Dr. Gemoules and my first Scleral Lens

[tealeaf]

L8rgator / DID,
I read somewhere that Dr. Gemoules laserfit lens are mainly to help patients with vision issues. My main problem is post lasik DRY eyes. Are the sclera lens from Dr. Gemoules able to help? I read also that post lasik patients tend to have more sensitive eyes and not all are suitable to use sclera lens, did Dr. Gemoules commented about this?

I may travel down to Dr. Gemoules if the lens really help.

[Gerri55455]

Thanks so much, miki-mama! This is good to know. Best, ~Gerri

[miki-mama]

One question: can one use serum tears while wearing scleral lenses? I didn't ask my doctor that question. Thanks a lot. ~Gerri

Yes, you can use the serum tears while wearing the scleral lenses. In fact, I was told to add the serum drops into the scleral lenses with the saline when ever my eyes were severely inflamed. My vision blurs slightly when I do this, but it works to calm the inflammation noticeably.

[Gerri55455]

Thanks, L8rgator for the wonderful tips! I really appreciate it. I might end up going to Dallas, then. ~Gerri

[L8rgator]

If you are in MN, then Chicago would be a long to repeat every Friday - especially if you are one of the unlucky ones who ends up taking many months to fit a PROSE. ( I think they only do Sclerals/fittings on Fridays -and then I THINK they have to order from Boston each time so you have to come back each time to test & refit).

Isn't Jedlicka in MN? I emailed him a few times. But I think he only does the cheap rotational kinds (because his fitting takes 1.5-2 hours, like the Jupiter ones offered at U of I). But if you want to try something very basic, it might be worth a shot. In January he said a fitting appointment for my eye was roughly $500, and lens $500. Lens is refundable for 90 days, but fitting fee is not. Future adjustments are charged as new appointments. He did add "The lens should help to manage the dryness of your eye, and having your eye open will obviously be better visually. However, it is worth mentioning that if your contact lens surface gets dry, even though your eye underneath is lubricated, your vision may be intermittently blurry. I only say that in advance so you are aware, it should still be a big improvement over having your eye taped shut." I know stock rotational lenses tend to have this type of blurring problem more often then custom fitted ones, because of fit, so that makes sense.

I didn't ask my doc about using serum either, but I did want to. I have others with PROSE have previously mentioned that they do combine the two.

[Gerri55455]

Hi L8rgator and others who've used scleral lenses,

My doctor suggested that I get a scleral lens fitted in MN but I just don't know someone who's had a lens done here. Hence, I'm looking for a place with some 'reputation.' If U of I has good reputation, Chicago would be easier for me to travel to than Dallas. One question: can one use serum tears while wearing scleral lenses? I didn't ask my doctor that question. Thanks a lot. ~Gerri

[André Pereira]

DryInDenver

I read your last post. I am a Post-Lasik and researched a lot about scleral lenses in recent months.

You had red eyes? The lenses have helped with this?

I tested a couple of sclerais here in my country. they irritated my eyes, but I think that was due to preservative eye drops that the doctor used inside the lens.

I intend to do another test with physiological saline only.

[L8rgator]

Hey L8rgator, have you also experienced your lens tightening up on you, or do you also have this increased feeling of suction as your wear time increases?
Do you feel the fit on yours is just right as it is?

Actually mine have definitely loosened. When I take mine out now, there is almost no suction and it comes right out with the tool. I don't even hold my eye open to remove the lens, since it comes out so fast and easy. They wear perfect still - no sliding around or anything, so fit is still great I guess. I can just tell that there was a bit more suction when I first got them as compared to now.

When I say "them", I mean that I have multiple lenses for my left eye (no scleral in my right at all). I don't know if I posted it in this thread, but I did get a regular soft contact for my right eye. And I upgraded my left to have vision correction (that cost me $250 for the new lens to be mailed out). Honestly, I like the scleral much better than the soft contact. It's easier to put in, much easier to take out, and I don't feel it. The soft contact I feel every few hours - like it's sticky or something (annoying but tolerable), and it is very uncomfortable when I get up in the morning or after a nap so I've started to always take it out when I take my scleral out (overnight). But with that combination I now have 20-10 vision. And reading is working out ok as long as I hold things out further than I used to before corrective lenses.

Once the weather went up over maybe 72-74 degrees, I have been able to cut my drops by half or more. The cool feeling around the uncovered parts of the scleral very noticeably diminished. Sometimes I forget drops for hours when it is warm out. Many times I forget I have a bad eye! Until it cools off at night, or it's time to take the scleral out, that is. That is SO different than the past few summers, which were unbearably painful 24-7. My husband thinks that now since my eye is protected maybe the broken tear-making nerves are finally healing, and that's why it feels better. Maybe. I think it's something to do with the heat and humidity, so I'll keep my hopes up for healing but am also seriously considering moving to a warmer climate (maybe northern florida?) if winter comes and I find the cooling feeling returns. The chilled feeling is not painful, but it IS distracting and annoying. So if a scleral + constant warm climate can make my eye feel great all the time I think it's worth considering for me. This will be my first full fall and nasty wisconsin winter with a scleral in coming up, so we'll see how it goes!

