Dr. Gemoules and my first Scleral Lens

[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

[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.

[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]

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.

[DryInDenver]

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

[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!

[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.

[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 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.

[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?

[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?

[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....

[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."

[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]

Yep, all his lenses are plasma coated.