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Scleral Right for Me?

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  • Scleral Right for Me?

    Hello Dry Eye Folks,

    I'm trying to get a sense of whether scleral lenses are appropriate for me. I have MGD and some aqueous deficiency as a result of the use of Accutane (which destroys oil glands). I have four punctal plugs, have been on restasis for a good 9 months, do lid scrubs, and use topical antibiotics on my eyelids. Nevertheless, I'm in pain ~60% of the time, and it's much worse when I'm socializing extensively (trying to hold eye contact, for example), focusing really hard on something, or zoning out. Basically any time my blink rate seems to fall.

    I've spoken to three doctors about it, and two have told me that the scleral lenses are too difficult to use to be worth it, but they cannot offer any other treatments. Apparently my eyes are relatively moist during exams, which is wonderful and all, except that I'm still in pain whenever I'm in one of the moods described above.

    Reading news stories about Scleral lenses seems to suggest that most patients are the really, really bad, non-functional types of dry eye sufferers. The type of people who are functionally blind as a result of their condition. I certainly don't consider myself to be a part of this population, but I do feel as though I'm losing a part of my emotional register to this disease. I'm less social and find myself keeping myself busy to distract myself from the pain.

    But given that most people who talk about successes with scleral lenses are disaster cases, I'm wondering whether the lenses are appropriate for someone with a more marginal (though I would certainly still say serious) condition, like myself.

    Any thoughts?

    Nick

  • #2
    I don't think you have to be non-functional to get referred to BFS. I'd think it would be worth a try.

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    • #3
      I'm not a dry eye disaster (I don't have a super low Schirmer for example) and I've been a very succesful wearer. However, I also had a very different indication for them (uncorrectible vision problems).

      Originally posted by nick View Post
      I'm in pain ~60% of the time, and it's much worse... any time my blink rate seems to fall.
      To me that suggests it could be appropriate for you, depending what all else you have tried. Personally I think that those who - in addition to traditional dry eye therapy - have also maxed out MGD treatment and don't get sufficient perceived benefit from moisture chambers, and are still seeing their everyday life greatly affected, may be suitable candidates. Depends on the person though. What's a minor hassle to one person (in terms of lens care etc) may be thought of as an insuperable difficulty to another.

      I've spoken to three doctors about it, and two have told me that the scleral lenses are too difficult to use to be worth it, but they cannot offer any other treatments.
      Common story . Hard to tell whether they're trying to be realistic or - like so many doctors - they simply are not aware of the current advances in BSL design and benefits. Personally I'll never understand these doctors who, when they clearly have nothing left to offer, still discourage patients from pursuing BSLs.

      Couple of things to keep in mind about BSLs. One, you can call and talk to BFS and just describe your situation and ask them. They're a nonprofit, and they're so booked up, that it's not as though they want to "sell" everybody who contacts them - they'll give you an honest opinion about whether you sound like a decent candidate. Two, you go through an initial evaluation and testing with a trial lens before either side commits to moving forward.

      By the way, what is it the two docs consider so difficult about the use of BSLs? They're more complicated to put in and take out, sure, but otherwise, the lens care regimen is not that big of a deal.
      Rebecca Petris
      The Dry Eye Foundation
      dryeyefoundation.org
      800-484-0244

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      • #4
        I noticed that you are in India (I bet the Indian food is good there). The Boston Foundation for Sight does have a facility in India.

        But in the States there is another experienced scleral lens fiiter who was at the Boston Foundation for Sight for ten years as clinical directory, Janis Cotter, O.D. Her website is www.parkwaysclerals.com/

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