Dr. Gemoules and my first Scleral Lens

[tealeaf]

All the best Andre! I am hoping to see him soon ....

[grandsporta]

Good luck! He really is the best.

[L8rgator]

I was having a problem recently that after a trip to a warm climate, my eyes both turned super red and I had to stop wearing both contacts (I have a soft contact in the other one). My guess was allergies, or maybe swimming with manatees (highly recommended by the way!). After leaving them out for a week, the soft one was fine, but the scleral felt terrible - burning that increased throughout the day - and my eye would turn super red. I thought I might need to go in for another fitting, but I decided to try getting them cleaned and plasma treated first. It's been a year so probably good timing. I just got them back today. I have 5. The first one I tried was not normal comfort level but not burning, but I think it was a first edition that was replaced after Dr G made some adjustments when I got home - so I shouldn't have been wearing it anyways. I can't tell which one is which now because they darkened all the orientation
dots and now they all look the same (argh - now I have to keep the prescription ones and the non-prescription stored separately again!)!!! The second one seems to be working well so far so I think the cleaning and plasma did the trick. I didn't try 3 and 4 yet, and 5 I didn't send in for cleaning yet.

[L8rgator]

Best of luck!

[André Pereira]

My consultation with Dr. Gemoules is scheduled.
May 04 I'll be in Dallas!

Dr. Gemoules is amazing. Cleared all my doubts and ever so gently.
The lady who makes the schedules too. Very patient with my bad English. And very kind. I feel really comfortable with them.

Fingers crossed that everything right now.
A cauldron of emotions here.

Thanks Largator for the topic and for introducing me to this tool.

[DryInDenver]

Hi tealeaf,

Sorry it's taken me so long to respond. Things have been really busy from me so I haven't had much time to get on DEZ. For whatever reason my right lens just isn't quite as comfortable as it was before my surgery. The discomfort is a bit hard to describe. It isn't like any of the sensations that I would consider to be normal as far as discomfort related to feeling the lens in your eye. It's just a weird feeling that is kind of a discomfort and kinda-maybe a bit painful sometimes after several hours of wear. I know this is a vague explanation, but living with chronic eye pain makes it hard to figure out what is pain, what is normal, what is discomfort, and so on. This feeling is different than anything in my left eye so I think it is most likely surgery related. I mainly use the lens to help me out in social situations or when I'm in meetings. Then I'll take it out and resort to moisture chambers and using one eye for most of the day when I'm on the computer at work. My wear times can get up to 6-8 hours depending on the event without too much of a problem. I might be able to wear the lens more, but I'm admittedly a bit gun shy now after my most recent surgery so I'm trying not to push it. But overall it still helps me to keep an element of normalcy in my life.

On the tightness front, I was able to get some improvement in tightness from a lens that Dr. G crafted for me that has channels in the lens that make it easier to remove. So that's been good.

Going back down there was not the perfect fix but I'm still very glad I went. I really hope you have some good results.

Good Luck!

[tealeaf]

Hi DID,
How's your eyes now? Are both eyes comfortable with Dr G's sclera lens? Do you have to take them out and re-insert during the day? I am traveling to Dr G this year and really really really hope that his scleral lens can give me relief to my dry eyes.

[DryInDenver]

I looked a bit more into pannus and from what I can find it doesn't look to be a common risk with scleral lenses. Dr. G can decide to use different materials based a particular patient's needs, but most of his lenses are made with high DK materials with the same oxygen permeability that is used in the PROSE lenses. I think that there are enough people using this material that it would be well known if pannus was a common from the lenses.

That said, I think some of the issues above that some of us have dealt with after getting these lenses illustrate that it is important to continue to pay close attention to your eyes and maintain good hygiene. Sometimes it's too easy to get a bit to lackadaisical when the eyes stop hurting all day.

Last, as an update to my most recent surgery recovery, the epithelial cell ingrowth has mostly receded. That's great news because I shouldn't need to go back under the knife to scrape them out and start the recovery process all over again. I've asked my surgeon and a few other doctors when they thought it would be okay to put my right eye back into a scleral lens and the common answer seems to be to wait at least three months. The basic idea is to allow the flap enough time to heal and also for the vision to stabilize before getting a new lens. So once I figure out my schedule I'll most likely be going back to Dallas in Feb or possibly March.

[DryInDenver]

DID/Miki mama/L8rgator,
Do you still do warm compress and lidscrub? Do you apply eye gel to sleep at night?

DID,
You mentioned you managed to get your eyes dryness under control and not back to post lasik kind of dryness, is it due to the use of sclera lens?

Apologies for the many questions, I was about to fly down to Dr G in November but had to go for a sudden operation, thus the delay. Am trying to get as much information before scheduled to see him.

I don't do the compresses anymore or the lid scrub however it is important to stay on top of eye hygiene since our dryness makes us more susceptible to infections. My eyes are better at night too even though the lenses are out while I am sleeping. I didn't use the night gel much before the lenses, but I would wake up at night with my eyes painfully sticking to my eyelids and that does not occur anymore. I think it is mainly because the surface of the eye is just in better and healthier condition.

