Using Scleral lenses to manage dry eye

[quattroboy]

After a bit of advise around using Scleral lenses to help dry eye.

I'm struggling with dry eye after LASIK and it's impacting my professional life as a software engineer.

I've read about people using lenses to manage their condition.

I was wondering how this would help, I would of thought lenses are the last thing people with dry eyes could tolerate?

Currently relying heavily on Systane Ultra to manage my condition, do you still continue to use drops during the lenses wear or does the fluid in the lenses provide enough lubrication?

Sorry to ask really basic question but I'm really new to all this and looking at all my options to try and get my life back on track.

I've also heard of one guy using Dailies TOTAL 1, soft lenses to help, again he suffers from LASIK dry eye.

An added complication is I've got MGD caused by poor blinking, of course I don't want to make this worse.

Big thanks in advance for tips and advise.

[Hokucat]

Hi quattroboy. Scleral lenses are being used increasingly to treat dry eyes (including from LASIK) and other eye issues, as well as some patients without any eye issues except vision correction, are opting for sclerals due to its superior ability to correct vision compared to soft contacts. So it's not so much a last resort anymore, especially if it can help manage the discomfort and help protect one's corneas from further damage, while one continues to look for resolution of the root cause. I wear sclerals, and it helps me with daily functioning and activities that otherwise would be more uncomfortable or not possible.

Below is a good general description of sclerals on the PROSE scleral website:

http://www.bostonsight.org/PROSE/PRO...ats/Post-LASIK

Not everyone can tolerate sclerals, and it does not help all LASIK patients, but it would be worthwhile to go in fo a consult to try on the lenses, to see if you can wear them and if it makes your eyes feel better.

I don't believe there is a PROSE clinic in the UK, but
@PhoenixEyes has shared the following on where to get sclerals in UK:

"The NHS in UK are familiar with scleral lenses, there are NHS scleral fitting clinics around the country. The most famous / experienced scleral fitter I think is Ken Pullum who is available on the NHS at Moorfields in London. Or you can visit him private at Hertford. Here's a link to his clinic site and a few links to other clinics I've heard of from these forums that can fit sclerals outside the NHS."

http://www.kenpullum.co.uk/ (Hertford)
http://www.peterivins.co.uk/ (Glasgow)
http://www.thecontactlenspractice.co.uk/ (Birmingham)

Some people still use drops when they get sclerals. Most people find greater comfort putting a couple drops of thicker artificial tears like Refresh Celluvisc or Systane Ultra in with the saline to fill lenses. Also some periodically apply a less thick drop or saline over the lenses while wearing them.

[farmgirl]

If you have poor blinking, as in an incomplete blink, sclerals may exacerbate this because of the vault of the lens it occupies more space and might make an incomplete blink worse. That would certainly be a question I would be asking.

[Hokucat]

Would definitely recommend taking more breaks from using the computer, and getting into the habit of doing blinking exercises, whether you get sclerals or not. There are several different blinking exercises, but this is the one I use:

http://www.skyvisioncenters.com/blog...exercises-app/

[quattroboy]

Thanks all.

Yes, my problem is partial blinking. I've been doing blinking exercises for about a month now. Wasn't aware this was an issue until my Lippiview assessment.

I'm hoping the lenses would help me during working hours. I'm really worried about the ongoing damage I may be doing during work, even with regular breaks. With the lenses providing a constant lubrication of my cornea I could limit any progression of my dry eye.

Am I being a bit nieve here?

[farmgirl]

If you can tolerate them they can be a lifesaver, you just have to try for yourself. Personally I can't tolerate them so they are out of the question for me. You might try a mini scleral the vault on them is much less. The good news is that usually you can try them out before you commit to buy.

Dry eye syndrome can be very complex and multifaceted. What the lens does is help protect the cornea from the dryness and protect it but it will not 'cure' the underlying cause of the dry eye. They probably won't halt the progression of dry eye they are just an adjunct therapeutic device that can make the dry eye more tolerable.

