Case Report
Rigid Gas Permeable (RGP) Contact Lens Treatment For
High Compound Myopic Astigmatism
With Isoametropic Amblyopia
M. Rifqi Ulwan Hamidin*
Consultant
dr. Ani Ismail, SpM, Subsp. ROV
dr. Eva Kumalasari, SpM
MEDICAL RESIDENT OF OPHTHALMOLOGY
MEDICAL FACULTY OF SRIWIJAYA UNIVERSITY
MOH. HOESIN HOSPITAL PALEMBANG
2023
1
INTRODUCTION
Introduction
Myopia Myopia is a condition when the object
light focus was fell in front of the retina.
Also called ”Nearsightness” This refractive disorder might affect all
ages.
The most common type Usually affecting
of refractive anomaly children
Epidemiology
Asia
Myopia occur most in
Global children and
prevalence is adolescent in Asia
estimated at
0.2-3.8%.
- AIMS
To report the management of compound
high myopic astigmatism with
Amblyopia Isoametropic using RGP
Contact lens as one of the options.
2
PATIENT IDENTITY
PATIEN’S IDENTITY
Age Gender Job Location
11 Years Female Student Outside city
Chief Complain
Difficult to see distant object since she was 5 years old
History of Pressent Illness
The patient complains that she has blurry vision in both eyes, especially
when looking at distant objects. The patients said that blurry vision got
worse approximately 2 months ago, and she is not comfortable with her
current spectacles
There were not any complaints of redness,
photophobia, teary eyes, and eye discharge. There
were also not any report of hazy vision and perceiving
any flying object or light flashes.
History of Past Illness
Patiens was using spectacle with correction:
● OD S–5.00 C–1.00Ax180o 6 years ago
● OS S–4.50 C-1.00Ax 180o. 6 years ago
Family and habitual History
(+) Family history of refractive disorder
patient’s father
(+) Screen time approximately 6-7 hours a day,
with distance less than 30 cm
(-) History of eye trauma
(-) History of contact lens usage
Pedigree
Pasien
OPHTHALMOLOGY Examination
OPHTHALMOLOGY Examination
Ophthalmology Examination
Test Right Eye Left Eye
2/60 ph 6/60 3/60 ph 6/60
VA
S-16.00 C-4.00 Axs 10 S-15.50 C-4.50 Axs
6/12 10 6/12
Correction crowding phenomenon crowding phenomenon
(+) 6/9 (+) 6/9
Binocular acuity 6/12
IOP 11.3 mmHg 13.3 mmHg
Eye position Orthophoria
Eye movement Good to all gaze Good to all gaze
Ophthalmology Examination
Test Right Eye Left Eye
Palpebra Normal Normal
Conjunctiva Normal Normal
Cornea Clear Clear
Anterior
Medium Depth Medium Depth
Chamber
Iris Good appearance Good appearance
Round, central, Ø 3 Round, central, Ø 3
Pupil
mm, LR (+) mm, LR (+)
Lens Clear Clear
Ophthalmology Examination
Right Eye
Fundus
(+)
reflex
Oval, normal disc margin,
Papil myopic crescent (+), normal
color, c/d 0.3 a:v 2:3
Macula Normal foveal reflex (+)
Normal vascular contour,
Retina
tigroid appearance (+)
Ophthalmology Examination
Left Eye
Fundus
(+)
reflex
Oval, normal disc margin,
Papil myopic crescent (+), normal
color, c/d 0.3 a:v 2:3
Macula Normal foveal reflex (+)
Normal vascular contour,
Retina
tigroid appearance (+)
USG Result RIGHT EYE
Interpretation:
You can write here
• Vitreous was echo-
free
• Retina is intact and
theres’s no coroid
thickening
• Axial length is 26.82
mm
Elongated eyeball, Susp. High
Myopia
USG Result Left EYE
Interpretation:
You can write here
• Vitreous was echo-
free
• Retina is intact and
theres’s no coroid
thickening
• Axial length is 25.94
mm
Elongated eyeball, Susp. High
Myopia
WORKING Diagnosis
High Compound Myopic
Astigmatism + Isoametropic
Amblyopia
Management
• Counselling and Education
• Refractive Correction (with RGP lens)
• Education regarding Contact Lens’ Hygiene
• Evaluate the management after 2-3 months.
