Clouding and discomfort after... 30 minutes?

[diydry]

Hi! I'm in the middle of getting fitted with sclerals for my chronic dry eye. I am just wondering if anyone else has experienced clouding/fogging after an unreasonably short amount of time, about 30 minutes on average, making the lens essentially unwearable.

I've already tried 3 fittings from whom I understand is (and believe to be) a highly experienced and competent practitioner, yet the fogging continues! We're still trying more fittings so we're not throwing in the towel, but I get the sense that it's more "trial and error" at this point and I'm wondering if others have experienced similar challenges and perhaps discovered a solution that I might even bring up with my optometrist. It's especially perplexing given that my level of dryness is "only" moderate (currently) leading to my doctors and I initially hopeful that the sclerals would be a useful addition to my treatment plan and allow me to work on the computer for 8+ hours a day again at my office job.

Other details for those curious 1) The clouding is usually accompanied by discomfort including a sore/tired feeling which forces me to take it out after 1-2 hours max, and then rest my eye afterwards. 2) It's one eye that's the major problem. The other eye I've managed to go 8+ hours without much fogging and I'm quite pleased with the results overall. But then again the problem eye was always dryer in the first place 3) It's not a PROSE or anything fancy as we felt my level of dryness did not require a state of the art product. 4) I test positive for inflammatory biomarkers and I have MGD; most of my symptoms began post-LASIK last year, not surprisingly.

Grateful for any thoughts or reactions from seasoned scleral wearers! It's just so frustrating that after trying dozens of DES treatments over the past year with limited improvement and spending lots of $$$ that even the scleral lenses might not work.

[m4shore]

Hi! I'm in the middle of getting fitted with sclerals for my chronic dry eye. I am just wondering if anyone else has experienced clouding/fogging after an unreasonably short amount of time, about 30 minutes on average, making the lens essentially unwearable.

I've already tried 3 fittings from whom I understand is (and believe to be) a highly experienced and competent practitioner, yet the fogging continues! We're still trying more fittings so we're not throwing in the towel, but I get the sense that it's more "trial and error" at this point and I'm wondering if others have experienced similar challenges and perhaps discovered a solution that I might even bring up with my optometrist. It's especially perplexing given that my level of dryness is "only" moderate (currently) leading to my doctors and I initially hopeful that the sclerals would be a useful addition to my treatment plan and allow me to work on the computer for 8+ hours a day again at my office job.

Other details for those curious 1) The clouding is usually accompanied by discomfort including a sore/tired feeling which forces me to take it out after 1-2 hours max, and then rest my eye afterwards. 2) It's one eye that's the major problem. The other eye I've managed to go 8+ hours without much fogging and I'm quite pleased with the results overall. But then again the problem eye was always dryer in the first place 3) It's not a PROSE or anything fancy as we felt my level of dryness did not require a state of the art product. 4) I test positive for inflammatory biomarkers and I have MGD; most of my symptoms began post-LASIK last year, not surprisingly.

Grateful for any thoughts or reactions from seasoned scleral wearers! It's just so frustrating that after trying dozens of DES treatments over the past year with limited improvement and spending lots of $$$ that even the scleral lenses might not work.

Hey diydry,

You mention choosing not to opt for a specialty fit lens because you level of dryness is not that bad. I just want to point out that specialty fit lenses have benefits that extend beyond that, mostly related to a better fit which solves many fo the comfort/fogging issues people have.

What are you filling the lens with? Some people report solving their fogging issues by putting a drop of Refresh Celluvisc in the lens before insertion. Might be worth trying.

https://www.amazon.com/Refresh-Cellu...resh+celluvisc

[diydry]

Thanks for the reply, m4shore! I will ask my doctor about the prospects of PROSE or a specialty fit lens, although that would have to be a future solution since I assume I'm locked in contract with this brand. I didn't notice any benefit from a PROSE lens when I sampled it at my initial visit but it may not be something you can tell right away.

I typically fill the lens with Purilens but I've also tried Systane Ultra a couple times when I ran out of the Purilens, can't say I noticed much of a difference. I will ask about Refresh Celluvisc as well. My doctor also says the clouding may have to do with the lens rotating around in my eye, for some reason it keeps getting moved by my eyelid when it shouldn't for most people given the fit parameters (hence we are still working on fitting). Thanks for the ideas!

[Hokucat]

I used to have that clouding problem with my sclerals too, and I had PROSE lenses. If adding a thicker drop or further adjustments to fit do not work, it may be that you just cannot tolerate the scleral in that one eye at this time, until you can improve your tear film.

When I was originally fit with sclerals, they fit well, were comfortable, and I had no clouding issues. Then my MGD and aqueous tear deficiency started getting much worse. At my lowest point my TBUT was 0-1 seconds and Schirmers was zero, the doctors said I had no tear film and the surface of my eyes, including my sclera, were like sandpaper. Putting the lenses on the surface of my eyes in that state was like touching a wound.

It was during that time that as soon as I put on my sclerals, my eyes would ache like suction cups were pulling on my eyeballs, it was unbearable. I tried to keep my lenses in, but they would just get all cloudy and my eyes further irritated. I couldn't keep my eyes open and would have to remove the lenses. My PROSE specialist tried adding a few drops of Refresh Celluvisc, which she said helped several people with clouding and discomfort, but that's when I discovered the main ingredient in Refresh drops bothered my eyes. I also tried various other drops, but the lenses still quickly clouded up and were unbearable.

