Dr. Gemoules and my first Scleral Lens

[DryInDenver]

I went to Dallas after reading this, and wallah, I AM ALMOST NORMAL AGAIN!!!

Dr. Gemoules is a genius. He used to fit people with the kits of various sized scleral lenses offered by various makers of lenses and peck through them like a chicken pecking through dirt for food trying to find the best fit. The system just wasn't good enough and he didn't like not being able to help his patients more. So he developed his own system to craft a lens customized to each individual eyeball. He's designed and patented this incredible system where he gets a digital scan of your eye to get the perfect shape, combines it with wavefront technology to get the perfect correction (stigmatism and high order aberrations included!), and builds a file that he sends to a lab near his office. The next day the lab delivers the lens. Once you get the lens he goes through the same process again and again until he finds the perfect fit. My first lens was uncomfortable, but tolerable - or at least better than the intense and debilitating dry eye my lasik left me with. That was on Tuesday. Wednesday was a bit better, so was Thursday. Then on Friday, bam, he nailed it. I couldn't even feel the lens in my eye! It amazed me what a huge difference such miniscule changes in the shape of the lens made. I think that by far, he offers the very best chance of a successful outcome with scleral lenses.

On my way out the door he extended his arm to shake my hand. I pushed his hand aside and gave him a huge man hug. I was choking up with tears in my eyes. "This is huge for me," I said. I felt liberated!

I can't thank Dr G. enough for the personal time, investment, and tireless persistence he put into his researching and developing these lenses. I suppose I should thank his wife too for putting up with the countless late nights he spent at the office. I believe he has only been up and running with his full blown system for a year or so now so I want to help spread the word and recommend his services. If you want to look into it, he calls it LaserFit and has a good description of the process and costs on his website LaserFitLens.com

[MGD666]

Really great to hear about that DryinDenver. Please post updates about how these work out for you in the future. Are you still wearing the oakley wind jackets or wiley x echos?

[DryInDenver]

I suspect I will need the Echos when I ride a bike (unthinkable before these), but that's probably it. My clear Echos are in my glove box as a fall back, and I use the sunglasses but have taken out the foam insert. I still use drops through out the day but at a much slower pace. This is to wet the corners of my eyes because they get dry and itchy as they are unprotected by the lens. But even that, the dry and itchy corners, isn't even close to the pain and discomfort I'd get from dry eye.

Work has been very busy for me this week. Lots of computer time and long days followed by logging in from home after dinner and working to midnight and waking up early. My eyes have handled it in stride. I've also sat through a couple 2hr business meetings without the distraction of drops or goggles. That is another big milestone for me. Conference rooms are so dry and always seem to have significant airflow (only noticed by the dry eye sufferer). I'd often try to rough it without my Echos and would get weird looks as I ended up putting in drops every few minutes.

[L8rgator]

I definitely notice that on the computer my eye with lens gets drier (by dry it feels like the lid is catching on the lens in different areas when I blink, and sometimes feels colder than average) than if I'm doing other activities. I KNOW I don't blink nearly as much as necessary. I suspect I also get lazy about putting the drops in regularly, because time flies and I just don't notice when I'm so into what I'm doing. Or I lose my bottles and vials under the massive pile of papers and junk that is my desk.

One think that surprised me was now I look in the mirror and think "I don't look as old as I thought I did". Not sure if it is because there are no more googly goggles and patches, or just because I'm not squinty all the time any more like I used to be

I am considering getting a second lens for my other eye. Having one eye feel "cold" is a little bit annoying at times (NOTHING like dry eye pain, but still distracting), so I'm wondering if having a lens in the normal eye might balance the feeling. I'm unsure though, because I don't know if the "cold" feeling is due to having a liquid filled lens on the broken eye, or just due to the evaporation of tears from the uncovered parts of the broken eye (in which case adding a lens to the 2nd eye would not help any). Any thoughts or opinions on this?

Either way, my husband prepped my honda scooter last week, and I'm looking forward to getting out on our first motorcycle ride now that I can do that again! I'm so excited!

[André Pereira]

Anyone else ever heard of Dr. G?
I sent an email to him and he replied on the same day.

L8argator, I'm very happy that you have found a relief. Good luck on your motorcycle ride. I can't wait until that day for me again!

DryInDenver.
I sent a private message to you. But I'll ask here too!
The lenses you helped with the redness of the eyes?
And with inflammation?
I was very interested because I saw that you are a LASIK patient. If you can tell us more about the positives, negatives and about your routine with the lens, I will be grateful.

Thanks man!

