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Scleral lenses -- where to begin

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  • Scleral lenses -- where to begin

    I have been reading posts on this forum for almost a year, since my dry eye symptoms appeared, but this is my first post.

    I live in Northern California and have been treated at UCSF, Stanford, and now UC Berkeley. I have been diagnosed with ocular rosacea, lagophthalmos, and MGD. I am currently doing the following: taking doxycycline and omega 3 supplements, using warm compresses and performing lid hygiene twice a day, using moisture chamber glasses all day, including sunglasses outdoors ,using a humidifier at night and during the rest of the day to the extent possible, taping one eye each night (alternating) and wearing moisture goggles at night in addition, using OTC drops (Refresh Plus) and autologous serum drops, and taking xiidra. My symptoms have abated some -- I no longer need to take pain pills to deal with the pain in the evenings, but things are very far from normal. I have known for some time that scleral lenses might be a good idea, and my doctor has now recommended them.

    These are my questions: Should I start with something like PROSE or eyeprint pro, or should I start with less-customized scleral lenses? In addition, does anyone have a recommendation about the size of the lenses?

    I ask the first question because: 1) it appears that my vision and medical insurance will not contribute to the cost of scleral lenses; 2) there is currently no PROSE clinic in northern California, although there is one in Los Angeles (USC) and there is an eyeprint pro provider in San Francisco; and 3) both the PROSE provider at USC and the eyeprint pro provider in San Francisco have suggested that I see the contact lens specialist at UC Berkeley's optometry school before moving on to the more expensive and more custom-fitted options. These optometrists all know and seem to respect each other, so although I was thinking that PROSE or eyeprint pro was definitely the way to go, I am now thinking that I should try UC Berkeley. The cost difference seems to be significant. UC Berkeley will charge about $1500 for the fitting and the lenses. I have been told that Eyeprint pro may cost $4000 per eye or more, and I understand that PROSE may also be in that ballpark.

    As to my second question, I don't know what brand of lenses the UC Berkeley clinic uses, but the doctor there has suggested using 16mm lenses on my eyes. I know that there has been concern about smaller sclerals being used in dry eye patients. I just don't know whether there is a consensus view on how small is too small in this context.

    Thank you in advance for any advice you can provide.

  • #2
    Hi. This forum is a great place to ask questions and for support. Glad you are here.

    I wear PROSE, but if your insurance does not cover it like mines did, you're right that PROSE and EPP sclerals can cost ~$7-$10K because of the custom fittings. You could go for the consult for PROSE where they have you wear a trial pair for an hour or so to see if if it helps, and if it does not, you would only pay for the consult. Not everyone can tolerate sclerals.

    My PROSE doctor is the one at USC, and I have a lot of respect for her. So if she recommends you go to UC Berkeley, that's good advice.

    There are also sets of sclerals called Boston Sclerals that have been rolled out to various practices including local optometrists, where the lens sizes in these kits are based on Boston's several years history of fitting the majority of the PROSE patients. I believe these kits were meant to reduce the costs and time fitting sclerals for the typical patient, and make availability in more locations. You might also want to look into these, maybe the UC Berkeley optometrist is using this or something similar.

    That said, the experience and expertise of the doctor fitting sclerals for dry eye patients is critical. They should also know what lens size is optimal for you. Mines are 18mm. Have heard larger sizes can be more comfortable than small, but everyone is different. So if you are treated or referred by someone reputable, hopefully that will give you the best chances of success being able to wear sclerals, or advise you off the bat at the consult if you are not a candidate.

    Hope it works out.


    • #3
      Do not get a prose lens. Their fitting methods are obsolete and cost over $11k. There are much better and less expensive alternatives out there. I can tell you that the is less expensive than Eyeprint and this doctor makes great lenses that fit much better. I've been wearing his lenses for 6 years with no issues.