Dr. Gemoules and my first Scleral Lens

[L8rgator]

Weather Averages in Coppell TX:
http://www.weather.com/weather/wxcli...ly/graph/75019

[André Pereira]

I´ve read quite a lot about scleral lenses these last days . I think that the technology used by Dr. G. produces high quality lenses .
Reading about other scleral lenses, I always see stories about bubbles , poor fit , and some other things . Of pages I researched , I do not see anyone complaining about such things in Dallas lenses .
I am willing to spend U $ 8,000.00 to get out of Brazil and try.
He answered all my emails and sent me contact of two patients who wear lenses . One uses it for over 10 years. After all this , I was pretty confident .

Largator , you told me not to go to Texas in the summer . I was planning to go in January or February . But after everything I've read and the possibility of a big improvement in my eyes ( and get out at night and arrange a date again) made me want to anticipate the trip . Probably in July or August .
I'm here with fingers crossed . Thank you for making this topic and call my attention to the scleral lenses.

Good luck on your visit miki -mama !

[miki-mama]

Thanks for the information about the fitting process L8rgator. I am already liking Dr. G a lot. I emailed him last night, and he replied right away! I think it was past midnight his time! I am inclined to go see Dr. G in Coppell. Dallas is closer to where I am than Boston. I used to live in Dallas, so I'm familiar with the area.

[L8rgator]

Ugh that blood vessels thing sounds awful!!! Is that a common thing? Are they permanent? Sometimes I leave this forum feeling sooooo lucky!!!

My understanding is that Boston still starts with trial kits. Or "standard iterative approach using trial devices and custom modification [via CAD] of device contours based on clinical findings." as put in one article I just googled. I've previously read from people that commented that the first trial lens days were painful- so that makes sense that the first lenses could cause painful pressure points, or tight pinching, for some.

So with PROSE they subjectively choose a starting lens, evaluate how it fits/functions/feels, make adjustments as needed, evaluate, repeat. But I'm going by the research articles I can find on the internet. They don't really talk much about the exact specifics of what level and methods of "customization" is available as far as I've found. I know some brands of scleral kits are built with "modifiable areas" than can be lathed to better fit an eye. But I don't know if that's what Boston does. Probably a good question for the PROSE forum. I know they have a ton of different lenses to start from - which is why they have been often suggested for hard to fit cases or when other non-custom lenses fail.

Gemoules's lenses are made from scratch. Your eye is scanned and the scans are digitally converted to a 3D digital map. A virtual lens design is molded on it, and further manipulated to adjust for vision - so your prescription, astigmatism, and high order aberration(?) correction, etc. I get a little lost here, but he explained it like when lasik patients talk about glare and issues at night - that's aberrations. A regular scleral lens can sometimes partially correct these, but also could even add it's own aberrations. Gemoules's has a patent on a process that cancels out eye and lens aberrations. I guess that part is unique.

The virtual lens design is then sent to TruForm to manufacture from scratch (dr g does pick a material to use also). Since it's custom contoured, the first is generally very comfortable and doesn't need any further adjustments. In my case, the edge felt scratchy on my outer upper lid so Dr. G tweaked the design to have thinner edges, and sent for another lens. He also tried a different material this time to see if there was any noticeable difference in wettablility. Unfortunately you have to travel to go Texas to get a lens made this way, because their patents prevent other fitters from using this technology.

I was in a better situation to get a PROSE because there was a fitter less than 2 hours from me. If I remember right though they would have had to send for each lens from Boston, so I would have to come back repeatedly until a good fit was achieved. I think you have to go to Boston to be able to stay overnight and get it done in consecutive days (or maybe very nearby also?). In Chicago they only did fittings on Fridays, so it would have likely taken weeks. No extra charges for fitting adjustments for like 6 months though, so that would have been a plus given a fitter was in my region.

[miki-mama]

This so wonderful! So happy for you that you found something that has worked so well for you!! I have been considering a visit to Boston, but I will explore Dr. G's Laserfit lenses before I make my decision. I have also been fitted with Maxim lens (I live in Denver). I am waiting to see if the lens alleviates my problem. I have blood vessels growing over my cornea due to injury/oxygen deprivation from my last scleral lens which I got in Europe. My plan was, if the Maxim lens doesn't help with the blood vessels, I was going to Boston. Are they utilizing still utilizing "trial & error" lenses in Boston, does anyone know?

[L8rgator]

...sent my anxiety level spiking up during the period after I booked the trip and before I made it down there. It was this weird blend of excitement and pure terror.

