Dr. Gemoules and my first Scleral Lens

[miki-mama]

Thanks! I think it is really awesome, too.

I wanted to share a little information that I know of corneal pannus. It is defined in medilexicon as:

"fibrovascular connective tissue that proliferates in the anterior layers of the peripheral cornea in inflammatory corneal disease, particularly trachoma in which the pannus involves the superior cornea. Three forms occur: pannus crassus (thick), in which there are many blood vessels and the opacity is very dense; pannus siccus (dry), pannus with dry, glossy surface; and pannus tenuis (thin), in which there are few blood vessels and the opacity is slight."

It is often caused when oxygen supply to your cornea is reduced, for instance by overuse of contact lenses (mostly soft lenses) or the lenses that fit too tight. Your body's response is to supply the oxygen to the cornea by sending new blood vessels. The blood vessels cannot grow on the the hard, smooth surface of cornea, so the body "grows" extra fibrous tissue over the cornea upon which the blood vessel can grow. The result is opaque cornea.

I was taught one of the ways you can tell if your sclerals fit too tight is, if you look at your sclera, the white part of your eye through a magnifying mirror, you would be able to see a white ring around where the edge of the scleral lenses sit. This is similar to when you press your thumb on your skin, it briefly turns white as the blood flow is restricted. One of my optometrist showed me how to take pictures of my eyes looking at all directions, up, down and two sides, with his iphone camera.

[L8rgator]

That IS really awesome! It's amazing what Dr. G can build into a lens for custom corrections - stuff that you can't even get with average regular lenses.

Personally I've been struggling as of late. The lens has made things 1000x better than pre- lens (when I wanted to physically rip my eyeball out of my head and periodically envisioned doing it with various sharp objects). But this climate has me down in the dumps. I have to be extra careful about remembering to do frequent drops for my sclera health. And on the coldest driest days I've had to seal over the lens with tape and plastic or a bandage or the sclera starts to feel very cold, then itchy, then irritated for the rest of the day. My job is walking dogs outside, so it's so terribly dry and windy and COOOOOLD. And a few times I've had allergy attacks where I can tell my eyes become inflamed and red (generally both), or what I think was a third stye starting (but I nipped it in the bud with fastidious lid scrubs), or this week I think I've got fiberglass in the skin around my eye from crawling around the attic for hours because it's red and itchy and warm. And because we are working on a some home repairs that require the house to be super dry and humidifiers to be off, the skin around my eye is getting very irritated and burned from taking my tape bandages off in the morning - sometimes to the point that it bleeds. Just so sick of it all. I got really spoiled during the warm season, and now I'm just tired of being back to wearing a patch and avoiding people and activities while caved up in my house because it's easier than to explain to people. Because it's only one eye for me and I have no fat under the eye so it looks bruised, people treat me like I'm a domestic violance victim and I have to explain the story practically every day - often to the same people I've told it all to many times and they just forgot completely. Even my shrink, argh! Doesn't help that I had to cut down the only antidepressant that has finally worked for me because I was gaining far too much weight. Winter sucks and I just want outta here so badly.Yep I'm a biiiggg baby right now. I'm so down I've been too drained to call the new doctor I'd like to try - the one that makes serum drops and seems to be more of an expert in dry eye. Just feel blahhh.

I do think planning for yearly or so refittings or check-ups is a good idea. I haven't had a problem with tightness except for a few of the allergy days. But I am seeing a bit more halos at night when I drive, and I think my prescription could probably be increased, so I think it would be worth a trip if I can swing it. And I'd love to get the other eye done if I can swing the cost. Still love being able to put my scleral in in the first try and have it be comfortable all day - unlike my other soft contact that is a real struggle and gets uncomfortable at random inconvenient times. This time I would be lazy about filing with insurance. I'll have new insurance next year, so maybe that will help. At the very least maybe I can head to grapevine just to take a vacation from the crappy weather. We did vacation in florida in October, and my eye enjoyed the mostly patch free time. As did I. Thanks for listening to me whine.

As a side note, I learned an important lesson: Always close the drain or put a napkin over it before taking out or putting in your lens. Especially in the public bathroom of your shrink's office (I take my contact out for relaxation and meditation therapy since my eyes are closed.) Or always carry a big wrench in your purse!

[DryInDenver]

Miki,
Thanks for the thorough and well written write up of your experience. I read your post with great interest and relief to see you are seeing some improvement.

