Bandage lens trial

[YGB]

Dr. G - thank you for lending your expertise through this forum.

I plan on trying one or several of the silicone hydrogel lenses in the coming weeks to see if they may promote post-LASIK healing on the cornea/sclera and/or maintain ocular surface hydration.

I had some e-mail correspondence with Dr. Tseng in Miami and he said that he feels it would be fine for me to try such a lens, but if it is not working well initially, it may be due to the tear function not being sufficient. In that case, Dr. Tseng recommended that I should have a plug inserted to each eye before doing another contact lens trial. Note that I presently do have one plug in my upper right puncta.

Do you have any additional thoughts and/or suggestions before I start my silicone bandage lens trial? Some questions that I have at this point include ... what do you recommend is the best silicone hydrogel "starter" lens for dry eyes? Hopefully the initial lens trial will be "comfortable", but how long should I try a lens and experience possible mild discomfort or even worse before deciding to try a different lens or option? Thank you.

[DrG]

I would recommend starting with the lens that has the lowest water content and the highest oxygen permeability, which is the Focus N&D. This lens has a 13.8 diameter, and is available in two base curves.

Of course, you need to do this under the supervision of your eye doctor, who should help you decide which curvature fits the best and has the best initial comfort. My philosophy is that if the initial comfort isn't good, then try another lens. The next closest lens would be the O2Optix, then the Acuvue Oasys, Purevision, etc. Any of the silicone-hydrogel lenses with water contents below 38% are OK, in my opinion. It's just a matter of which fits the best, like shoes.

Naturally, if the eyes are dry, then tear supplementation is necessary. I recommend punctal plugs first, then tear supplements as needed. Any lens should lead to increased comfort, and not the opposite.

[DrG]

Rather than amend my previous answer, I'll make this a separate post with respect to bandage lenses. I also prescribe a topcial antibiotic to be used along with the bandage contact lens depending on the condition of the cornea, and especially if the lens is to be worn continuously.

[YGB]

Thanks Dr. G!

I met with the contact lens person last week and he recommended many of the lenses you stated and he also put the Focus N&D at the top of his list. I will take the lens out nightly and use Clear Care solution ... don't worry, the contact lens guy explained the proper way to use this hydrogen peroxide/sodium chloride solution so that I don't end up in excruciating pain.

He suggested that I start the trial with the Focus N&D and see how that goes for a week. If it's going great, then great. If it's just marginally good, then the next step would be to try the Purevision. Then the last trial would be the Proclear. Hopefully one of the three will help. He told me that for him, he finds that for these trials you usually get 3 strikes and if none work, then bandage lenses will likely not be right for me.

The one thing I noticed is that all 3 of the lenses cover the cornea, but very little of the sclera. I feel like my sclera (and related cells) can use a break from exposure to the environment, but as the very nice contact lens guy said, "the Focus N&D comes in 2 sizes, 13.8 and 13.8 ". He said the other 2 lenses that I may try are only marginally larger.

I mentioned that I wore a larger silicone hydrogel bandage lens when I had a "ridge" on my sclera and he said that the problem with the larger lenses is that they have a higher water content and are therefore not as potentially beneficial to dry eye. My question to you is ... do you know of a large silicone hydrogel bandage lens that can cover a good part of the sclera and has a low enough water %?

I know the Boston Scleral Lens (BSL) is certainly big, but it seems like the silicone hydrogel lenses for dry eye mostly just cover the cornea (which is still worth a try for me since the cornea certainly causes the most discomfort from my dry eye). I suppose that in the absence of a larger lens, I should try the lenses noted above and be sure to stay lubricated with "Nature's Tears" so that my eye (including sclera) still gets enough moisture. Best. YGB

[DrG]

In certain situations, the sclera does need some protection. Unfortunately, I am unaware of any silicone-hydrogel lenses available in a diameter larger than 14.2 mm (Purevision and O2Optix) at this time. Ciba is going to be launching a total custom series using the O2Optix polymer in the near future. I'll ask them more about this when I visit them in Atlanta at the end of February.

However, given that the sclera is relatively insensitive and contributes nothing to vision, the cornea is usually the main focus of therapeutic lens treatments, and that includes scleral lenses.

[DrG]

OK. I just ran across this abstract in Eye and Contact Lens about soft scleral lenses. The link is here

I'll try to find out some more details, since I have a copy of this journal lying around the office.....somewhere.

[YGB]

Dr. G - I presume that the large scleral referred to in the abstract is not available yet. I'm not sure what an abstract publication is, but I figure it means that something has been developed but is still in the fine tuning stage ? Also, will the big lens referred to in the abstract be a low water content lens? Thanks for the latest and greatest scoops!

[DrG]

Dr. G - I presume that the large scleral referred to in the abstract is not available yet. I'm not sure what an abstract publication is, but I figure it means that something has been developed but is still in the fine tuning stage ? Also, will the big lens referred to in the abstract be a low water content lens? Thanks for the latest and greatest scoops!

An abstract is a synopsis of the article, i.e. a summary. It is required of anybody who submits an article for journal publication. Obviously, many details are missing from an abstract that can be found in the body of the article.

In the abstract, the authors stated that they had been using those particular lenses for 4 years. It is usually a journalistic requirement that the author references the manufacturer of any of the products used in a study.

I apologize for not getting to this article today, but I shall put it on my agenda of things to do this weekend.

[DrG]

I could not put my hands on that issue of Eye and Contact Lens.

I did, however, do a survey of available soft lenses, and found at least 3 manufacturers who make lenses in the 16 - 22 mm diameter range, in a variety of mid-water hydrogel materials.

Regarding the custom silicone-hydrogel lens from Ciba, the O2Optix situation has apparently set that back. Their literature indicates that 14.8 will be the largest available diameter.

If anybody has an interest, give me shout via private email.