Best Scleral Lenses (PROSE vs LaserFit vs U of I vs....)

[shakenbake]

Hi Everyone!

So a little background on myself:

Like all of you I suffer from dry eyes. I'm 23 years old and my problems started when I was 21. After a year or so of trying to figure out what was wrong, a Sjogren's lip biopsy came back positive. All of my blood work is normal. And I have no other symptoms.

My current dry eye treatments are as follows:

Restasis 2 x a day
Xiidra 2 x a day
Ocusoft Lid scrubs 2 x a day
Azasite (rubbed into eyelashes) 1 x at night
Doxy 50 mg 2 x a day
2 lower punctal plugs ( my top ones always fall out )
Allergy shots ( started these about a year ago. Obviously an indirect treatment )

I'm writing this post because although my symptoms are miles better than they were when I first started treatment, I'm really looking for something that will make me feel almost "normal". My eyes still bother me at least to some extent most of the time; especially in the morning/night/when I'm working on the computer.

I've done a lot of research into scleral lenses. However, it appears as if there are a ton of different options.

I've seen references to:

PROSE lenses
Jupiter lenses
Dr. Gemoules LaserFit lenses
lenses from the University of Illinois

Anyway, I can't find any head to head comparisons for any of these lenses. I understand that the PROSE lenses are custom fit but it's more of a trial and error process while the LaserFit and University of Illinois lenses involve taking exact measurements of your eyes. PROSE sounds great because of what I imagine is an immense amount of expertise at the Boston Foundation for Sight, but I can completely understand the argument that taking custom measurements would lead to a better fit.

Money for me isn't an issue: My insurance will cover the entirety of the lenses. So cost will have no bearing into my decision.

So I have 2 questions:

1. Would scleral lenses work well for someone who is young, has reasonably well (but not incredibly well) managed symptoms?
2. What lenses are the best????

[Hokucat]

Hi Shakenbake. I've had PROSE lenses since 2010. Like you, I also have dry eyes likely due to Sjogrens, which does not show up on any tests. When I first got my scleral lenses, the dryness was moderate/severe, and the lenses worked very well to manage the dryness for about six months. Then the dryness became so severe, I could no longer wear them for several years, likely because the Sjogrens was getting worse, not from the lenses. Now I'm better and can manage my condition, so am back to wearing my lenses, now 12+ hours a day and it works great and is totally comfortable. So based on my experience, to answer your questions:

1. I think sclerals could work well for many adults young and old, with reasonably well managed symptoms. Sometimes it's the people with extremely severe dry eyes (including the white scleral part of their eyes) who may have problems wearing sclerals, like I had for several years. But there are also people who cannot tolerate sclerals, period. When you go for the consult and try on a sample pair, that should give you and the practitioner a good idea whether you can tolerate the lenses, and if it helps the dryness.

2. My opinion is it's not so much the brand of sclerals that matters, but the experience and expertise of the practitioner fitting you. That said, I totally trust the PROSE doctors, because they are true scleral specialists. They all go through an extensive training program, and the main thing they do is fit people with PROSE lenses. They are not also fitting people for regular contacts and glasses or doing other treatments, like some who are now fitting sclerals. For me it took my PROSE doctor only one fitting, she really knew what she was doing, and that's the type of specialist you'd want to go to in order to have the best chances of success wearing sclerals. Besides PROSE doctors, Rebecca and others in this forum have also put Dr. Gemoules right up there too. There's also EyePrintPro sclerals, that take a mold of your eyes and make custom scleral lenses for you from that mold.

Hopefully once you get sclerals, you can eliminate some of the drugs you are taking too.

That's great your insurance will cover the entire cost of the lenses, so all you need to decide is just which route to go. Others would love to be in your situation!

Hope this helped!

[shakenbake]

Hi Hokucat,

Thanks so much for responding! I've read a lot on this site but this was my first post so it's really great that someone responded!

1. It's great that they work for you now! I got my diagnosis about a month ago, and the scariest part is not knowing what the future will hold...I'm afraid my eyes will get worse. I'm hoping that the disease has already manifested itself and therefore will be stable for the rest of my life. My rheumatologist believes the latter but based on my research I don't know if I believe him. I hope to get fitted within the next few months, and we'll see how I do from there.