I did encounter an issue with my eye last week. I got a cyst, probably a stye? I freaked out because I read you are are supposed to stop wearing contacts - especially hard ones- until it heals. So as a precaution I tried to get in to see my local eye doctor to see if he wanted to give me drops or anything - or at least tell me if it was better to use the scleral versus the other option (patching up the eye with an air tight wet bandage - causing the perfect breeding ground for infections) for a while, but none of the nurses took me seriously I think because they didn't really know what a scleral was, so they wouldn't make me an appointment with any of the docs and kept telling me to just use warm compresses (duh). So I said whatever and wore the scleral anyways, but rinsed it and my eye periodically and swapped it with a freshly disinfected scleral at least once per day. And did moist compresses and massage. The stye went away in a couple days and everything seems fine now.

I really wish there was a scleral that could be worn at night.

[spmcc]

spmcc: I know it's been awhile since you wore them, but back when you initially were fitted for them some 5 years ago, was the fitting process the same as it seems to be now (stay in the area for 5 days or and make several visits to ensure the fit is just right and that you are tolerating the lenses well)? What exactly was it about them that your eyes and lids had problems with them? Did you feel any discomfort as in the "suction" as DryinDenver talked about? Had you ever worn regular contacts prior to trying them?

(not in order) No, I had never (and still haven't) worn contacts.

Yes, the fitting time seems to be the same (5 days in Coppell going to see Dr. G every day). I don't know if there are new machines or anything else different now though.

I have rosacea and the lenses just flared up my eyes (made bloodshot), lids and even face while inserting. They are BIG!

I didn't feel a sensation of suction, but I still felt my "normal" dry eye when they were in (e.g., burning and menthol are my norms). I happened to get home from TX on a Saturday and saw my regular ophthal in Vancouver on Monday. I wore them to the appointment. She asked me how my eyes felt, I said that my eyes felt dry, she looked and said there seemed to be no fluid in the sclerals, I took them out, and never put them back in. They just weren't for me. Dr. G also stressed to me (when i got there) that the lenses are for vision correction, not dry eye.

I do recommend now that people find a place where they can try sclerals before committing to paying for them. Altho Dr. G is less expensive than, say, BFS, I am still out $2500 (not including travel costs). Live and learn.

[MGD666]

spmcc: I know it's been awhile since you wore them, but back when you initially were fitted for them some 5 years ago, was the fitting process the same as it seems to be now (stay in the area for 5 days or and make several visits to ensure the fit is just right and that you are tolerating the lenses well)? What exactly was it about them that your eyes and lids had problems with them? Did you feel any discomfort as in the "suction" as DryinDenver talked about? Had you ever worn regular contacts prior to trying them?

[spmcc]

SPMCC wearing scleral lenses during the day makes my eyes better at night. I can't tell you exactly how or why, but I know that it does.

That is great to know. I wish I tolerated the sclerals but my eyes and lids were just too unhappy with them.

And I understand completely about the seeming lack of sense of this. And I agree that accidental experiments often help us learn about what works and doesn't.

[Rebecca Petris]

DID what a great post - thank you. Like you said at some level most people don't have hopes of miracles when they get to this stage, yet... it really is hard to remember that there is no true free lunch out there. EVERYTHING has tradeoffs. Success is always measured in the delta between the pros and cons.

SPMCC wearing scleral lenses during the day makes my eyes better at night. I can't tell you exactly how or why, but I know that it does. Actually though there are only two periods I remember being very aware of this: 1) When I first got PROSE so many years ago. In the early period I knew my nights were better. 2) Recently, when I was out of lenses altogether for several months (and still am not able to wear a lens in my left eye). Never had such severe night dryness as those months. Never knew my left eye was even capable of getting that dry at night. Never used so much saline to douse my eyes in the morning. Never had so much constant fear of erosions in the mornings waking with the lids completely stuck down if I forgot or didn't think of putting on a goggle.

If you'd asked me a couple of years ago if they helped my nights, I probably would have said either No or I don't know. But then, that was when I was wearing them every day in both eyes, so I had nothing to compare to.

[spmcc]

*I no longer wake up with my eye lids painfully sticking to my eyeballs. They are dry when I wake up, but it doesn't hurt to open them and I can get a drop in before the get painful. Even that, not being reminded of the relentless pain of dry eyes before being totally conscious in the morning has been a great relief.

Hello DryInDenver,

How do scleral lenses help when you sleep and wake? Dryness at night was my first problem and continues to be one of my main problems 17 years later. I got sclerals from Dr. G but couldn't tolerate them so they've been sitting in a drawer for 5 years. I couldn't wear them to sleep so they couldn't help my eyes at night.

Thanks for all the info.
Spmcc

[MGD666]

Great, informative post there Denver, thanks for sharing all of the details. It's nice to hear how willing he was to re-make the lenses to alleviate the problem you were having - at least for the most part. It's also nice to know that you've had improvement in overall eye health, as a result of having worn these now for awhile.

