Abstract
A patient presented with months of variable refractions across multiple exams and worsening best-corrected vision yet reported better vision in contact lenses. The patient had worn contact lenses for most of every day for over ten years. At presentation, vision was correctable only to 20/40, with irregular astigmatism and significant higher-order aberrations on tomography and ray tracing aberrometry. After one week without contact lens wear, reevaluation revealed diffuse, severe punctate keratopathy with superior superficial corneal neovascularization. Epithelial mapping tomography showed thin epithelium, and anterior segment OCT showed hyper-reflective epithelium, findings consistent with limbal stem cell deficiency. Over four months of contact lens avoidance and ocular surface treatment with lubrication and autologous serum tears, repeat tomography showed decreased magnitude and more regular astigmatism. Refraction stabilized, vision reached 20/20 in both eyes, and the patient was satisfied with both ocular surface comfort and quality of vision.
Presentation Date: 10/22/2026
Issue Date: 10/23/2026
