Fitting contact lenses after myopic keratomileusis

Purpose: To evaluate the long-term efficacy and results of contact lens fitting following myopic keratomileusis (MKM). Setting: Department of Ophthalmology, Manhattan Eye, Ear, and Throat Hospital, and Swinger Vision Center, New York, New York, USA. Methods: Postoperative fitting of contact lenses was studied as part of a prospective evaluation of myopic keratomileusis. In this series, 27 eyes of 20 patients had residual postoperative refractive errors that were corrected with contact lenses. Patients were fit at a mean of 9.4 months after surgery by the trial-lens method. Preoperative keratometry readings and refractions, as well as postoperative keratometry readings, refractions, and contact lens specifications, were recorded and used for fitting. Results: Twenty-six eyes (96%) were fit successfully: 24 (89%) with rigid gaspermeable lenses and 2 (7%) with daily-wear soft lenses. The mean diameter of the rigid lenses was 10.00 mm (range 9.4 to 11.0 mm) and the mean base curve, 8.52 mm (range 7.9 to 9.2 mm). The 2 soft lenses had base curves of 8.6 and 8.9 mm. The mean lens power was -5.24 diopters (D) (range -0.37 to -14.75 D), which was, on average, 4.06 D more myopic than the postoperative spectacle refraction. Postoperative keratometry provided a good starting point for the trial lens. Lenses were tolerated for up to 16 years. One eye, fit with a soft lens, developed significant myopia during the fifth year. Conclusion: After lamellar refractive surgery, the topography of the cornea is significantly altered. Although the postoperative keratometry readings are steeper than the actual curvature, they are reasonably reliable for determining the base curve of the initial trial lens, validating the use of conventional methods of fitting rigid contact lenses in patients who have had MKM.