• 59-year-old Hispanic female, (+) keratoconus
• CC: blurry vision at all distances with five year old glasses. She attempted corneal GP wear over 20 years ago and experienced poor comfort.

• Entering Visual Acuities (VAs) with habitual glasses:

OD: 20/60
OS: 20/70

• Patient’s Rx via Lensometry:

OD: -7.00 -4.25 x 056  Add: +1.00D
OS: -10.75 -4.75 x 137 Add: +1.00D

• Slit Lamp Examination (SLE) OU
  • • Inferior corneal thinning and steepening, (+) Fleischer Ring
• Corneal Tomography (Figure 1):
• Dilated Fundus Examination (DFE):
  • • unremarkable

• Patient was hesitant about the size of scleral lenses.
• The innovation in GP lens materials since she last wore GP lenses was emphasized.
• Tomography revealed:
  • • Corneal elevation difference between major meridians: 78 mocrons OD and 71 microns OS
    • Paracentral cone
• Corneal GPs were selected (keratoconic aspheric design)

• Initial diagnostic lens based on fitting guide:
  • • OD: -11.00DS / BCR: 6.3mm / OAD: 8.7mm / std edge
      • • SLE: Apical bearing with excessive edge lift 360˚
    • OS: -14.00DS / BCR: 6.0mm / OAD: 8.7mm / std edge
      • • SLE: Apical bearing with excessive edge lift 360˚
• Second diagnostic lens
  • • OD: -14.00DS / BCR: 6.0mm / OAD: 8.7mm / std edge
      • • SLE: Lid attached, feather touch on apex, mid peripheral bearing, minimal edge lift, decentered inferiorly with 1mm of movement.
    • Over-refraction: +5.00DS
    • VA: 20/20
    • OS: -17.00DS / BCR: 5.7mm / OAD: 8.4mm / std edge
      • • SLE: Lid attached, feather touch on apex, mid peripheral bearing, minimal edge lift, decentered inferiorly with 1mm of movement.
        • Over-refraction: +7.75DS
• Lens order
  • • OD: -8.75DS / BCR: 6.0mm / OAD: 8.7mm / Hyper Dk F-S/A  green / flat 1 edge
    • OS: -8.50DS / BCR: 5.7mm / OAD: 8.4mm / Hyper Dk F-S/A blue / flat 1 edge
• Dispense appointment
  • • OD: -8.75DS / BCR: 6.0mm / OAD: 8.7mm /Hyper Dk F-S/A  green / flat 1 edge
      • • VA: 20/25
        • SLE: lid attached, feather touch on apex, mid peripheral bearing, adequate edge lift, decentered inferiorly, 1mm of movement
    • OS: -8.50DS / BCR: 5.7mm / OAD: 8.4mm / Hyper Dk F-S/Ablue / flat 1 edge
      • • VA: 20/30
        • SLE: lid attached, feather touch on apex, mid peripheral bearing, adequate edge lift, decentered inferiorly 1mm of movement
        • Final lens parameters – Rose K2
    • OD: -7.75DS / BCR: 6.0mm / OAD: 8.7mm / Hyper Dk F-S/A green / flat 1 edge
      • • VA: 20/20
        • SLE: lid attached, feather touch on apex, mid peripheral bearing, adequate edge lift, decentered inferiorly, 1mm of movement
    • OS: -9.00DS / BCR: 5.7mm / OAD: 8.4mm / Hyper Dk F-S/A blue / flat 1 edge
      • • VA: 20/25
        • SLE: lid attached, feather touch on apex, mid peripheral bearing, adequate edge lift, decentered inferiorly 1mm of movement

• Not all keratoconus patients need scleral lenses.
• Corneal GPs are a great option!
• Pay attention to the elevation map when deciding what contact lens to fit.
• <350 microns elevation = corneal GP