Dr. Gemoules and my first Scleral Lens

[L8rgator]

I think it's important too to check the context of old experiences you read. From what I understand, Dr. G's custom crafting and fitting process ("lazerfit he calls it now") has only been around for a few years. You'd have to ask him when because I don't remember, but it was suprisingly recent. Before that he was a still great fitter, but was working with a whole different set of materials and fitting methods. So today's fit is far improved over the fit even a few years ago. I think Boston has been more a stock-out of a kit type fit for a long time, but it's only been more recently that they've started to use lenses that have modifiable areas that they can mill to create a closer fit. Plus, the scleral lens industry itself is fairly new, because previously lenses were did not let oxygen in so people did not start playing with them until oxygen permiable lenses came out - which was not very long ago at all. Since then EVERY fitter has been able to get much more experience with what works and doesn't. So everyone has come along way with getting better products and better fits.

[DryInDenver]

How long post lasik before you start using scleral lens?

For post lasik patients, will wearing scleral lens affect the flap?

I hesitate to answer this question because I am not a medical expert so I'd say ask a doctor (or two). But, my guess is that the answer will be similar to the time frames often given as for when a normal patient would be "healed" - I'm guessing at the 3 or 6 month mark. I haven't looked, but potentially there is some literature out there about how soon it is safe to start wearing contact lenses. If contacts lenses are safe at a certain point, I'd expect scleral lenses to also be safe. For reference, I got my lenses at the 9 month mark and have had no issues whatsoever with the flap.

While wearing the lens, I would actually expect the lens to provide the flap protection and in a sense be safer for the flap. The risk to the flap as I see it (again in my non-expert opinion) would be on insertion and removal of the lens. Getting the lenses in and out is pretty easy to learn, however a reflexive blink at the wrong time can cause you to bump your cornea with an edge of the lens (not enjoyable but not too painful). So there is a potential to lightly bump the flap area. Additionally, if the lens gets tight, there may be some extra suction that pulls on the flap when you remove the lens. I've had both these issues - blinking at the wrong time and a tight lens - and it's caused me zero issues with my flap.

So to summarize, I think that once a safe amount of time has elapsed since the surgery, the lens will actually provide some protection to the flap area, but wearing a scleral lens the day after surgery would be very dangerous for the flap. I have a friend who stepped on a downed Russian olive tree branch with large thorns. The branch swung up as if he'd stepped on the end of a rake and a big sharp thorn pierced his cornea. He had previously had lasik and there were a few complications with his healing process as a result of the flap that was created (certain cells that disrupt vision started migrating into his field of vision). Ultimately they were able to fix his issues and his eye healed fine, but I have to think that if he had a scleral lens on, it would have stopped the thorn like Captain America's shield!

Can one wear the scleral lens with the plugs? Currently, I have lower plugs in my eyes.

Absolutely! I had lower plugs when I got my scleral lenses. Additionally, I have since had my uppers plugged too so all four are now plugged. This seemed to provide me incremental improvement with the dryness I get in the whites of my eyes.

Do you have to remove the lens and re-lubricate them during the day?

Sometimes I do take them out once or twice a day. For me though, this is to "reset" them rather than to re-lubricate them. As I've mentioned before, one of my problems is that the lens gets a bit tighter throughout the day. If I take them out and put them back in, this helps to prevent the suction from building up.

[André Pereira]

L8rgator and DryInDenver

Many thanks for the information!

DID
I get so focused when you post some information that my eyes dry out, lol

[tealeaf]

L8rgator / DID,
Appreciate your replies

After using scleral lens for quite a while now, do you feel the condition of your eyes improve/worsen? Also, how do your eyes feel after removing the lens at night and before putting them in the morning? Read somewhere in this forum that some scleral lens wearers feel good while the lens are in but eyes are feeling worse (than before the use of the lens) after the lens are out.

Is it good to travel to Dr G in early November?

Once again, apologies for the many questions as I am trying to get more information before embarking on the scleral lens journey. It's going to be a long flight from Singapore to U.S.

