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Scleral Lenses -- Where to Begin?

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  • Scleral Lenses -- Where to Begin?

    I have been reading posts on this forum for almost a year, since my dry eye symptoms appeared, but this is my first post.

    I live in Northern California and have been treated at UCSF, Stanford, and now UC Berkeley. I have been diagnosed with ocular rosacea, lagophthalmos, and MGD. I am currently doing the following: taking doxycycline and omega 3 supplements, using warm compresses and performing lid hygiene twice a day, using moisture chamber glasses all day, including sunglasses outdoors ,using a humidifier at night and during the rest of the day to the extent possible, taping one eye each night (alternating) and wearing moisture goggles at night in addition, using OTC drops (Refresh Plus) and autologous serum drops, and taking xiidra. My symptoms have abated some -- I no longer need to take pain pills to deal with the pain in the evenings, but things are very far from normal. I have known for some time that scleral lenses might be a good idea, and my doctor has now recommended them.

    These are my questions: Should I start with something like PROSE or eyeprint pro, or should I start with less-customized scleral lenses? In addition, does anyone have a recommendation about the size of the lenses?

    I ask the first question because: 1) it appears that my vision and medical insurance will not contribute to the cost of scleral lenses; 2) there is currently no PROSE clinic in northern California, although there is one in Los Angeles (USC) and there is an eyeprint pro provider in San Francisco; and 3) both the PROSE provider at USC and the eyeprint pro provider in San Francisco have suggested that I see the contact lens specialist at UC Berkeley's optometry school before moving on to the more expensive and more custom-fitted options. These optometrists all know and seem to respect each other, so although I was thinking that PROSE or eyeprint pro was definitely the way to go, I am now thinking that I should try UC Berkeley. The cost difference seems to be significant. UC Berkeley will charge about $1500 for the fitting and the lenses. I have been told that Eyeprint pro may cost $4000 per eye or more, and I understand that PROSE may also be in that ballpark.

    As to my second question, I don't know what brand of lenses the UC Berkeley clinic uses, but the doctor there has suggested using 16mm lenses on my eyes. I know that there has been concern about smaller sclerals being used in dry eye patients. I just don't know whether there is a consensus view on how small is too small in this context.

    Thank you in advance for any advice you can provide.
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