Can RGPs be better for dry eye?

[aLensUsr]

I have moderately (? -- tear breakup time = 5 sec) dry eyes. I have worn contact lenses for almost 30 years -- the 1st 4 years I was in PMMA. Then I switched to soft contacts and the past 2 years have been in SiHys. Is it reasonable to ask to try RGPs, given that that they have 0 water content?

The plugs did not help and I am having some small success with fish oil. In summary my experience has been:

Proclears: slide on my eye
N&D: Cannot wear beyond 12 hours due to stiffness/edge design. However, when they feel great they feel better than anything. But they do not consistently feel great for 12 hours.
Oasys: Can wear 16 hours but tends to feel "grimy", although vision is fine.

If RGP's are an option worth looking into, how does one find an optometrist who is well-versed with these? I am under the (perhaps mistaken) impression that hardly anyone fits RGPs anymore.

Thanks in advance.

[DrG]

It is definitely reasonable to try RGP's. Whether they actually perform better than soft lenses in sub-clinical dry eye has been debated for years. Surely, patients who have severe clinical dry eye find large RGP scleral lenses helpful, although lubrication and wettability are still big issues. You will find that many people still have to remove them, clean them, rewet, them, re-insert them, etc.

Given what you have said, I wonder if you have set your expectations a bit high for contact lens wear. It seems like you do reasonably well with the silicone hydrogels, often times getting 16 hours of wear. Have you tried the Purevision lens? I think the surface is a bit smoother than some of the others.

I wonder if fitting RGP's is becoming a lost art. I hear different opinions. Many contact lens reps do tell me that. On the other hand, there has never been a greater wealth of RGP lenses available for dry eyes and difficult to fit corneas. Witness that three labs in my immediate area are now manufacturing scleral lenses. Some must be fitting them. My guess is that the fitters gravitate to the source of patients with complicated corneas, and that would be the major teaching universities and hospitals.

You didn't say where you are located, but I am located in North Texas.

[aLensUsr]

I should have added that part of my interest is due to the fact that I am in my late 40's and now carry readers around with me, although at the moment I use them only about once a day. I also wonder sometimes if my "problem" is really in part due to "grumpy old contact lens wearer" syndrome .

I have not tried Purevision lenses. Any lenses that I have tried so far with a base curve greater than 8.4 slide on my eye (e.g. O2optix), and even the Proclears in 8.2.

I live near Seattle, so I guess if I decide to try this route I should gravitate toward University of Washington ...

Thanks again for your reply.

[DrG]

Well, the fit is at least as important as the material, and I wish you had stated that in your original post, because now I have to go back and contradict myself based on this new information.

If you can't wear an 8.2 Proclear, then you are not going to do well with the Purevision, which is only available in an 8.6 base curve and does not fit steep eyes very well. In March, they will be rolling out their new and improved version in an 8.3 base curve with a lower modulus and a smoother edge. I think it will perform better than the previous version.

It is quite possible that you need something in a base curve and a larger diameter than can be addressed by the disposable lens market. There are a number of manufacturers who use the Extreme H2O material in a custom design, with an almost unlimited selection of diameters and base curves.

I might also recommend something like the Macrolens, which now has a different name and is manufactured by Dakota Sciences.

[aLensUsr]

That makes alot of sense. My previous OD had me in larger diameter vial lenses which I did well with (for the most part, although my eyes are now drier) until 4years ago when he retired. When he retired I stopped getting the annual "time for a contact lens checkup" reminders and therefore ended up overwearing my annual contacts for 1 1/2 to 2 years before I figured out the problem.

I then went with planned replacement and have had trouble with the fit (to more or less degree) ever since. I cannot go back to the previous annual replacement lenses as they do not make them anymore.

Thanks again.