After probing (my glands had scar tissue) and finding the right changes to my diet, what glands I have left began producing some oil and generating some tears, so I started getting a thin tear film back, and the surface of my eyes started to heal. When I tried wearing the same sclerals that had become unbearable, I was able to wear them more comfortably again, and only occasionally they get cloudy when I'm tired or I've worn them too long.

I still cannot add Refresh Celluvisc, but a few drops of Genteal Tears with the Purilens saline makes it most comfortable for me. Sometimes putting a few drops of Purilens or Genteal Tears over the lenses while wearing them feels good too. Once in awhile the outside of my lenses get cloudy. When that happens I put a few drops of Purilens over my lenses, and then also drench a cotton swab in Purilens to lightly wipe off the debris while still wearing the lenses.

[L8rgator]

When it comes to sclerals, the need for a better fit isn't related to the level of dryness or illness in your eye. Fogging and comfort are both directly related to fit for most people. The better the process for fitting, the better the comfort.

My left eye has schrimers = 0 since 2012, and my right eye tears normally.

My main set of lenses are made by Dr. G in Texas. His LaserFit lenses are custom milled for fit from a scan of your eye, so they fit like a glove. These lenses are extremely comfortable for me. The left side (my dry eye) has fogged under the lens maybe 3-4 times total since I got them - generally when I've had a bad cold and my eyes are swollen. During fitting we noticed that thick edges bother my lids, so Dr G made them extra thin on the second day of my fitting. The comfort is superb. Then on the other side, I can't wear regular contacts in my right eye because of a pinguecula. So Dr. G made me a lens for my right eye that has an arch over the pinguecula. Now I can't feel a lens is even in and my vision is better than I can get with glasses.

I have also been fitted with a prose lens that is bigger than the average PROSE lens. My insurance was willing to pay for this one and the PROSE doc was interested in seeing "how big" of a lens would be tolerated by an experienced lens user, so we spent a long time testing this out. PROSE lenses use trial and error for fit (with computers to help narrow down the candidates). I always recommend Dr G's lenses first, as they are more comfortable (as well as having a more comfortable fitting process). But I wouldn't hesitate to tell people to consider a PROSE either - especially if your insurance carrier is going to cover most of it. Dr G's prices are much more affordable, but PROSE providers often have alot more experience dealing with insurance, which might be a better deal for the few lucky people with policies that haven't yet been edited to write out scleral coverage. I tend to wear my PROSE lens when I travel back up north and on colder days. I like the extra coverage against wind and cold. Although I never could have had this as my first lens - it definitely takes experience and patience to put in this such a large size. The PROSE lens also does fog a few days a week. I've learned to rinse my eyes with drops more often to help wash away any gunk before it sneaks under the lens. It doesn't hurt when they get cloudy. but there is this weird, full feeling that is so gross I have to pull them out right away, rinse with addipak, and reinsert. I did have days where this was every 1/2 hour or less for the first couple fittings. As the fittings got better, this did happen less and less.

When I started this journey, the PROSE doc also first trial- fitted me for a Jupiter, just so I could get a feel for sclerals. . But with a small selection of sizes and shapes available, it's much harder to find a comfortable fit. I would have bought it if it was the only option. but I would have been only mildly less miserable than I was without sclerals at all. The thing was SO damn irritating. I only wore it like 2 hours, but it drove me nuts. If you happen to the exactly the right shape to fit into one of the less-fitted brands, that is terrific. But the odds go down significantly.

Wearing either of my sclerals noticeably improves the condition of my bad eye. On days where I'm lazy and just leave a wet sealed bandage around it (sometimes with few drops added here and there) instead of wearing my scleral, I end up having a much more irritated eye the following day.

Unfortunately sclerals are not comfortable for everyone. Some people have issues that just don't work with sclerals. And it's impossible to determine if that's the case until you try it. It SUCKS. But for *most* people, discomfort is the result of poor fit.

[diydry]

Hi all, I just wanted to thank everybody for their helpful replies and update you as to the situation. Unfortunately, my lenses still cloud much too quickly, about 1-2 hours in the bad left eye. We've tried multiple fits after about 6-7 visits so my practitioner feels this is the best fit at this time. I asked about premium lenses like PROSE and she felt there would be no advantage (she does PROSE too) because the debris is coming from inside the eye and not the result of transfer of debris from outside the sclerals (at least that's how I understood it). This may be related to the MGD or the LASIK, it's not clear why. Naturally I am disappointed but I'm going to persist and see if maybe my eyes can adapt to the lenses somehow after wearing them a few hours each day. I will also try putting a few drops of Celluvisc.

While I'm on the topic I'm just wondering if anybody has experienced visual problems with the scleral lens, like higher order aberrations I think it's called. I actually see better without the lenses than with them, which is bizarre to me because I thought people can get sclerals or see Dr. G in order to correct HOAs. Yet in my case the lenses seem to magnify the refractive error caused by my irregular tear film. So the best I can get in my right eye is 20/40 with great fluctuations while I'm 20/20 normally. So the sclerals really are a bust for me on all fronts.