Dr. Gemoules and my first Scleral Lens

[tealeaf]

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.

Thanks L8rgator for your replies, as always.
Good to hear that a normal contact lens solution case is good enough. I don't think Singapore sells Clearcare disinfecting solution, but has similar type. As for the saline you are using at home, are they buffered saline? Don't think Singapore has Unisol too

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.

You got new lenses from Dr G. Same dimension? Blink contacts drops better than normal saline?

[DCRdryeye]

L8rgator, are the new lenses you obtained asymmetrical or rotational?... how are they going for you compared to the first lens? Are you finding the extra width helpful? I certainly find 20mm provides better relief than an 18mm. But everything in dry eye is so individual, so I'm sure 18mm is fine for many people, it just wasn't for me.

[skazak]

Thanks L8rgator for your replies, as always.
I don't think Singapore sells Clearcare disinfecting solution, but has similar type. As for the saline you are using at home, are they buffered saline? Don't think Singapore has Unisol too

tealeaf, you may want to check for any peroxide solution that is available in your country. For instance, Clear Care is marketed in my country under AO Sept Plus by CIBA Vision which is the same, as CIBA is owned by Alcon. Other similar solutions include One Step by Sauflon (UK Company) and Avizor Ever Clean (by Avizor, Spain). All these brand cases may carry the lens up to 16 mm of diameter. Fitters may have containers for bigger diameters as well so it is worth asking.
Unisol is a NaCl 0,9% solution and this was widely told on this site. You may find bottles or small 5ml or 10 ml capsules in a regular drug store in any country.
Here's a question though. My lens fitter told me not to rub sclerals just to put into the ClearCare or similar solutions as I may damage the coating whilst Alcon's instructions states that RGP material made lens should be rubbed before putting it into the case with solution. I'm kind of puzzled here.

[tealeaf]

Skazak,
Many thanks for the information. Yes, Singapore sells AO Sept Plus!! I will go find out on NaCl 0,9% solution.

L8rgator,
Is you Clear care case 16mm diameter?

Dear all,
Do you clean your lens with cleanser and put in weekly protein remover tablets? I am seeing Dr G next month, feeling nervous and excited. How I hope that the lens can help me.

[skazak]

Do you clean your lens with cleanser and put in weekly protein remover tablets? I am seeing Dr G next month, feeling nervous and excited. How I hope that the lens can help me.

As of now I use only ClearCare that I brought from the US. Dr.G did not recommend any rubbing the lens with cleaning solutions. He said that peroxide would do the job. Do not be nervous you'll be in good hands.

[tealeaf]

Hi Skazak,

Thanks for your reply. What is the size of lens? Can they fit into the standard clearcare case?

Do you still put eye drops while wearing the lens? How many hours do you wear the lens? and do you need to take the lens out and refill with saline?

Apologies for the many questions

[L8rgator]

I haven't finished writing up my details yet or deciding if I prefer one new lens over the other, so here a quick response. Both work in the clearcare case (dark blue top). I like it better than the PROSE style case (light blue top)
.
Other cleansers not needed, and Dr. G prefers we just use Clearcare. Some scleral users have suggested one time cleaning with Lobob RGP helps if lens develops deposits, or sending it in for cleaning+ plasma retreatment.

My symmetrical lens is about 19.5mm, my asymmetrical is about 18mm. I use unisol or sterile saline vials in the lens, and in my nighttime bandaid (I seal my eye area after taking contact out). I use blink over the lens, and sometimes before bed. Othertimes before bed I'll use whatever at random (you name it, I have it here), but I generally stick with solutions that do not have preservatives. I also don't really use ointment as much as I am mildly allergic to these (as well as ointments of any kind that are petroleum based). Whatever I use is gone by morning. I do rinse my eye with saline in the shower or just before I put my lenses in in order to get any hair and sand out (I have 2 dogs, 4 cats, and a long line of dog clients to walk - pet hair and dander is everywhere, all the time). I think that may have been the constant problem with the soft lens I was using in the other eye. But I digress...

If the pictures I attached show up, the white side of picture 1 has my 19.5mm and the blue side has my right eye 18mm. Hard to tell in the picture, but the net doesn't close 100% with the 19.5, and does with the 18 (the edges touch the lens, but it closes). You can see the black dots of my left at the top.

