Dr. Gemoules and my first Scleral Lens

[L8rgator]

A couple of weeks ago I wrote about researching lots of scleral lens makers, and my resulting trip to try the trial lens at U of I. It was a good experience, but after doing some additional careful evaluation, I decided to get my lens from Dr. Greg Gemoules in Coppell, TX at the Coppell Family Eyecare facility. Dr. G was always my first choice just based on all the positive experiences so many people had posted about in different forums (even non-dry eye forums), and because of his specialized techniques for measuring and custom fitting lenses. But initially I thought I'd save money if I found someone local I could drive to. And considering these lenses have no guarantees when it comes to working, saving money was important to me. There were a few reasons why I changed my mind:

1. Dr. Gemoules answered all my questions by email, in detail, the same day I asked them. And this was an expensive proposition (I would have to travel to the other end of the USA), so I asked a million questions over the course of a few weeks. He also didn't sugar coat anything - he told me his concerns, and what to expect both good and bad so I had a realistic feel for how everything would work. And it is very obvious how very knowledgeable he is when it comes to dry eye problems.

2. Dr. Gemoules was more affordable upfront. The fitting fee was a fraction of what I would have paid for a Boston PROSE lens from other providers. Actually the fee to stay in a hotel + airfair + fitting + a lens was about the same price as a PROSE lens.

3. The biggest factor for me was the price of future lenses. For the PROSE lens the price was in the thousands. From Dr. G the price was a couple hundred. I knew that if I lost or chipped a PROSE lens, I'd be heartbroken and very hesitant to buy another. But with the price of Dr. G's lenses, I actually bought 2 spares right away to have on hand.

4. Dr. G uses advanced technology to measure each eye in order to create a precise custom fit. This sounded more accurate than the trial and error used by some of the other fitters. I'm not sure why other fitters don't do this, as it really seems to work very well.

5. Texas is nice this time of year. Wisconsin is not. Chicago is not either. Especially this year! I really needed a vacation and was excited to have an excuse to spend a few days in the sun. The thought of having to drive back and forth to Chicago over the next few weeks, or even few months, was very uncomfortable also. The drive is long, the traffic is bad, the parking is tough, and it's not a place I'd feel comfortable driving to alone- and my husband wasn't able to take off that often to go with me.

6. Dr. G is easy to get in to see. He basically said plan to come any day of the week and plan to stay for at least 5 business days. I knew Tue and Wed are the cheapest travel days, so that's what I chose. When I went to look for tickets I realized I already had a layover in Dallas coming up in like less than 2 weeks - so I just asked if I could come then and it was no problem.

7. I couldn't find a complaint about Dr. G's lenses anywhere. I know these don't work for everybody, and sclerals are never going to be perfect. But there were so many good reviews, it make me feel confident that this was my best bet.

So I chose Dr. G, and am going to fly home with my new lens in the next couple days. I'll write more about that in a separate post so this one doesn't get too long.

[L8rgator]

To give you some background, about 18 months ago I damaged my cheek after a fall and required 4 plates be put in to fix it. The surgery damaged the nerves that make my eye produce tears (although I do still produce emotional tears, i.e. crying - different nerves I guess). My shirmers test is 0 with anesthetic, so it's as severe as it gets. Honestly, I was in so much agony that if the scleral lens didn't work, I was determined to have my eye shown shut by the end of the month. I was keeping it covered with a waterproof bandage, wetting the inside and taping the bandage all the way around for a complete seal, 24-7, and it was still so dry that it burned constantly. I couldn't handle it any longer.

So here is my experience:

Dr. G gets a great deal at the local hotel, and it is a really really nice place to spend a week. The bathrooms have full whirlpool tubs, which are awesome for moisturizing the eyes after a flight in. Free transportation gets you to Dr. G, as well as anywhere within a 3 mile radius. There is a huge mall with an aquarium, a theater, food, massages, and other entertainment nearby (I actually walked there - about a 30 minute walk, to test out my new lens in the wind and sunshine). And breakfast with fresh hot items is included (and they are yummy). It ended up being less expensive than the cheapest local hotel because I didn't have to rent a car or buy breakfast.

On the first day Dr. G measures your eyes. You just look into a machine and it does the rest. There is also the usual basic exam before this. The staff and Dr. G take their time and really listen to you - I never felt rushed, like I've felt with most other eye doctors in the past. The visit itself doesn't take long at all.

Then the next day at 1:00 your new lens is delivered to Dr. G's office, and you come in and learn how to put it in. I've NEVER worn any type of contacts before, and was intimidated with the youtube videos I watched before I traveled. It took me about 5 tries to get it in the first time, but I was totally at ease. It wasn't scary at all, and the staff did a great job of keeping the process completely stress free. I figured out I was squinting just before it touched my eye, so my bottom eyelid was getting in the way. That was an easy fix. Sometimes it takes me 2 tries to get it in because I miss a bit the first time, or don't push hard enough, but I never worry I won't be able to get it. It's easy. Getting it out is even easier.

