a second chance for sclerals

[texaseyes]

After two trips to Boston and exorbitant time invested, lenses made, and money spent, I had pretty much given up on sclerals. My right lens was never comfortable enough to wear, and the left lens would fog up shortly after inserting it. Needless to say I was extremely disappointed. When I read about Dr. Gemoules’ new methodology of fitting sclerals using technology to calculate the fit rather than the trial and error fitting process used by BFFS, I decided to give it one more try. I recently got back from Coppell, and here is how it went:

Dr. G was very low pressure, and didn’t make any promises, but I went ahead and had him make lenses for me. When he put the FIRST pair of custom made sclerals in my eyes I was blown away. They felt amazing, and the vision was greatly improved, including many high order aberrations. I have worn them the last few days haven’t had any fogging. Dr. G shared information about my scans with me, and answered my questions. Overall, the experience was quite efficient in terms of time and money spent (about 75% cheaper than the BFFS Lens/Fitting). Will these sclerals be the answer for me? Only time will tell. My sclera is very tender, and has conjunctival staining. I do believe, though, that I got my best chance at success with the lenses I got in Coppell.

There is a real need for scleral lenses for dry eye and post LASIK patients, and that lens need to be affordable and obtainable in a reasonable amount of time. Dr. G recognizes this, and is working to fill this niche. I believe that I’m a good example why his calculated fitting process can be very efficient and effective - I got lenses I can actuallly wear. Sclerals are not a miracle cure, and don't work out for everyone - I don’t even know how well it is going to work for me in the long term, because post LASIK eye pain is very complex. However, I am very glad that I went ahead with the lenses that Dr. G made for me, because it's another tool in my dry eye toolbox.

[ALK-O'd]

Hi Texaseyes. I'm glad to hear Dr. G's lenses are working for you. I too am a post refractive surgery patient w/ dry eyes and poor night vision. Currently at night I am wearing Blanchard’s MSD semi-sclerals (15.8mm). The lenses are off the shelf type lenses (not custom fit). The vision I get with them is fabulous. Comfort-wise they are tolerable for a few hours - ok, but not great. I’m hoping to get into something better at some point.

What are the size of the lenses you got from Dr. G? I was under the impression that his "scleral" lenses were really semi-scleral (16mm range - big enough to just clear the cornea but not quite big enough to provide dry eye therapeutic effect). Of course I could be wrong and that's why I'm asking. Do you find that his lenses provide a therapeutic effect for your dry eye or is it more that the lenses are just tolerable despite having dry eye? How long have you had them now and how many hours a day are you wearing them?

Also, you mentioned you failed with BSF’s lenses. Just out of curiosity, had you been fit with BSF’s “T6” lens and fitting process or was it an earlier version?

[odydnas]

Texaseyes, i am so glad you found a potential solution for your post-lasik eyes! I am so grateful that you posted lens from Dr. G, since there are so many of us on DEZ who want to try sclerals because nothing else had really worked, and are unable to get accepted for treatment at BFS.

My question is, the contact lens that Dr. G prescribes, are they like mainly for post-lasik patients, or does he also have success with mgd/ocular rosacea patients as well?

Thanks!

[Gretchen]

Odydnas -

Why are you unable to get BSL's? Will your doctor not give you a referral? Or has he and the Boston folks not accepted it?

Thanks,
Gretchen

[texaseyes]

to answer some questions

Hello fellow dry eye comrades,

To clarify my previous post based on some questions folks had...

I paid for and received lenses from BFFS. However, I was unable to wear them. The right lens was never comfortable enough and the left lens fogged up after minimal wearing time. Yes, you do pay for them whether you can wear them or not.

My lenses from Dr. G are comfortable and do not fog up. They are smaller and I think a little thinner than the lenses I got from BFFS. My vision is better with these lenses than the BFFS lenses as well. They are 16 mm sclerals, not mini-sclerals. They are filled with saline upon insertion. Dr. G fits sclerals from 16 mm to 18 mm but he can go bigger if needed. He can also fit mini-sclerals or corneal lenses if you prefer. No, he doesn't fit Synergeyes.

Another person asked if sclerals will help with people who have dry eye from MGD. I think Rebecca is proof that they can help her with that. She got hers from BFFS.

Please try to understand that you just can't know if the sclerals will work for you until you try them. You can ask Dr. G questions based on his experience by emailing him on his website. However, if you are going to ask him about whether the lenses will work for you I can guarantee you that he will tell you that you have to try them to find out. That is why I made it clear in my first post that this isn't a miracle cure for some specific type of pain or dryness. Everyone is unique, and you have to be willing to spend the money to take a chance. Fortunately, you can spend a WHOLE LOT LESS MONEY than the BFFS lenses if you try Dr. G's lenses. Obviously there are people with unique medical needs, such as scarred corneas, that need the expertise of Dr. Rosenthal in Boston. The majority of us on this website would do great with Dr. G.