My new lenses are great, especially in combination with the recent weather. I'm spending tons of time outside. The old left ones were warped from freezing, and it's sooo nice to be in lenses that fit again. And no more struggling with a soft lens in the right eye. I spent hours outside jumping on the trampoline with the kids yesterday, after hours in an air conditioned high school watching their dance recital. Smiles all around.

[skazak]

Hi Skazak,

Thanks for your reply. What is the size of lens? Can they fit into the standard clearcare case?

Do you still put eye drops while wearing the lens? How many hours do you wear the lens? and do you need to take the lens out and refill with saline?

Apologies for the many questions

No problem tealeaf! There you go:
1. My lens are 16 mm if I'm not mistaken. I did not ask Dr.G and will measure them and let you know. They perfectly fit into standard ClearCare/AO Sept Plus container.
2. I do not use any drops just Unisol 4 prior to removal to release the suction.
3. I wear the lenses for 8-12 hours depending upon the tasks of the day. When I am at home I usually do not need them.
4. To date I've not had a need to refill the lens with solution just wear them all the day long.

[Irina]

L8rgator, so now you have a pair of sclerals instead of one for the left eye?

[tealeaf]

Hi Skazak,
May I know what is the cause of your dry eye? Reason for asking as I am post lasik sufferer and want to find out if the sclera lens are able to help people like me. Do you have plugs in your eyes?

[tealeaf]

Hi L8rgator,

Thanks for the details. How long do you use the lens before you send for cleaning?

With the 19.5mm symmetrical len, do you still have to put eye drops? Do you still have to go Dr G's clinic to check on eye? How much do you pay to get new lenses?

Ask you something more personal. How do you comfort yourself should you have to wear sclera lens for life? Asking the question for myself. What if Dr G retires, who can provide the lens? Maybe am thinking too much.

[L8rgator]

It's a lot easier to comfort myself thinking I have to put lenses in the morning for the rest of my life verses the ugly uncomfortable bandaid patches I had to build every morning and wear in public. There was no comforting that. As I've said before, i was ready to get the eye sewn shut in order to stop the pain before I got my first lens. The pain was unbearable.

And the upside is so far my sclerals are way more comfortable for a full day than the soft contacts I've tried.

I've already informed Dr G that he will not be retiring until he is 90, minimum.

[L8rgator]

Here is the more detailed reply I started earlier about my latest experience:

Since my left sclerals were warped from freezing, and my prescription had since changed in both eyes (I didn't realize it would go down a whole point once I hit 40!!!), and I wanted to try a lens in my right (normal eye- not dry), and I wanted to also test out a larger lens in my left, I decided to travel to Coppell get refitted. Before getting fitted this second time I went well over a month with just patching the eye over completely with a sealed patch all day (there is a video on youtube of my homemade “moisture chambers”) and no scleral because I was worried my warped lens might damage my eye. It sucked. Anything else than a complete seal was way too painfully dry.

For the unimportant stuff, the area is as nice as I remember. We went horseback riding and it was awesome. Hotel had an issue, but they made it right. Walked to the mall a few times to get chair massages and snacks- also awesome. Lots of time to do vacation-y stuff.

My Right: I wasn't having any dry eye problems in my right, but in winter my left feels really cold - not sure if it's dryness on my outer scleral or the pocket of liquid feeling cool or whatnot. I wanted to see if having two lenses in would make them feel more similar, making the less less distracting. And I was having a really hard time with a soft contact in that eye (lots of irritation, and having to clean and reinsert frequently). Plus I noticed some ghosting with night driving that needed improvement. And my soft lens didn't correct for astigmatism, which was obviously getting more pronounced. The verdict: The lens is a definite improvement on the soft lens. My vision is awesome. I've learned that I have a small yellow bump on my right sclera, and I think that maybe my old soft lens /my fingers taking it in and out were irritating my eye previously. Dr. G expertly built some space around the lump under my new scleral lens, and I wear the lens all day comfortably. This lens is non-rotational/non-symmetrical (so custom fitted like a mold, and corrects astigmatism and high order aberrations) and I think about 18mm. It was a learning curve to start inserting a different eye. This eye also has more muscle tone in the lids than I'm used to with the other, so eyelids slip a little easier when wet. It took me over a week to get a rhythm.