Then Dr. G runs you though the measuring machine again so he can check how well the vault is about your eye and the fit of the lens. You get to see pictures. Then you leave with the lens in and a strict schedule of how long to leave it in. The first day is 4 hours, and then add 2 hours every day. I'm glad I came mid-week, because I got to wear the lens for the entire weekend to get an good test run.

Then anytime anything needs to be tweaked, he makes the changes to the specs, orders a new lens, and you come back in after 1 each day to try the new lens.

In my case the first lens felt like a perfect fit on my eye. Upon putting the lens in, I felt immediately relief from the burning. But it felt a bit scratchy or grainy on the far end of my eyelid each time I blinked. It also felt very cold, unless I covered the eye with a moisture chamber. The Jupiter lens I had tested for a couple hours with another doctor had had these feeling also (but more pronounced). I was relieved when Dr. G said "I can fix that" to the scratchy feeling. I happily wore the scratchy lens all weekend, and enjoyed being able to SEE! On Monday I walked to his office in my new lens. Once there I popped the new one in, and there was no scratchyness whatsoever. I walked all the way back to the hotel (about an hour). The cold sensation has either went down, or I've gotten used to it because I didn't notice it with the second lens. It is in the 70s this week though, so could just be the weather. I'll know when I get back to Wisconsin I guess. But even a "chilled" feeling wouldn't stop me from wearing the lens.

I wore the new lens for 10 hours and it felt awesome. The next day I put it back in, and noticed my lids felt slightly itchy. Not scratchy like before, but like when allergies make you feel a bit itchy. I think my eyelids are probably just adjusting to the new feel. Otherwise the lens functioned great. I walked all over the place, got 2 chair massages, toured the aquarium, and had a great day being able to SEE and not feeling like I needed to keep my head down in order to avoid people looking at some big honking eye patch. It was awesome. I actually hate when it's time to take it out at night and patch everything back up for bedtime.

And getting it in and out has been easy. After my ride was delayed , I decided it was time to take it out according to the schedule - and took it out with no mirror in the target parking lot. Very easy.

So I've only had lenses for a couple of days now so I can't give a full review. But I can say I'm excited. I think my family is even more excited. I think they hated to see how much I was suffering more than I hated suffering. My mom nearly cried!

[Gil]

Thanks for sharing your experience w/ us!

[patientpatrick]

Yes. This has been the best thing I've read in a long time.

P

[Santaklauzz]

This is great. I'm happy for you.

[L8rgator]

As it get warmer and less dry outside (i.e. no longer 10 degrees F and 17% humidity every day), I'm happier and happier with my lens. I don't wear my moisture chambers anymore- mostly because I lost them. I do keep drops in to lubricate the outside of the lens and the uncovered areas. I wear sunglasses when it's windy.

My eye feels healthy now. I can walk around the house for 30-60 minutes with nothing in my eye before I realize I forgot to put in my contact. It feels normal that whole time.

My Scleral does not get any less comfortable throughout the day, so I've never taken it out early.

Dr. G did send me a revision with even thinner edges and more wettable in the hopes that I could use less drops. I am.

The eye still feels cold with the scleral in, and I can feel that the lens is there. Not dry menthol cold at all. More like cool moist bath cold. Like picking up a cold bag from the refridgerator. This lens not itchy like the first ones. But I can feel that the lens is in there. I think if I had a lens in the other eye, I wouldn't even notice them. It's that one eye is different that makes it noticeable and sometimes a bit annoying. On warmer days & humid days the sensation is very minimal so I'm looking forward to summer. Or moving to a warmer climate.

So here is my new routine:

at night:
Put a drop of solution in my eye (helps break any suction). Remove scleral with wet plunger. Takes about 3seconds.
Soak lens in clear care container overnight.
Bandage eye with Nexcare waterproof active cushion bandage, with Nexcare absolute waterproof first aid tape around one side (bandage is not quite big enough). Bandage is first wetted with sterile saline.
Morning:
Remove bandage. Drip some unisol 4 in eye.
Shower and clean around eye as normal
Fill Scleral with Unisol 4
Insert with plunger. Takes 30 seconds. Repeat if necessary (every 5 days I have a bad day where it takes 3 or 4 tries. Otherwise usually goes in first try). Done is less than 10 minutes.
Turn lens so dots are at top, and wet with drop.
Insert more drops every 30-60 minutes. Theratears preservative free works the longest, but the vials suck because they can't be transported. Blink Contacts drops come in a bottle I can carry in a pocket, so I use those away from home.