How are you doing??? It must have been quite a frightening experience for you and your family. What is the post-op prognosis?

Thanks Miki! I’m doing well. You are right, it was somewhat frightening. One of the worst things I’ve heard through this ordeal was when the doctor said that the thing he saw was UNDER the flap. It was like someone punched me in the gut. I’ve got to say though, it doesn’t sound nearly as harrowing as what you’ve been going through. I can’t tell you how happy I am to read that you are getting some significant improvement. When the vision in my right eye started to deteriorate throughout this whole thing, I was very very very thankful that I had another one working, but much more protective and fearful with my other eye. I’m sure you were going though that same emotion but to the 25th power. That’s really great news.

The right eye vision seems to have leveled off and is okay, but I have some double vision/shadowing and halos at night are much worse. Both of these symptoms are likely due to some scarring in my lasik interface where the white thing was. I’m excited to see if a new lens from Dr. G will help with those issues or not. I’ll be going back to Dallas sometime in the first quarter to get a new lens on my surgery eye.

As far as the dryness goes, it’s about the same as it was prior to the surgery – so far at least. After LASIK, it was at about the 1 month mark when my dryness spiraled out of control. I made it past that point without returning to that absolutely agonizing, hellish eye state which I’m pretty happy about. It’s also been an easier “recovery” from this surgery because I can close the one right eye and just use my left one that has the scleral in periodically throughout the day. In fact, I’m doing that right now as I type this.

What do you mean by epithelial cell ingrowth?

As you probably know, epithelial cells are the outer most layer of cells on your eye and are some of the fastest reproducing cells in the human body. When you touch your eyeball, once you break through the tear film (if you are lucky enough to have one) you are touching epithelial cells. Epithelial cell ingrowth is one potential complication of LASIK where these cells get under the flap and start to reproduce. Usually this occurs at the edge of the flap first and then progresses inward towards the visual access. It looks like a white sheet starts progressing across the cornea under the flap. It’s bad for 2 reasons, one it distorts your vision, and 2 it uses up the limited amount of oxygen in the cornea and starves the cornea itself of oxygen. This lack of oxygen eventually causes the flap itself to disintegrate in what is referred to as flap melt. Thus if it progresses, it is important for the doctors to remove it by re-lifting the lasik flap and scraping the cells out despite the additional risks of the re-lifting procedure. So far, my ingrowth has note progressed beyond the outer edge of the flap and doesn’t need to be scraped out, although I’m going in every few weeks to keep a close eye on it.

Could it be pannus? I had pannus on my right cornea that caused complete clouding in my right eye

Prior to your post, I have not heard of pannus before. Based on what I’ve read, I think there is little to no probability it was the cause of my problem. I want to thank you for bringing it to our attention however so that we are aware of that risk. Based on my tightness issues I’ve had, it sounds like something I may be at risk for some day. It sounds like from what you wrote that you think an overly tight lens was the cause. Is that right? If so, do you or your doctors have any recommendations on what to watch for and how to alleviate the risks? For instance, would taking the lens periodically out for 5,10,30, or 60 minutes during the day help at all?

Also, when I am in Dallas, I am going to get my left eye refitted again too to try and get that perfect fit that will carry over to this DRY Denver climate. Especially now that I know about this pannus thing and the fact that I know now that I have some tightness issues.

The result is, I am seeing better than I have in a long while, and the pannus on my right cornea has receded significantly, enough to avoid the corneal debridement surgery. Yeah!

Awesome, awesome, awesome, awesome!

I have posted earlier that I've learned that some vision care insurances cover "medically necessary contact lenses" dispensed by an OD, which is what these Laserfit lenses are. I'm actually in the middle of battling with my insurance company.

Thanks for sharing. I certainly think that the medical benefit these lenses provide are in line with the intentions, objectives, and principles of health insurance. They just seem to get too easily confused with standard vision correction and are too easy for the insurance companies to say no to. Your persistence is informative and inspirational. Please keep us updated on your progress.

The result is, I am seeing better than I have in a long while, and the pannus on my right cornea has receded significantly, enough to avoid the corneal debridement surgery. Yeah!

Seriously, that is seriously freaking awesome.

[MGD666]

Thank you for posting all of your impressions on these miki, as I am one of those here definitely considering these. It's encouraging to hear this from you (as well as DID and L8rgator), as I have the same anxieties and uncertainty about whether they will help me, that you seem to have had prior to "taking the plunge".

