Future Scleral Lens fitter

[DrGary]

Hi there everybody,

I am new to this thing and to online forums/blogs in general. I joined for many reasons, but ultimately I am trying to help those of you out there who can't seem to find a solution to their corneal problems.

A little bit about myself:

I am a 4th year optometry student out of the New England College of Optometry. Originally from the Toronto, Ontario area. My passion in optometry is helping patients return to a better quality of life via specialty lens fitting. Secondarily, I am interested in nutrition. It is important not only for eye health, but also for heart, brain, and whole body health

I will be an optometrist in several months (summer of 2012) hoping to start practicing in the Vancouver, BC, Canada area. During my rotations I had the great opportunity to work with a big name in the SCLERAL LENS arena. His name was Dr. Ed Boshnick out of Miami, FL. There I witnessed patient after patient coming to see him for a plethora of reasons (mostly kcone, post corneal grafts, post corneal surgery problems (LASIK, RK, PRK) and all with the same story - "Doc, I've been everywhere and tried almost everything. I don't know what to do and you're my last resort". It has amazed me how fitting of scleral lenses and other special lens modalities has improved not only his patients vision/site, but also their comfort and quality of life. It has been a great opportunity for myself to learn and start to hone this skill, but also to see the great need - many people of which do not know where to turn for help.

I am looking forward to communicating both with the professional eyecare community as well as patients regarding their eye conditions and specialty lenses and eye nutrition.

[Hopeful2]

Well this is good news for Canadians, especially those living in the Vancouver area. We do not seem to have many scleral lens fitters at all in Canada. You might be interested in finding out about the work that Dr. Lee is doing in Vancouver. I believe he is fitting 'specialty contact lenses' for post refractive surgery patients.

If you come across any nutritional connections to 'dry eye' please let us folk on the DEZ know about it!

Best of luck! I think fitting scleral lenses is a very honourable career!

[Lacey1]

This is wonderful. There need to be more doctors out there like you. I'm afraid I've been to too many who only care about making the money, and don't really seem to care about the patient's quality of life. I also really like your interest in nutrition. Our eyes don't exist in a vacuum, they are connected to our entire body, which makes nutrition very important. Best wishes in your career and please never change your willingness to seek ways to help your patients, I think that's what makes a great doctor.

[DrGary]

Well I'm glad someone responded. Thank you guys!

I am not certain how best to get started on this forum. From what I have read before joining this forum, it seems as though kcone and post refractive patients in canada are either getting transplants, getting to see a scleral lens fitter in the US or making due with out. Is this accurate? ie is there a great need for it in Canada especially? In addition, since we have universal health care, how is the payment handled with regard to cost covered for the patient? Does anyone know?

If you have any other comments or suggestions, I'd love to hear or help

[Hopeful2]

Hi drmatter,

I went to the US to get sclerals. It is difficult to find someone locally, the Capital area, to assess fit issues. The Ottawa Eye Institiute had an optician that fitted sclerals, but he retired. I believe there is one other fitter (optician) and he uses trial kits. . . not the same as custom fit from US doctor or Boston foundation for sight. I believe that there is a doctor in Montreal who fits sclerals as well. Also, Dr. Caffery (optometrist) in Toronto fits sclerals. As a patient I think there is a need for doctors with scleral lens experience.

Best of luck!

[Rebecca Petris]

Hi drmatter and welcome! Great to have you here!

I don't know about the kcones as I don't deal with many but I've known an awful lot of post refractives traveling to the US for lenses over the years... and an awful lot of others doing without. The only lens fitter I recall hearing about from members of the various refractive boards over the years is Steven Lee in Vancouver who I know has done some excellent work including on challenging RK'd corneas. Z-waves if I remember right.

[Guest]

I am not certain how best to get started on this forum. From what I have read before joining this forum, it seems as though kcone and post refractive patients in canada are either getting transplants, getting to see a scleral lens fitter in the US or making due with out. Is this accurate? ie is there a great need for it in Canada especially? In addition, since we have universal health care, how is the payment handled with regard to cost covered for the patient? Does anyone know?

If you have any other comments or suggestions, I'd love to hear or help

I think many Cdn patients who might benefit from sclerals go without due to the high cost and lack of coverage (in some provinces).

