Having access to Onefit MED scleral lenses has been a game-changer for our patients in Plymouth Hospital.

After struggling to achieve a good fit and comfort for our irregular cornea patients with other lenses, we trialled the Onefit MED lenses and I was amazed by how many modifications could be made.

Here are a couple of our patients who have successfully been fitted with Onefit MED lenses from No7 Contact Lenses.

Case 1

• Unaided 6/76.
• Aided with specs 6/48.
• RE enucleated.
• LE Pellucid Marginal Degeneration corneal ectasia.

Initial trial lens:

• Onefit MED, sag 4900 microns, -5.00.
• Toric periphery Flat +75 microns, Steep -75 microns.
• Over refraction -3.50D.
• Large central clearance of 900 microns.

New lens ordered with the assistance of the Technical Dept.

• Sag 4800 microns, toric periphery +/- 75 microns.
• M Zone increased by 200 microns to lift off in the mid-periphery.
• Central Clearance Reduction of 230 microns to reduce excessive clearance.

This new lens was placed on patient’s eye and after 30 minutes the fit was much better but there was still some touch inferiorly at 6 o’clock.

Confirmed by OCT imaging.

Using the online tool, we were able to calculate a new lens.

New lens ordered as:

• Sag 4900 microns, toric periphery +/- 75 microns.
• Mid Peripheral Zone +200 microns.
• Central Clearance Reduction 230 microns.
• Power +5.87D.

• This gave full clearance with no corneal touch and a V/A 6/6.
• The patient is now able to wear the lens well and continue with his career as a DJ.

Outcome:

This gentleman had one eye removed in 2019, so the health of his remaining eye was most important. With specs, we were only getting VA’s of 6/48 at best. With the help of Ian and the technical guys at No7 and a few modifications, he was able to read the 6/6 line and shed a few tears. Losing his eye and very poor vision in his remaining eye put a hold on his career and his social life, also affecting his mental health. He is over the moon with what he can see and even more pleased he can return to driving.

Having access to the online fitting tool was incredibly useful when we needed to make modifications.  Any questions I had for the team were always answered quickly.

Case 2

We also used Onefit MED lenses on Case 2 who had undergone bilateral full-thickness corneal grafts following Epikeratophakia, causing Endophthalmos and central corneal scarring.

He had found keeping Corneal GP lenses in his eyes troublesome. This has stopped him from pursuing his dream of sailing around the Med.

We decided to trial the Onefit MED lenses on both eyes.

Unaided visions:

• RE 6/48.
• LE Counting Fingers.

Onefit MED trial lens inserted.

RE:

• Sag 5100 microns, diameter 15.60, -12.00D, tp +/- 75 microns.

• Over refraction of -1.00D found.
• Edges are tight.
• Mid periphery, Limbal and edge needs increasing.

LE:

• Sag 5150 microns, diameter 15.60, -10.75D, tp +/- 75 microns.

• Giving touch and after the insertion of several trial lenses we found we needed a sag of 5750 to clear protruding cornea.
• With an over-refraction of -4.25D.

New lenses ordered using the online ordering tool.

The new lenses were assessed on the patient.

RE:

• 5100: 15.60 -11.12D.
• Mid Peripheral Zone +75 microns.
• Limbal Zone +100 microns.
• Toric periphery Flat +150 Steep -75.
• V/A 6/19.
• Achievable V/A reduced by central scarring.

LE:

• 5750 15.60: -20.62D.
• This resulted in touch at 10 o/c.

A new lens was designed with the help of No7 Technical and we arrived at a new lens specification of:

• 5850: 15.60 -21.50D. 
• Central Clearance Reduction 190 microns. 
• Mid Peripheral Zone +100 microns.
• Limbal Zone +100 microns.
• Toric periphery Flat +200 microns Steep +75 microns.

This gave a V/A of 6/7.5+

At the highest point, the lens cleared the cornea by only 50 microns. So, we increased the L and M Zones to +150 microns.

Final spec:

RE:

• 5100: 15.60 -11.12D.
• Mid Peripheral Zone +75 microns.
• Limbal Zone +100 microns.
• Toric periphery Flat +150 microns, Steep -75 microns.
• V/A 6/19.

LE:

• 5850:15.60 -21.50D.
• Central Clearance Reduction 190 microns.
• Mid Peripheral Zone +150 microns.
• Limbal Zone +150 microns.
• Toric periphery Flat +200 microns, Steep +50 microns.
• VA 6/7.5+.

Outcome

Case 2 could not believe the improvement in the quality and contrast of his vision with his Onefit MED lenses.

Conclusion

The more lenses I fit, the more confident I am becoming. Knowing that I always have support from the guys at No7 gives me the confidence to keep going and improve my skills. Support has always been available Via Zoom, telephone and before the pandemic face-to-face.

Rebecca Watt FBDO CL
Contact Lens Optician
Royal Eye Infirmary
Plymouth University trust Hospital

For more information on Onefit MED, take a look at our fitting course: