Scleral lens confusion

[lizlou29]

I know I've started quite a few posts on here recently but this is where I get the most useful advice so stay with me here!

I had an appointment with an optometrist today about trying scleral lenses. I was told by an ophthalmologist a few months back that they were big and not easy to put in but my current ophth felt they would be good to try seeing as I can't go anywhere that is air-conditioned, eyes very irritated all day etc.

The appointment was very quick, he was very nice but a man of few words. He showed me two possible lenses the first was a hard contact, about the size of a 5p/ dime. He said this may not be suitable for me as my eyelids get irritated so he wants me to try a soft contact. Basically it looked like a slightly vaulted normal contact lens (though I've never used them).

I'm really confused as I thought soft contacts were bad for dry eyes or are these different? I said I thought I'd need an eye drop that you could put a solution (saline?) in before you insert it but all he said was I could put eye drops in with these in.

I mentioned I wanted my upper punctal plugs out as I don't think they are helping and they are uncomfortable when I look left or right and he said well your eyes are only a bit dry so I don't see why not but you may need to use more drops if you are uncomfortable at night (I'm always uncomfortable!) My diagnosis is severe dry eye from MGD and aqueous deficiency, Schirmers's of 0 and 1. Did he prescribe these lenses because he doesn't THINK my eyes are too bad??? He gave me a leaflet with "more information" but it's just a guide 'soft contact lens instructions for use' leaflet.

[Reggie]

There aren't any soft contact lenses that will help with dry eye that I know of. The scleral lenses work for people such as myself, because they rest on the sclera which is the least sensitive part of the eye. They also hold saline over the eye and act as a corneal bandage.

[DCRdryeye]

I agree with Reggie. Although, my sclerals are 20mm and I need as much as conjunctiva covered as possible since they are so dry and in pain too. So the smaller the scleral for me, the worst the outcome. The soft sclerals do not assist dry eye other than make it worse. Your optometrist didn't know what he she was talking about and had little knowledge about dry eye it seems. The consultation was very quick? that should NEVER happen. My first consultation with my new optometrist to fit the trial lens involved 3 hours along with over 40 photos taken of my eyes in all directions 'before' and 'after' one hour wear time. Then the same was conducted when the custom sclerals were ordered.

Find a Scleral lens expert fitter with many years experience. Indeed my optometrist has been fitting them for decades.

[lizlou29]

I thought as much.

These are just a standard size, they didn't have them in stock so to pick them up in a week. The thought of something resting on my eyes makes me wince. He said he'd liked at my notes and said I seem to have ''a problem with a bit of dry eye at night". I said no I have severe dry eyes that are sore and ache all the time so why would he give me soft contacts? Maybe he just didn't think they were that dry or maybe he read the notes from the first (idiot) ophth I saw who said it was just a bit of bleph and not to worry. Goodness knows. Maybe I should try and get a look at my notes. I was hoping sclerals might make gong outside a little easier

[lizlou29]

Saw the lens specialist today. He hadn't remembered me at all from last time so he thought we were starting from scratch. All got a bit confusing but anyway he had the lenses he had ordered in for me before Christmas but said from the pain I describe I need a bigger lens to cover cornea. They are Bausch & Lomb PureVision lenses made from silicone hydrogel. Said he thinks sclerals would be too uncomfortable for me because of my very sensitive eyelids but my corneas need protection and these won't dry my eyes like ''ordinary contacts". He is ordering the 15.5 diameter lenses.

He was really sympathetic about the pain and could see the chemosis. After 4 days of Pred Forte so far my eyes still hurt like hell. Can't work right now and can't keep eyes open after 7ish or open them wide, that awful menthol feeling. Also had a few hard white bumps come up just above the eye lashes on right eye. No idea what they are. Very miserable right now. Eyes feel worse with the steroid drops but need to get inflammation down. They are PF so it's not a problem with preservative.

[L8rgator]

Your doctor/specialist sounds alot like mine. I stuck with mine for far too long. When I decided to go elsewhere to find out more about sclerals, I read his previous notes and he had written that "previous schirmers were normal" and he didn't understand my irritation complaints because my eye is in good condition (duh, I kept it covered with a wet bandage 24-7). Yeah, he never did a test, and thought it was just a minor problem with some minor nerve damage causing the pain more than dryness. When they finally did my shirmers it was a 0 with anethetic, 2 without.

You need to make a clean break and find someone else. I'm just starting in my scleral lens process so I don't know all the details yet. But I had my first visit and tried some on, expecting my sensitive eyelids to be very unhappy. These were test ones to see if my eyelids would be irritated by sclerals.

Instead I was amazed that when the test contact went in (which was VERY quick and easy), there was instant relief. The pocket of juice feels like a nice bath going in, and just stays there between your eye and the lens. I had forgotten what it felt like to be without the pain. I walked around for 2 hours outside in 5 degree weather and other than a chilled (not menthol - just soothing) feeling in the eye it was completely happy. I know I'll still have to put in drops so the outside doesn't stick, but I'm excited to get one fitted for me ASAP!

There are many different types of sclerals also. I tried Jupitor and PROSE. The Jupitor did bug my eyelid just a bit in the corner, but if it was the only one available I'd use it regardless just because of the relief. So my point here is try to find someone that either does high end fitted sclerals, or one that has multiple options. I had to travel, but it is so worth it. See if you can find some place that will let you wear a trial pair for a couple hours. Insurance usually does pay for the first exam, even if it doesn't cover the lenses or fitting later.

[lizlou29]

Happy that you've found some relief.

The lens specialist is very experienced so I'll see how it goes. If the lenses he's ordered aren't right we can try sclerals but I agree that my eyelids are probably too sensitive right now. I tried the hydrogel lense and it felt quite ok but it was only a 30 min trial. I said I didn't think moderate to severe dry eye sufferers could use any lens other than sclerals but he said he's had some luck with the ones I'll be trying. . I'm in the UK so it's NHS, there aren't many experienced lens fitters around here! He wants to work with me to find something right for me.

[littlemermaid]

Lizlou ~ do they think you've lost any sensation on the eye surface? Chemosis might be 'medicamentosa' if that helps Google. I've never heard that oral anti-allergy eg Loratadine helped anyone but some people try it. Does it help to cover your eyes at night? http://www.dryeyezone.com/

[lizlou29]

SH tested sensation and thinks it's ok. Any slight breeze on my eyes is painful. Lens specialist agreed with SH that I should be examined with confocal microscope when they get it.

I have ordered the Onyix goggles. My eyelids are so hot and sore at the moment that wearing Tranquileyes or normal sleep mask is too painful.

[lizlou29]

Also Littlemermaid I've emailed SH as I really think the Pred Forte is making things worse. Could be that it is making eyes drier. Want to find out if it's absolutely necessary to use it. Googled 'medicamentosa' - another possibility. Hard to know when reaction can be delayed by weeks or months. I know Unicorn's ophth told her to stop using all drops because of hypersensitivity but I've never seen an ophth who advocates this with my level of dryness, such a tough call.

[CC00]

DCRdryeye,

Who is your doctor? And how do you recommend finding a doctor with a lot of scleral fitting experience?

[DCRdryeye]

Hi CCOO, I'm only aware of scleral lens fitters in Australia so I don't think that will help you much sorry.