I have read a few posts that have said their doctors recommended Addipack sterile saline 5ml dose vials for filling the lens instead of unisol since unisol contains boric acid or something like that. I'm not sure if that is true, but they are cheap so I ordered some to give it a try.

All in all - my scleral isn't a cure, or a perfect solution. But in terms of how much it has bettered my life and my eye health, it's indispensable. Definitely better than my expectations.

[L8rgator]

I forgot 2 other downsides. You aren't supposed to go in hottubs or shower with scleral lenses in. I go in a hottub most days (it's so cold here in WI!) and like to shower at night sometimes, so I've had to put that off until after I take out the scleral.

[Gil]

L8rgator,

What solutions do you use to clean and disinfect your sclerals? Do you use the Unisol 4 to rinse the cleaner off before disinfection?

[DryInDenver]

I just booked a trip to Dallas! I hope I have as good of an outcome as you! I hear you on the dry winters. Thanks for all of the fantastic info and detailed review of your experience.

[L8rgator]

L8rgator,

What solutions do you use to clean and disinfect your sclerals? Do you use the Unisol 4 to rinse the cleaner off before disinfection?

Clear Care is a hydrogen peroxide based solution. The case it comes with has a neutralizing disk. So I fill the case with hydrogen peroxide, and put my lenses in for at least 6 hours to bubble clean. After that the solution turns to neutral saline, so the lenses don't need to be rinsed. I usually squirt with Unisol 4 just to make sure any lint or cat hair hasn't floated on from my clothes or anything like that. Or I rinse with the knock off sensitive solution from walmart, and finish by filling with Unisol
http://www.clearcaresolution.com/how...ear-care.shtml
Just watching the video for the first time now, I just figured out I was putting them in the case wrong - I was putting them in the door and closing it instead of in the center. Oops.

[Gil]

Thanks for the info.

[bonedrye60]

Sorry, i responded to incorrect blog.

[patientpatrick]

Glad to hear you are improving. I'm surprised you are still using drops every 30-60 min with the sclerals tho. I thought trapping that moisture would prevent the need for drops.

P

[L8rgator]

Glad to hear you are improving. I'm surprised you are still using drops every 30-60 min with the sclerals tho. I thought trapping that moisture would prevent the need for drops.

P

Ok, please excuse me if I use the wrong words or didn't get this quite right but I'm going by pictures I just googled...
The lens keeps moisture on the cornea, which only covers the iris. This part has the major nerve endings, so keeping it bathed takes away the pain of dry eye. And I never worry about my vision getting blurry from being dry like I had to 24-7 before (that used to REALLY scare me.) The lens also covers some of the sclera (over the whites). But the outer edges are still bare.
Sometimes when I do not add drops, after a while my eye feels has a sort of barely noticeable sticky feeling periodically as I blink. I think the dryness on the outside of the lens and on the uncovered whites get a little tacky.

I think that if I don't lube it back up with drops, the next day it'll feel a bit 'off' right after I put the lens back in. By 'off' I mean a chilled and a little itchy around the corners of my eye. However, honestly I haven't let it go more than a couple of hours without drops since leaving Texas or getting my new lens so I can't say for sure if that would still be the case. And when I was wearing my airrages or other chambers, I had to use very few drops at all. I'm planning to buy a new pair once they bring the old foam back and start using them again when I'm not in public.

I still have alot of trial and error to do. I did try the new vials of saline i purchased on amazon in bulk. I do like them, and have even been using them as simple drops over my sclerals.

I also found a soap that works well http://www.amazon.com/s/ref=nb_sb_no...20hand%20scrub
I cleaned out a bath and bodyworks bottle and used the vista-prep to refill itl

Good luck!

[L8rgator]

I've now tried the addipak vials of sterile saline in place of unisol to fill my lenses, at the recommendation of a number of posts on various boards. For the most part it feels the same I think. I do like that they are more transportable (albeit not recloseable) than the bigger unisol containers. And that I'm opening a fresh vial with no chance of contamination often. They are like $8 for 100 5ml or 3ml vials- so cheap. They don't really "squirt" though, so when I'm looking just to rinse something I still use the nice stream that comes out of a unisol bottle (for lenses) or a knock-off walmart sterile saline (to rinse plungers).

I have also decided that my favorite drop is Theratears in the bottle with "disappearing preservative". It is a bit longer lasting. I also still use blink contacts, and sometimes just the Addipak vials for drops. I've stopped using everything else, including refresh and refresh optive preservative free because I was seeing clouding consistently.

One thing that was important for me was to get a paper towel holder installed on the wall. I go through alot of paper towel now since I'm trying to be extra "clean" (i.e. wash and dry hands and tools frequently) when working around my eye supplies. I give my husband a pat on the back for getting that task done