Scleral lenses advisable for dry eyes?

[Rick]

Hello dry-eye sufferers and community,

I just contacted an ophthalmologist from a local eye institute who was surprised that I was inquiring about scleral lenses. He said that they would be horrible for dry eyes as they would only irritate the cornea. The logic makes complete sense. If your eyes are already dry, there won't be any buffering water and oil to protect them from the constantly abrading material. I remember distinctly suffering from wearing contact lenses when I was younger and could finally no longer tolerate them. Now that my eyes are even drier, I simply can't imagine putting any kind of lens in my eyes. But my optometrist is considering them and some people seem to do well with them. There's also something in the literature supporting the use of scleral lenses for dry eyes. So I'm confused. What gives? Are scleral lenses appropriate? And if so, why? I understand that they may provide a barrier that protects the eyes from the environment (such as keeping tears from evaporating), but if the problem already resides from producing enough tears and/or oil from the glands, how could such lenses be of any help when they must be rubbing against the cornea? Either ophthalmologist have not yet learned about the potential benefits, or what I heard from this particular one is square on. Any comments would be appreciated. I have tried everything (as most in this group), and am willing to give it a shot but clarity on this somewhat "strange" treatment would be a huge help!

Rick

[Hokucat]

Hi Rick. Sclerals are not for everyone, however these lenses have also helped many people, I'm one of them. These are nickel-sized dome-shaped lenses which vault over your cornea to keep a layer of saline over your eye, the edges sit on your sclera/white part of your eye. Below is some information on the Boston PROSE lenses that provides a good description of sclerals in general:

http://www.bostonsight.org/PROSE/PRO...y-Eye-Syndrome

When I initially got my sclerals they worked well, but likely due to an auto-immune condition, my eyes including the whites of my eyes, became so bone dry that after 6 months I could no longer wear them, I had zero tear film. My eyes would “suck up” all the saline and the lenses stuck to my eyes like dried suction cups. So there is some good logic to your questioning how can these lenses help, when with dry eyes you could not wear regular contacts!

However several years later my eyes started getting a little better (mainly from diet changes), so I tried the sclerals again, now I wear them at least 12 hours a day. Some people also use artificial tears over their lenses as needed, to help with the comfort. I don’t, but for additional cushioning, before inserting I put a couple drops of my favorite unpreserved artificial tears in each lens and roll it around to cover the inside of the lens, then fill the rest with saline vs. using saline alone. Besides helping me a great deal with my daily functioning, I think over time the sclerals have also helped heal the surface of my eyes, because when I am not wearing the lenses I no longer need to use any artificial tears.

If you do try sclerals, I recommend seeing a doctor who has a lot of experience successfully fitting these lenses, because the right fit is just as important at the lens material or brand. They should have sample lenses close to the shape/size of the lenses they would fit you for, so you can try them on for a few hours, to see if it indeed makes your eyes feel better and is comfortable before proceeding. The Boston PROSE lenses which I have are very expensive, but my medical insurance covered almost all of it and the Boston locations have experience dealing with the insurance companies on this, of course if depends on what insurance company you have. There have been several people in this forum who have also had success with other non-Boston PROSE doctors/sclerals, and the price was alot less.

[farmgirl]

Hi Rick: Scleral lenses require a specalist to fit them, not just any optomotrist is qualified nor will have the specalized equipment for the fittings.

Like Hokucat says these lenses have helped a lot of people. Unfortunately I am not one of them. I can tolerate them for about 4 hours and then my eyes get sore and red and I have to take them out. I was intolerant of every product related to them, the cleansers, the saline used to fill them and so what I finally found was non preserved saline and I clean them with the new Clear Care hydrogen peroxide system. Those things I could tolerate. 4 hours of wear is pretty much useless though and so I don't bother with them anymore. I may try again later like Hokucat did and perhaps something may have changed (hopefully not my prescription though). Unfortunately you won't know if you don't try. Mine set me back $1200 out of pocket...sigh....F/G

[Rick]

Hi Rick. Sclerals are not for everyone, however these lenses have also helped many people, I'm one of them. These are nickel-sized dome-shaped lenses which vault over your cornea to keep a layer of saline over your eye, the edges sit on your sclera/white part of your eye. Below is some information on the Boston PROSE lenses that provides a good description of sclerals in general:

http://www.bostonsight.org/PROSE/PRO...y-Eye-Syndrome

When I initially got my sclerals they worked well, but likely due to an auto-immune condition, my eyes including the whites of my eyes, became so bone dry that after 6 months I could no longer wear them, I had zero tear film. My eyes would “suck up” all the saline and the lenses stuck to my eyes like dried suction cups. So there is some good logic to your questioning how can these lenses help, when with dry eyes you could not wear regular contacts!

