Dr. Gemoules and my first Scleral Lens

[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?

[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!

[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.

[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]

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]

Hi DCR,

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

[DCRdryeye]

Interestingly, hours after I posted my recent comment above asking you about the availability of 20mm lens with Dr. G - he personally emailed me and provided an update. He must read these threads 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.

[L8rgator]

The software and Dr. G can design custom larger sizes now, and I think a few people successfully got some. I was all scheduled to go down and get fitted. But unfortunately Truform encountered sudden issues with the milling process one day and put a long term moratorium on making bigger ones in fear that their expensive machines would be damaged. So I canceled my trip (which I now know was a mistake given I need a new fitting, but hindsight...). At least that was my understanding at the time. Dr. G would have more info for you.

For the plugs I have one other thought. No doctor will tell you this because it's just my experience, so take it with a grain of salt. When I first got my plugs filled, my eye was NORMAL for like a month. I thought it was the plugs working (I hadn't had a shirmers test up to that point, so I didn't realize that previously my tear production was ZERO so the plugs shouldn't have done anything). After they fell out, my eye was bad. Plugs and cautery did nothing after that. Which makes NOOOOO sense to anyone. My theory is that my eye was irriated enough by the plug (not enough that I could feel it - because my face was still very numb at that point from the accident, but enough that my eye could react to it) that I was producing irritation tears. Which at the time I did get from things like holding my eye open until the inner eyelids burned, onions, poking it, etc. After that I lost the irritation tears also. Now all I have left is emotional tears (which seem to be in ample supply when I cry - both eyes seem about equal). I mention this in case MAYBE your eye is producing extra tears with the top plug in. Hopefully that's not the case, and I don't know if it even works that way at all.

Or if it is remotely possible maybe they can put in some type of plug that is less irritating??? I know one of the ones I had had sharp prongs in it - which actually kept it in far longer than the temporary ones, but could make it sore if I rubbed it too hard. Which I do (prescription by my surgeon) to try to stimulate nerve regrowth around my eye.

[DCRdryeye]

Hi L8rgator - is Dr. G offering the 20mm size Scleral lenses now? I was speaking with him last here and he was in the process of adapting the software and lathe to produce a 20mm lens. I'm not sure if he's succeeded with it yet. He sounded very confident about it.

Scleral lenses can definitely change, or the eyeball can slightly change shape with age or inflammation. This requires re-fitting unfortunately. I've had about 20 fittings over the last several years.

[L8rgator]

My lower plug fell out a couple weeks ago, and strangely enough I also hat that itchy red sensation - and it was painful to the touch. I am cauterized also so loosing the plug wasn't that big of a deal (just was a backup in case the cautery opened up for like the 4th time), but it was odd that after it fell out it because so inflamed. Fortunately mine want away on it's own in a couple of days.

[L8rgator]

L8rgator, after getting the lens cleansed and plasma treated, are the lens comfortable again?
DID, are you able to wear the lens in longer duration now?

One of the clear ones yes is back to comfortable. The others though have a pinchy feeling at the outer side (9 o'clock) or outer left (11 o'clock). No more burning and ok to wear for a while, but pinchy and feel different from when I got them. Dr G said that probably either they got warped, or my eye may need to be refitted because conjunctiva has a way of swelling so my eye shape may have changed. The warped theory is very possible, since many times this winter I left lenses in cases full of solution in my car, overnight, in in -10 degree weather (oops). But instead of ordering a new lens to test the warped theory, I'm saving up to go and get refitted. I've found my insurance doesn't need pre-approval, so I'll have to get it and see. My regular eye surgeon gave me a prescription for a scleral in hopes this will help it get accepted by insurance when I file myself after all is said and done. I'm not thrilled with the cost, but eager to get back into a lens I can't feel at all. You don't realize how blind you are until you can't use your milled prescription scleral with wavefront correction anymore! My glasses just give me headaches now. I think I'm also going to ask to try a non-custom symmetrical lens after getting my custom one. I want to see if a bigger lens (only available in non-custom) provides any different relief or fit or comfort that the custom one.

I'm going to see if there is anyone nearby down there that can make serum drops. Up here it's a hassle and very expensive, so I haven't tried it yet. But I really want to!!! Crying provides such a relief to my eye, and I think serum drops will be similar.

