August 2009

Prosthetic Lenses Improve Cosmesis After Traumatic Injury

Ocular prosthetic devices are not usually associated with general optometric practice, however, optometrists are uniquely positioned to use their knowledge and training to design special-effect lenses to mask disfigurement and improve vision.

Hydrophilic prosthetic lenses are commonly used to manage various conditions of sighted or non-sighted eyes, including: colobomas, cataracts, corneal leukomas, diplopia, amblyopia, aniridia, albinism, injuries, disfigurements or abnormalities. The ideal cosmetic outcome is to match or recreate the patient’s natural appearance. Ready-made prosthetic soft lenses with set parameters and colors are available from several manufacturers and work well in many cases. These designs should be trial-fitted using fitting sets available from the manufacturers.

This case is an example of the successes that can be realized using a ready-made prosthetic soft lens.

Presentation

This 46-year-old woman presented with a history of frontal head trauma from a horseback-riding accident 8 years earlier. Injuries to the right eye included a retinal detachment, resulting in central vision loss as well as damage to the ciliary plexus, leaving a fixed, dilated pupil, and photophobia. Surgery preserved her peripheral vision. Visual acuity in the right eye was 20/300 with or without correction.

The patient was specifically interested in improving her visual performance, decreasing the photophobia and matching the appearance of her left eye. Examination and evaluation revealed no contraindications to contact lens wear. The ocular details were as follows:

       Pupil size:           5.0 mm Dim
                             2.5 mm Bright
       Iris color:           Green

A ready-made prosthetic trial lens was cosmetically acceptable.

The patient was fit with a CooperVision Prosthetic Hydrophilic Lens DW. This product is available in 9 colors with either a clear or black (opaque) backing, giving 18 color effects. Standard iris diameter is 12.0 mm, with pupil sizes of 3.0 mm, 4.0 mm, 4.5 mm and 5.0 mm, with either a clear (open) or black opaque (closed) pupil. Base curve choices are: 8.4 mm, 8.7 mm, 9.0 mm, and sphere powers are +20.00D.

The parameters chosen for this patient were:

       BC                     8.7 mm
       OAD                    14.5 mm
       PWR                    Plano
       Pupil                  3.5 mm
       Iris                   12.0 mm
       Color/Detail:          04 (green) Color/Black backing/Open pupil.

I prescribed a nonoxidizing care system.

Outcome

The patient was pleased with the result. She reported overall sharper vision based on contrast and elimination of the photophobia. She can wear these lens 10 to 12 hours daily. She is no longer self-conscious about making direct eye contact with others, fearing comments about her eye’s appearance.

By Sunny M. Sanders, OD, FAAO
Fullerton, Calif.

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