[miki-mama]

Hi, DID.

I've been out of touch lately, and only now read your message from a few weeks ago regarding your surgery. How are you doing??? It must have been quite a frightening experience for you and your family. What is the post-op prognosis? What do you mean by epithelial cell ingrowth? Could it be pannus? I had pannus on my right cornea that caused complete clouding in my right eye. The cause turned out to be an ill-fitting scleral lens. I really hope that you recover and regain your vision quickly.

I wanted to share my own experience working with Dr. G with everyone. Sorry it took a while. I was in Dallas in August.

To give you all a little background info, I have dry eyes (schirmer test "0") resulting from Stevens-Johnson syndrome. I also have scarring on my cornea. Right eye significantly more damaged than the left eye. I have worn scleral lenses from various providers over the years with success (meaning they provided me with restored vision, comfort and protection from further damage). A few months ago, I started to experience clouding in my right eye. We ruled out cataract and infections, but the vision became increasingly cloudy until I could no longer see shapes, just light/dark. It was as if someone had lowered a shade on my eye. Thankfully, I was able to see fine with my left eye. My local ophthalmologist ruled it as a part of deterioration caused by SJS, and offered no idea how to fix it. Another cornea specialist felt that the ill-fitting scleral lenses had caused an injury, and recommended getting the fit of the lenses checked, and possibly a corneal debridement procedure, where you literally scrape the tissue growth off the corneal surface and hope it will heal without scarring. My optometrist, adjusted the fit of my scleral lens. The originals had become too tight. After extensive research, I learned that ill fitting lenses (scleral or others) can cause pannus (growth of fibrovascular tissue on the cornea) due to oxygen deprivation. I also learned that adjusting the fit of the lens can sometimes cause the pannus to recede. The cloudiness in my right eye was reduced somewhat with the use of steroid drops, improving my vision somewhat. The photos of my eyes showed that top 1/3 of my cornea was covered with pannus, which at that time was encroaching my visual axis.

Making a long story short, I decided to try all possible treatment options, starting with the least invasive approach. I needed to get fitted with a new pair of scleral lenses. After first reading here and researching all over the internet about Dr. G and exchanging numerous messages directly with him, I went to Dallas to be fitted with Laserfit lenses. The whole experience was as pleasant as could be under the circumstances. Dr. G is a lovely, lovely man, and Ashley, his assistant is absolutely sweet and caring. They really went out of their way to make my experience of being away from home on my own as comfortable as possible. I think the worst part of the week, apart from being away from my family, was drinking coffee out of styrofoam cups at the hotel cafeteria! (note to self: remind patients headed to Dallas to bring their own mugs!) I met and bonded with other patients of Dr. G's staying at the same hotel, some of whom traveled all the way from Europe and S. America.

About the lenses: The Laserfit lenses are physically a little different from any other scleral lenses I have worn. So far I have tried 5 different variety including Laserfit. The Laserfit lenses are thinner and thus more flexible. They have less vault. Most importantly, in terms of vision correction, they far exceed any I have experienced with other brands. Despite being told my case is different from Lasik induced cases -- in fact much more challenging to correct, Dr. G managed to fit me with lenses that corrected not only my day time vision, but some of the night time issues. For the first time since SJS 23 years ago, I was able to look out into the street at night time without the harsh halos and painful burning sensation caused by street and headlights. Really amazing! I was so happy after the first set of lenses I got, I ran out of the hotel room, stood out side and looked around in amazement. To be precise, the halos around the lights are not gone 100%. It may depend on the severity of each patient's conditions, but in my case, the halos are reduced by at least 50% in my left eye, and about 30% in my right eye. To put it in perspective, I was not able to drive at night at all. Legally, I could have, since I can see through my left eye. But I was very nervous about running over a pedestrian or into another car driving at night with only one seeing eye, so I never did.

In terms of comfort, They are very comfortable. I have experienced fluctuation in the fit after I returned home, particularly with my right eye. It would start out feeling comfortable for a few days, then the eyes became inflamed and I could not tolerate the lens. It got pretty bad at one point, and I had considered keeping my left lens, and replacing the right one with another brand that worked for me in terms of the fit, but definitely not the same quality of vision. However, Dr. G continued to work with me. Neither of us would give up, and we went back and forth via email, trying to come up with the best possible solution. I now have perfectly comfortable left lens. We are working to improve the fit of my right lens, which is so close to being perfect. Dr. G admitted, in cases like mine, he needs to spend more than the standard week to get the right fit. He said in most cases, he is able to get the fit right in the week that patients work with him.

