Dr. Gemoules and my first Scleral Lens

[runnergirl]

Wow, that freaks me out! haha. It looks like one of my lacriserts! I hope it went away for good. thumbs down on LASIK! Keep us posted!

[DryInDenver]

Just for fun, here is a picture of the foreign object under my LASIK flap that I took with my iPhone.

[DryInDenver]

Thanks tealeaf.

Yep I'm still quadra plugged. I actually didn't get my uppers put in until after I got the lenses. At the time they seemed to provide a slight incremental improvement in the dryness of my whites and the amount of drops I'd use throughout the day. The difference was minor though, so if your uppers are bothering you for one reason or another I'd certainly consider taking them out - perhaps one at a time to see if you notice a difference.

GOOOOOD LUCK in June. I wish you the best.

[tealeaf]

Hi DID,
So sorry that you had gone through such a tough time. I really hope your eye is recovering well. Reading your post makes me HATE lasik once again. It has caused so much agony to us post lasik sufferers.
I am planning to go to Dr G next June.

By the way, are you still quadra plugged? I am currently quadra plugged, with 2 upper temporary plugs. Am wondering if I wear scleral lens, can I go without the upper temporary plugs.

Rest well and keep us posted of your eye progress. Take care.

[DryInDenver]

Well, 3 and a half weeks ago I had eye surgery so I'm back with another update.

Writing the whole surgery story would get pretty long so I'll try to limit this post to matters that pertain to my LaserFit scleral lenses from Dr. G. But for a background here is a summary:

-Near the end of September my right eye got inflamed and red and then the lids started to swell significantly.
-The doctors identified a foreign object underneath my LASIK flap but weren't sure what it was. They described it as looking like someone had sprinkled powdered sugar under my flap and in the middle of the powdered sugar there was a big with rectangle. The big white spot was large enough to see with the naked eye and is visible in my iPhone pics of my eye. Or should I say my eyePhone pics... (sorry to waste your short dry eye computer time on bad jokes).
-We treated it aggressively with steroid and antibiotic drops (vigamox and durazol).
-Within a couple weeks, the lid swelling went down but nothing else improved so I underwent surgery. They lifted the flap, took cultures to check for bacteria and fungal infections, and irrigated the interface with antibiotics.
-A slit lamp evaluation immediately after the surgery confirmed that the foreign object had been removed. My follow up appointment the next day revealed the flap laying flat, but that there was some mild scarring in the interface where the foreign object had been.
-Post operatively, the plan has been to keep attacking the eye with strong antibiotics until the culture came back and to treat with steroids to control the inflammation. I started on amikason and continued using the vigamox and durazol all 4 times a day. Amikason had to be specially compounded by the pharmacy and burns like hell on the way in. It's very hard on the surface of the eye and not great for post-op healing but was warranted to prevent a possible dangerous infection from getting out of hand. Fortunately the cultures have come back negative. Two weeks post op I quit using the amikason and reduced the frequency of vigamox and durazol to 3 times a day.
-As expected, the amikason left the surface of my eye looking pretty beat up. I started on blood serum drops to help facilitate healing of the surface and hopefully aid in regrowth of the nerves in an effort to hopefully minimize the severe dry eye symptoms I have from LASIK.
-My 3 week post op appointment revealed some epithelial cell ingrowth at the lower temporal side of the flap. Perhaps we were too early in starting the serum drops so I've discontinued using them. If the ingrowth stops where it is, the surgeion thinks it's okay to leave it be. But if it continues to grow under the flap like a sheet he'll have to lift the flap again and scrape it out. My 4 week post op appointment is this Friday so I'll have an update then.
-My vision has been fluctuating a bit since the surgery. Prior to the surgery, the foreign object was causing my vision to get worse. I was getting some double vision shadows that made it hard to see detail and read. Interestingly, the scleral lens helped with this considerably but I had to discontinue wearing it as the condition got worse. A day after surgery my vision had improved considerably and I saw steady improvement over the next two weeks. At two weeks post op I think was about 20-50 to 20-40. Not too bad. But then, in the third week, it got a little worse again and I had some double vision coming back. This time the shadows were going up and to the right, 180 degrees from where they appeared before surgery. My guess is that this worsening is an effect of the epithelial ingrowth. It's tough to tell, but it might be getting a bit better now. I don't think the double vision is quite as bad as it was.
-Last night something weird happened though. I was at home in bed watching TV with my scleral in my left eye and moisture chambers (safety goggles) over both eyes. My surgery eye was more sore than normal after a long day of work and had an annoying foreign sensation feeling in it. I closed my good left eye and looked just through my post-op right eye and I could read the little Comedy Central water mark in the lower left corner of the screen. I couldn't believe my eyes - err, I mean - I couldn't believe my eye! There is a bottle of lotion in our bathroom with varying sizes of text that I try to read from the shower every morning to gauge my changing vision. So I jumped up out of bed and stood in the shower. I could read the big text, the medium text, and with a little bit of study the small text too! Sweet! The weird part is that this morning, it's back to blurry and I can barely make out the big text. Hopefully that is a sign of vision to come though.