However several years later my eyes started getting a little better (mainly from diet changes), so I tried the sclerals again, now I wear them at least 12 hours a day. Some people also use artificial tears over their lenses as needed, to help with the comfort. I don’t, but for additional cushioning, before inserting I put a couple drops of my favorite unpreserved artificial tears in each lens and roll it around to cover the inside of the lens, then fill the rest with saline vs. using saline alone. Besides helping me a great deal with my daily functioning, I think over time the sclerals have also helped heal the surface of my eyes, because when I am not wearing the lenses I no longer need to use any artificial tears.

If you do try sclerals, I recommend seeing a doctor who has a lot of experience successfully fitting these lenses, because the right fit is just as important at the lens material or brand. They should have sample lenses close to the shape/size of the lenses they would fit you for, so you can try them on for a few hours, to see if it indeed makes your eyes feel better and is comfortable before proceeding. The Boston PROSE lenses which I have are very expensive, but my medical insurance covered almost all of it and the Boston locations have experience dealing with the insurance companies on this, of course if depends on what insurance company you have. There have been several people in this forum who have also had success with other non-Boston PROSE doctors/sclerals, and the price was alot less.

Thank you Hokucat for a thorough and helpful reply. After looking up the Boston lenses I found a center that use them at USC (I'm in Southern California). I think it's worth a try. I've tried everything (like most people here), so I don't want to leave any stone unturned. I'll be sure to post my experience with them. Thanks again for a great reply.

[Rick]

Hi Rick: Scleral lenses require a specalist to fit them, not just any optomotrist is qualified nor will have the specalized equipment for the fittings.

Like Hokucat says these lenses have helped a lot of people. Unfortunately I am not one of them. I can tolerate them for about 4 hours and then my eyes get sore and red and I have to take them out. I was intolerant of every product related to them, the cleansers, the saline used to fill them and so what I finally found was non preserved saline and I clean them with the new Clear Care hydrogen peroxide system. Those things I could tolerate. 4 hours of wear is pretty much useless though and so I don't bother with them anymore. I may try again later like Hokucat did and perhaps something may have changed (hopefully not my prescription though). Unfortunately you won't know if you don't try. Mine set me back $1200 out of pocket...sigh....F/G

Hi farmgirl. I'll be sure to take that into consideration. I knew that not everyone benefit from them. I'm a bit nervous about it because of my memories of contact lenses just feeling awful. I hope my insurance will cover them. I've been fortunate with them so far. The exception was with lipiflow which set me back about the same amount as you (and it didn't work despite all the hype about it). I think we are all used to being disappointed. The sad thing is that I'm getting used to it

[Hokucat]

Rick, you will be in great hands at USC with Dr. Gloria Chiu! That's where I went for my sclerals. Dr. Chiu was trained and certified at BostonSight in a full-time program specifically for fitting the Boston PROSE lenses. She told me evaluating and fitting patients with these lenses is the ONLY thing she does all day at USC Roski Eye Institute. So she's definitely a specialist, like farmgirl emphasized is important for these lenses. Dr. Chiu is one of the best specialists I have ever encountered. And she is very thorough, patient, and friendly. You have the best chances of success with sclerals with her as your doctor. I cannot speak highly enough of her!

[Rick]

Hokucat: That's great you went there too! I'll make sure to make the appointment with her, then. And I'll tell her she has a fan on the dry eye forum! I'll post about it after I have my first experience with the lenses.

[farmgirl]

Best of luck Rick, I'm rooting for you...cheers....F/G

[Hokucat]

Yes, we look forward to your post after your appointment, Rick! Good luck to you!

[Rick]

Thank you, guys!