I think a few important lessons can be learned from my experience, for those who are considering scleral lenses:
(1) scleral lenses, like any other treatment options is not a 100% solution, but they can offer a significant improvement in correcting the vision and offering comfort.
(2) not all scleral lenses, and there are far greater choices available out there than even a decade ago, are created equal and one may offer more relief to one patient than another.
(3) once you find the right fitting lenses, it is important to check the fit of those lenses regularly to check for any changes, so that an ill fitting lenses do not cause more harm than benefit.
(4) and in my opinion, who you work with makes a world of difference. If you are fortunate enough to come across a doctor who cares enough to succeed in helping his/her patient, you are far more likely to find relief. And if you happen to find someone you have experienced success with, please spread the word. It could save many of us the trouble and cost of trial and error with providers who may not be as knowledgeable.

I thought long and hard before deciding to travel to Dallas to see Dr. G. It could have been a bust or a success. I had no idea of knowing, despite all the glowing recommendation by other patients. Not because I had any doubts that these patients are telling the truth, but I know from experience that every case is different and one treatment that works beautifully for one patient, doesn't necessarily mean it will work well for me.

I am happy to report that my decision to go to Dr. G was the right one for me. I have come across great many doctors in 20 some years I've had this eye conditions, many of whom have tried in earnest to help me. Some could, and some couldn't. Dr. G has made an incredible amount of effort in the sincerest way to help me. The result is, I am seeing better than I have in a long while, and the pannus on my right cornea has receded significantly, enough to avoid the corneal debridement surgery. Yeah!

For those sitting on the fence about what to do, my advise would be to take a chance and give it a try. There is a chance it may not work for you. But any gain you do make, even minor, could make a big difference in quality of your life.

I have posted earlier that I've learned that some vision care insurances cover "medically necessary contact lenses" dispensed by an OD, which is what these Laserfit lenses are. I'm actually in the middle of battling with my insurance company. Their policy says they will cover up to $2500 of the total, because Dr. G is not a "participating provider" (they would have covered 100% if he had been a participating provider of this particular insurance). At the moment, they are giving me the run abouts saying I need to provide more information, or somehow the additional information I sent over twice has gotten lost, etc. I'm so used to this. I'm pretty persistent, and have gotten insurance companies to pay up in the past.

Good luck to all of you going to Dallas to be fitted with Laserfit lenses!

[MGD666]

Thanks, that's good to know. Was anything mentioned about the possibility of having them "re-coated" after a period of time, or the expected longevity of this coating/treatment? I realize, I should probably just question him myself at this point

[DryInDenver]

Yep, all his lenses are plasma coated.

[MGD666]

Can anyone here who has these (L8rgator/DryInDenver, etc) advise as to whether the lenses provided here are manufactured with a plasma-coating (like many of the sclerals are)? I would think that that might be helpful, especially given that my main problem is lipid-deficiency/MGD.

[DryInDenver]

I had good news on Friday as the surgeon thinks the epithelial cell ingrowth may actually be receding a bit. Felt kind of weird to come out of an eye appointment with some good news

do you have tightness or any vision issue for your left eye? Do you need to remove the scleral len (due to tightness) for the left eye?

My left eye gets some mild tightening after extended wear but the tightness problems with the right eye have always been much, much worse. A couple drops of saline in the left eye is usually all it takes to loosen it up enough to get out without any problems. If it won't come out right away, I put in the drops wait a minute or two and it pops out without much trouble. I generally do not take the left lens out during the day to relieve the tightness. I've done it a few times preventatively if I know I'm going to have a late night, but I don't really know whether or not it helped.

And do you have to put eye drops when wearing scleral lens?

I do put eyedrops in when wearing the scleral. When I'm at work on the computer it is probably every 30 minutes or more, but on the weekends when I'm out and about it is much less frequent. Particularly if I am being physically active I'll unwittingly go several hours without even thinking about a drop.

Do you wear moisture chamber glasses over the scleral lens?

I don't generally wear moisture chamber glasses over my scleral lens but it does help when I am feeling extra dry. For instance, if I'm up late working on the computer I'll strap on some goggles but I am able to go without them when at work and in public.


