This is a classic case. Hopefully most of you will get this one. If not, take a hard look at it and once you've read the answer, log the case into your permanent memory banks. It is one you almost assuredly WILL see one day. I've had a couple of these, at least. This particular case was submitted by Bob McClenathan, OD of Lancaster, PA.

The patient G.T. is a 68 y/o white male who presented with complaints of near vision problems. His glasses were a mess, bent up and scratched. With the old glasses he was about 20/50 OD, OS, OU. But with a bit more minus, his vision improved to around 20/30- in each eye.

Biomicroscopy was performed, revealing the corneal changes seen in the photo to your left. The other eye was about the same. Some mild lenticular changes were found as well. IOP was normal, and retinal health was fine as well.

What is this condition? How should be patient be managed? What sort of sequelae may result if this is handled properly? These are some open ended sort of questions, but ones I'd like you to think about. Once you've made your decision, we'll discuss things a bit more in the answer.

Thanks!