2. I live in NYC so the PROSE doctors are only a 4 hour bus ride away. Based on the literature I read, they seem amazing, and I almost already trust them explicitly

I'm doing a decent job staying positive. I have top notch health care and I realize that while this disease is incredibly unfortunate, my situation could be drastically worse. I'm trying out an amniotic membrane tomorrow and if that doesn't work I'll try serum tears. I'm also reasonably hopeful that in a few years, more dry eye/Sjogren's drugs will be developed to help combat our symptoms.

Could I ask one more question though: when your lenses are in, how "normal" do you feel? Do you need to put artificial tears in regularly? Do you need to replace the saline in the middle of the day? My expectations are that I'll have to put artificial tears in about 4 times a day, and refill the saline around once a day. I just want to make sure these expectations are reasonable, and if not, readjust them.

It's been a long journey and I'm hoping to find something that works for me !

Thanks again for being so encouraging! I don't know what I'd do without you guys.

[Hokucat]

Hi Shakenbake. I'm glad to help. It can be overwhelming to look into all the dry eye treatments, let alone having an autoimmune disease like Sjogrens.

To answer your questions:

-I feel very normal while wearing sclerals, I usually forget I have them on. They help so much in doing activities where I am staring a lot, like using electronic devices, reading, driving, watching tv, going to the movies, shopping, etc. Without sclerals, these activities can be uncomfortable, especially for extended periods of time.

-I no longer use artificial tears while wearing the lenses (nor while not wearing the lenses), and do not need to replace the saline during the day. But that's because I have been able to reduce the dryness of my eyes - see link below on factors that helped my condition. Many people benefit from using artificial tears and replacing the saline. You can also put a few drops of artificial tears in with the saline to make the lenses more comfortable. Just know the degree to which sclerals help has varied, even amongst Sjogrens patients...some cannot wear them at all.

It is possible your Sjogrens can get worse over time, if not properly treated. When the dryness in my eyes became unbearable, I also got dry mouth, cracked lips, dry skin all over my face and body, my joints and muscles ached...my body was literally falling apart because apparently all my moisture glands were being attacked by my own immune system.

At one point my rheumatologist wanted to give me chemo, but given all my tests were negative for autoimmune disease, the success rate for chemo for Sjogrens was only 30%, and chemo is a very strong drug, I opted not to take it.

Instead I had probing to open up my meibomian glands because I had MGD (my glands were blocked from abnormally thick oil which caused scar tissue). Then I continued to change my diet to include drinking fresh lemon juice in green tea 2x daily, which was almost a complete turnaround for me in reversing the dryness in my eyes. I think somehow the antioxidant, anti-inflammatory, and antibacterial properties of the lemon/tea helped my immune system function correctly, and killed off bad bacteria in my system, to help my oils flow. For you, it might be something else that helps. Anyways, with the probing, all my diet changes, and a few other tweaks, now my only remaining symptom is moderately dry eyes, for which mainly the PROSE sclerals address.

http://www.dryeyezone.com/talk/forum...ccumulate-info

What treatment has been discussed to address your Sjogrens? The amniotic membrane, autologous serum tears, sclerals, Xiidra, etc. can help manage your dry eye symptoms, but the underlying cause of Sjogrens should be addressed with diet and/or other treatment or you're right, it's possible, but not certain, your condition can get worse. Also, do you know if you have MGD? If so, that may also need to be addressed with IPL, probing, etc. if your glands are blocked.

[keratoyyz]

I have Keratoconus and have been wearing RGP for 40 years and mini-sclerals (13.5 mm) for about two years. Having a tough time getting a satisfactory fit - perhaps because they lens in rotational. It’s not clearing the limbus entirely and I am having some limbal stem cell loss. If I go to a larger lens from the same fitter in Toronto, the eye gets red. Now, I am exploring:

- PROSE
-Laserfit
- EyePrint Pro.

In deciding which way to proceed, Inhave several questions. I would greatly appreciate advice from folks who have experience with these various lenses.

1) Regarding PROSE - is the maintenance more onerous than regular sclerals or the Laserfit or EyePrint Pro? I read that several solutions are required and rejuvenation of the plasma coating every few months.

2) Are the optics of Laserfit superior to those of the other two?

3) Just because I wasn’t able to tolerate. Non-custom built 16 mm scleral, should I be concerned about the PROSE?

4) Are there people who have tried any of these 3 lenses and were not able to continue? This is a concern because of the cost - insurance will not cover much.