[Rebecca Petris]

Ultimately they were able to fix his issues and his eye healed fine, but I have to think that if he had a scleral lens on, it would have stopped the thorn like Captain America's shield!

It's a great point! I have to say that I feel protected with sclerals (ok one scleral... haven't been able to wear a left lens in a long time) on. It really IS like a shield. I can cut up onions and never notice.

I am hand-building a tiny house and awhile back on a bad day I got a whole bunch of sawdust in my left eye from a powersaw when I forgot to wear goggles (one of the reasons I hate power tools and use hand tools whenever possible)... it was really scary for awhile till after rinsing everything out and making sure I had nothing worse than scratches. I have had sawdust in the eyes with sclerals before and it was no big deal at all, quick rinse and it was out.

With sclerals, my eyes feel impervious to the outside world. Perhaps I shouldn't think of them that way, but I do!

[L8rgator]

With sclerals, my eyes feel impervious to the outside world. Perhaps I shouldn't think of them that way, but I do!

Ha, exactly! Sometimes I tap on it just cause I can

My eye is far better 24-7 when I wear my lens. On the weekends I sleep in and am very lazy. I used to think "don't put your lens in until after you shower", and then I'd get to doing housework and not shower, leaving the nighttime bandage or patch on all day instead. My eye is definitely not quite as happy the next day when I do that. After some time under the lens, it gets back a happy normalBut when I wear my lens everyday, my eye feels healthy. My eye never feels worse after I take the lens out. Just the opposite.

As I've said, I've been worried about winter, now that I've been spoiled with my eye feeling so great this summer. But the last two days here it's been 40's and rainy, and my eye has still been great with the lens in and I haven't been distracted by a cooling sensation. So maybe there is a chance that my eye is healthy enough now that winter won't be quite as annoying. Or at least a climate withs temp or higher with humidity (like maybe Oregon ?) works, that gives me alot more options of where i can move to in order to have my eye feel no cooling sensation all year long. I'm hopeful!!!

[tealeaf]

Ha, exactly! Sometimes I tap on it just cause I can

My eye is far better 24-7 when I wear my lens. On the weekends I sleep in and am very lazy. I used to think "don't put your lens in until after you shower", and then I'd get to doing housework and not shower, leaving the nighttime bandage or patch on all day instead. My eye is definitely not quite as happy the next day when I do that. After some time under the lens, it gets back a happy normalBut when I wear my lens everyday, my eye feels healthy. My eye never feels worse after I take the lens out. Just the opposite.

As I've said, I've been worried about winter, now that I've been spoiled with my eye feeling so great this summer. But the last two days here it's been 40's and rainy, and my eye has still been great with the lens in and I haven't been distracted by a cooling sensation. So maybe there is a chance that my eye is healthy enough now that winter won't be quite as annoying. Or at least a climate withs temp or higher with humidity (like maybe Oregon ?) works, that gives me alot more options of where i can move to in order to have my eye feel no cooling sensation all year long. I'm hopeful!!!

L8rgator, yes, I hope your tear film is healing and not bothered by the winter anymore!!

[tealeaf]

L8rgator/DID,
I have written to Dr G. He replied within a day. Did he request for a picture of your eyes before your appointment? Regarding floaters, he said laserfit lens are not able to fix this problem

Can I check if the whole fitting process involves any physical touch on the eyes? I have enough of lasik bad experience, thus just want to be so sure that nothing touches my eyes again. Why is there a need to do dilation of the eyes?

How long can a pair of scleral lens last?

When I was much younger, I used to wear hard lens. Was really uncomfortable. Do the scleral lens feel the same as hard lens?

Thank you for your replies in advance

[tealeaf]

With sclerals, my eyes feel impervious to the outside world. Perhaps I shouldn't think of them that way, but I do!

Rebecca, that's great!! Ever since lasik, I always have this urge to protect my poor eyes.

By the way, how long did you use your pair of PROSE lens?