LOL I'm glad it was not just me!!!

[DryInDenver]

I can confirm the cost for two lenses is currently $3500. The process is almost exactly the same whether or not you have vision correction in the lens and the price is the same. The hotel was very comfortable and the daily free breakfast was much better than I had anticipated. The room was very spacious with a king size bed, large flat screen TV, couch, desk, and large bathroom with Jacuzzi tub. The hotel also offers free WIFI. I was easily able to work remotely from Dallas which greatly reduced the impact on me of being gone for a week.

Thus far I have absolutely zero problems with clouding or fogginess.

The only other lens I tried prior to my trip to Dallas was called the Maxim lens made by Accu Lens. I hadn't heard of it but found a local optometrist who fit them in the area so I gave them a try. It would have been great if they worked because they were relatively inexpensive, but they did not work for me. It felt like I had an eye lash digging into my cornea. After going through that experience and then reading about the LaserFit process Dr. Gemoules uses, I knew that he was who I wanted to try. The sense I got from talking with him is that his patients get some sort of relief in at least 90% of cases. He is very modest and does not speak poorly towards any other lenses or fitter, but I am a firm believer that he has the best system out there right now (since he won't say it I will for him. I also liked how easy he made the process. Once I decided to go I think I had the whole trip booked in less than 30 minutes: cleared it with work, cleared it with the family, booked a fight, booked the hotel. Do your research but for me the decision was pretty easy (and if it didn't work, Boston was next on my list).

Leading up to my appointment I actually believed that the LaserFit lens would be able to help which, ironically sent my anxiety level spiking up during the period after I booked the trip and before I made it down there. It was this weird blend of excitement and pure terror. For all other treatments, I've intuitively felt that the treatments would not help much but I had to try (right?). So going to those I just felt like I was going through the motions. But this was probably more like an inmate wrongfully convicted with a life sentence waiting for the verdict to be read at his retrial. I thought I would get out - at least on work release or something- but I was shaking in my boots!

It's been about 3 weeks now and my lenses are still providing me with enormous amounts of relief. I'll try to provide occasional updates on my progress as I continue to get to know my sclerals. Good luck to all of you! I really hope relief is on it's way.

[L8rgator]

A few people pm'd me about cost.

My lens cost me:
a flight to dallas ($300)
a hotel in dallas for 1 week (discounted rate, transportation all over included, full buffet breakfast included - I put alot extra in my fridge and ate it for lunch also) - $69 guaranteed rate for patients + $8 taxes per night
$2000 total for a final lens (plus all the custom trial lenses created during the fitting process) + custom measuring/digital imaging/vision correction integration + milling each lens from scratch + fitting + all care necessary for a week, and a flight-approved kit of stuff to take care of the lens (plungers, solutions, case, etc). I was originally told that adding the other eye would have added only $1500 more.
$250 more for each extra lens I wanted to order. This was the selling point for me. The next cheapest lens other providers offered was the stock Jupiter for $900 - and PROSE replacements were many times that.
A week off of work (unpaid, because I am self-employed)
and maybe about $30 for extra plungers and solutions and cases. Normally people don't need this, but I lose things so I wanted plungers for every car.

[L8rgator]

About the clouding and foggyness -I think that using ointments or oil containing drops the night before definitely increases this. it might be worse for me because I'm allergic to petroleum based products. I stick to a small set of drops now, even at night, and no ointments. So I have no fogging now. I am still looking for better solutions to night time relief, and am open to suggestions! Right now I'm bandaid-ing over the eye (with waterproof bandages and nexcare beige tape) and just using theratears drops and saline under. Works ok for the eye, but irritates my skin to pull the band-aid off.

[L8rgator]

I don't know how people do insertion and removal with their fingers. I tried that once each and just laughed because it was just way too much work and didn't work!

I read something a few days ago that says that some people (especially elderly or children), put the lens on a stand-like plunger and bring their eye TO it. I could see how that might work even better, since then you can use both hands to hold the eye lid open. Putting the lens in with a plunger is the easy part - it's the holding your eyelids open without them slipping all over that's the hardest thing. Once you get a hang of that, it's really no problem at all. You really don't even need a mirror, except to turn the lens after it's in (I've used my phone for that a few times instead).

When I used the refresh drops, I experienced clouding every couple of days, usually when I was lazy and the lens had gotten dried out. Adding drops on the outside cleared the cloudiness. Since I'm started just using sterile saline or theratears instead, I almost never have any clouding. Honestly I expected to have clouding all the time. But for a year I wore a foggy patch over a ointmented eye, and then for another year I wore a bandage over the eye. So I really wasn't concerned about foggyness. However, I was pleasantly surprised it hasn't even been an issue.