Contact Lens Base Curve
Right Eye Left eye
7.79 mm -7.11 mm = 0.68 7.74 mm – 7.23 mm = 0.51
mm mm
(Conversion: 0.20 mm) (Conversion: 0.20 mm)
Base Curve Base Curve
7.79 mm – 0.20 mm = 7.59 7.74 mm – 0.20 mm = 7.54
mm mm
Fitting RGP Lens
S-16.00 C-4.00 Axs 10 S-14.00 C-4.50 Axs 10
BCVA 6/12 6/12
BC 7.40 mm Ø 9.2 Trial Lens 7.45 mm Ø 9.2 Trial Lens
Power S -9.00 D Power S -9.00 D
Over- S -6.00 D 6/12 S -6.00 D 6/12
refraction Binocular 6/9
BC 7.40 / D 9.2 / S-15.00 BC 7.45 / D 9.2 / S-15.00
RGP Lens
RGP Lens
Fluorescein Test
Prognosis
Quo ad Vitam Bonam
Quo ad Functionam Dubia ad Bonam
Quo ad Sanationam Dubia ad Bonam
3
PROBLEM ANALYSIS
Discussion Previous spectacle correction:
● OD S–5.00 C–1.00Ax180o
● OS S–4.50 C-1.00Ax 180o
A 11 years old female • Patien’s family
Current correction: history.
patient with Blurry S-16.00 C-4.00 Axs 10o
vision in both eyes S-14.00 C-4.50 Axs 10o • Screen time
while looking at distant
object Spherical + Cylindrical
Dx: High Compound Myopic Astigmatism
Discussion
Funduscopic Examination
USG examination reveals: reveals: OCT Examinations
AL is 26.82 mm in the Oval optic disc reveals:
right eye and 25.94 mm
Myopic Crescent Retinal Thinning
in the left eye
(+)
Tigroid Appeareance
Elongation of AL
High Myopia > Patologic Myopia
~
Discussion
Current correction:
Crowding S-16.00 C-4.00 Axs 10o
Phenomenon (+) S-15.50 C-4.50 Axs 10o
6/12 6/9 in both eyes
Both eyes having VA worse
than 20/30
Amblyopia Isoametropia
Discussion
Myopia
Myopia Classification, Based
on its Severity:
Mild myopia( < -3.00 D) Myopia is a condition when the
object light focus was fell in front of
Moderate myopia(-3.00 the retina. This refractive disorder
to -6.00 D), and might affect all ages.
High myopia(> -600 D).
Management of High Myopia
There are several option of high myopia management, it can be
classified into:
•Surgery intervention
•Non-Farmacological
•Farmacological -
Spectacles
Non-farmacological
Contact Lens
Contact Lens RGP SCL
Rigid Gas Permeable
• Able to correct
astigmatism
• Able to control myopia
• Longer adaptation period progressivity
• Lower comfort rate • Higher oxygen transfer
compare to SCL rate higher durability
• Relatively expensive
RGP > SCL
Discussion Pre- RGP
FITTING
Assessment Of Tear
Production RE: 7.79 mm – 0.20 mm =
On this patient, the blnking rate 7.59 mm (BC)
was 14x/minute in RE and LE: 7.74 mm – 0.20 mm =
15X/minutes in LE , with 17 7.54 mm (BC)
mm Schirmer test on the RE
and 19 mm in LE
considered normal, there’s no
contraindcation
Management of Amblyopia
Treatment involves the following steps:
1. Eliminate (if needed) any obstruction of the visual axis, such
as a cataract.
2. Correct any significant refractive error.
3. Promote use of the amblyopic eye.
-
elemination
Patching
Management RGP
CONCLUSION ……
Myopia is the most common refractive anomaly
High myopia without proper management will developed into
patologic myopia.
Refractive correction in Isoametropic amblyopia will improve
success rate
Patient’s age is important factor in management of amblyopia
success rate.
Thank you
