Looking for Schleral Lens Provider in Northern CA

[LaDiva]

I would like to look into getting schleral lenses, and am wondering if anyone can recommend a Dr. who makes these in Northern CA. I am near Sacramento and San Francisco, but am also willing to fly. Also, I have tear deficiency, Ocular Rosacea and MGD, so am not sure these lenses would be recommended in light of all of those different factors. Thank you for any and all suggestions!

[Hopeforothers]

LaDiva, Go online and look up Dr. Edward Boshnick Global Vision Rehabilitation Center in Miami, Fl. I know it's not CA but Dr. B gave me my life back and he is on FB always and answers to messages himself. People come from all over the world to see him. He has a big heart and really cares about his patients. You can read my story. Hope this helps!

[LaDiva]

Thanks so much Hope! I'll write and ask him what he thinks. I am not sure whether or not schlerals are an option with MGD, but hope they might be the answer. Your story is wonderful. Thank you for writing! I am so happy to hear you are doing well, and send good wishes for continued success.

[PotatoCakes]

Have you looked at USC? Gloria Chiu is amazing. My understanding is that there are ppl in SFO that do sclerals as well. IMO, it's good to have someone nearby for checkups and re-fitting

[LaDiva]

Thank you so much PotatoCakes! I'll look into that. I wrote to Dr. Boshnick on Facebook, and received a very nice reply. He made me feel quite hopeful. I appreciate the info., and you are right about being able to find something close to home. After reading Dr. Boshnick's material online, it is very impressive. He is quite an anti-lasik advocate, and that in itself is impressive. Have not seen you for awhile PC! It is nice touching bases again. Sending good wishes.

[LaDiva]

Thanks to Hope and PotatoCakes, I was able to find a contact person at UC Berkeley, and am in the process of setting up an appointment with them. UC Davis apparently also fits schleral lenses, and the doctor at UC Berkeley was willing to find out if there were other providers closer to my home. So far, a great experience. I am hoping these lenses will give me back at least part of my former life.

[Irina]

LaDiva, I wish you luck! Did you ask the doctors what names (brands) of lens they work with? Because some of them do not have big diameters, but only 14 and 15 mm which can be too small and uncomfortable.

[LaDiva]

No Irina. Have you had problems with the smaller lenses? Thank you for the information. It is greatly appreciated!

[Irina]

Yes, I had. I'm still waiting for my lenses, and I hope that they will fit well. In my first appointment on August I tried Blanchard lenses. They have 14 and then 15 mm diameter, and I found them very uncomfortable. Especially 14 mm ones. I was very disappointed of them, but the doctor suggested to me to try Zen lenses on my second appointment ( she was waiting for the trial set). when I tried on September Zen lenses. which were 17 mm diameter, I was pleasantly surprise because they fit much better. On my left (good ) eye it was almost unnoticeable. What for the right eye, the doctor said they have to change some parameters.So, she sent them back to the place where they do the changes, and I will try them again after two weeks from today (6 weeks from my second appointment). As you see ,it takes time.There are some other places where you don't need to wait so long and they do your own lenses( like Dr. G in Texas, or Boston, or Dr. Boshnic...), but their price much higher. My doctor and I hope that my insurance covers the price for lenses. So, we will see. You should ask your doctors if they have different diameters from small to big.This will give you more options and you will safe your time(and money for fitting appointments).

[LaDiva]

Thank you so much for sharing your experience Irina. It is very helpful. Not sure how I would know which lens would work best since I don't know if I have a large eyeball or small. I will ask the Dr. about sizes and will share what you have said. I am sure that I will need to pay for these myself. Do you have vision care insurance?

[Irina]

I have limited one.Usually my insurance doesn't cover contacts.My doctor says that sclerals are not just for vision ,but for dry eyes .So, this is health problem,and she works with my insurance on that. Anyway, the price is not to high if they work.I agree to pay if my insurance refuses.

[LaDiva]

Great to know Irina! I am wondering if you were ever able to wear regular contact lenses? I was not, so am hoping these will not be too uncomfortable.

