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  • GVHD causing dry eye

    Hello,

    This is the first time I am posting and I am glad to have found this site because I have many questions.

    I received scleral lenses for both eyes about a year ago. I am 7 years post allogeneic stem cell transplant because of having chronic myelomonocytic leukemia. I am happy to be above the terra firma, but my eyes are the worst part of my life these days. The dry eye syndrome is part of the myriad of side effects caused by graft versus host disease.

    I did not go to Boston to receive scleral lenses; I was told that a local optometrist could do as good a job. I live in Charleston, SC so I wanted to save the cost of transportation etc. The $5000 for the pair of lenses was significant. Of course, the lenses themselves were "only" around $400. The fee for the measurements etc was the bulk of the cost.

    Scleral lenses have been a tremendous help. I had difficulty going outside in the bright sun as well as driving at night before I received them. My biggest problem is it is necessary to clean them many times a day (often as many as 30 times or more).

    Sometimes I will put them in and they become cloudy almost instantly. I have noticed if I refrain from blinking sometimes the lenses will clear, but as soon as I do blink they become cloudy again. When I take them out, I can see a definite waterline that remains visible on the inside of the lenses.

    I have been using Unisol 4 saline solution (mfg by Alcon) to fill the lenses. I store them at night in Boston Conditioning Solution (mfg Bausch & Lomb), and I use Boston Cleaner (mfg Bausch & Lomb) to clean the lenses.

    After experimenting by adding a drop or two of the conditioning solution to the saline when I fill them up, I've noticed that sometimes I can delay some of the clouding, sometimes not.

    Bill Rosenthal gave me the name of this website and told me "the fact that debris is clouding the lenses means it is entering from the edges. Whether or not a better fit can solve or mitigate this would be impossible to know without seeing you."

    Has anyone else had a similar experience? It is just not convenient to carry a backpack with all the paraphernalia necessary to take the lenses out, clean them, and put them back in again. I do this in my car, in restaurant restrooms etc. I could care less about the looks I get, it’s just a pain. It is also psychologically frustrating to view the world through a cloud most of the time. Mentally speaking, it wears you down; especially since as soon as I clean them there is a brief glimpse of what the world used to look like and it is wonderful. I hope I am not complaining too much, but if a trip to Boston would fix this, I am ready and willing.

    Thanks in advance for any suggestions!

  • #2
    Hi there and welcome (from a fellow scleral lens wearer)!

    Originally posted by plasirbaby View Post
    My biggest problem is it is necessary to clean them many times a day (often as many as 30 times or more).

    Sometimes I will put them in and they become cloudy almost instantly. I have noticed if I refrain from blinking sometimes the lenses will clear, but as soon as I do blink they become cloudy again. When I take them out, I can see a definite waterline that remains visible on the inside of the lenses.
    Oh boy. Problems problems. I'd sure tend to agree with Bill on this that it is probably fit related. Also, I'm curious, are your lenses fenestrated (one or more holes in them)?

    There are a couple things I think you can do to see if it's possible to improve performance short of going through that fun and costly fitting process again.

    1. Change cleaners. Try Lobob (Optimum) extra strength cleaner or Miraflow. Those are the best out there.

    2. This is a trick I learned from BFS: Put something much more viscous than saline in the lens to impede stuff getting in. Personally when I was having debris problems for a little while I filled the lens halfway with Dwelle and then topped it off with Unisol. (At BFS they recommend Celluvisc, but personally I have a problem with methylcellulose drops.) It really did help.

    3. Lately I've been having a periodic debris problem with my left eye again - not fit related as I've been wearing these lenses for 2 years. Once every few days I remove the lens as soon as I put it in, clean it again, and put it in again. If I do that, I'm fine all day. If I don't, on those odd days (who knows what's causing it) I get great globs of stuff soon after putting them in.

    If you are getting all the intended benefits of sclerals and the only problem is the debris, personally I would be confident that a BSL would get you the rest of the way to where you need to be, simply because they have greater ability to customize the fit.
    Rebecca Petris
    The Dry Eye Foundation
    dryeyefoundation.org
    800-484-0244

    Comment


    • #3
      Thanks for the reply, Rebecca

      Dear Rebecca,

      I will go get the cleaners you recommended.