My Left - Non-rotational: This lens is non-symmetrical (so custom fitted like a mold, and corrects astigmatism and high order aberrations) and I think about 18mm. It feels as good as the old ones did before I froze them in my car too many times. ("Store your spares DRY". Ok, got it!). This is my go-to lens. I haven't worn a moisture chamber over it since I got it. It's just been great. I do drops at a max every 20 minutes when it's windy, up to about once per hour when it's warm (if I remember). I’m so much more comfortable now, and no longer hesitant to go out in public – both of which things have really improved my mood tremendously. I wear this lens and the right lens all day. I do notice at about 11pm my left does starts feeling distractingly cool/dry. I probably should find my moisture chamber glasses and put them on while I watch tv at night. I haven’t seen them in months, since I haven’t really needed them.

My Left - Larger: This lens is symmetrical and rotational, and is about 19.5mm. I wanted to get a larger one to see if more coverage of my sclera in colder weather gave me significantly more relief. It's only been below 60F a few times since I got back, and so far I haven't noticed any significant difference on those days or any days. I think next fall will be a better test. To make a symmetrical lens Dr. G still scans your eye, and does his magic to design a good fit. But he averages the measurements to work out a good balance, since a lens this large can only be custom made as symmetrical. He had previously said my eye was not very asymmetrical, so a symmetrical would probably feel ok. Since I've been back I've worn this lens a couple days each week to test it out. Fit wise it does feel like a very good fit. I can feel a slight difference from the non-rotational. This one I notice I can feel a bit on the far left when I blink. Not uncomfortable or bothersome exactly- but noticeable sensation that I'm wearing a lens. I generally forget about it after about 20 minutes now. I don't hesitate to wear this one, and have been choosing it when I think the weather is going to be windier or cooler to see if I can use my drops less frequently. No verdict on that yet. Insertion-wise I haven't really had additional trouble with the larger size, which was my big fear (especially with my smaller eye opening after my eyelid surgery). Any bigger than this though and I think I'd REALLY struggle - this definitely seems to be the max because I'm lid to lid and sometimes have to work my around them when inserting.

Because my prescription is stronger now, it's less comfortable to read (same as with stronger glasses on). I bought a bunch of reading glasses, but after a couple weeks my eyes have adjusted and I now I always just go without. I am going to buy a spare for the left, and I think it will probably be non-symmetrical 18mm without vision correction in it - so I have something to wear if I plan to do close-up work for a really long period of time (like work on the computer all day).

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To answer other questions:

I clean gently with lobob every once in a while just for good measure. It's really not usually necessary.

Replacement lenses (and spares) with no new fitting or changes are $250/lens. I could have gone this route since it's very likely my old lenses were just warped, but I wanted to try a right lens and a larger left lens so I decided to bite the bullet and pay for new fittings. I'm hopeful insurance will cover alot of at least one of the left lenses - but I still have yet to fill out and file the paperwork. I hate insurance paperwork.

Dr. G didn't ever tell me to come back and get my eye looked at by him regularly or anything like that. If the scleral is working fine, then my understanding is that you can just see your regular eye doctor for regular eye checkups. You really just need to contact him in case of problems. Or questions. Some people get 10 years or more out of various sclerals without any issues.

[tealeaf]

L8rgator,
I just love your optimism and your long and detailed replies. So, do you still put drops in your left eye with the 19.5mm len?
I REALLY REALLY hope that Dr G's lens will help me.

Since you started sclera lens, does your left eye feel consistently good? I cannot understand my eyes, is a lot of roller coaster experience, at times, feel good, at times bad, at times, really bad.


Do you advise that I should get an extra pair of lens back with me after Dr G get me a suitable pair?

[tealeaf]

Replacement lenses (and spares) with no new fitting or changes are $250/lens. I could have gone this route since it's very likely my old lenses were just warped, but I wanted to try a right lens and a larger left lens so I decided to bite the bullet and pay for new fittings.

You mean no need to fly down to Dallas again to get replacement lenses?

Is unisol a buffered saline? I have checked my local pharmacy, they sell buffered saline, I suppose buffered saline is preservative free.