Dyna Z Intra-limbal Lens

[neil0502]

Last night, I was evaluated (at length) by the Southern California College of Optometry. I went to them to be fitted for scleral lenses.

Long story short: they told me that sclerals are often associated with decreased wear times (I've certainly heard this) and that they prefer to use those only in cases where no other practical solution exists.

They told me about a newish technology called intra-limbal contact lenses. The idea is the same: a larger rigid gas permeable that covered the entire cornea. In this case, though, the overall diameter is smaller than the scleral lenses.

For severe dry eye, they're theorizing that this lens will have all of the advantages, with none of the disadvantages, of scleral lenses.

Here's the link to the website of the manufacturer from whom they're ordering. I go back in two weeks to try the pair that are being ordered to my specifications.

Another article on the lens, and on big-RGP's, generally.

I'll keep you posted....

[Rebecca Petris]

The idea is the same: a larger rigid gas permeable that covered the entire cornea. In this case, though, the overall diameter is smaller than the scleral lenses.

I wear large gas perms called Macrolenses and am a big proponent of them. Not sure why these weren't covered in that article but they are larger than the ones they describe there as large. These have been around for awhile and DrG has extensive experience fitting these on post RS patients for vision problems - many of whom have dry eye. I think DrG has an article on his site explaining the differences between corneal, corneal-scleral and scleral lenses but I can't seem to find it just now. I gather corneal-scleral and intralimbal are being used pretty much synonymously?

While I wear these lenses because of vision problems (certainly not as a dry eye treatment) my eyes are much more comfortable in terms of dry eye discomfort, aching, sensitivity and irritation when I have the lenses in compared to when I do not have them in. I still have to wear wraparounds outdoors and in the car to be really comfortable but I am a lot better off with the lenses than without.

[neil0502]

I probably should have mentioned that MacroLens as being in that category, too, Rebecca. Forgot.

I used the C&H Contact Lenses site a while back to find a local practitioner with experience in MacroLens fitting. The OD that I wound up with--despite my (overly) explicit direction, on the phone, that I was coming in to be fitted with the MacroLens--performed the exam, then said he'd order some regular old RGP's for me, saying that "I didn't really want the MacroLens," but offering no rationale.

I asked him to cancel the order and be sure not to bill me for the eval. Failing to locate another local practitioner for the Macro, I worked my way up to the folks at SCCO.

How's your comfort and wear time? Do you know the actual diameter of your lenses?

Best,
Neil

[Rebecca Petris]

How's your comfort and wear time? Do you know the actual diameter of your lenses?

I think they are either 14 or 14.5mm? Not quite sure. They each have one fenestration hole.

I typically go through an hour or so in the morning of some moderate discomfort with them, then they settle down. I have some unique fitting issues, though, that would not be present for most patients (I have to have reverse geos because of my corneal shape and also have central islands). The best comfort level which I've achieved is basically equivalent to my soft lens comfort back in the 90's before I had surgery, although I do blink more often now than I did back then.

I wear the lenses basically all my waking hours now. I don't think wearing them that much is necessarily a good idea, it's more of an addiction, because without them I can't see and my eyes hurt. (DrG, honest, I AM trying to give my eyes a break now and then.) To be honest - and this is NOT a sales pitch - I do not believe I could wear them even half that long without NutraTear. I have never found anything else that I can tolerate as a wetting agent, and I need drops every 3-4 hours typically. When I find myself reaching for the drops too often at night I know it's time to take them out and go to bed.

[Philipp_from_Germany]

@ Neil

The idea is the same: a larger rigid gas permeable that covered the entire cornea.

Hm, I was under the impression that a scleral lens is there to hydrate the surface of the eye by constantly retaining a liquid reservoir. At least that's what my sclerals do for me
A few month ago I did some googling about semi-sclerals and macros but it looks like those still need some kind of stable tear film to float upon. From what I can find out about intra-limbals they are pretty much the same and I cannot see a clear indication for dry eye (But according to your website you need those lenses for other purposes also). Please let us know how it turns out for you and I would love to know if those lenses also help hydrate the eye. I am looking forward to a trip to my scleral lens optometrist in England at the end of february and I think I will probably be discussing different lenses as well as the decreased wearing time of my sclerals is the bigest setback for me.
Again, thank you for sharing and take care!