[DryInDenver]

L8rgator/DID,
I have written to Dr G. He replied within a day. Did he request for a picture of your eyes before your appointment? Regarding floaters, he said laserfit lens are not able to fix this problem

Can I check if the whole fitting process involves any physical touch on the eyes? I have enough of lasik bad experience, thus just want to be so sure that nothing touches my eyes again. Why is there a need to do dilation of the eyes?

How long can a pair of scleral lens last?

When I was much younger, I used to wear hard lens. Was really uncomfortable. Do the scleral lens feel the same as hard lens?

Thank you for your replies in advance

Personally, he didn't request a picture of my eyes before my appointment. I sent him some afterwards when I was having some suction problems but not before.

I don't recall any touching directly on the eyeballs during the fitting process. It is very similar to an eye exam where you stare into machines and try to hold your eye open. It was much easier to keep my eye open the second day when I had a lens in.

He dilates the eyes because it helps him get the best vision correction possible. He measures light refraction as it enters and exits they eye. I think if he didn't dilate the eye he wouldn't be able to get complete measurements.

A scleral lens can last many years. In my case it will probably be till I accidently lose it or step on it. I think the longest he indicated a patient had used the same lens was 9 or 10 years or something like that.

I've never worn a hard lens so it is difficult for me to compare. The comfort level will depend on how well the fit is though I think. My conjunctiva was a bit mushy so the first lenses I tried on were a bit uncomfortable - but tolerable and I would have kept wearing them even if he couldn't improve the fit. He was able to tweak it so I have a very comfortable pair of lenses now. I do experience discomfort here and there but any discomfort I get is mostly related to dryness of the whites of my eyes or extended wear times. My GUESS is that there is a small population of eyes that have some characteristic (like super duper mushy conjunctiva or some other sensitive characteristic) that makes scleral lenses prohibitively uncomfortable to wear. I think his fitting process probably gives the best chance of a successful outcome and odds that a scleral lens provides some level of relief are 90%ish.

Additionally, I recently noticed something relating to your previous questions of plugs and eye protection. If I look slightly down and all the way right or left, my lower plugs rub my cornea and bother me a bit. However, when my sclerals are in I don't feel a thing.

[L8rgator]

L8rgator/DID,
I have written to Dr G. He replied within a day. Did he request for a picture of your eyes before your appointment? Regarding floaters, he said laserfit lens are not able to fix this problem

Can I check if the whole fitting process involves any physical touch on the eyes? I have enough of lasik bad experience, thus just want to be so sure that nothing touches my eyes again. Why is there a need to do dilation of the eyes?

How long can a pair of scleral lens last?

When I was much younger, I used to wear hard lens. Was really uncomfortable. Do the scleral lens feel the same as hard lens?

Thank you for your replies in advance

I don't remember any touching of the eye. And the scleral sits on the white part only, so it stays far away from the very sensitive colored part.... Can someone tell me what the colored part is called because I can never keep straight iris, pupil, no that's not it argh! .... so it's comfortable to put in and actually gives immediate relief - at least it did for me. When you get trained to put it in there is a learning curve. I figured out I was feeling the liquid touch my eye, and was thinking it was "in" so I was squeezed and would drop the lens. Over and over. And over. I did get it in once or twice then with a bubble, which isn't right either. Then they told me to actually put it in with some pressure and not be afraid of pushing the lens onto my sensitive eye (something I'd been avoiding touching with anything but drops for years) and walla - breakthrough! No pain, or ickyness. Just instant cooling relief, and a bit of scratchyness in the far corner of my upper eyelid (which was corrected with the next lens the next day via a thinner edge).