I feel strongly that his method of calculating a fit (he's the ONLY one who does fitting this way and has filed for a patent on this method), rather than using a bunch of trial lenses, not only reduces the cycle time, but also gets you a better fit in the end product. It make sense that making any needed "tweaks" on your fit is going to be a whole lot more successful when you have a better starting point. The fit on sclerals is very important because it covers a lot of surface area.

If you are serious about sclerals, and have specific questions about the fitting process or cost, look up Dr. G's practice on the web - Coppell Family Eyecare. He is good about answering emails. Don't ask him whether they will work for you, though, because he can't answer that question. You have to have a leap of faith and try. My tear film is total crap both in quantity and quality, and it doesn't effect my vision in these lenses. My issue is more scleral pain. Again, everyone is unique, and my issues are not your issues. No, they don't work for everyone. I just wanted folks to understand there is a high quality and more cost effective option out there if you want to give it a try.


Linda

[Lucy]

Linda, thanks for posting about your experience with Dr. G and the sclerals. I see you live in texas, but since maybe you didn't have to travel--how many days did it take Dr. G to have your lens finished? I realize they may still be a work in action. Thanks for your info. Lucy

[odydnas]

Odydnas -

Why are you unable to get BSL's? Will your doctor not give you a referral? Or has he and the Boston folks not accepted it?

Thanks,
Gretchen

My doc won't give me a referral for a couple reasons: my eyes aren't bad enough for them (based on clinical signs) and my doc thinks that anyone with ocular rosacea should not be putting a lens in their eye. I assume I can contact BFS directly to see if they will take me, but since my schirmers and tbut are not absolutely horrible...i'm not sure they will take me. I do feel miserable though, despite the pretty good clinical signs....which is the sucky part of dry eye...hard to get a doc to take my seriously when my eyes dont look that bad.

[texaseyes]

Linda, thanks for posting about your experience with Dr. G and the sclerals. I see you live in texas, but since maybe you didn't have to travel--how many days did it take Dr. G to have your lens finished? I realize they may still be a work in action. Thanks for your info. Lucy

Hi Lucy,

I saw Dr. G on a Monday, and he had my first lens on Tuesday. I could have walked out with those lenses. He ended up making a few minor adjustments because the lens was sinking into my sclera more than expected (I have conjunctivochalasis). I left with the second pair he made me, on Thursday. Contrast that to 17 working days I spent in Boston.

Coppell is close to the DFW airport, and right in the middle of the USA.

Linda

[texaseyes]

My doc won't give me a referral for a couple reasons: my eyes aren't bad enough for them (based on clinical signs) and my doc thinks that anyone with ocular rosacea should not be putting a lens in their eye. I assume I can contact BFS directly to see if they will take me, but since my schirmers and tbut are not absolutely horrible...i'm not sure they will take me. I do feel miserable though, despite the pretty good clinical signs....which is the sucky part of dry eye...hard to get a doc to take my seriously when my eyes dont look that bad.

Hi,

I don't have Ocular Rosacea. However, I think it would be worth it for you to send an email to Dr. G and ask him about his patients with OR. He has been in practice a long time and has seen many, many eye problems. I have learned that when a doctor is extremely opinionated about something not working that I go elsewhere. It's not that cookbook in this world of dry eye. I would rather have a doctor that is open minded and willing to accept that everyone's eyes and eye pain respond differently.

I have aqueous dry eye. I got quad plugged because I thought the extra moisture would help. After three months my eyes became red and mucousy and it never occured to me it could be the plugs. When I went to Dr. G he suggested taking out the top plugs - "try it and see if it helps". It did - a lot. If you are in pain, you try things to see if they help, which is why I tried the quad plugs. For me that didn't work out.

If Dr. G says Ocular Rosacea is a reason not to do the sclerals, I would trust him. He doesn't want anyone to fail with these lenses - that's bad press. Talk to him and see what he says about OR and sclerals. BFFS sclerals are not going to be any different in that regard, so don't get fixated on that. What everyone wearing sclerals needs, though, is a good fit.

If I come across as a big advocate for Dr. G, it's because the experience I had with him was so much more efficient and effective than my previous experience in Boston, for a lot more reasons than I have posted about. I know how expensive sclerals are, as I have paid for them multiple times!!! I know how time consuming trips to BFFS are, because I had to be away from my kids for around 20 or so days! The BFFS is a wonderful organization that help so many people with devastating problems, but because of that they have lots of expensive overhead. Dr. G's scleral fitting is relatively new compared to the Boston folks, but he has tons of experience in fitting corneal lenses over the years, and has seen lots of dry eye patients as well.

