I had a case that was very challenging, but at first glance looked to be very easy. Custom-designed toric orthokeratology lenses using Eyespace resulted in excellent refractive and topographic results. More significantly, it resulted in a very happy patient and a very happy doctor!!

The patient is a 12 yr old Asian male, who was not wearing spectacle correction (refused to wear glasses) but was having difficulty with distance vision in school.

His baseline refraction was:

R: -2.00 / -0.50 x 180 with VA 20/20-

L: -2.50 / -0.50 x 175 with VA 20/20-

Although this initially appeared to be an easy case, topography showed significant WTR astigmatism. It proved to be a challenge to get ideal Nafl pattern 360 degrees, with the initial diagnostic lenses showing decentration and excessive movement.

SimK’s were: R: 44.12 x 45.41 and L: 44.53 x 46.65

Manual K’s were: R: 44.50 x 47.50 and L: 44.75 x 48.00

Corneal diameter was 11.8 mm.

EyeSpace axial power topograpy maps:

EyeSpace axial power map of the right eye showing 2.28D WTR astigmatism.

EyeSpace axial power map of the right eye showing 2.12D WTR astigmatism.

Using EyeSpace software, a beautiful simulated Nafl pattern for the ideal corneal reshaping lens was generated. The Forge Toric orthokeratology lens had toric reverse curves (z-zone) and toric alignment curves.

EyeSpace NaFl simulation of the Forge Toric orthokeratology lens fitted on the right eye.

EyeSpace NaFl simulation of the Forge Toric orthokeratology lens fitted on the left eye.

At dispensing, lenses looked very good with ideal NaFl pattern, good centration and minimal movement.

At one week:

Unaided VA was 20/20- in each eye and 20/20 binocularly.

Manifest was:

R: +0.50 /-0.50 x 90

L: +0.50 / -0.25 x 90

Sim K’s: R 43.10 x 45.40 and L 43.00 x 44.60

Man K’s: R 43.25 x 44.50 and L 43.25 x 44.00

At one month:

Unaided VA was 20/20- in each eye and 20/20 binocularly.

Manifest was:

R: +0.25 / -0.25 x 90

L: +0.25 / -0.25 x 180

SimK’s: R 42.30 x 43.00 and L 42.20 x 43.30

Man K’s: R 43.00 x 43.50 and L 43.00 x 43.50

Medmont topography:

Medmont axial power maps of the right and left eye after 1 month of lens wear.

EyeSpace topography:

EyeSpace axial power difference map of the right eye.

EyeSpace axial power difference map of the left eye.

In summary, a challenging topography made simpler using Eyespace to create the ideal corneal reshaping design and lens.