Other learning tips: I also had and still have trouble getting my eyelids not to slip out from my fingers. Putting the lens in is easy. It's holding the lids that's hard - mine slide out a lot when I reactive blink or am especially sweaty and lazy to shower on the weekends (lol tmi!). I figured out that I have to dry around my lids with a washcloth, completely. Then I put my thumb and finger deep into the inside corner of my eyelashes. As I spread the fingers, they catch the dry eyelashes and naturally slide back to the perfect position (I have no idea why, but it works 90% of the time the first try). Also, every once in a while when I'm in a hurry I feel the lens touch a bit of the inside of my eyelid before my eye. I've learned to just ignore that, because if I keep going it just slides right around and goes on perfect with no bubbles. Just have to make sure I start with it completely full of saline (overflowing) and bring my eye level to the ground.

10 years is probably the max people have done it. They haven't been around much longer than that in the current forms, but the current forms are more wettable and air permeable so I'm betting if I don't break it (just jinxed myself I'm sure) I'll have it for 20 years. It's really about how you take care of it. If you drop it alot, or rub it between your fingers and things like that it will get eventually scratched I assume. I have spares (clear and prescription) and I rotate the prescriptions, for no particular reason, so I should have coverage for a long time.

Is dilating where they put a drop in your eye? I think he did that. Was it yellow or something like that? I was worried that meant he was going to do that air shooting thing that other doctors do (I hate that), but I don't think he did. I think it was just so the laser machine could take better pictures of the eye.

Does anyone know if Dr Gem has a video of the process. I was afraid of the whole laser fitting machine (lasers? In my eye?!!?), but it wasn't anything like I envisioned. You look into the machine like you would any other machine at the regular eye doctor. You see like a target/star shaped light. The machine takes pictures (digital images). You don't see or feel anything, and it's done immediately. Dr Gem checks to make sure they aren't blurry. And your done for the day. At least that is that I remember. The next day you stop in to get the first lens and learn how to put it in and take out. You wear it back to the hotel (or I went shopping and for long walks). The next day you tell him if there were any problems, and he tweaks the design and orders a new lens for the next day. Repeat.

Since I've gotten my regular contact in my other eye, I've come up with a way to describe the feeling of my eye. If I wash my hands in tap water, and then touch my sclera (white part - that I can remember!) it feels cool. That's the feeling I got on the whites of my eye when I was wearing the scleral last spring before it started to warm - a cold sensation that was not painful but was very distracting and annoying - especially outdoors under 20 degrees. If I wore moisture chambers or motorcycle glasses also over the scleral, that feeling for the most part went away completely (except maybe on windy days outdoors). With the scleral in, or in weather above 71 degrees or rainy, I feel basically nothing - but I do try to keep drops in at least once every few hours. If I didn't I think it would start feeling cool like during winter.

How does my eye feel before I got a scleral (with drops & moisture chambers & bandaids & tarrosphy & plugs): wash your hands with icewater, and touch the colored part of your eye. My whole eye felt exactly like that. And only one eye, so it was the focus of everything.

Now to explain how my eye felt with just drops before scleral, no chamber: similar to above, but add a pile of nettles in the eye, a layer of sand, and cover with a thick layer of vicks vapo rub. Yep that about sums it up.

[tealeaf]

Many thanks all for your replies. Am going to try serum drops these few months to see if there is any slight improvement, otherwise, will proceed to Dr G's clinic next June. May ask more questions when next year comes.

Andrea, please keep us posted after you have seen Dr G. Thanks!

[Rebecca Petris]

I think they have to dilate the eyes before a tomography scan.

I don't remember any touching of the eye. And the scleral sits on the white part only, so it stays far away from the very sensitive colored part.... Can someone tell me what the colored part is called because I can never keep straight iris, pupil, no that's not it argh! ....

Black center = pupil
Colored part = iris
White part = sclera

[Rebecca Petris]

By the way, how long did you use your pair of PROSE lens?

My last set lasted nearly 5 years. I have worn PROSE for about 8 years total.

[tealeaf]

Rebecca,
The same pair for 5 or 8 years - do you use protein tablets to clean the lens? How to maintain the cleanliness of the lens?

Keeping you in my prayer ...

Dear all,
Can I check if you are still doing warm compress and lidscrubs after using the scleral lens? Can you use serum drops with the lens?