Hey L8rgator, have you also experienced your lens tightening up on you, or do you also have this increased feeling of suction as your wear time increases?
Do you feel the fit on yours is just right as it is?

Thanks again DryinDenver

[DryInDenver]

A quick update on my experience with the LaserFit Lenses.

In general things are great. I haven't been on the boards as much which is usually a good sign (as it is in my case) but there is an issue that came up with my lenses that may be of some interest to those of you considering these lenses. First I'll discuss this issue and then I'll get into some improvement I've seen in my eyes that may be particularly interesting to recent LASIK patients that have found their way to this blog.

Fluid is able to pass underneath the sclerals (and is supposed to). Additionally, there is quite a bit of evaporation that occurs outside the lens. For patients with dry eye, and particularly those in a dry climate like Denver, this can cause suction to increase and make the lens tighten up a bit throughout the day as fluid is sucked out from underneath the scleral. For this reason when Dr. G sees a patient with dry eyes, he prefers to use a larger lens size. For me however, a smaller lens was more comfortable and seemed to help with a certain issue with my conjunctiva where it would squeeze out and over lap the lens a little. So I came home from Dallas with a smaller lens (17mm rather than the 18mm he originally tried if I remember correctly). This smaller lens had incredible comfort but it did tighten up later in the day. The problem seemed to be worse at times when my dryness would normally be worse before the lenses, namely when I'm tired or late in the day. The tightness didn't cause any discomfort though so I probably endured it a bit longer than I should have. I could tell the lens was tight because the increased suction would make it difficult to get the lens out. By using drops, rotating the lens a bit, and repeating if necessary I was always able to get the lens out without yanking too hard on the plunger but it could end up taking several minutes to get a lens out. Eventually this increased tightness aggravated a temporal pinguecula that had swelled up on me once many years ago when my eyes were becoming unable to tolerate a soft contact lens (the main reason I got stupid LASIK in the first place). I reported this back to Dr. G and sent him pictures of the ping. The good news is that you don't have to return to Dallas to get a tweaked lens. He was able to create a new one that is a bit bigger (19mm is my guess) and looser and send it to me. In my opinion, this is one of the benefits to his lenses - his ability to tweak and customize it even from afar. I forget the exact cost but it was $250 plus some amount to pay for his time involved in tweaking the file (which I volunteered to pay before he asked for it). I think that was probably around $75 or $100.

When the new larger lens showed up, it was less comfortable and, mostly because of the inflamed pinguecula, I couldn't tolerate wearing it for more than 4 or 5 hours. But as time has gone on I think it may actually helping the pinguecula recede and my wear time has increased to a full day. Upon insertion the lens is still not as comfortable as my smaller lens and I notice a slight annoyance. But within 20 minutes this dissipates and I don't really notice it at all the rest of the day. So I'd say the new lens has been a success.

I think this issue also serves as an example that these lenses are not a cure. They come with their own set of issues and inconveniences so despite the wonderful increase in my quality of life, I do want to temper expectations to some extent. Usually, if you are on to sclerals, your expectation for a successful outcome with treatment has been beaten out of you by now. I think that can actually help when getting these because any improvement is welcome and clearly some people are helped more than others. That said, for me, HOLY COW it's WAY better than what I dealt with before.

So, moving on to the good stuff, I have seen some natural improvement in the health of my eyes and the dryness has slightly improved. In particular:

*I no longer wake up with my eye lids painfully sticking to my eyeballs. They are dry when I wake up, but it doesn't hurt to open them and I can get a drop in before the get painful. Even that, not being reminded of the relentless pain of dry eyes before being totally conscious in the morning has been a great relief.
*My right eye has had the greatest improvement and if I need to I can tolerate going without a lens for a day. I had to do this while waiting for my new lens and it was remarkably better. I even went without moisture chambers and didn't go home from work in extreme pain. This is MAJOR improvement. I got these around 9 months post lasik, and wish I did it sooner because I think the protection from the lens facilitated improvement in the overall health of my eyes which in turn facilitated my eyes ability to heal. The improvement within a month or two really was remarkable.
*My left eye hasn't quite had the dramatic improvement but it is a bit better. I notice this when I am without the lens, as it can tolerate the natural environment for a few minutes before the pain kicks in. Previously the pain would be immediate. There is also some evidence clinically as my tear break up time has gone from 2 seconds to 4 seconds.
*The improvement in each eye has renewed some hope that I may get some additional natural healing. I had all but given up on my eyes getting better on their own. Further, this renewed hope is not the desperate form of hope that haunted me as time wore on leading up when I threw in the towel on healing and decided to shell out the dough for the lenses. This is a hope that is comfortable, as in I think it could happen and I'm optimistic it could happen in some form, but I am going to be just fine if it doesn't.

That's it for now. I hope to check back in periodically and give an update on my experience.

Good luck to all of you!