[L8rgator]

I first heard of Dr. G actually on this forum. If you use the search box to search for "Gemoules", you'll find lots of posts over the past year or more. You can also try "Coppell" (where he does the fittings). One of those links has a link to another forum site with more conversations about lenses he has done (including those for conditions other than dry eye).

[DryInDenver]

Anyone else ever heard of Dr. G?
DryInDenver.
I sent a private message to you. But I'll ask here too!
The lenses you helped with the redness of the eyes?
And with inflammation?
I was very interested because I saw that you are a LASIK patient. If you can tell us more about the positives, negatives and about your routine with the lens, I will be grateful.

Thanks man!

I didn't really have a problem with redness so it is hard for me to speak to that specifically. My intuition is that it may help or hurt redness depending on the underlying cause of the redness. The lens does rest on the white part of the eye, so that could cause some redness, however, if you are getting redness from the irritation of the dryness, it may help. That's just my speculation though.

Positives:
I don't live in pain every second of every day. I used to vary from very mild to severe pain through out the day. When I'd get home from work, despite wearing goggles and using drops every 5 minutes, my eyes would be a wreck. Most day's I'd have to do a hot or cold compress. I had trouble reading books at bedtime to my 3 year old and often asked my wife to do it because my eyes were just in too much pain. I can read to my kid any night of the week. Just thinking about regaining the ability to do this gets me a bit emotional.

My eye's feel generally healthier. For instance, when I used to wake up in the morning, I'd reach for a drop before I opened my eyes because my lids were sticking to my eyes. It hurt to keep them closed, but it hurt more to open them, so I needed the drop immediately. Now, I still use a drop in the morning, but I can open my eyes and it's not that. I just put a drop in within a few minutes of waking up. Also, when I take the lenses off, my eyes are not quite as sensitive to the dryness and moving air and can tolerate it for a wee bit longer (as in for a few minutes instead of zero seconds).

I can wear the lens for almost the whole day and have had success wearing it on long work days where I am up at 6 am, on the computer from 7:30-6 pm, then back on the computer from 8 to midnight. There can be some discomfort at the end of the day and I feel like the lens wants should come out, but I don't want to take it out because that discomfort is still way better than the dry eye pain. I'm still trying to figure out my optimal wear time.

My social life and desire to be sociable has increased 1000 fold. Before I'd try to tell myself I didn't want the disease to limit that aspect of my life too much. But the inability to stay out late, anxiety over wearing bulky goggles out, and fear of inflaming my eyes kept me in a lot. And I wouldn't reach out to people to plan get togethers. That is no longer the case.

I'm excited to ride my bike again.

Negatives:
These are not a cure.

I still use drops every 20 minutes or so to keep to corners of my eyes from getting too dry and itchy. BUT, this doesn't seem bad compared to what I had to do before and the consequences for not using a drop are not nearly as harsh. I've sat through a few 2 hour business meetings and lunches without using a single drop. It did not cause the incredibly painful inflammation I used to get that would take a week to get under control. The corners of my eyes were just a bit dry, itchy, and red and drops over the next few hours fixed that.

I occasionally feel some discomfort that is a bit reminiscent of the dry eye pain I'd get before, but in this case it is discomfort not the pain I used to have and can go away during the day. It not surprisingly seems to be more common if I am tired or sick.

[André Pereira]

Thanks L8argator and DryinDenver

I researched a lot about Dr.G here on the forum.

It seems to me that the lenses produce a good result. I found many reports of people having lasik. Of all the tools I had already researched, this seems to be the most efficient for the effects of LASIK.

I am willing to fly to the USA. But this will only happen at the end of the year. I intend to finish the treatment I'm doing.

I'll research more about the PROSE lenses also. I do not know why, I had never read anything about scleral lenses.

What's cool to do in Dallas? laughs

[L8rgator]

I didn't do anything too exciting in DFW. I loved my hotel room, so I spent a lot of time relaxing there - especially in the whirlpool tub, or soaking up sun outside. There is a big mall that I walked to. It has a nice sized aquarium, chair massages, and a movie theatre where some of the shows are in recliners and they bring you food. There were some other area activities that I didn't try - like a couple zoos.

If you have a choice to go in summer or winter, I'd choose winter. I hear summer in Texas is HOT HOT HOT in summer. Not sure about Coppell in particular though.

[L8rgator]

I made an little video of my lens routine and the products I'm using right now - https://www.youtube.com/watch?v=Oxs3cu3Ws0Y . By "little" I guess I mean I forgot to turn the camera sideways to take a correctly sized video (oops!).

