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  • Boston Sclerals #1

    The first in a series of threads on my trip to the Boston Foundation For Sight (hereafter BFS). I know that when someone on the board tries something new to help their dry eye, I really want to know specifics about their treatment, and will try to provide that as I go along.

    First a bit of background: I decided to pursue a BFS trip after reading Lucy's positive review of her experience there, and of the scleral lenses which she was fitted for. Bad grammar, but hey, it's Friday night. Lucy is (and I mean this in a the best possible way) a tough, honest customer, with worse eye problems than me (or, probably, you) and if she likes a treatment, I'm thinking it must be pretty good. (Remember that kid Mikey, who didn't like any food, but loved Life cereal? Analogy: Lucy = Mikey, BFS = Life cereal. Get it?)

    Also, I realized that I was sending lots of my own beleaguered patients (I'm a cancer specialist) away to Boston, NYC, DC, Houston for experimental treatments that they could not get anywhere else, and our military insurance, TRICARE, was approving and paying for every penny. Turns out that this is because our clinic's incredible social worker, Mrs. J.P., knows how to work the system in each patient's favor. So, I got Mrs J.P. to start working the system for me. I told her what i wanted to do (go to BFS, get the scleral lenses) and she looked into it, and told me that she could easily arrange it so that, polar opposite of Lucy, it would not cost me "one red cent." Nice to have a good person on your side (though it really shouldn't have to be that way).

    So, I contacted BFS on the number on their website, and was quickly routed to Bill Rosenthal, who was incredibly friendly and encouraging as he heard my basic story. Before he was certain that Boston Sclerals could help me, he wanted a narrative from my opthalmologist, who is an outstanding and caring Army CPT named Gary Fillmore. Dr. Fillmore wrote the narrative which summed up my story (lasik 2003, dry eyes a few months later, and ever since), and I faxed it to Bill, who e-mailed me the next day and said I sounded like a good candidate. We then proceeded to set up the visit. After a few stops-and-starts because of my insane work hours and my inability to leave for more than a day or two, we finally got a good workable date: for BFS to fit you with scleral lenses, it takes a full week, and my week was set as 8/28 - 9/1.

    Costs are as follows:
    BFS visit and scleral lenses: about $8000
    Sheraton Needham for 6 nights: $600 ($99 per night)
    Flight: the Army paid $400 each way, but you could may do better or worse depending on where you are coming from
    Rental Car: Ford Focus from Budget with military discount = $105 plus fees = $140
    With gas, food, etc added in, your looking at around 10 grand, which is a lot of wampum, especially if you are forking it out yourself. But it is important to remember that these doctors are not in in for the money. BFS is a non-profit organization, not a commercial enterprise trying to turn a buck. A large number of patients are subsidized, and the cost of materials and the machines to make the lenses is substantial.

    So I leave in two days, have my appt in three. Here's what I am curious about: Do these lenses hurt? It seems like the edges would bump against your lids and cause some discomfort. Maybe they stay put enough to prevent this, or maybe you get used to it. I will know soon enough, but if one of the veterans wants to respond, I'd love to hear it.

    Also: do they need to be re-wetted (grammar again) during the day? Rebecca stated that she had no pain when taking them out, but do BFS lens wearers get dry during the night like the rest of us? And can I still use my restasis? All questions I'll get answered soom, but if anyone of you veterans wants to jump in, go right ahead.

    Erik, out for now. More to come...

  • #2
    Originally posted by Erik
    So I leave in two days, have my appt in three. Here's what I am curious about: Do these lenses hurt? It seems like the edges would bump against your lids and cause some discomfort. Maybe they stay put enough to prevent this, or maybe you get used to it. I will know soon enough, but if one of the veterans wants to respond, I'd love to hear it.

    Also: do they need to be re-wetted (grammar again) during the day? Rebecca stated that she had no pain when taking them out, but do BFS lens wearers get dry during the night like the rest of us? And can I still use my restasis? All questions I'll get answered soom, but if anyone of you veterans wants to jump in, go right ahead.
    OK, I'll bite!

    Do the lenses hurt? Nope - not in my case. They have about the same comfort level as the Macros I've worn the last three years (Macros being about as comfortable as soft lenses). At certain times of day I have some 'awareness' of them, but never pain. Intuitively, it is certainly not natural to have an object this large for eyelids to swish against all day long - but dang, I'd never guess most of the time that anything unusual is going on. My right eye as I write this is awesome. I've had the scleral in for going on 16 hours straight and it feels good and the vision is good. I'm having some kind of problem with my left lid right now so I took that lens out earlier. I think the problem is unrelated to the lens - need to get it looked at, it's something I've had before - and meantime I'm trying to go easy on it.

    Maybe they stay put enough to prevent this You got it. Even smaller RGPs like Macros (14.5mm) don't move around with your lids like regular cornea RGPs. The full sclerals really just sit there. And the main point is, there is no point at which the scleral touches your CORNEA, which is where all the sensitive nerves are concentrated. Your sclera really couldn't care less what's sitting on it.

    do they need to be re-wetted (grammar again) during the day Probably. Depends how dry you are. I know people who cannot get through a day without taking them out, refilling them etc - and in fact Perry Rosenthal rather expected I'd have to (I don't, thankfully!). I sometimes feel the need to lubricate them, and I try to remember to lubricate them preventatively in any case, but frankly I just forget about them most of the time. Outdoors or in the car I'm definitely reaching for drops before too long.

    Rebecca stated that she had no pain when taking them out, but do BFS lens wearers get dry during the night like the rest of us
    Sure. Of course everyone's different. But if say you've got lagophthalmos, you're going to get dry during the night, no matter you do during the day. In my case the difference I'm observing is that I'm not making my corneas more vulnerable to night stress during the day but rather keeping them in this healing environment all day long, which makes the night much less of a problem. What I've really noticed is that some stubborn symptoms that NOTHING ever seemed to change have definitely started to give way since starting sclerals. My "dream team" right now is sclerals during the day (with Panoptx outside) and Dwelle + Tranquileyes at night. Without the scleral, all my regular gear greatly reduces the night dryness to the point my lids don't stick in the morning, I don't have to worry about erosions etc. But with the scleral, a stubborn gritty pain in my right eye that I have always woken up with is really changing. That was one of the things I found very encouraging in just the first two weeks of wear.

    Sorry so wordy. Short questions... long answers!
    Rebecca Petris
    The Dry Eye Foundation
    dryeyefoundation.org
    800-484-0244

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    • #3
      Erik --

      Wishing you all the best.
      Looking forward to your reports.
      I have been so elated to read of Lucy's success and Rebecca's, thanks to the Boston Foundation for Sight.

      (Lucy showed me her sclerals, and I swear that they looked like egg-cups to me,
      but she swore that they were actually quite comfortable on the eye. )

      Hoping that you will find both comfort and good vision, Erik.
      And hey, I hear that the seafood in Boston and the history tours aren't half bad.

      mary

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      • #4
        I have referred to them as my hub caps and/or my toilet plungers. Affectionately, of course.

        I'm sure Erik will not have the same problem, but my acrylic fingernails present a challenge when cleaning the lens. (I have a solution, but since I know Eric does not have long fake, fuschia nails, it will be my secret.)

        PS. I frequently have to rewet my lens throughout the day. Wearing glasses/goggles is most important if stepping outdoors. The lens is more friendly with my right eye than my left. I've had lasik, cataract, very recently YAG laser all on the left eye. The rewetting is required mostly for the problematic eye.
        Don't trust any refractive surgeon with YOUR eyes.

        The Dry Eye Queen

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