[Irina]

I was able to wear contacts before lasik. However, the vision wasn't good with them.Then I tried them half of year after lasik ,but could wear on my left eye only. Sclerals are different. I too really hope you can wear them. Try different diameters and brands,and you will find the good one for you.

[LaDiva]

Thanks so much Irina. This is very helpful!

[L8rgator]

There are a few different types and fitting methods of sclerals, and they make a huge difference. It's always great to try them - even with some of the more basic types of sclerals - just to see if it's something that does or might work for you. But if you start at the lower end of lens quality or fitter experience and you don't have success, please don't let it rule out trying the better options! I've heard from a few people who tried the most basic lenses a few years ago, had a miserable experience, and now poo-poo all talk of sclerals. Sclerals don't work for everyone. That is certainly true. But they've come so far in the past few years, and do work for so many, that I recommend that people give the better ones a fair chance before giving up hope.

So here is what I've learned over the past 2 and a half or so years. I apologize if I get any information wrong - technology is changing so fast with these lenses it's hard to keep up.

For the lens itself:

Comfort and function are the most important features. A lens that does not fit well can easily fog, be irritating or annoying, or not work properly. A lens that is not large enough will be very uncomfortable and not provide much relief from dryness, leaving much of the eye exposed. A lens that is too large is too difficult to insert. Usually sclerals for dry eyes run from around 18mm to 20mm, but they can go much larger as needed.

The most basic sclerals are symetrical, meaning there is no top or bottom -it's the same all the way around. Because they don't follow the shape of a human eye, these can be the most uncomfortable even with the best fit. They are the quickest to fit, because the doctor just has you try a few off the shelf until you find the most comfortable one of the bunch. The lens itself can be less expensive than the rest (although when I tried jupiters they were actually more expensive than the custom ones I ended up having fitted elsewhere - so price can vary).

The next level up would be a scleral that is not symetrical and is instead shaped like an average human eye, but still an "off the shelf" fitting method. You just keep trying them until you find the one that fits the best.

The next best would be a scleral that has had areas customized to better fit the surface your eye more closely. Some of these are the most expensive.

The best would be a lens that has been custom build to match the exact surface of your eye. They are generally the thinnest and least bulky lenses, since only the material that is necessary is milled into the lens.

For the fitting:
You MUST choose a doctor that is good at fitting. Personally I think this is more than the lens type itself. The facilities that specialize in these types of lenses are your best bet. The next best are probably ones that have been recommended highly by others, or who have experience with a few different types of lenses over time. Ask what brands of lenses they offer, and how many people they've had success with.

Symetrical and basic non-symetrical lenses can be fit in the office often in just a few visits. The doctor gives you a set to try based on how your eye looks with it in, and if it doesn't work he gives you a new set next time to try that might be a little steeper, looser, tighter, etc. You kinda get what you get - and the "best" looking fit works ok, for you or it doesn't. If not, don't hesitate to try a different brand or more customized lens. A better fit can make all the difference.

The longest fitting process happens with the lenses that can be customized to better fit your eye. It can take more than a week, and I've heard a couple reports of some people having to go back for months for adjustments (which are often at no extra cost). First the doctor will choose diagnostic lenses for you to try to find a good base size (just like the previous lenses). They start with a very large assortment of trial lenses to choose from. Then the customizations are made and you try the newest changes daily over the course of days or weeks until they determine you have the best fit. The first few trial days can be painful I've read.

For the customized lenses that follow the shape of your eye, the fitting process takes more than a couple of days. Because there is less waste and less time, the fitting process can be less expensive. One way takes electronic images of your eye, and those are used to virtually design your lens - which is then custom milled. Then the lens designs are tweeked over the course of up to a week, or two weeks in difficult cases. Another method pours a blue substance into your eye that hardens into a mold of your eye. That is used to create a lens (I'm not familiar with how that is done or how long it takes). Testing out custom milled lenses are generally not painful during the fitting process, because they are molded to the surface of the eye and they have an exact clearance throughout the center right from the first lens.