[MGD666]

L8rgator: Thank you so much for taking the time to make the video and posting the link to it here. Very interesting to see the regimen, especially the insertion and removal process with the little plunger. So, how often do you experience fogging or cloudiness with these? Do you ever have to remove them to clean and reinsert? Also, do you happen to know the main differences between these lenses and the PROSE and/or Jupiter sclerals?

[L8rgator]

I don't know how people do insertion and removal with their fingers. I tried that once each and just laughed because it was just way too much work and didn't work!

I read something a few days ago that says that some people (especially elderly or children), put the lens on a stand-like plunger and bring their eye TO it. I could see how that might work even better, since then you can use both hands to hold the eye lid open. Putting the lens in with a plunger is the easy part - it's the holding your eyelids open without them slipping all over that's the hardest thing. Once you get a hang of that, it's really no problem at all. You really don't even need a mirror, except to turn the lens after it's in (I've used my phone for that a few times instead).

When I used the refresh drops, I experienced clouding every couple of days, usually when I was lazy and the lens had gotten dried out. Adding drops on the outside cleared the cloudiness. Since I'm started just using sterile saline or theratears instead, I almost never have any clouding. Honestly I expected to have clouding all the time. But for a year I wore a foggy patch over a ointmented eye, and then for another year I wore a bandage over the eye. So I really wasn't concerned about foggyness. However, I was pleasantly surprised it hasn't even been an issue.

I put in my lens at 10 am. I go to bed on average at 1am, so I'll have the lens in until bedtime between 11pm and 3am. I've only taken it out to reinsert once - on a day when I was having allergies and wanted to see if it looked cloudy when I held it up. And so I could show it to the kids. I have warn the lens for a lot longer twice - til about 5 am - with no problems. That's not recommended though, because you do need to keep it clean to prevent possible infections.

Don't take my word for it, but in my understanding and limited experience...

The jupiter lens comes in fewer sizes, and has a thick material. When I put in the test lens, it worked great, but it felt scratchy around the outer and inner edges. I know now that was my eyelid going over the edge and getting inflamed. Dr G had to adjust for that same thing with me on my current lens. The Jupiter lenses were far cheaper than the Boston Sight co lenses (but still much more expensive than Dr. G's). And I could have gone home with one that same day. Because there are fewer sizes, you just can't spend the time finding a "perfect fit", and the dr. can keep them all in stock. With the jupiter fitting, any changes to the lenses and future appointments needed were billed extra. If it were the ONLY option, I'd have taken it and tried to meditate through the annoying scratchy feeling (which was still better than the burning dry eye I walked in with).

The Boston Sight PROSE treatment / scleral lenses I don't think actually refers to a "lens". It's more a difference of a fitting method. I think (although you'll have to ask to be sure!) Dr. G actually also uses the same brand of lenses for some of his fittings. At the U of I the PROSE lens I tried was very comfortable. It wasn't fitted, so the hour that I tested it, it slid all over the place and everything was warpy. My pupil also looked grossly oversized. I think getting a fitted one would have corrected all that. There was a little scratchiness, but it came and went. for the Prose process, they order some lenses that look like they "might fit" as per the doctor's subjective opinion. Then they go through trial and error to pick one that fits best. You have to return multiple times to get (have shipped from boston) a new lens to test, so he can check your eye and things like that. The PROSE lens looked different from the Jupiter lens - the Jupiter lens had distinct levels. The PROSE lens was more smoothed on the outside so maybe would slide easier under the eyelid? For cost, the Boston lens is scary expensive. But they are really familiar with working with insurance, and can often get some insurance providers to cover it or parts of it (although you often can't get a decision from insurance until AFTER you buy the lens and bill them). The fee includes follow up visits for a long time (like 6 months or something?) so there was some big money saving there, at least if you were drying to the place.

The Dr. G lenses are custom milled from scratch. He has a variety of lens MATERIALS to start with, but he doesn't even have to choose from stock lenses of different sizes to start with. He uses a machine to noninvasively take a detailed roadmap (digital image) of your eye. He uses that to build a custom 3D image of your eye, and a digital representation of a lens to fit it. For a corrective lens, he also manually maps out a correction for the lens and integrates that into the design (tedious). Then he subjectively picks the type of lens material he thinks may work best (I tried an extra oxygen permeable, but then since I was still using drops every 20-30 minutes he decided to make the next one from highly wettable) and the local lens factory mills the lens from scratch based on the digital and custom specs. For mine he specifically thinned the edges more, since the first test run was a perfect fit, but slightly "itchy" to my upper eyelid periodically because of it's thickness. The finished lens gets driven over every morning so you can stop in and try them up in the afternoon - and then test them the rest of the day and next morning. He also takes new roadmap of your eye each visit in order to check each the fit. Because the lenses are custom, they can be mapped to fit particularly difficult eyes. And they can be made corrective.

