Dr. Gemoules and my first Scleral Lens

[MGD666]

Hi DCR,

So, what was his update? Did he indicate that he should be able to make a custom 20mm version for you?

[DCRdryeye]

He basically said he does make 20mm lenses but only as symmetrical. He cannot provide 20mm laserfit lenses as asymmetrical. The email was:

"20 mm scleral lenses are available, but only in symmetrical designs. Our Laserfit asymmetrical lenses are available only up to 18 mm. This is due to our manufacturer's concerns about tooling limitations, and the possibility of damage to the equipment".

Basically, the lenses I currently have are 20mm symmetrical so it wouldn't be practical to attend Laserfit in Texas. With my current optometrist in Melbourne, I've had at least 8 different lenses to get a good fit over the past 16 months and was regarded as a very difficult client to fit. The downside is there's always a 4-6 weeks wait for a new lens. I couldn't begin to imagine the luxury of waiting 'overnight' for a new lens.

[MGD666]

Thanks for the info. So, your current 20mm symmetrical lenses aren't providing you with any kind of significant relief? Do you think that's due to them not fitting as well as they could (such as a lens custom designed for you might)? - Or is it more the case that even with that amount of coverage, your eyes are still painfully dry?

[DCRdryeye]

I'm at the stage where I'm comfortable. The left lens is perfect now and the right lens is being tweaked to reduce the sensation of the upper edge. It's a real trial and error journey. 20mm is more comfortable for me than 18mm. I've had lenses that felt perfect but produced soreness after 8 hours of wear. So whilst it felt comfortable, there is still a problem and it was tightness.

I know when a lens is fitting correctly. It's when I can wear it for 14 hours without a problem (as long as I keep it lubricated) and can wear it again the following day. That's achievable with my left Scleral lens, not quite with the Right lens.

You are correct about the dryness. Whilst wearing the lenses I still apply drops hourly. My lenses are actually custom made and fitted using OCT but I'm just a difficult case apparently. The drier we are, the more sensitive our eyes tend to be making Scleral lens fitting all the more difficult.

[L8rgator]

It's not often we receive such immediate responses from a highly respected professional.

Unfortunately, I haven't obtained relief from wearing 18mm Scleral lenses. And extra 2mm seems to make a difference for me, so require 20mm.

Well in that case I was just kidding about leaving my lenses in a freezing car over night. I would never do such a careless thing. Ever. :X

Have you tried any other sizes than 18 or 20? Putting in an 18 is a piece of cake for me, but I'm a little concerned that a 20 will be difficult given that I have to pull my lids apart absolutely to the max and then some to get the 18 in. At least I think my current ones are 18mm - I'm not sure I ever asked the size. I've been very interested in trying the 20s for comparison since you PM'd me a while back. But now I think with the potential added difficulty of insertion, lack of fine-tuned correction for halos and ghosting, and lack of a custom milled fit and minimal profile and thickness, I'm not ready to put put all my eggs all in one basket with symmetricals. I've read here from others that Dr Gemoules is one of the best fitters with custom lenses or not, and when I voiced my concerns about symmetrical comfort and he said it probably wouldn't be uncomfortable if my eye isn't asymetrical. So I should keep an open mind about it. Still, I'm more excited to get a new custom one cause I know that works great. Soon!

[tealeaf]

Hi Andre,
Have you gotten your sclera lens? Are they helping you? I am seeing Dr G in July.

Hi L8gator,
Having both tear ducts cauterized in 1 eye, do you experience any infection or toxic tears build up?

[DCRdryeye]

Tealeaf why are you having both upper and lower ducts cauterized in one eye? that's usually not recommended, it's always best to have the lower duct cauterized and if there's no relief, use a temporary 'upper' plug and if it helps then cautery maybe advised. That's the usual course of action. I've had both my lower ducts cauterized late last year and for the first time experienced 'seasonal conjunctivitis'. Apparently, histamines in the environment was building in the corners of my eye due to the pooling. I see it as "short term pain for long term gain" and Zaditen quickly cleared it up.