I put in my lens at 10 am. I go to bed on average at 1am, so I'll have the lens in until bedtime between 11pm and 3am. I've only taken it out to reinsert once - on a day when I was having allergies and wanted to see if it looked cloudy when I held it up. And so I could show it to the kids. I have warn the lens for a lot longer twice - til about 5 am - with no problems. That's not recommended though, because you do need to keep it clean to prevent possible infections.

Don't take my word for it, but in my understanding and limited experience...

The jupiter lens comes in fewer sizes, and has a thick material. When I put in the test lens, it worked great, but it felt scratchy around the outer and inner edges. I know now that was my eyelid going over the edge and getting inflamed. Dr G had to adjust for that same thing with me on my current lens. The Jupiter lenses were far cheaper than the Boston Sight co lenses (but still much more expensive than Dr. G's). And I could have gone home with one that same day. Because there are fewer sizes, you just can't spend the time finding a "perfect fit", and the dr. can keep them all in stock. With the jupiter fitting, any changes to the lenses and future appointments needed were billed extra. If it were the ONLY option, I'd have taken it and tried to meditate through the annoying scratchy feeling (which was still better than the burning dry eye I walked in with).

The Boston Sight PROSE treatment / scleral lenses I don't think actually refers to a "lens". It's more a difference of a fitting method. I think (although you'll have to ask to be sure!) Dr. G actually also uses the same brand of lenses for some of his fittings. At the U of I the PROSE lens I tried was very comfortable. It wasn't fitted, so the hour that I tested it, it slid all over the place and everything was warpy. My pupil also looked grossly oversized. I think getting a fitted one would have corrected all that. There was a little scratchiness, but it came and went. for the Prose process, they order some lenses that look like they "might fit" as per the doctor's subjective opinion. Then they go through trial and error to pick one that fits best. You have to return multiple times to get (have shipped from boston) a new lens to test, so he can check your eye and things like that. The PROSE lens looked different from the Jupiter lens - the Jupiter lens had distinct levels. The PROSE lens was more smoothed on the outside so maybe would slide easier under the eyelid? For cost, the Boston lens is scary expensive. But they are really familiar with working with insurance, and can often get some insurance providers to cover it or parts of it (although you often can't get a decision from insurance until AFTER you buy the lens and bill them). The fee includes follow up visits for a long time (like 6 months or something?) so there was some big money saving there, at least if you were drying to the place.

The Dr. G lenses are custom milled from scratch. He has a variety of lens MATERIALS to start with, but he doesn't even have to choose from stock lenses of different sizes to start with. He uses a machine to noninvasively take a detailed roadmap (digital image) of your eye. He uses that to build a custom 3D image of your eye, and a digital representation of a lens to fit it. For a corrective lens, he also manually maps out a correction for the lens and integrates that into the design (tedious). Then he subjectively picks the type of lens material he thinks may work best (I tried an extra oxygen permeable, but then since I was still using drops every 20-30 minutes he decided to make the next one from highly wettable) and the local lens factory mills the lens from scratch based on the digital and custom specs. For mine he specifically thinned the edges more, since the first test run was a perfect fit, but slightly "itchy" to my upper eyelid periodically because of it's thickness. The finished lens gets driven over every morning so you can stop in and try them up in the afternoon - and then test them the rest of the day and next morning. He also takes new roadmap of your eye each visit in order to check each the fit. Because the lenses are custom, they can be mapped to fit particularly difficult eyes. And they can be made corrective.

I know others mentioned that they tried sclerals, but they couldn't keep them in for more than an hour or two so they just "didn't work" for them. I feel bad for these people, because I think some of them didn't have the benefit of years of refinement in the fitting and lens care process that I did. Plus that had to be expensive. Plus I personally had the added bonus of custom fitting - which pretty much ensures a perfect fit from the first milled lens (often any tweeking after the first lens involves changes in materials, edge thicknesses, sometimes visit correction - but not any fit changes). I do personally think the fit and structure makes all the difference - especially when it comes to fogging, based on research I'm read. I really hope in 10-20 years these types of lenses become really common, refined, and therefore affordable so that everyone with dry eye can affordably take their best shot at this as a solution. And that other fitters all over start using this technology so that travel isn't required!.

