Sclerals a good option?

[WellEyes]

Hello there,

Having tried many ways to get treated or some kind of relief from ocular neuropathic pain with MGD without success, I started to weigh the possibility of scleral lenses with the advice of my ophthalmologist who is also a bit desperate now, knowing that I have neuropathy induced MGD/dry eye.

I am just trying to be careful here before jumping onto yet another option, especially because I heard that the cornea needs oxygen like anything else and as the sclerals stop it from breathing, they can be damaging. I hear stories about it causing enlarged veins on the cornea. Or that they are very uncomfortable etc... Maybe there are other issues as well.

I would be very grateful if you could give your personal experience with scleral lenses and hopefully after a number of comments I can make a better decision regarding this. Because of course each experience is individual and can differ.

Many thanks in advance!

Regards

[Guest]

I am going to test the new Guest system. I am an optometrist and a long time fitter of scleral lenses. This topic is near and dear to my heart.

Based on my evidence, scleral lenses are one of the most effective options for corneal neuropathy from LASIK and/or dry eye. They may not eliminate the pain completely, but can significantly attenuate the pain signals in my experience. It is incorrect that scleral lenses stop the cornea from breathing. All modern scleral lenses are made from oxygen permeable plastics. We know that scleral lenses can reduce the amount of oxygen to the cornea compared to an eye without a lens, but this is typically not clinically significant except in diseased states where the corneal endothelium has been compromised. Blanching of vessels can occur if the lens compressive forces are not evenly distributed over the entire lens surface in contact with the eye. All eyes are more or less irregular but scleral lenses do not conform automatically to that shape as soft lenses do and have to be machined into a particular shape in order to avoid or minimize compression. Avoiding the compression of large vessels is one of the basic tenets of scleral lens fitting.

[Guest]

Have you joined the FB group - Corneal Neuralgia Patients. Some people love scleral lenses there, others (like me) find their sclera is too sensitive to find them comfortable, others find they don't take away their corneal pain. You just have to try to find out, but they can be life changing.

Also as far as I know sclerals definitely do let your eye breathe. As long as you don't wear them at night oxygen deprivation isn't a problem I've commonly heard of after talking to many other scleral lens users.

[Hokucat]

Most scleral lenses these days are rigid gas permeable lenses which allow oxygen to penetrate. I’ve been wearing my PROSE sclerals 10+ hours a day for over three years now, and have had no issues. The lenses are an integral part of my regimen that provides me comfort that greatly improves my ability to function daily. My dry eyes are not from LASIK, however sclerals are indeed commonly prescribed for LASIK-induced dry eyes.

You would not necessarily be jumping into sclerals. Typically you would go for a consult first to determine if you are a candidate for the lenses. At Boston PROSE, part of the consult is having you try on a trial pair of lenses for an hour or so to see if you can tolerate wearing sclerals (not everyone can tolerate them on their eyes), and if the lenses provide some relief. If so, then you would move forward with the fitting process, which is where more costs are incurred because it can take several lenses and visits to get the fit just right. If during the consult you cannot tolerate the lenses and/or they don’t provide relief, you would not go forward with the fitting and just pay for the consult. So in short, go for a consult, or you’ll never know.

I would recommend going to one of the big three who are most experienced and reputable for fitting sclerals for dry eyes, if possible...PROSE, EyePrintPro, and Dr. Gemoules in Texas. Here’s the PROSE website which includes a good general description of sclerals, info on insurance and clinic locations, etc:

http://www.bostonsight.org/PROSE/PRO...ats/Post-LASIK

I hope you get some relief soon.

[WellEyes]

Have you joined the FB group - Corneal Neuralgia Patients. Some people love scleral lenses there, others (like me) find their sclera is too sensitive to find them comfortable, others find they don't take away their corneal pain. You just have to try to find out, but they can be life changing.

Also as far as I know sclerals definitely do let your eye breathe. As long as you don't wear them at night oxygen deprivation isn't a problem I've commonly heard of after talking to many other scleral lens users.

Thank you so much for your reply. I'm not on FB- not a big fan of social media but I can imagine the group you mentioned would be indeed helpful. I think I will be in the category- sclera too sensitive to be comfortable with sclerals. Wind, a/c, cold, schirmer strips- whatever it may be, my sclera feels it x100. A bit despaired with this idea though... Good to know they are safe otherwise. I will have to try...

[WellEyes]

Most scleral lenses these days are rigid gas permeable lenses which allow oxygen to penetrate. I’ve been wearing my PROSE sclerals 10+ hours a day for over three years now, and have had no issues. The lenses are an integral part of my regimen that provides me comfort that greatly improves my ability to function daily. My dry eyes are not from LASIK, however sclerals are indeed commonly prescribed for LASIK-induced dry eyes.

You would not necessarily be jumping into sclerals. Typically you would go for a consult first to determine if you are a candidate for the lenses. At Boston PROSE, part of the consult is having you try on a trial pair of lenses for an hour or so to see if you can tolerate wearing sclerals (not everyone can tolerate them on their eyes), and if the lenses provide some relief. If so, then you would move forward with the fitting process, which is where more costs are incurred because it can take several lenses and visits to get the fit just right. If during the consult you cannot tolerate the lenses and/or they don’t provide relief, you would not go forward with the fitting and just pay for the consult. So in short, go for a consult, or you’ll never know.

I would recommend going to one of the big three who are most experienced and reputable for fitting sclerals for dry eyes, if possible...PROSE, EyePrintPro, and Dr. Gemoules in Texas. Here’s the PROSE website which includes a good general description of sclerals, info on insurance and clinic locations, etc:

http://www.bostonsight.org/PROSE/PRO...ats/Post-LASIK

I hope you get some relief soon.

Thanks a lot for your reply and all the info. Indeed it looks like a good option in case I tolerate them. Unlikely but I should try... I live in Dubai. We have Moorfields Eye Hospital and there is a possibility to try them there. Though I don't know their level of experience with sclerals. (I don't assume much)

It's good to know they give you some level of relief. It's essential to be able to function in daily life.