On the upside, it's warmed up some around here, and my eye doesn't have that annoying cold feeling outside the lens often at all anymore. Ahhhh, spring... .

[tealeaf]

Thanks both for replying
Infection as in the eye gets very itchy and red at the area near the plug. Dry eye is just hard to understand and my overflow is nothing to be jealous about. My shirmer score is 0mm, thus, I guess my dry eye is due to evaporative tears.

DID, I have yet to see Dr G to make the sclera lens and should be going to him soon. I REALLY REALLY hope that the lens can bring me relief and comfort like many of you here. And I can just make do with the current lower catutery. Having 1 lower cautery and 1 temporary plug make marginal relief to me but 1 lower cautery with 1 permanent umbrella plug make a hugh relief to me but comes with blur vision which makes me unable to function. Thus, currently, I am having 1 worse eye with total occlusion and 1 slightly better eye with marginal relief.

L8rgator, after getting the lens cleansed and plasma treated, are the lens comfortable again?
DID, are you able to wear the lens in longer duration now?

[DryInDenver]

Hi L8rgator/DID,
Not sure if you are able to advise on this:
I have cauterised my lower punctums and upper tear ducts have umbrella plugs. This results in overflow in my eyes. If I remove the upper plugs, my eyes will be too dry. I am wondering if sclera lens are helpful enough to allow me not to use upper plugs? Any advise if they help you in this area?

I am considering to remove the plugs as they keep causing infection to my eyes. Do you have issues with infection due to plugs?

Hi DID,
I hope your eye will continue to heal and there will be increased comfort in using the lens.

Thanks tealeaf.

It is possible that you can go without the upper plugs but whether or not it will help probably varies from person to person (like almost everything else dry eye related - it seems like something that helps one person makes another worse - plugs especially). Part of the reason I think you might prefer to have the upper plugs removed is the same reason my eyes feel better at night and don't stick to my eyelids when I'm sleeping anymore. Overall the surface of my eye is less irritated and less inflamed so it doesn't respond as immediately and as harshly to irritants compared to before I got sclerals.

In my non-expert opinion, it sounds like it is worth a try to remove the uppers since you are having recurrent infection issues. If I were in your situation I think I would remove an upper plug on one eye so I could compare it to the other eye that still has a plug in. Then either take out the other upper plug or reinsert the old one once you determine which one is better.

My lower plugs have been out for a few months because they fell out. I just had them put back in on Monday. Personally, there is not a huge difference with or without the plugs, but things are definitely marginally better with them in. Also, coincidently, I have only one upper in because the other fell out. I wish I could give you a detailed account of the difference between my two eyes but my eyes are too different from each other to make them good comparisons. That said, I don't think I notice a big difference between the two because of the missing upper plug.

[L8rgator]

Hi L8rgator/DID,
Not sure if you are able to advise on this:
I have cauterised my lower punctums and upper tear ducts have umbrella plugs. This results in overflow in my eyes. If I remove the upper plugs, my eyes will be too dry. I am wondering if sclera lens are helpful enough to allow me not to use upper plugs? Any advise if they help you in this area?

I am considering to remove the plugs as they keep causing infection to my eyes. Do you have issues with infection due to plugs?

Hi DID,
I hope your eye will continue to heal and there will be increased comfort in using the lens.

I have no advice. It's a good question for the doc. My ducts are cauterized, although they do open up periodically. My shirmers is 0, so the thought of getting overflow admittedly makes me sarcastically jealous. Are you getting eye infections, infections in your ducts, or like styes? I haven't had any infections, but have had maybe 2 styes, and 2 almost styes that went away before they started with compresses and extra cleaning. Maybe a different kind of plug, or a cauterization with a smaller opening made but not completely closed (??? is that even possible. I ask since mine kept opening up, but not fully) would make difference ??? Definitely ask the docs.

[tealeaf]

Hi L8rgator/DID,
Not sure if you are able to advise on this:
I have cauterised my lower punctums and upper tear ducts have umbrella plugs. This results in overflow in my eyes. If I remove the upper plugs, my eyes will be too dry. I am wondering if sclera lens are helpful enough to allow me not to use upper plugs? Any advise if they help you in this area?

I am considering to remove the plugs as they keep causing infection to my eyes. Do you have issues with infection due to plugs?

Hi DID,
I hope your eye will continue to heal and there will be increased comfort in using the lens.