Any insight will be greatly appreciated.

[PhoenixEyes]

I hear the coating on sclerals is moving to Hydra-PEG, it has some specific cleaners you have to use with it so as not to remove the coating, but supposed to improve wearability, they give you a leaflet about what the best cleaners are to use. I think many scleral manufacturers in the US can offer Hydra-PEG now and I know I've heard of people with all the above mentioned manufacturers having this coating added (PROSE, LaserFit and EyePrintPro). Here's a video about the coating properties:

https://www.youtube.com/watch?time_c...&v=-40f5p7IzzQ

I've seen someone who wasn't able to get good vision with PROSE and felt the wavefront optics of LaserFit worked out better for them. Of course there may be stories out there of the opposite and may depend on which PROSE doctor you see. LaserFit is cheaper than PROSE on average without insurance, but more insurance companies know about PROSE so you may need to work out whether PROSE is cheaper after insurance coverage.

I think the administrator of this site uses EyePrintPro and Hydra-PEG coating with success. Here's a quote from them via the Facebook sclerals group they also run:

All the specialty lenses have their place. I have worn so many great PROSE and know so many hundreds of people whose lives were changed by them that I will always have a very high regard for them. Love my EyePrintPros, such an exciting technology and the slam dunk fit process is so impressive As for LaserFit although I haven’t had any I know they’re awesome because Dr Gemoules is and I know so many successful patients of his. Specialty fits are a puzzle and I’m so thankful there are multiple technologies available.

Group: https://www.facebook.com/groups/1499817493657314

I am in UK so have no experience with any, they're not available here. =(

[Hokucat]

I've worn PROSE lenses several years now. The daily maintenance only takes a few minutes, at most. At the end of the day after removing them, I clean the lenses by rubbing each lens in between my fingers for about 10 seconds with a few drops of Lobob Extra Strength Cleaner (only for plasma-coated lenses), and then soak them overnight in a disinfecting basket filled with Clear Care 3% Hydrogen Peroxide Cleaning & Disinfecting Solution. This two step process is fairly common, and recommended, for many scleral wearers across brands, except if your sclerals are coated with Hydra-PEG you would use a different cleaner than Lobob.

I personally have never needed the plasma re-coated on my PROSE. But if you're concerned about that, Rebecca announced in one of her recent Kerato Scoop e-mails that PROSE now offer the Hydra-PEG coating.

I don't know how much experience your Toronto fitter had with your condition, but the PROSE fitters definitely have a lot of expertise and they have dealt with many cases of Keratoconus and other conditions like Limbal Stem Cell Deficiency. It's not only different diameters of the lens, but also the vault, contour, edges, etc. can be changed.

http://www.bostonsight.org/PROSE/PRO...us-and-Ectasia

http://www.bostonsight.org/PROSE/PRO...s-PROSE-Treats

But as PhoenixEyes said, PROSE tends to be the most expensive. However, they are excellent at working directly with my insurance, and I only ended up paying a few hundred dollars total for the consult, fitting process, and lenses. I think you can ask them to check your insurance, if you have not already done so, prior to having a consultation or proceeding with the fitting process.

Many in this forum have also had great results with LaserFit and more recently with the newer EyePrintPro, however I believe you have to pay up front and try to work with your insurance yourself, but that may have changed. From what I've heard, EPP is somewhere between PROSE and LaserFit in costs. Of course you would need to factor in any travel and lodging, depending on how close you are to each of those fitters.

So all three providers are considered tops. I personally feel you are in good hands no matter which way you go. So for you, it may just come down to costs. For what it's worth, my PROSE doctor did tell me that once in a great while, she will refer her patients to an EPP fitter, when the patient has an extremely unusual shaped corneal that PROSE cannot accommodate.

[keratoyyz]

Hi Hokucat and PhoenixEyes,

Thanks for your replies. Gives me something to think about. In reading through the posts here, a couple of questions arise in my mind:

1) Is PROSE largely a trial and error process? Laserfit and EyeprintPro seem to measure the attributes of the sclera and the cornea, electronically or by a mould. How does the PROSE achieve the fit?

2) is the PROSE a non- rotational lens?


My fitter (he also fabricated the lenses in his lab)in Toronto is very experienced but the only strike against him is that he does not have expensive/sophisticated equipment that the other 3 in this forum. The lenses by him are not customiZed to take into account the asymmetry of the sclerals.