L8rgator, I'm sorry to hear that the winter is bringing back some discomfort. Back in April, before getting sclerals, I spent a week in Florida and it was much better than here. We rented a pontoon boat and went cruising on the calm waters between the network of costal islands. Even with that headwind I was able to keep my eyes open and drive the boat (lots of discomfort, but not lots of pain!). I was thinking Hawaii would be superb because you don't need much heat or air conditioning so you could go without processed air most the time. Every time I check the Hawaiian weather forecast it seems like it is "sunny with a chance of afternoon showers followed with clear skies and a chance of perfect."

[L8rgator]

I have used the same surgeon every time. I requested sutures but he was not comfortable doing that because he never did it before. So I called everyone I could find looking for someone who would, and everyone said no. Everyone. My doc made a point of telling me that he's never had them open up before, but he spends most days trying to open up people's ducts because their eyes water too much - not the other way around. So not exactly an expert in dry eye.

I don't think I'd sit under a ceiling fan without a patch over the eye. The white would feel too cold. Although I have been out on very windy days in summer when it was warm and fairly humid for hours with no patch and no problems. I wouldn't say that's the norm though.

I don't know specifically what role the meibomian gland has with my problem, if any at all. When I cry my tears are normal and my eye feels wonderful, so I think it's an overall tears aren't initiated by my parasympathetic system. Twice now, however, I got styes since I got my lens. I never had styes before that I can remember. Both times I had tried using theratears liquid-gel when I went to bed, and woke up with a stye the next day that lasted for a few days. So I think it was either an allergy (I'm allergic to vasoline, so maybe related?), or the oil clogged my glands. Since then I started washing my lids in the shower with baby shampoo or eyelid wash ever couple days or so. I haven't had another stye in the couple months since. I tried the theratears liquid-gel a couple times since then. It feels like I've got something in my eye after I put it in, so I think it's likely an allergy issue. I used to use the stuff all the time before I got my lens, but Dr G recommended switching to preservative free only so I did. At night though sometimes my moistened bandaid patch detaches over my nose, so I was hoping to find something more greasy for night use in my eye. Didn't work out though, so now if my skin is feeling slippery I add an extra slip of tape for good measure. That's working good so far, except the one day where the tape peeled off a bit of skin and I had a big scab on my nose to work around. But I digress....

[tealeaf]

Hi L8rgator,
Is really great that the scleral len provide consistent comfort all the time. With the len, can you go under the ceiling fan? Do you have problem with the meibomian gland? do you do warm compress and lid scrub?

[DCRdryeye]

L8rgator - Just wondering if you've been using the same surgeon to cauterize your ducts, and if they use sutures after the cautery to assist it's binding and joining together for a permanent seal?

[L8rgator]

I wear my lens when I'm awake. It doesn't become uncomfortable with longer wear. It feels the same when I put it in as it does 12 hours later. I've worn it for more than 24 hours. I've only taken it out to rinse maybe 3 times since I got it - when I've had bad allergies. In comparison, my other eye has a regular soft contact, and I have to take that out overnight daily and maybe 4x a week to clean and reinsert because it gets sticky, scratchy, or dry. I'm supposed to be able to keep that one in for like 3 weeks without taking it out, so I don't know what the problem is. My house does have a lot of pet dust and hair floating around.

I've had my plugs cauterized maybe 3-4 times. It doesn't take (it opens up after like a month, even after the plug has been completely mutilated in very deep in an attempt to get it to stay shut). So I currently have permanent plug over the cauterization in the bottom also. Just got a new one last week. I was without for about 2 weeks, and could feel my drops run down my throat - yuck. Usually they stay in maybe 2-4 months. The doctor says I'm not at the largest sized plug, so if the hole gets any bigger he has to cauterize again. Definitely think it'll be time for a new opinion at that point.

[tealeaf]

Hi DID,
Understand that your right eye is recovering, do you have tightness or any vision issue for your left eye? Do you need to remove the scleral len (due to tightness) for the left eye? And do you have to put eye drops when wearing scleral lens? Do you wear moisture chamber glasses over the scleral lens?

Apologies for the many questions.

Hi L8rgator,
How many hours do you wear scleral lens?
I am staying in South east Asia with tons of humidity, I hope my eyes are able to wear scleral lens and be of help to me. Do you have permanent plugs in your eyes?

Thanks for your replies

[L8rgator]

I posted this update for myself in another thread about eye coverings. it said...
I have made quite a few homemade options for myself. Usually it involved buying motorcycle sunglasses, and then adding material to seal it to my face. None of the motorcycle glasses come close to a seal without being heavily jury-rigged. I've had the best luck with using glue from a glue gun, or clear ear-plug wax (which doesn't stick to the frames or lenses well, but gives a bit of stick to the face so holds it on better). I've also used the foam from tranquileyes, but that never worked quite right.