I know others mentioned that they tried sclerals, but they couldn't keep them in for more than an hour or two so they just "didn't work" for them. I feel bad for these people, because I think some of them didn't have the benefit of years of refinement in the fitting and lens care process that I did. Plus that had to be expensive. Plus I personally had the added bonus of custom fitting - which pretty much ensures a perfect fit from the first milled lens (often any tweeking after the first lens involves changes in materials, edge thicknesses, sometimes visit correction - but not any fit changes). I do personally think the fit and structure makes all the difference - especially when it comes to fogging, based on research I'm read. I really hope in 10-20 years these types of lenses become really common, refined, and therefore affordable so that everyone with dry eye can affordably take their best shot at this as a solution. And that other fitters all over start using this technology so that travel isn't required!.

[L8rgator]

About the clouding and foggyness -I think that using ointments or oil containing drops the night before definitely increases this. it might be worse for me because I'm allergic to petroleum based products. I stick to a small set of drops now, even at night, and no ointments. So I have no fogging now. I am still looking for better solutions to night time relief, and am open to suggestions! Right now I'm bandaid-ing over the eye (with waterproof bandages and nexcare beige tape) and just using theratears drops and saline under. Works ok for the eye, but irritates my skin to pull the band-aid off.

[L8rgator]

A few people pm'd me about cost.

My lens cost me:
a flight to dallas ($300)
a hotel in dallas for 1 week (discounted rate, transportation all over included, full buffet breakfast included - I put alot extra in my fridge and ate it for lunch also) - $69 guaranteed rate for patients + $8 taxes per night
$2000 total for a final lens (plus all the custom trial lenses created during the fitting process) + custom measuring/digital imaging/vision correction integration + milling each lens from scratch + fitting + all care necessary for a week, and a flight-approved kit of stuff to take care of the lens (plungers, solutions, case, etc). I was originally told that adding the other eye would have added only $1500 more.
$250 more for each extra lens I wanted to order. This was the selling point for me. The next cheapest lens other providers offered was the stock Jupiter for $900 - and PROSE replacements were many times that.
A week off of work (unpaid, because I am self-employed)
and maybe about $30 for extra plungers and solutions and cases. Normally people don't need this, but I lose things so I wanted plungers for every car.

[DryInDenver]

I can confirm the cost for two lenses is currently $3500. The process is almost exactly the same whether or not you have vision correction in the lens and the price is the same. The hotel was very comfortable and the daily free breakfast was much better than I had anticipated. The room was very spacious with a king size bed, large flat screen TV, couch, desk, and large bathroom with Jacuzzi tub. The hotel also offers free WIFI. I was easily able to work remotely from Dallas which greatly reduced the impact on me of being gone for a week.

Thus far I have absolutely zero problems with clouding or fogginess.

The only other lens I tried prior to my trip to Dallas was called the Maxim lens made by Accu Lens. I hadn't heard of it but found a local optometrist who fit them in the area so I gave them a try. It would have been great if they worked because they were relatively inexpensive, but they did not work for me. It felt like I had an eye lash digging into my cornea. After going through that experience and then reading about the LaserFit process Dr. Gemoules uses, I knew that he was who I wanted to try. The sense I got from talking with him is that his patients get some sort of relief in at least 90% of cases. He is very modest and does not speak poorly towards any other lenses or fitter, but I am a firm believer that he has the best system out there right now (since he won't say it I will for him. I also liked how easy he made the process. Once I decided to go I think I had the whole trip booked in less than 30 minutes: cleared it with work, cleared it with the family, booked a fight, booked the hotel. Do your research but for me the decision was pretty easy (and if it didn't work, Boston was next on my list).

Leading up to my appointment I actually believed that the LaserFit lens would be able to help which, ironically sent my anxiety level spiking up during the period after I booked the trip and before I made it down there. It was this weird blend of excitement and pure terror. For all other treatments, I've intuitively felt that the treatments would not help much but I had to try (right?). So going to those I just felt like I was going through the motions. But this was probably more like an inmate wrongfully convicted with a life sentence waiting for the verdict to be read at his retrial. I thought I would get out - at least on work release or something- but I was shaking in my boots!

It's been about 3 weeks now and my lenses are still providing me with enormous amounts of relief. I'll try to provide occasional updates on my progress as I continue to get to know my sclerals. Good luck to all of you! I really hope relief is on it's way.