[neil0502]

Hm, I was under the impression that a scleral lens is there to hydrate the surface of the eye by constantly retaining a liquid reservoir. At least that's what my sclerals do for me

Actually, Philipp, I believe you are correct. From my early investigations of the Boston Scleral, they do form a 'reservoir' to maintain a liquid layer against the cornea. The intra-limbal lens does not.

The doctors yesterday assured me (time will tell) that the minimum tear film required to float the intra-limbals shouldn't be a problem for anybody other than a Sjogren's patient (Schirmer's = 0mm)--even in extremely dry Colorado, where my wife and I are hoping to move--and that the gas-permeable lens should dramatically slow tear evaporation while still serving as a sort of corneal bandage.

Again: time will tell.

I do like the idea that they are proceeding in a 'stepwise fashion,' trying to maximize the advantages of the larger lens while playing down the potential disadvantages (perhaps difficult fit, low wear times, cost, ?) of the full scleral.

I will keep everybody posted.

Danke vielmals for your feedback.

[Lucy]

Neil, good luck. About 2 years ago, I was fit with ZWAVE lens. I could actually wear them despite my dry as dirt eyes. Vision was improved much, too. Then less than a year later, I had cataract surgery and my situation changed dramatically. My ZWAVES are 14 mm. Not sure about the scleral lens. I can tell you they hold 16 drops of saline.

Hoping this is your answer!

[Rebecca Petris]

I think that the ZWaves while similar in diameter are different in concept than the Macrolens... i.e. that they follow the "reservoir" idea while the Macros don't.

p.s. Phyllis, IT IS TOO. THE FDA SAYS SO.

[neil0502]

Neil, good luck. About 2 years ago, I was fit with ZWAVE lens. I could actually wear them despite my dry as dirt eyes. Vision was improved much, too. Then less than a year later, I had cataract surgery and my situation changed dramatically. My ZWAVES are 14 mm. Not sure about the scleral lens. I can tell you they hold 16 drops of saline.

Hoping this is your answer!

Thanks, Lucy.

I only did a tiny bit of Googling about the ZWAVEs. I'll mention those on 2/8 when I'm up there to get an idea of the differences between those and the intra-limbals.

The good news is how many options are out there that might help any one of us. The challenge is finding practitioners able to keep track of so much fast-moving data with enough facility to understand what works best for whom.

[DrG]

Intralimbal is any RGP lens that fits within the limbal region of the cornea, and is also larger than 10 mm in diameter. I started using them in 2000 for post-LASIK problems, when I requested Metro Optics of Dallas to make me a custom lens set ranging from 11.2 to 12.0 mm in diameter. Was Lens Dynamics even making intralimbals then? These proved to be the first really successful design for me. For specialty cases, more than 80% of the lenses I use are greater than 11.0 mm. Insofar as many post-LASIK patients have dry eyes, I suppose I would consider myself an expert on fitting dry eyes with intralimbal lenses.

Since I have no desire to get into a long-winded discussion on using such lenses for dry eye, I will defer to Neil to report back to us on his experiences. All of the various types of lenses have their pluses and minuses. As Neil observed, it behooves the astute practitioner to be able to offer a number of alternatives, as well as to be able to think outside of the box in order to solve complex variables. The only types of lenses I have not gotten involved with are scleral lenses, mainly because I think that their application is rather narrow and reserved for highly diseased eyes. But, I won't hesitate to recommend them to patients I feel would benefit.

[Lucy]

I think that the ZWaves while similar in diameter are different in concept than the Macrolens... i.e. that they follow the "reservoir" idea while the Macros don't.

p.s. Phyllis, IT IS TOO. THE FDA SAYS SO.

I don't know if ZWAVES follow the reservoir idea or not. Could be. I never thought about it, so that "one" is ok.

PS Rebecca, it is not. Like we really care what the FDA says. Who is he (FDA) anyhow?

[Lucy]

I just wish I was able to wear my old glasses and forget what happened that day. I would have so much more money than I do now.

[DrG]

I don't know if ZWAVES follow the reservoir idea or not. Could be. I never thought about it, so that "one" is ok.

PS Rebecca, it is not. Like we really care what the FDA says. Who is he (FDA) anyhow?

The large ZWAVES I have seen are non-fenestrated, small scleral lenses that are sealed. Therefore, one has to remove the eyeball from the socket with a suction device in order to remove the lenses (intentional hyperbole).

[Lucy]

Super Plunger

You should see the super plunger (with suction air device) that I use to insert my sclerals!