I wanted to share my experience because I hope it opens the doors to feeling better and is more attainable for many folks.


Good luck to all of us.
Linda

[Rebecca Petris]

Linda, I am so glad to hear that things went so smoothly for you and that you were fitted so well & efficiently. I would love to hear back from you in 6 months to see how you're doing with the lenses.

I just feel I need to put in my 2 cents on the trial lens issue. While technology to improve fitting is great, and I'm sure DrG's is excellent or he wouldn't be doing it, I also don't believe it is ever as simple as comparing the automated approach to a labor-intensive manual approach. There is always a critical role played by an expert fitter, technology aside. I would not be in a hurry to disparage trial lenses as somehow inherently inefficient or even less accurate. DrG himself used this method with great success and efficiency for many years with other lens types. As a long distance patient of his for years, it's his skills that kept me coming back, no matter what technology he was using at the time.

[texaseyes]

Hi Rebecca,

I understand your point, as you are a successful user of the BFFS lenses. Certainly the manual fitting process works for many people. It didn't for me.

I am an engineer, so in my heart I believe there is always technology that will make manual processes better. After having 18 different right lenses made by the manual process at BFFS, and a first time comfortable fit on this eye by the technology assisted fit with Dr. G, I cannot be convinced that the technological assistance is not superior. Dr. G has the advantage of being a very experienced manual fitter as well - bonus! If my lenses don't work out for me it will not be because they don't fit right. I have other pain issues. I don't even feel the lenses in my eyes.

I wanted to also add that a really cool thing about the images Dr. G takes is that you can see them on the screen yourself. Do you want to see if the 16mm lens vaults your cornea or how much tear film is between the lens and your eyeball? Well, you can see it for yourself. Good stuff.

Linda

[ALK-O'd]

Texaseyes & Rebecca,

I know both of you have been to both BSF and to Dr G. I'm a little confused though as to the comments being made discussing Dr.G's automated approach vs. BSF's trial lens fitting approach. I thought that lenses were custom designed at each facility? Doesn't BSF now use some kind of CAD-like computer application to custom tailor each lens to each eye? Do they scan the eye to come up with an initial lens design? Even though Dr G uses an OCT scanner to scan the sclera for an initial lens design, I would imagine he must use some similar kind of software to make "tweaks" to subsequent lenses during the fitting process? Could one (or both of you) elaborate on this? I'm just trying to get a solid understanding about how both facilities operate as I am seriously considering going to one of them in the near future for a better scleral lens then the "off the shelf" kind I am using now.

Texaseyes - How long ago did you go to BSF? Were you fitted using their "T6" fitting method or was it prior to that?

[texaseyes]

Hi,

My last trip to Boston was October 2008. There were no scans done on my eyes of any kind. They looked at many lenses on me under the slit lamp with dye. How they get that measurement information to the lathe I do not know. Have they changed their fitting process since last October, I don't know.

Dr. G does several kinds of scans on your eyes first, before he makes your first lens; that results in data he can adjust based on his clinical experience, and then send to his lab. Then he puts the lens on your eyes, tests your vision, and does more imaging, and of course looks at you at the slit lamp as well. If you are that interested in the technical details my suggestion is to contact Dr. G at Coppell Family Eyecare. He is very good about responding to email.

Linda

[texaseyes]

Scleral Update

Hello dry eye comrades,

I haven't been on the website for a while, which is a sign that I've been doing better. Some folks asked for an update after a few months with my sclerals, so here it is. My eyes have done better this summer than any previous time since my LASIK. I have been diligent with my Omega Brite fish oil, got my upper plugs removed, and got new sclerals from Dr. G. Which of these has helped the most? It's hard to say. I just know my best days are better and my worst days are less painful and fewer. This winter and spring, with the heater, fireplace, and allergans will be a good test to see if my improvement is significant, or just seasonal.

I do not wear my sclerals every day - a matter of laziness, but rather when I feel that I need the covering on my cornea, or when I need my vision, particularly my night vision, to be at it's best. With the loss of daylight savings time, that may happen more often. However, when I do wear my sclerals, they are perfectly comfortable, and I can go from not wearing them to wearing them 14 hrs. at a time with no problem. I have to remember not to fall asleep in them! They are a fantastic tool in my dry eye toolbox, and I'm so grateful to have them. A lot of folks have asked me questions about Dr. G's lenses that I felt were best answered by Dr. G himself. Since then, he has updated his website: www.globalrefractivesolutions.com. It has a lot of information. For anyone interested in sclerals, it's a great place learn.

Well, I'm off to live my life. Feel free to email me if you have questions about my personal scleral experiences, but check out Dr. G's website first to get the basics. Here's to better feeling eyes for all of us.

Linda