My dryness was better only in my right eye but still pretty bad so I wouldn't quite characterize it as "under control" but it was much less painful. It's impossible to know for sure if it the improvement occurred because of the scleral lens, but I attribute the improvement to the lens. I just think that my eyes would have remained too inflamed without the lenses to heal at all.

[DryInDenver]

When I go in for a regular checkup for glasses/contacts for my other eye and the doctors and assistants look at me like "a WHAT lens? What is that for? So you wear it all the time time and never take it out?". Ok, seriously - aren't you the ones that went to school for this type of thing???!!!
So that's why I come out to these boards and spill out and rehash every little details, so that others might not wait as long as I did. Or at least so they'll be more informed about their potential options then you'd get from an average optomologist/eye surgeon/optomitrist/face surgeon. Sometimes I want to scream from the hilltops.

THANK YOU for screaming from the hilltops! I heard you and that's why I went to Dallas.

[grandsporta]

The lenses need to be tight enough to prevent movement and to contain the fluid inside from leaking out, but not so tight as to cut off the oxygen supply. According to Dr. G, patients notice the loose fitting lenses more readily, because the movement causes irritation and inflammation, but not the tightness as much because they feel comfortable in the eyes. Speaking from experience, you can look at lens tightness as a "silent killer" (when it is excessively tight), because you don't notice it until it causes problems such as neovascularization and inflammation as it did in my case.

I think if we look at scleral lenses as a part of a number of regiments for offering comfort to damaged eyes, which need to be carefully monitored and maintained, it would be safer than considering it a solution which can be ignored as long as it continues to offer comfort. Before my comment scares anyone from considering the benefits of the scleral lenses, I would not live without, or more precisely, I COULD not live without my scleral lenses, because they offer tremendous amount of protection and pain relief to my eyes. My eyes cannot be fixed. Permanent damages have been done. So the only thing I can do is protect them, so that further damages don't occur. And the scleral lenses are absolutely an integral part of achieving that goal. I don't want to sound alarmist, but in my case, immediately after the trauma that caused my eye damages (in my case Stevens Johnson Syndrome) my eyes were in much, much better shape than they are in now. I thought it was pretty bad back when it first happened, but I wish I could go back to how it was back then. Because there is no cure, but things can continue to get worse, my recommendation is to do everything you can do now to protect your eyes from getting any worse.

I thought I was very proactive about my treatments. I didn't wait until things got terrible to seek help. I admit to being complacent occasionally, and that's when I got myself into hot water, frantically searching for treatments, etc. I have learned my lessons the hard way, and hopefully, I won't find myself in the recent situation I was in, again.

That's good to know.

I had TENS in 2003 and Dr. G fitted me for my lenses back in 2012 and they have saved my life. My life completely changed after I got those lenses. It's still a work in progress because there is so much damage but what a difference his lenses make! I am probably going to go back soon after the new year and have him check it out again since it's been a couple of years and have him make sure the lenses still fit properly.

[L8rgator]

When my injury occured, I counted on my doctors to "take care of it". So I kept going back when I couldn't handle the discomfort a second longer (so about once every 3-5 weeks), and hearing the promises that the nerves will likely grow back, that it was temporary. Just use drops. Didn't work? Ok try ointments. Didn't work? Ok try moisture chambers.... we'll sew up the corner so your eye closes more tightly.... put in plugs... oh yeah there are top drains too so we'll do those... cauterize them permanently... recauterize because they opened up... put plugs over the cauterization to prove that they are closed... use drops (because if your regular eye doctor has had enough of you and is now "too busy" to make special appointments to see you, you get to see a new doctor who decides it's not a serious probably and you are just a baby so start back at scratch). I kept going back every month in agony, and didn't realize how much damage was being done to the surface of my eye. I just wish at any point any one of them would have at a minimum said "this is a serious dry eye problem, and it might be permanent". At that point I would have looked up desperation solutions much earlier and found scleral lenses far sooner and probably saved a year or more of letting my eye (not to mention my personality and mental health) get more damaged. I'm just so angry that nobody in the universe out here knows what sclerals - and many don't even know they exist. When I go in for a regular checkup for glasses/contacts for my other eye and the doctors and assistants look at me like "a WHAT lens? What is that for? So you wear it all the time time and never take it out?". Ok, seriously - aren't you the ones that went to school for this type of thing???!!! So that's why I come out to these boards and spill out and rehash every little details, so that others might not wait as long as I did. Or at least so they'll be more informed about their potential options then you'd get from an average optomologist/eye surgeon/optomitrist/face surgeon. Sometimes I want to scream from the hilltops.That and I want to get sclerals to be so common that insurances stop trying to jerk people around by initially denying claims as medically unnecessary, forcing everyone to have to appeal to even get insurances to take a first look at the claim.

Speaking of which, has anyone with sclerals had Humana? I had BCBS this year, and didn't even bother following up with paperwork because I was so emotionally messed up and dreading dealing with all the appeals I tried to fill out that I just could carry it through. I think Humana will be worse, but it would be interesting to find out if anyone else had luck with them.

