Case report: using the Medmont Meridia Pro to monitor treatment response for anterior eye conditions

The following case highlights the use of the Medmont Meridia for high-definition imaging, utilising white light and blue light fluorescein capture, to monitor treatment response in anterior eye conditions.

Case presentation:
Mr. SB, a 31-year-old male, has been a long-term rigid contact lens wearer since his diagnosis of bilateral keratoconus in his early teens. He underwent corneal cross-linking in both eyes in 2009 and was subsequently fitted with scleral contact lenses in his hometown in New Zealand from 2011. He has a history of herpes simplex virus (HSV) keratitis in his right eye in 2012, followed by disciform keratitis in the same eye in 2017.

1/11/24 – Initial Consult:
Having recently moved to Melbourne, Mr. SB presented for an initial consult due to a red left eye persisting for the past two days, accompanied by significant pain, photophobia and tearing. As a result, he had not worn his left scleral lens during this period. His right eye remained unaffected, and he continued to wear a scleral lens in his right eye without issues.

Anterior slit lamp examination revealed grade 2 bulbar hyperemia and a raised central corneal infiltrate with stromal haze and overlying fluorescein staining. The anterior chamber was deep and quiet. The Medmont Meridia was used to capture high-definition fluorescein imaging of Mr. SB’s left cornea, as shown in the image below.

As Mr. SB is a contact lens wearer and the corneal infiltrate was central and raised, he was treated conservatively as microbial keratitis (MK) in consultation with a local ophthalmologist. Treatment included Ocuflox 0.3% eye drops every two hours, with a follow-up review scheduled in three days. He was advised to refrain from wearing his left contact lens during this period.

3/11/24 Three-day review:
At the three-day review, Mr. SB reported significant improvement, with no redness, pain or photophobia. Slit lamp examination revealed substantial improvement; however, the corneal infiltrate remained raised with mild residual staining. The Medmont Meridia was used to document the progress.

Mr. SB was advised to continue Ocuflox 0.3% eye drops every two hours for an additional two days (completing a five-day course) and return for a follow-up review in two days.

6/11/24 – Six-day review
At the six-day review, Mr. SB was asymptomatic after completing a five-day course of Ocuflox 0.3%. Slit lamp examination showed significant improvement, documented with Medmont imaging. The lesion was no longer raised, with no epithelial involvement, though mild stromal haze remained. Pred Forte 1% QID was prescribed to minimize scarring.

20/11/24 – Final review
The following Medmont image documents Mr. SB’s final review, showing complete resolution of the corneal lesion. Pred Forte 1% was tapered appropriately, and he was refitted with a left scleral contact lens with increased central sag to ensure full corneal vaulting.

This report was prepared by optometrists Dr Van and Dr Rossi from Richard Lindsay & Associates.

Jacinda Van

Jacinda Van

Optometrist, Richard Lindsay & Associates

I developed a keen interest in myopia control and contact lenses after fitting myself in ortho-keratology lenses when I was an optometry student at the University of Melbourne. This has now expanded to include keratoconus, paediatric aphakia and all sorts of custom contact lens fitting. I enjoy having the opportunity to fit the latest and greatest contact lens designs and having them as options available to provide my patients with the best possible outcomes. I also enjoy my role as a clinical supervisor at the University of Melbourne and find it very rewarding to teach enthusiastic students. Outside of work, I am a keen traveller and spend as much time as I can eating and hiking my way around the world. I have recently begun camping and am keen to explore more of regional Victoria.
Michaela Rossi

Michaela Rossi

Optometrist, Richard Lindsay & Associates

Originally from Adelaide, I graduated from Flinders University. My mother’s experience with keratoconus, and the transformative impact of corneal rigid lenses and now scleral contact lenses on her quality of life, inspired me to pursue a career where I could make a similar difference for others. I now practise in a specialty lens clinic, continually advancing my skills, and offer full-scope optometry alongside my colleagues at Richard Lindsay & Associates. Together, we remain dedicated to improving our patients’ vision and staying at the forefront of the latest research and technology. I also love Buddy, our practice dog, who never fails to bring joy to everyone he meets. I occasionally look after him whilst Jillian, Buddy’s mum, goes on holiday. Outside of work, I enjoy spending time at the beach, cooking, and travelling around Australia.