      Are these OTC products?
      Lobob (Optimum) extra strength cleaner or Miraflow. Those are the best out there.

      To my knowledge, my lenses are not fenestrated. I assume I would be able to see this, correct?

      I think the lab the optician uses a lab located in Texas. I have never received many details.

      More importantly, how would you proceed with returning to the optician to provide the information about debris and improper fit that I have received here. I am sure he will not be thrilled to hear I think it is his incompetence or the lab he uses, that is responsible for my suffering. Any suggestions?

      What is BFS? It sounds like what you are suggesting is what I referred to in my post about adding some of the conditioner to the saline. I have not heard of Dwelle either. I use carboxymethylcellulose sodium 0.5% ( the generic for Refresh Plus) for lubrication, but I never poured it in the scleral lenses. Is this what you're suggesting?

      I am a rookie when it comes to all this stuff because I have been living in a vacuum. I haven't gotten any help from the optician even when I suggested having other patients he has fitted call me to compare experiences. Duh?

      Anyway, Merci, I appreciate the help. By the way is a referral necessary for an appointment in Boston? Maybe I can use some of those fast becoming useless frequent flyer miles.

      Thanks again,

      Martin (plasirbaby)

      Comment


      • #4
        Lobob and Miraflow are OTC. Miraflow is available only over the internet. Lobob is still stocked in some drugstores.

        Yes, fenestrations are obvious (little hole near the edge of the lens).

        More importantly, how would you proceed with returning to the optician to provide the information about debris and improper fit that I have received here. I am sure he will not be thrilled to hear I think it is his incompetence or the lab he uses, that is responsible for my suffering. Any suggestions?
        I think I would start by simply calling them and explaining the problem you're experiencing and ask what they suggest. This is NOT a normal problem to have and there is no way they could try to brush it off as unimportant - having to remove lenses every half hour is a ridiculous proposition and most people would not tolerate it at all. This type of lens fitting is well known to be challenging/off the beaten track so I wouldn't be too worried about them getting defensive as long as the issue is presented without animosity.

        BFS is Boston Foundation for Sight.

        I use carboxymethylcellulose sodium 0.5% ( the generic for Refresh Plus) for lubrication, but I never poured it in the scleral lenses. Is this what you're suggesting?
        Yes but that's much too low a concentration to be helpful, I think. If I remember right, Celluvisc is something more like 2.0%. The whole point is to get something more viscous in the bowl to reduce fluid exchange.

        Anyway, Merci, I appreciate the help. By the way is a referral necessary for an appointment in Boston?
        Yes, I believe so. If there is any problem with that I think that possibly the foundation may be able to help by pointing you to a local ophthalmologist who can refer you. But with GVHD, sclerals are almost a no-brainer, so it shouldn't be too difficult.
        Rebecca Petris
        The Dry Eye Foundation
        dryeyefoundation.org
        800-484-0244

        Comment


        • #5
          I have to put in a reminder that Boston Scleral Lens are not always successful at fixing the problems that bother us. I have lens for two years that are sitting in my kitchen drawer. I went to Boston 3 different times for fitting. My eye problems are from a bad Lasik surgery on both eyes, a cataract surgery on one, plus I have Sjogrens. Lucy
          Don't trust any refractive surgeon with YOUR eyes.

          The Dry Eye Queen

          Comment


          • #6
            I don't quite understand the need to interject that in this context Lucy. I'm responding to questions from someone who already gets what they need from sclerals in terms of comfort and benefits. He's facing a specific lens problem which, IF it proves to be related to fit, it's reasonable to imagine that improvement to his own lenses, or failing that a better customized fit (and it is simply a matter of fact that BFS has more customization capability than most) would resolve the issue.
            Rebecca Petris
            The Dry Eye Foundation
            dryeyefoundation.org
            800-484-0244

            Comment

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