My sclerals were definitely more snug when I got them. They were a perfect fit - just a bit of a hesitation when they came out (like an itsy bitsy pop as the suction released). I think my eyes had been inflammed from the damage I had for so long, and being bandaged over 24-7 previously with no fresh oxygen, that they were a bit swollen. When I got home and my eyes started to heal (which was very exciting) the pop went away. I think they fit even better now that they are a hair looser. no problems with loosing suction, or fogging, or moving around at all. Just feels smooth. When they feel loose and they move around on the first blink, I know instantly that it's because there is an air bubble. So I reinsert, and they are fine. That happens around once a month maybe. The liquid isn't really runny in the lens. Just the scientific structure of the fluid keeps it well seated in the lens of the eye.

I'll have to find a new doctor around here that is competent enough to watch for the signs of lenses that are too tight. I do think I'm going to head down to Dr G to see if I can get my lens made one size bigger (19mm instead of 18mm) and take my prescription. I measured 20-10 when I came out of Dr G's office at my other doctors offices and walmart. And now I can tell the prescription has gotten weaker. Unfortunately for the custom built lenses, 19mm that's the max size. He can do larger ones, but they are just stock rotational lenses - so manually fitted as much as can be, but not made for your eyes. I wonder why nobody has yet constructed a lens with a bit more of a lip in the east and west directions - like an oval. That would help cover more scleral, without adding to the difficulting if inserting them.

I also read about an electric device implant that can implanted near your lacrimal gland is in first round of clinical trials, in the US now! I'm excited about that and it really gives me hope for a long term solution in the future.

What kind of doctor do you recommend getting a scleral referral from?
OHHH I just remembered what SJ syndrom is. YEOCH that is scary scary! I know it has a big black warning on Lamical. And I just read a story today about a girl that took a bactrim and had it, and now she is burning from the inside out and may possibly go blind. Terrifying. I do count my start that I'm lucky that: It's only one eye; The eye can see fairly clearly, at least with no patch on; and there are not a bunch of other eye symptoms to treat.

[miki-mama]

Don't the lenses need to be tight in order to keep the lens from moving and sliding around the eye? If we all have dry eyes, won't the lens move around too much when you blink?

The lenses need to be tight enough to prevent movement and to contain the fluid inside from leaking out, but not so tight as to cut off the oxygen supply. According to Dr. G, patients notice the loose fitting lenses more readily, because the movement causes irritation and inflammation, but not the tightness as much because they feel comfortable in the eyes. Speaking from experience, you can look at lens tightness as a "silent killer" (when it is excessively tight), because you don't notice it until it causes problems such as neovascularization and inflammation as it did in my case.

I think if we look at scleral lenses as a part of a number of regiments for offering comfort to damaged eyes, which need to be carefully monitored and maintained, it would be safer than considering it a solution which can be ignored as long as it continues to offer comfort. Before my comment scares anyone from considering the benefits of the scleral lenses, I would not live without, or more precisely, I COULD not live without my scleral lenses, because they offer tremendous amount of protection and pain relief to my eyes. My eyes cannot be fixed. Permanent damages have been done. So the only thing I can do is protect them, so that further damages don't occur. And the scleral lenses are absolutely an integral part of achieving that goal. I don't want to sound alarmist, but in my case, immediately after the trauma that caused my eye damages (in my case Stevens Johnson Syndrome) my eyes were in much, much better shape than they are in now. I thought it was pretty bad back when it first happened, but I wish I could go back to how it was back then. Because there is no cure, but things can continue to get worse, my recommendation is to do everything you can do now to protect your eyes from getting any worse.

I thought I was very proactive about my treatments. I didn't wait until things got terrible to seek help. I admit to being complacent occasionally, and that's when I got myself into hot water, frantically searching for treatments, etc. I have learned my lessons the hard way, and hopefully, I won't find myself in the recent situation I was in, again.

[grandsporta]

Miki mama,
Is really good news to know that Dr G's lens help you. I hope both your eyes are able to be comfortable with Dr G's lens soon. In terms of dryness, are Dr G's lens able to give the same amount of comfort or better?

DID/Miki mama/L8rgator,
Do you still do warm compress and lidscrub? Do you apply eye gel to sleep at night?

DID,
You mentioned you managed to get your eyes dryness under control and not back to post lasik kind of dryness, is it due to the use of sclera lens?

Apologies for the many questions, I was about to fly down to Dr G in November but had to go for a sudden operation, thus the delay. Am trying to get as much information before scheduled to see him.

Don't the lenses need to be tight in order to keep the lens from moving and sliding around the eye? If we all have dry eyes, won't the lens move around too much when you blink?

[tealeaf]

Miki mama,
Is really good news to know that Dr G's lens help you. I hope both your eyes are able to be comfortable with Dr G's lens soon. In terms of dryness, are Dr G's lens able to give the same amount of comfort or better?

DID/Miki mama/L8rgator,
Do you still do warm compress and lidscrub? Do you apply eye gel to sleep at night?

DID,
You mentioned you managed to get your eyes dryness under control and not back to post lasik kind of dryness, is it due to the use of sclera lens?

Apologies for the many questions, I was about to fly down to Dr G in November but had to go for a sudden operation, thus the delay. Am trying to get as much information before scheduled to see him.