[MGD666]

L8rgator: Thank you so much for taking the time to make the video and posting the link to it here. Very interesting to see the regimen, especially the insertion and removal process with the little plunger. So, how often do you experience fogging or cloudiness with these? Do you ever have to remove them to clean and reinsert? Also, do you happen to know the main differences between these lenses and the PROSE and/or Jupiter sclerals?

[L8rgator]

I made an little video of my lens routine and the products I'm using right now - https://www.youtube.com/watch?v=Oxs3cu3Ws0Y . By "little" I guess I mean I forgot to turn the camera sideways to take a correctly sized video (oops!).

[L8rgator]

I didn't do anything too exciting in DFW. I loved my hotel room, so I spent a lot of time relaxing there - especially in the whirlpool tub, or soaking up sun outside. There is a big mall that I walked to. It has a nice sized aquarium, chair massages, and a movie theatre where some of the shows are in recliners and they bring you food. There were some other area activities that I didn't try - like a couple zoos.

If you have a choice to go in summer or winter, I'd choose winter. I hear summer in Texas is HOT HOT HOT in summer. Not sure about Coppell in particular though.

[André Pereira]

Thanks L8argator and DryinDenver

I researched a lot about Dr.G here on the forum.

It seems to me that the lenses produce a good result. I found many reports of people having lasik. Of all the tools I had already researched, this seems to be the most efficient for the effects of LASIK.

I am willing to fly to the USA. But this will only happen at the end of the year. I intend to finish the treatment I'm doing.

I'll research more about the PROSE lenses also. I do not know why, I had never read anything about scleral lenses.

What's cool to do in Dallas? laughs

[DryInDenver]

Anyone else ever heard of Dr. G?
DryInDenver.
I sent a private message to you. But I'll ask here too!
The lenses you helped with the redness of the eyes?
And with inflammation?
I was very interested because I saw that you are a LASIK patient. If you can tell us more about the positives, negatives and about your routine with the lens, I will be grateful.

Thanks man!

I didn't really have a problem with redness so it is hard for me to speak to that specifically. My intuition is that it may help or hurt redness depending on the underlying cause of the redness. The lens does rest on the white part of the eye, so that could cause some redness, however, if you are getting redness from the irritation of the dryness, it may help. That's just my speculation though.

Positives:
I don't live in pain every second of every day. I used to vary from very mild to severe pain through out the day. When I'd get home from work, despite wearing goggles and using drops every 5 minutes, my eyes would be a wreck. Most day's I'd have to do a hot or cold compress. I had trouble reading books at bedtime to my 3 year old and often asked my wife to do it because my eyes were just in too much pain. I can read to my kid any night of the week. Just thinking about regaining the ability to do this gets me a bit emotional.

My eye's feel generally healthier. For instance, when I used to wake up in the morning, I'd reach for a drop before I opened my eyes because my lids were sticking to my eyes. It hurt to keep them closed, but it hurt more to open them, so I needed the drop immediately. Now, I still use a drop in the morning, but I can open my eyes and it's not that. I just put a drop in within a few minutes of waking up. Also, when I take the lenses off, my eyes are not quite as sensitive to the dryness and moving air and can tolerate it for a wee bit longer (as in for a few minutes instead of zero seconds).

I can wear the lens for almost the whole day and have had success wearing it on long work days where I am up at 6 am, on the computer from 7:30-6 pm, then back on the computer from 8 to midnight. There can be some discomfort at the end of the day and I feel like the lens wants should come out, but I don't want to take it out because that discomfort is still way better than the dry eye pain. I'm still trying to figure out my optimal wear time.

My social life and desire to be sociable has increased 1000 fold. Before I'd try to tell myself I didn't want the disease to limit that aspect of my life too much. But the inability to stay out late, anxiety over wearing bulky goggles out, and fear of inflaming my eyes kept me in a lot. And I wouldn't reach out to people to plan get togethers. That is no longer the case.

I'm excited to ride my bike again.

Negatives:
These are not a cure.

I still use drops every 20 minutes or so to keep to corners of my eyes from getting too dry and itchy. BUT, this doesn't seem bad compared to what I had to do before and the consequences for not using a drop are not nearly as harsh. I've sat through a few 2 hour business meetings and lunches without using a single drop. It did not cause the incredibly painful inflammation I used to get that would take a week to get under control. The corners of my eyes were just a bit dry, itchy, and red and drops over the next few hours fixed that.

I occasionally feel some discomfort that is a bit reminiscent of the dry eye pain I'd get before, but in this case it is discomfort not the pain I used to have and can go away during the day. It not surprisingly seems to be more common if I am tired or sick.