Great Experience with Dr. Gemoules

[ultrajko]

Having tried every eye drop known to man, punctal plugs and one duct cauterized, meibomian gland probing, restasis for 2 years, eyelid cleaning and expression, night goggles (they helped more than most) and who knows what else; I finally gave in to the doc suggestion to try scleral lenses. I am lucky enough to live in the 8th worst city in the U.S. for dry eye (Amarillo, TX) but the good part is that it is just a quick 5 hour run down to Dallas.

Went to see Dr. Gemoules (Dr. G) in Coppell based on my research and unwillingness to invest hugely in scleral lenses ala BFS since I had never worn contacts of any kind in my life! Dr. G is incredible! Took a lot of time to work with me, we built four different sets of lenses before it was right, was very communicative about what was going on and his staff was incredibly patient teaching a beginner how to deal with them!

I broke one shortly after returning home and left an e-mail on a Sunday night expecting them to pick it up first thing Monday. Dr. G "personally" responded on Sunday evening and the next day we made the arrangements for a replacement and a back up set to be sent to me.

Cannot say enough about the talent, patience and ability of this doctor--should have done these long ago as they are already a huge help and I am already up to wearing them 12-14 hours per day with no problems. Great Experience all around!
Jim

[NeedMyEyes]

But I don't understand how a dry eye does BETTER with a contact in...

I'm pretty sure my eyes wouldn't be able to tolerate a hard scleral contact like that especially not for 12-14 hours.

Am I wrong about this? I called Dr. Gemoules' office and was going to go down there, but I can't figure out if these are for me or not....

I am a computer user at work and really really need to be able to function for 10 hours or so on a computer.

[abbygirl]

I don't understand how one can wear a hard lens when the newer soft ones can't be worn. I asked my eye doc yesterday about the scleral lens and he told me they no longer fit them for patients because of the poor results and he told me they were very difficult to remove..they "stick" to your eyeball!! I was so disappointed when he told me this because I was holding out hope to be able to wear contacts again. Maybe I need a second opinion.

[Rebecca Petris]

UltraJKO, congrats on your success. That's great to hear. DrG is always great.

NME & abbygirl:

The reason people with dry eyes do not tolerate contact lenses is because contact lenses rest on their corneas, which are the most innervated tissue in the body and which for most (not all mind you) of us are the source of discomfort when the tear film is absent or messed up. Frankly, I've never really understood how some people with severe dry eye can tolerate soft bandage lenses on a long term basis! I can't tolerate soft or hard lenses at all. I tolerated a corneal-scleral lens (partially vaulting the cornea) only for awhile. Lens tolerance problems are what drove me to sclerals.

A scleral is a completely different matter. It doesn't rest on the cornea. It completely vaults the cornea and holds fluid over it. Your cornea, instead of being irritated by having something rub on it, and instead of being constantly irritated by a mucky tear film that evaporates too fast, doesn't even know what's going on because it's sitting under a nice thick watery layer. The new acronym for the Boston sclerals is mouthful but it sums it up nicely: Prosthetic Replacement of the Ocular Surface Ecosystem.

On the other hand, while the cornea is being babied there is still the question of the interface between the TOP surface of the lens and your eyelids. And a scleral has a large top surface. So a dry eye still needs lubrication with the scleral in. I find myself amazed time after time at how well people with SJS, GvHD and Sjogrens often do with PROSE lenses in that regard when their lids are so dry. Obviously it's not a slam dunk (doesn't work for everyone) and it's not problem-free for everyone - some people have to remove and refill the lenses regularly, some have to wipe mucous off them during the day. That is why the people who are most likely to succeed with sclerals are those who are most motivated, which is usually driven by the severity of their condition. For myself, these lenses are the only way I can see well enough to work, drive, etc. That's motivation.

I asked my eye doc yesterday about the scleral lens and he told me they no longer fit them for patients because of the poor results and he told me they were very difficult to remove..they "stick" to your eyeball!!

That's too bad. But yes a second opinion may be in order. For perspective... I would class scleral-fitting practices as follows:

1) Optometrists who occasionally fit commercial scleral lenses (typically for keratoconus). Don't waste your time/money there.
2) Optometrists who regularly fit commercial scleral lenses (typically for keratoconus). Some few have started branching out into dry eye, usually the very severe cases like SJS. If you were to pursue sclerals for dry eye with this type, you need to be aware of lower success rates; make sure you can afford it if it doesn't work out; and I would insist upon being put in touch with at least one patient of theirs whom they successfully fitted exclusively for a dry eye indication. Actually that's a good idea no matter who you go to.
3) DrG. He's in a class of his own. I'm not familiar with what he's doing in dry eye right now (though Ultrajko is obviously evidence that it's working) but he's a wizard with lenses and always has been, and uses unique technology. He's one of very few people I would trust to design a lens for my eyeballs.
4) BFS. This is all they do - this is where all their resources and brainpower and technology go, so there are reasons why they're really good at it.

Again... take-home is that sclerals are never a slam dunk, and I'm always so thrilled when it works out for someone with dry eye.

[Anthony16]

From what i have read on here,sclerals seem to have a pretty good success rate for at least prolonging peoples computer time.U rarely hear good stories here as most people stop posting when they improve but i have heard a lot of good stories from people with sclerals on this site alone.