The cautery didn't help me very much at all unfortunately. I will try temporary plugs in the upper punctae and see if it helps.

[André Pereira]

Thanks to everyone who wished me good luck.
I was very anxious.

The lenses have already been made. Are comfortable.
I prefer not to talk too much now because I'm out of my parameters.
When I return home, I can tell you my experience.

But I can tell that for sure they helped me relieve symptoms.
Tealeaf
Good luck on your trip.
Dr. G and his staff are excellent. You'll be in good hands.

Next week I will write more about the subject.

[tealeaf]

DCRdryeye,
I asked the question as L8gator has cauterised both tear ducts in 1 eye. I have lower tear ducts cauterised for both eyes and plugs in upper tear ducts (1 eye has temporary one and 1 eye has umbrella plug). I am worried about infection building up in the eyes due to the pooling.

I have problem with temporary plug. Apparently, it dissolves too quickly. A 6-month plug usually takes 3-4 months to dissovle in my eye. The comfort is really marginal. A permanent umbrella plug helps but at times when the overflow is too much with the wrong tear composition, the eye still feels dry. But better than bone dry.

Do the use of sclera lens and cautery of lower punctums made your eyes feel comfortable?

Andre,
Sure, appreciate your update. I am keen to know since I am going in 2 months' time. I am feeling nervous too.

Dear all,
I am using eye gel to sleep. Understand that the use of eye gel at night will cause clouddiness in the sclera lens. What do you use in your eyes at night to sleep in (other than eye mask to cover the eyes)?

[L8rgator]

My shirmers is 0, so pooling and toxic tears are not an issue with my cautery. Temp plugs laated less than 3 weeks for me. Permanent at most 6 months. After the last lower fell out i did have redness and swelling, bit it went away after a couple of days. Never happened before.

My flavor of the week this week forr nighttime is plain saline. Anything with oils has started to feel like i have dirt in my eye. But i seal my eye at night so that works for me. You may have no problems with residual clouding. I go through phases of using night gels and ointments without problems. You can wash and rinse with saline in the shower if you think it is becoming a problem.

[tealeaf]

L8rgator,
Thanks for your prompt reply. Are you saying you used to apply night gel and yet no clouding with sclera lens?
Maybe I am thinking too much and worry too much

Can you share what solution do you use to disinfect the lens, wash the lens, etc? Many thanks.

[L8rgator]

I use clearcare.

[tealeaf]

Andre,
Any update on the sclera lens?

L8rgator,
Does the clearcare contact lens container big enough to fit sclera lens?

Dear all,
Do you still put eye drops in your eyes? How frequent? what drops do you use?

Thanks for your replies.

[L8rgator]

The clearcare case fits the 18mm scleral for the most part. The case could stand to be just a couple mm bigger, but it works. I decided to try the PROSE style case for my 19.5mm (more on this later) because it was a worse fit in the clearcare case. Yeah I like the PROSE case far less. It's so big that the lenses just drop down to the bottom Did I say big? I meant GINORMOUS. The "scrubbing bubbles" don't have a chance to scrub the inside of the lens because it sits like a boat at the bottom. Plus it uses 3x as much solution - that seems wasteful. I'm back to the slightly too small clearcase case. I just need to bump the lens a bit lower before I close it, and then make sure the solution is covering the lens when I put the cap on. It works ok, just looks a little mismatched.

I have new lenses, and in my dry eye I do every 20 (windy or cool) -90 (hot and humid) minutes depending on the weather . I don't use drops over my right. I use just blink contacts nowadays.

[MGD666]

L8rgator: Anxiously awaiting details on your fitting with the new 19.5mm lens/es. When you have a chance, I'll be very interested to hear you "compare and contrast" the differences between the 18mm in terms of comfort level, etc...