“Anna? Why Can I See So Well?” – between Precision and Trust following Severe Keratitis
This case demonstrates the remarkable potential of individualized contact lens fitting.
There are moments in contact lens fitting that stay with you. “Anna? Why can I see so well?” These were the words of a 29-year-old man who, almost a year earlier, could hardly perceive more than light and dark with his left eye. He said them after the first fitting of a diagnostic lens.
An Individual Contact Lens Case Following Severe Keratitis: Between Precision and Trust
Initial Situation: Severe Keratitis and Significant Uncertainty
While traveling in Africa, the patient developed a severe bacterial keratitis caused by a Pseudomonas infection associated with soft contact lens wear. The consequences included:
- Hospitalization
- Severe corneal opacification
- Initially almost no functional vision
- Long-term ophthalmological treatment
Even ten to twelve months after the acute infection, the cornea still showed:
- Residual scarring and opacities
- Persistent corneal edema, particularly in the temporal area
- An ocular condition that had not yet fully stabilized
The patient remained under regular ophthalmological care and continued topical therapy. Current treatment includes Ikervis® (ciclosporin) to support long-term control of the inflammatory process. Importantly, the healing process is still ongoing. At present, it remains unclear whether a permanent corneal scar will ultimately develop. Above all, however, the patient was dealing with one overwhelming emotion: Fear. Fear of damaging the eye further and fear of experiencing another disappointment.
Diagnostic Assessment and Current Status
Corneal topography of the affected left eye revealed:- Pronounced irregularities in the tangential curvature profile
- A central area showing increasing clarity
- Peripheral asymmetries that made standard lens designs unsuitable
The initial visual acuity was approximately 0.3 (decimal VA), achievable with a pinhole aperture.
Topography of the Left Eye
The topography demonstrates a markedly irregular corneal surface with pronounced asymmetric curvature patterns following post-inflammatory corneal changes. Centrally, a comparatively more regular area is visible, whereas peripheral steepening and flattening significantly increase the complexity of the lens fitting process.
Left Eye: Initial Presentation
Marked corneal opacification with residual stromal infiltrates and a central zone of partial clearing. The corneal structure appears irregular with heterogeneous transparency. Peripheral opacities and persistent tissue alterations remain evident following severe keratitis.
Left Eye: Six Months Later
The central cornea shows increasing clarity, surrounded by diffuse residual haze and an irregular tissue structure. Uneven light scattering illustrates the continuing irregular surface, while progressive tissue regeneration can be observed.
Lens Design Concept: Corneal Rigid Gas Permeable Lenses
Right Eye
Single-vision standard rigid gas permeable lens. Objectives:
- Provide a stable physiological reference
- Reduce complexity and emotional stress
- Uniform central alignment
- Stable centration
- Harmonious peripheral edge lift
- No evidence of mechanical stress
Left Eye
Individually calculated keratoconus lens. Custom-designed for the post-inflammatory corneal shape. Objectives:
- Neutralize corneal irregularities
- Protect the sensitive tissue
- Improve optical quality and image formation
The fluorescein pattern of the Excellent KK lens demonstrated: Uniform central tear pooling supporting optical neutralization of corneal irregularities, Stable and well-centered lens positioning, Smooth transition into the mid-peripheral and peripheral zones, Adequate tear exchange without localized pressure points or mechanical stress
Workflow: Step by Step Instead of Actionism
The fitting process followed a structured approach:
- Detailed topographical analysis
- Decision for a customized design on the left eye
- Transfer of data to the Appenzeller Professional Service
- Diagnostic lens fitting
- Deliberately postponed visual acuity measurement
- Allowing time for adaptation, observation, and confidence-building
"I wanted him to arrive first, both physically and emotionally," explains Anna Reichow. Visual acuity was only evaluated after several hours of lens wear.
The outcome:
- 0.8 visual acuity in the left eye
- Comfortable wear times of 5 to 7 hours
- Significantly improved subjective confidence and visual security
Particularly remarkable:
was the improvement from what had effectively become light perception only to a visual acuity of 0.8, fundamentally changing the patient's daily life. At the same time, clinical observations continue to show progressive healing, meaning the corneal condition may still evolve in the future.
Care Regimen and Interdisciplinary Collaboration
Lens care consists of:
- A peroxide-based disinfection system
- An alcohol-based cleaner
The fitting process remains closely coordinated with the treating ophthalmologist. As an integral part of the therapeutic concept, planned periods of lens-free wear are intentionally incorporated.
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Key takeaways from this case
“I’m Not a Classic Contact Lens Specialist – But I Rarely Say No”
The fitting was performed by Anna Reichow, Master Optician and independent practitioner since late 2024. She does not describe herself as a traditional specialist, which is exactly what makes this case so authentic.
"I didn't come from a practice highly specialized in contact lenses. But I've never been someone who says no. I accept challenges, working hand in hand with the manufacturer, following a structured approach and respecting the complexity of each case."
The decision against a more complex solution, such as a scleral lens, was intentional: The cornea still showed regenerative potential, The patient required emotional adjustment time, A corneal rigid lens had already achieved the desired outcome.
"Less complexity is simply the better starting point."
The Role of Appenzeller Kontaktlinsen AG
For Anna Reichow, one principle was clear from the beginning: One manufacturer. One clear workflow.
The decisive factors were: Fast delivery times, Clear communication, Confidence in lens design and implementation, Straightforward collaboration.
"Especially in cases like this, it is important to work with a partner who brings calm and clarity rather than additional uncertainty."
Conclusion: Two Dimensions of a Successful Fitting
This case illustrates that successful contact lens fitting always operates on two levels. The Clinical Dimension: Analysis, Lens geometry, Material selection, Fluorescein evaluation, Visual acuity.
The Human Dimension: Trust, Patience, Fear, Hope. Ultimately, the outcome is not merely a clinical result.
It is the restoration of vision and, with it, quality of life.
Because the most important achievement is not the visual acuity number itself, but the fact that the patient can once again perceive far more than light and darkness. Or, as he put it: “Anna? Why can I see so well?”
