CASE REPORT

1. Case report on Rose K2 XL
Fitting
MEENAKSHI
MOPTOM PR 003

2. Introduction
• Keratoconus is a disease characterized by thinning and protrusion of the cornea,
resulting in an irregular, conical shape. Irregular astigmatism occurs as the
keratoconus progresses, and results in blurred vision, which can be impossible to
correct with spectacles. Usually keratoconus occurs in both eyes, and involves the
central cornea with the apex of the cone just below the visual axis. Keratoconus
occurs in all races and usually affects both eyes. Sensitive techniques, such as
corneal topography, often detect keratoconus in both eyes in cases thought to be
only in one eye based on physical examination and refraction

3. Case Discussion
• A 27 year old gentleman came to the clinic for Rose k contact lens trial.
• He was diagnosed with keratoconus 8 years ago and was using RGP lens in both
eyes since then.
• His old lens was lost so presented to the clinic for new lenses. Currently he was
using soft contact lens in both eyes last removed 1 day ago.
• The usual wearing time of contact lens was 14-16 hours/ day. There was no other
history of medication or any drug allergy.
• Rest other history was not contributory.

4. Investigations
• On examination, the visual acuity with glass measured was 6/12P in the right eye
and 6/36 in left eye for distance and N6 and N12 @ 30-40 cm for near in right eye
and left eye respectively.
• Pupillary examination showed regular round and reactive pupil on both eye, no
RAPD was present on BE. Slit Lamp Examination shows normal conjunctiva, Steep
cornea , normal iris and clear lens in both eyes.
• Extra ocular motility was full, free and painless.
• Cover test showed ortho for distance and near.

5. • Present glass prescription
• OD : -8.00Ds/-0.25X40 OS : -10.00 Dsph
• Acceptance :
• OD : -9.00Ds/-1.50Dc X 45, 6/12 OS : -2.25Dc X 155, 6/24

6. Keratometry
OD: K1= 48.49D (6.96mm) OS: K1= 52.65D (6.41mm)
• K2= 49.55D (6.81mm) K2= 66.96D (5.04mm)
• Avg K=49.01D (6.88mm) Avg K= 59.21D (5.7mm)

7. OD
TOPOGRAPHY

8. OS
TOPOGRAPHY

10. • Trail 1 : OD
• 7.60mm/-1.00D/14.60mm/Rose K2
XL
• Slight central touch
• Peripheral fit : Ideal edge width
• Diameter: slightly less, increase
diameter to 14.8
• Location: Evenly around limbus
• Movement: 0.2-0.3 mm
• Over refraction: -1.25D Vision:
6/6-, N6
• Empirically reduce BC to 7.5mm

11. • Trail 1 OS:
• 6.70mm/-9.00D/14.60mm/RK2 XL
• Slight central pooling (Ideal)
• Peripheral fit : Ideal edge width
• Diameter: slightly less, increase diameter to 14.8
• Location: Evenly around limbus
• Movement: 0.2-0.3 mm
• Over refraction: +2.00D
• Vision: 6/9P, N6

12. Final lens parameter
• OD: 7.5mm/-2.25D/14.80mm/STD /Rose K2 XL/ Green (trial )
• OS: 6.7mm/-7.00D/14.80mm/STD /Rose K2 XL/ Blue.

13. Dispensing visit
• OD
• central touch after 1 hour of lens
insertion
• Peripheral fit : Ideal edge width
• Diameter: slightly less, increase
diameter to 14.8
• Location: Evenly around limbus
• Movement: 0.2-0.3 mm
Over refraction: -1.25D Vision:
6/6-, N6

14. • Slight central pooling
• Peripheral fit : Ideal edge width
• Diameter: optimal
• Location: Evenly around limbus
• Movement: 0.2-0.3 mm
• Over refraction: +0.50DS
• Vision: 6/9P, N6

15. • Lens ordered for RE
• OD: 7.4mm/-2.25D/14.80mm/STD /Rose K2 XL/ Green
• Left eye lens was dispensed
• OS: 6.7mm/-7.00D/14.80mm/STD /Rose K2 XL/ Blue.
• Patient was asked to continue RE own lens till ROSE k XL LENS come and for left
eye start wearing ROSE K XL LENS

16. Conclusion
• In the early stages, patients with keratoconus can usually achieve
adequate visual correction with spectacles.
• When irregular astigmatism makes clear vision with spectacles
impossible contact lens are tried which most of the times gives
excellent vision.
• If cylinder is soft toric lens can be given till vision is good as well as it
provides good comfort.
• If this doesn’t work then other option available are RGP, ROSE-k, mini
scleral, scleral lens where most of the time ideal vision and comfort
are achieved.