One of my biggest fears when this whole thing started was that I would not be able to wear my lens anymore. I am planning to go back into a lens. I think the cause of my problem was a sponge fiber or some other fiber left under the flap during my LASIK surgery that became inflamed. In my post op charts at the LASIK office, they noted a small fiber near the location of the foreign object I just had removed. This note appeared in my first two charts but not in any of the several follow ups there after. LASIK guy says it must have been organic matter that dissolved. He also is of the opinion that based on the chart, it was a different location than the foreign object. My thought is that they quit marking it in the next visits for a combination of reasons: it became harder to see as inflammation decreased and they run a hurried clinic so they could conceivably skip over a small detail they view as inconsequential. Location wise, the foreign object was very close to what they marked in the chart. Maybe the difference between 5 o'clock and 5:30. Given the imperfect science of scribbling a dot in a circle to mark the location, I'd say that is close enough to be the same thing.

Looking back, before the swelling was so significant that I discontinued wearing my scleral lens in the right eye, the scleral lens helped correct the double vision the foreign object caused. This leads me to believe that something was in there that were picked up on the wavefront scans in April and that is why it helped correct the double vision. Also, as I've mentioned in the past, the right lens would become too tight through out the day sometimes. The vision symptoms I complained of after removing my lens after it would become too tight were the same as those I had before surgery. Blurry, double vision, and a milky haze when looking at low light or high contrast situations. I think that my dry eye combined with the fiber and the tight lens had a snow-balling effect of inflammation that could have gone a little something like this: The dry eye caused a little inflammation. That inflammation gravitated toward the fiber which agitated the situation and caused a little more inflammation. The increased inflammation slowly changed the shape of my eye and caused the scleral lens to become tighter. The tight lens increased the inflammation and agitation at the foreign object and so on and so on. For five months or so this would improve when the lens came out and I got a good night sleep. Eventually, the fiber became so inflamed that my eye had a self sustained inflammatory reaction that eventually caused my eyelid to swell up.

So with all that said, I anticipate going back to Dallas to get a new scleral lens for my right eye. With that in mind I've had some of the following thoughts relating to the lenses:

- I'm not so sure the lens caused my pinguecula to get inflamed. I think what I identified as an aggravated pinguecula was actually just inflammation related to this problem. In my exams prior to surgery, they thought the pinguecula itself didn't actually look that inflamed.

-The lens tightness I experienced may have been a result of inflammation related to the foreign object under my lasik flap and the inflammatory cycle I described above. I am hopeful the tightness problem will go away once I get that eye back into a lens.

-I am also hopeful that some of the vision impairment that is a result of the scarring caused by the foreign object will be correct by the wavefront technology in the scleral lenses.

-A while back, Tealeaf posed a question relating to how long the LASIK flap should heal before going into scleral lenses. If memory serves me correctly, my answer was 2-3 months. Now that my feet are being held to the fire on this subject, I've obviously thought some more about it. I want to discuss this with my surgeon one more time, but at this point I plan to visit Dallas about 3 months post op so I may be in Dallas sometime in January.


I'll update my progress with a new lens periodically.

[Gerri55455]

Hello L8rgator, I inboxed you then thought you might not get to read that message so here is my question: how are you feeling several months after getting the scleral fitted? Please update. Thanks. ~Gerri

[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?

[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.

[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

[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!

[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.

[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.

[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?

[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]

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!!