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This is a publication of Valley Contax, the world’s leading independent custom contact lens
manufacturer. If you enjoy these case studies be sure to subscribe so you never miss an issue.
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THE CUSTOM STABLE ELITE RESTORES THE
VISION OF A GROUNDED PILOT
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Roya Habibi, OD, FAAO
Eye Associates NW, PC
Seattle, WA
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May 15, 2016
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CASE REPORT
70 year old male patient presented to clinic for a referral from a corneal specialist after
ruling out cataracts as main cause of decreased visual acuity. The patient is a commercial
pilot and wasn’t meeting the FAA guidelines for BCVA. He has no complaints of
dryness, eye pain or fluctuating vision. The patient had previously tried corneal gas
permeable lenses, which seemed to have improved the vision, but the instability of
vision, watering eyes, and potential for ejection led him to be uncomfortable with that
option.
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GOALS
His goals were strict: he needed to be able to see 20/20 at all distances (distance,
intermediate and near locations) in both eyes, though he had the option of spectacles,
contacts or both. He needed the vision to be stable and reliable due to the responsibility
of flying. He also wants to put off cataract surgery (unless it is the true cause of
visual blur) due to required time off from flying.
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BCVA WITH SPECTACLES
OD: -1.50-1.25x100 20/25-2
OS: -2.00-1.00x085 20/25
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KERATOMETRY READINGS
OD: 42.12 / 42.75 x 175; irregular mires
OS: 42.50 / 44.00 x 175; irregular mires
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EXAMINATION FINDINGS
OD: wavy lines throughout cornea 2+, no staining with fluorescein; 1+ cortical spoking,
2+ nuclear sclerosis; posterior segment unremarkable
OS: wavy lines throughout cornea 3+, no staining with fluorescein; 1+ cortical spoking,
2+ nuclear sclerosis; posterior segment unremarkable
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Figure 1: OS after 1 month of scleral lens wear
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PLAN
A contact lens over-refraction found that the vision improved significantly with gas permeable
contact lenses. The patient was fit in scleral contact lenses to provide the most
stable vision. It would also provide a liquid barrier to the cornea that is evident for epithelial
basement membrane dystrophy (EBMD) (see Figure 1). Though he was not yet
symptomatic, this would theoretically provide the cornea with less stress through the
day with the protection of the cornea from constant friction from the eyelids.
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BCVA WITH SCLERAL CONTACT LENSES + SPECTACLES
OD: Custom Stable Elite 41.00bc / 15.8 diam / -3.75 sph / std LCZ / +3/0 Toric SLZ
VA 20/20
Spec over correction: plano -0.50 x 069 +2.50 Add / DVA: 20/15 / NVA 0.4/0.4M
OS: Custom Stable Elite 42.00bc / 15.8 diam / -3.00 sph / std LCZ / +3/0 Toric SLZ
VA 20/15-2
Spec over correction: plano +2.50 Add / DVA: 20/15 / NVA 0.4/0.4M
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ADDITIONAL COMMENTS
EBMD is caused by faulty basement membrane formation of the corneal epithelium
and can result in blurred vision, recurrent epithelial erosions, glare; though many
patients are asymptomatic. This patient was ecstatic with our plan and final treatment
for his eyes. He was able to maintain his current aviation license without undergoing a
procedure that was not yet necessary for him. The procedure could have also destabilized
his corneas further, leading to more irregularity and decrease in vision. He is now
able to wear his lenses comfortable (without feeling like anything is in) for over 15
hours per day.
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