[Hokucat]

Hi Rick. I recently saw another post in this forum about a scleral lens called EyePrintPRO where they take a mold of your eyeball so it is a total custom fit, and this seems to work well for patients who have not been able to tolerate other scleral lenses. I think Rebecca who owns The Dry Eye Shop and this website currently uses it. Looks like it is offered here in Southern California at UCLA Jules Stein Institute, in case you want to look into it, if the Boston PROSE sclerals at USC don't work out for you.

https://www.eyeprintpro.com/patient/

https://www.uclahealth.org/vivian-p-shibayama

The Boston PROSE sclerals have worked very well for me and were almost totally covered by my insurance, so I'm not sure I would change over to EPP, plus I really like Dr. Chiu at USC. But our eyes are always changing, so good to keep alternatives in our back pocket in case what we currently use at some point no longer works!

[Rick]

Hi Hokucat,

That's really cool. My appointment with Dr. Chiu is on the 27th, so I'll make sure to ask her about it and see what she says. Thanks for the additional info. It's nice to know you've got options, especially when I have bad memories with contact lenses. Hope you keep doing well with your Boston lenses.

Rick

[Gram]

Reading about the scleral lenses that you all are trying, I'm wonder if any of you have had Prokaras applications. New optometrist I'm seeing is thinking of using his brand of amniotic tissue with the insert lenses for several days until a bonding begins on conjunctiva. Supposedly heals some of the scratching caused by the dry eye issue. He did say this healing may last for only six months but is easily repeated. My amniotic tissue sutured to my left eye last year did not help the dry eye condition so I guess this less invasive approach,and much less expensive will probably have the same result of zilch. One keeps trying, any one used Regenerist ? drops?

gram

[Hokucat]

Hi Gram. I've heard of PROKERA, assuming this is the treatment made with amniotic membrane tissue you are referring to, but I've never tried it and don't know much about it. My dry eye problem is much better now (went from 24 hours of pain daily and being home bound for several years, to now no pain and up and about again), but would like to learn more about PROKERA and its effectiveness, in case I need something new to try later. As we all know, the state of our eyes can change, so things that work for awhile sometimes stop working...aargh! Thanks for mentioning this treatment, and please keep us posted on how this works for you.

[Rick]

Hello everyone,

This is my update on my visit with Dr. Chiu. She is obviously quite knowledgable, skilled and very energetic. We discussed my case and I told her I had a 15 year history of dry eyes. She conducted the normal corneal examinations and concluded that I didn't have the dry spots that are normally observed despite the severity of reported symptoms. She did see evidence of the blepharitis. This is typical of what I have been told in the past. I don't show the spots and I believe this is due to the fact I nurture my eyes a lot. I'm one of those individuals who can benefit from eating (sucking on candies, etc. . .) to make my eyes tear. So on the way over to the appointment I had to feast on candies to keep my eyes from completely drying up during the long drive (1.5 hours) in the early morning traffic of LA. This saved my eyes but may have prevented the examination from showing the signs that the insurance company cares about. The shirmer strips have always showed the physical evidence of dryness in my eyes, but she didn't use those because I suppose that's not what the insurance use in their determination of coverage. But she let me try the lenses (something equivalent to the PROSE lenses) and let me hang out in the waiting room for 30-40 minutes to see how I would do with them. The result? I wish they had been clearer, but I noted the following: I definitely felt them in my eyes. They were not terribly uncomfortable, and I would have to wear them all day to see if they would lead to eventual unbearable irritation. My eyes were already a bit irritated (from the drive) so it's hard to say how they might feel otherwise. I do understand that it may take up to 2 days or so to get used to them (like regular contacts). But I really put them to the test by doing what is, to me, the ultimate NO-NO: read the news for an extended period of time on my cell phone. This would normally send me run off screaming with my eyes clasped over my eyes and run into walls (okay, yes, I'm exaggerating!). However, I noticed I could read fairly comfortably. The buffering water between the lens and the cornea really prevent your eyes from drying up.

So the question is now whether the lenses would work over the long haul. This is a dilemma because if my insurance does not cover anything, then it's $1,200 for the lenses and $2,000 for several appointments involving training for the wear (not sure why that's necessary but I'll ask her next time). The lenses are refundable, but the training is not of course. The staff at Dr. Chiu's office is currently checking with my insurance. One option is to recheck my eyes when they are at their worst, which means I would have to let them dry up and suffer for some time to show the (if any) spots to convince the insurance to cover the costs. Yikes. Otherwise, I'll have to decide if it's worth taking the chance on the lenses not working out in the long run.

That's where things stand. There's hope there, but the cost can be a deterrent if you're not sure. I wonder what experience some of you have had with the physical wear of the lenses, and if they became completely comfortable eventually.

Rick