone 250 vault/-4.50/14.5/ medium skirt Clearance central and light feather touch in ILZ, good movement

+3.50 Over-refraction of diagnostic lens = 20/30 vision Likely may improve when SPK/PEE resolves RTC 2 weeks for contact lens/cornea check

Decreased Vault: ClearKone 200 vault/-3.00/14.5/ medium skirt, Good movement (0.25 MOB) but too much touch central and in ILZ

Synergeyes Case 2 (if needed) 8 year old female with h/o traumatic corneal laceration due to stabbing herself in the right eye with a small knife when she was 3 y.o. Wore aphakic CL for several years, recently had sewn in IOL and pupilloplasty Best corrected vision with spectacles ( x010) 20/100, ph 20/80 – OS 20/20 sc

Started with synergeyes A/7.9/-3.00/ OR = 20/80 distance VA, 20/400 near Ordered in slightly steeper b/c to improve fit, and considered multifocal option for near VA

Final CL Rx: Synergeyes M /7.8 BC /-1.00,+2.25 add (2.2 seg size) /8.8 skirt/ /80 (ph20/70) with 20/60 near No improvement with distance or near Referred for VT/ambylopia tx.