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A 41-year-old otherwise healthy Pakistani male presented to our Cornea Clinic. He gave a history of bilateral, gradual, childhood onset myopia for which he used soft contact lenses (CL) daily for 20 years until 2009. Then, due to increasing astigmatism, he switched to rigid gas permeable (RGP) CLs. Because he experienced increasing discomfort after a year of using RGPs, his CL specialist tried several other CL options over the following 2 years, including mini-scleral and ‘piggy back’ lenses with little success.
On examination, his right eye Log MAR corrected visual acuity with glasses was 0.58, best corrected to 0.28 oculus dexter (OD) and 0.22, best corrected to 0.02 oculus sinister (OS). His slit-lamp photomicrographs and topographical findings are shown below (figure 1). Keratometry readings revealed irregular astigmatism of +9.40D OD and +11.90D OS.
Describe the findings in figure 1 and the most likely diagnosis …