Others go to the U.S. for custom lenses... the ones I hear about most often are Dr. Gemoules in Texas and the Boston Foundation for Sight.

Anyhow, I would think that if you go into sclerals, your best bet in starting out would be to set up shop in a province that will pay for them... I assume you'd get a higher number of clients that way. So far, I believe B.C. and Ontario cover them... there may be other provinces also...

[DrGary]

That's very interesting that the government of Canada will pay for people to go down to Texas or Boston, but not to other Canadian provinces. Say if ON and BC health plans cover it, presumably they could get coverage no matter where the point of service was? But if you live in PEI or MB then no matter what therapeutic contacts are not covered? I suppose that will have to be something to look into. I can attest that it is worth it to most people. Currently, in Miami I am seeing most people pay out of pocket for almost everything and the great majority couldn't be happier. It does surprise me to hear that even if the service is not covered more people are not willing to try. I suppose that may be due to proximity?

Rebecca, I will have to check out Dr Lee in Vancouver to see what exactly he is doing. He could be a great resource for me in the future.

[Guest]

That's very interesting that the government of Canada will pay for people to go down to Texas or Boston, but not to other Canadian provinces. Say if ON and BC health plans cover it, presumably they could get coverage no matter where the point of service was? But if you live in PEI or MB then no matter what therapeutic contacts are not covered?

No, the Canadian government will not pay for a patient to get this treatment in the U.S.... the folks that go there either pay for it themselves, or, if they are lucky enough to live in a province that pays for it, they can get it covered by their provincial government. From what I can tell, Health Canada will pay for medical devices that are imported IF they will be fit within Canada... not sure if lenses such as BFS's PROSE count in that category or not... but so far, there is no-one in Canada fitting BFS lenses.

I'm in Manitoba, so for me, when I go to Boston, I'll be paying most of the expenses out of pocket since Manitoba Health does not cover the lenses (they do pay for airfare however.)

[Reggie]

What's up. I live in Toronto, and have been wearing PROSE since 06 (when they used to call it the Boston Scleral Lens- I liked old name better). I've seen over 10 different eye dr's in Canada since I developed DES 11 years ago and only one is familiar with the scleral lens. I met her when she was a student out in Boston working at the BFS, and now she is an optometrist working here in Toronto. I have never asked her if she planned on bringing the treatment here, but with her seeing the "miracles" that were performed at the BFS, I'm not sure why it wouldn't be her ultimate goal.

[DrGary]

Thanks Reggie,

That is actually where I went to school as well. The contact lens residency in Boston mandates spending time at BFS. Recall her name?

Thanks for the info

[Emerald]

Scleral lenses sound very interesting for dry eyes etc. More doctors should learn about and explain them.

It's amazing what we all have to learn over the internet since ophthamologists and optometrists don't usually take the time to explain ALL options -- but they are very quick to ask you what your insurance is and let you know what your co-pay is!

Does anyone happen to know an optometrist or MD in the San Francisco/Northern California area that fits or knows if you would be a good candidate for scleral lenses?

Thanks!!

[DrGary]

Emerald,

The problem with the scleral lens option is that the great majority of eyecare professionals are unaware of a) the potential therapeutic effect of scleral lenses OR b) the mere existence of scleral lenses. Even if they did, it seems that local scleral lens fitters are so hard to find that it's not mentioned. I not believe the fault is their own.

If you go to the scleral lens education society website (sclerallens.org), they have a list of certified fitters that is searchable. You will see how small that list is, but it's a start. Needless to say, there are more eye doc's fitting sclerals than this, but again, hard to find. Maybe try contacting the nearest doc on the website, and asking if they know of anyone that is more local. Many of these doctors know each other from professional and society meetings, and should be able to offer some help.

I personally, do not know of any on the west coast. I do know of several on the east coast and in texas.

Dr. Matter

[spmcc]

RE: Boston Foundation for Sight partners

Here's the webpage that lists BFS's partners in the US: BFS PROSE US partners. The closest to Northern Cali is the one in LA.

[Rebecca Petris]

Emerald, it might be worth registering on the National Keratoconus Foundation's forum as their members probably are familiar with some of the more experienced scleral fitters around the country. - I am pretty sure I know of one near San Jose somewhere but can't for the life of me think of the name... I'll post again if it comes to me.