Right now I pretty much use only homemade patches with no frames. I use Durar-Lar clear film and cut out a shape similar to a larger eyeglass lens. I punch holes over the nose and by the ear, and tie a beige piece of thin elastic (I'm trying a few new things now I found on ebay that is used for hair and other unusual purposes) to both ends, and then hide that strap under my hair. The plastic sits on my eyebrow and cheek, so it's held off my eye but seals the entire way around. Then I can wear regular glasses over the patch to make it less noticeable. It helps not having any ugly foam showing. Sunglasses without nose pieces fit especially nice. I only have one eye to cover though, and have deep set large eyes, so this solution might not work for others. Or ear-plug wax might need to be added to hold parts off the face enough to make room for longer eyelashes.

I have a bunch of other materials I've played with that have been interesting also. Dragonskin makes a translucent silicone that can be used on skin after it forms. I used it to make some semi-clear gaskets to put under duralar. Keeps it's shape well and attracts much less dirt than ear-plug wax. Plus you could theoretically make yourself a mold (you'd have to be pretty creative here) and mold something to your face or your glasses. Like side gaskets. I tried to use clay to make a mold. Then I discovered I liked the duralar with no gasket, and stopped playing.

For the duralar, I'm liking .005 . .003 is flimsy, so it can cave in towards my eye if the strap is too tight. But that probably does make for a softer smoother seal. .005 is what I use now, but slightly thicker would probably be my preference. I got Duralar for $1.25 for a 20x25 sheet at Utrecht.

I wear my patches over a scleral lens, at least when the temp sinks below 65 degrees or it's windy and dry. The scleral is wonderful, but the dry air in winter sucks the moisture right out of the areas the scleral doesn't completely cover. The combo of lens + patch + drops makes life pretty bearable most of the time. Often I even forget about my eye (which is not always good because I'll forget to put drops more than a few times that day and the next day it'll be a bit scratchy). Hence why I haven't visited in a while. I am still very highly considering moving to a warmer/more humid climate. This summer was so wonderful compared to previous years (my first year with a scleral). I rarely wore a patch - just used the scleral and drops. I really want that year round. My little autofill humidifier helps in the house, but can only get the humidity up to 42% on a good day in the dead of winter. My eye prefers 65% and above. So I'm thinking about Florida, Oregon, or places in the southeast. Or Costa Rica & Ecuador would be nice


Another unfortunate thing to consider about glasses and patches are that the better the seal, usually the heavier the fog. I only have to cover one eye, so a sealed duralar patch is great -but it's often wet/foggy. When I talk to people, I generally wipe it before I look up, or take it off for short conversations. Or wear it behind sunglasses. I think the fog looks kinda gross . Hence the main reason I'm looking forward to a warmer climate.

People do get used to seeing you in your glasses also. It's embarrasing at first, but seriously if they are around you for a while, they stop noticing altogether. My husband is constantly asking me "did you grab a patch" or "have a bandage on", because he just looked me dead in the face 5 times and just doesn't notice it's already there anymore. Once the novelty wears off, nobody notices. And for me since my eye feels betternow , I'm much much less self concious then I was back when my pain drove me deep into to the depths of despair. I still have my days, but now I no longer feel like a hopeless hermit.

....
Today was the coldest day of the year so far. After putting my patch on my eye (over my eye with scleral in it) , it immediately felt dry- irriated. So I pulled out Nexcare waterproof tape and taped the edges to my face, and then my eye felt good again. Felt so good I didn't even take off the patch when I stopped in at a store and the doctor - I just put sunglasses on to help cover the foggy goggle some. Clearly the colder it gets, the more work I have to put into keeping the eye protected. With the scleral + eye patch + drops + tape my eye is a little cold feeling and sometimes a bit itchy, but mostly feels comfortable. In summer I felt comfortable with just drops, so I am planning to move to a warmer client when we can get some new job skills under our belts. In previous years before the scleral I kept the eye sealed shut airtight 24-7 with a soaked bandage, and it still was excrutiating 24-7. So I feel very excited about the vast difference. And pray I never develop an allergy to the scleral, or the doctor that makes it decides to retire without warning me to buy a bunch of spares first.