Monocular diplopia: contact lens related warpage?

Area of Science:

• Ophthalmology and Optometry
• Corneal topography and Contact lens fitting

Background:

• Accurate assessment of the cornea is crucial for successful contact lens fitting, especially in complex cases.
• Patient-specific factors, including refractive error and accommodation, significantly influence contact lens selection and success.

Observation:

• Corneal topography, utilizing Tangential and Absolute Scale maps, provides a comprehensive view of corneal shape and identifies irregularities.
• Fitting myopic presbyopes presents unique challenges related to accommodation compared to hyperopic presbyopes.
• Soft contact lenses may offer superior comfort over gas-permeable lenses when regularization of the corneal surface is needed, particularly for monocular fits.

Findings:

• Tangential maps offer a true representation of the overall cornea and corneal cap, aiding in the diagnosis of difficult-to-fit corneas.
• Absolute Scale maps are vital for detecting abnormally steep or flat corneal regions and enabling precise bilateral comparisons.
• Addressing accommodative issues is a key consideration when fitting myopic presbyopes with contact lenses.

Implications:

• Routine corneal topography is recommended for all difficult-to-fit corneas to ensure optimal lens selection and patient satisfaction.
• Understanding the nuances of fitting myopic presbyopes can lead to improved contact lens strategies for this patient group.
• Soft contact lenses represent a viable and potentially more comfortable option for corneal regularization in specific patient populations.