[Hokucat]

Farmgirl is right, sclerals likely will not halt the progression of dry eyes, especially MGD. And you are correct too, the lenses can help you during working hours and limit cornea damage. However, if your MGD continues to get worse, this can impact the quality of your tear film and the surface of your eyes, and at some point you might not be able to wear the sclerals anymore.

This is exactly what happened to me. When I initially got sclerals, it helped a lot for about half a year, so I was able to continue working and using the computer for my job, and driving the 2+ hours round trip commute to work. Then my MGD (and aqueous deficiency) got worse, to the point where just about all my glands were blocked, many with scar tissue. I had virtually no tear film, and was told the surface of my eyes including the white/sclera was like sandpaper. So I could no longer bear to wear my sclerals, wearing them caused an entirely different pain. It was not until I was able to get some tear film back via probing plus diet changes, that I've been able to wear my sclerals again, and my glands have not gotten blocked up again.

So would still recommend seeing if you can wear sclerals, just don't stop trying to resolve your MGD and LASIK damage.

[diydry]

I have MGD and LASIK damage since last year. Scleral lenses have not been a solution for my moderate dry eye. I’ve spent the last 3 months seeing an excellent optometrist (probably 7+ visits so far) trying different lens fits, but they’re still hard to tolerate and they cloud quickly. I am forcing myself to wear them more to see if I can ‘adapt’ to them, just trying to wear them a few hours each day. That said, you should give it a shot! My understanding is it’s hard to predict who it will work for, I don’t think MGD is necessarily a contraindication. Every eye is different (literally, in my case one eye tolerates the sclerals much better!). I would just adjust your expectations accordingly. And like Hokucat said, our bodies and eyes are always changing. It’s possible you might not tolerate it now but maybe after a few months you can.

[Rebecca Petris]

If you have poor blinking, as in an incomplete blink, sclerals may exacerbate this because of the vault of the lens it occupies more space and might make an incomplete blink worse. That would certainly be a question I would be asking.

Interesting. I've honestly never heard that one before. I mean, I know some people can't tolerate sclerals because of lid discomfort, but I have not heard of it interfering with blink in any way. For those whose blink is already very poor, the benefit in reducing damage from surface exposure would motivate them to use the lenses in any case I would think.

I talk to people almost every day who wear sclerals specifically for nonclosing lids, especially surgically induced, like botched blepharoplastics, acoustic neuroma surgery and so on.

[farmgirl]

I couldn't tolerate them even when I circumvented all of the sensitivities to what I was putting into the lenses and what I was cleaning them with. I know that I tend toward a weak blink which used to be an incomplete blink and don't know if I can blame it on that or not. It is not a fact, all I know is that the thought crossed my mind as they did seem rather large and I had no other explanation for why they made me so much worse. Could be that my eyes just don't like anything in them, not even a drop, I pretty much have to use non preserved saline.

[Guest]

I couldn't tolerate them even when I circumvented all of the sensitivities to what I was putting into the lenses and what I was cleaning them with. I know that I tend toward a weak blink which used to be an incomplete blink and don't know if I can blame it on that or not. It is not a fact, all I know is that the thought crossed my mind as they did seem rather large and I had no other explanation for why they made me so much worse. Could be that my eyes just don't like anything in them, not even a drop, I pretty much have to use non preserved saline.

I'm very similar, I don't like anything in my eyes, not even drops. I think that's why I like the serum so much, it's mostly saline and then a non allergic component (my serum). I want sclerals, I just hope I can tolerate them. Not to mention the incomplete blink, that's another concern. My eyes feel "full" sometimes when I blink now. I'm assuming sclerals would make that worse. Still going to give them a shot soon.

[farmgirl]

The good news is that you usually don't have to commit to purchase them until you are happy with them, at least that has been my experience but during the testing phase I just thought that in time my eyes would adjust but sadly they didn't and I am out $1200....sigh