Scleral Contact Lenses

More Scleral Tools and Tips

Today marks ten years since I awoke from microvascular decompression surgery to left-side facial paresis. Well, paralysis at that time. Single-sided deafness as well. Fortunately over time I regained most of my balance and hearing and enough facial function that most people don’t notice anything amiss. My blink and tear function have never returned, so I have spent a decade finding a remedy for painful dry eye. The solution that has worked best for me is the combination of an implanted eyelid weight and scleral contact lenses. These large-diameter specialty lenses are expensive and require quite a bit of maintenance, but in my opinion are worth every bit of cost and effort.

In past posts I outlined the care routine that works best for me. Since then I’ve discovered a couple more items that make it more manageable.

Several months ago I had to have my collarbone plated following an auto accident. Something went wrong with the nerve block and for a while my left arm did not function. My insertion technique requires both hands – one to hold the inserter and lens, the other to hold my eyelid wide open. For the first couple of weeks my husband helped with the eyelid part. We were both relieved when I regained the minimal movement and grip necessary to hold the inserter relatively steady. It was frustrating at first. My left hand did not have the strength to hold my eyelids, so I could only use it to hold the inserter and lens. Fine for my right side, but very awkward for the left. It wasn’t what I was used to and I kept bumping into my nose moving my right hand across my face to open the left eyelids. The weakness in my left hand caused me to spill the solution quite often. I also had a hard time aligning the left lens in the mirror I used on the counter. I was back to needing ten to fifteen minutes or more just to insert my contacts.

I remembered seeing a scleral insertion system that incorporated a lighted stand, but remembered it as pricey. I also didn’t want to have to wait on shipping. I thought about my craft light box but couldn’t find it, so we went to Hobby Lobby to see what they might have. A store employee directed us to this:

I snapped it up with a 40% off coupon and it worked like a charm. All I needed to do was align the inserter so that I could see a little circle of light. This lasted for a few weeks before it died. I think that even though I blotted up excess saline right away, some made its way into the box and shorted its circuits. In retrospect, I should have put a square of glass or plastic over it to keep the liquid out.

No worries though – since the concept worked so well I wondered if combining lights with a mirror I had been using wouldn’t be any better. I started searching at Amazon.com and found this lighted compact:

I highly recommend this for people who have trouble inserting their lenses. I find that it helps immensely to align lenses properly, plus it’s inexpensive and small enough for travel.

Before I regained normal strength and dexterity in my hand, I reverted to using disinfecting solution rather than ClearCare. I did not want to run the risk of snapping a lens, even having moved to PROSE cases with their larger baskets. As soon as I was able, I switched back to ClearCare, but there is a drawback. I have two pairs of lenses that I switch between every other day. Because the hydrogen peroxide system doesn’t seal, when I travel there is a risk of spilling the solution out of the second case. Before our most recent hiking trip to South Dakota, I made an exciting discovery. The PROSE case exactly fits into an empty eye makeup remover jar. (The labels peel off easily.)

Make sure it’s the extra-large 120-count jar. The 80-count is too short for the PROSE case, but might work with a ClearCare case. While a little solution may still seep into the jar, it won’t leak out into luggage.

It amazes me to look back and see how far scleral lens technology and use has come in the past decade. I’m looking forward to seeing what the next ten years bring.

 

A Scleral Quantum Leap

Those who know and love me, along with those who have read my series on scleral lenses, have some idea of how much they improve the quality of my life. To go from putting up with ointment-smeared blurry vision to avoid dry-eye pain to clear and usually comfortable vision was nothing short of miraculous. Sclerals rock!

I first heard about LaserFit lenses when Dr. Greg Gemoules commented on one of my web posts. The best way to learn about LaserFit is to poke around his website, but in short, rather than relying on hit-and-miss trial lenses, Dr. G uses computers to precisely measure the surface of each eye to design customized non-rotational lenses. I was intrigued by the concept of computer-designed customized lenses, but at the time I could not justify the trip. It remained in the back of my mind as a possibility, however, and late last year a number of variables fell into alignment, allowing me to schedule an appointment.

The most difficult part of the process was not wearing my prior set of scleral lenses for a week leading up to my initial appointment with Dr. Gemoules. Because the surface of the eye is malleable, this period of rest is essential to the best fit. Despite the discomfort at work and on the flight, I made it through. Coppell Family Eye Care has a medical rate arrangement with a local motel that supplies a shuttle service to the airport, eye clinic, and other attractions within a three-mile radius, including nearby Grapevine, Texas.

The Monday appointment is the longest at about two hours, during which Dr. G does a comprehensive eye exam and takes the digital measurements to design a first set of lenses. The staff carefully schedules LaserFit patients so that each one is allotted sufficient time for a successful outcome. Patients come from all over the United States and worldwide – there was a young man from China visiting the same week that I did. Custom made lenses arrive from the lab by about 2:00 p.m. the next afternoon. For the remainder of the week, Dr. G checks visual acuity and the fit of the lenses during follow-up visits that last about half an hour. In my case, the fit of the first lenses was excellent, but needed some adjustment for sharper vision.

Each subsequent set of lenses improved my distance vision. By mid-week, Dr. G experimented on designing multifocal LaserFit lenses since that was what I was used to with my prior scleral lenses. Unfortunately the multifocal aspect came at the expense of distance acuity, so we reluctantly gave up on the idea. Dr. G had warned me from the outset that I would lose near vision, but I had not expected the change to be so dramatic. He suggested trying monovision (one lens designed for distance and one for near vision) but just as when I had LASIK surgery, I prefer to have both eyes corrected for distance. After trying and rejecting various types of over-the-counter readers, I eventually bought a pair of glasses with progressive lenses that have no distance correction for wearing at work.

Dr. G recommends a different care routine than I was using for my previous scleral lenses. He prefers Clear Care® hydrogen peroxide solution (although not Clear Care Plus®). LaserFit lenses are larger than the maximum recommended for the Clear Care® case, but carefully centering the lens in the basket enables its use. Do be very careful, though, not to let the lens basket snap shut as this can cause the lens to snap as well.

Other noteworthy tidbits:

  • Because LaserFit lenses are designed to exactly follow the contour of the eye, they do not rely on suction and are therefore much easier to remove.
  • It’s very very important to check with your vision insurance before booking an appointment. VSP, for example, pays hardly anything toward the lenses or the exam.
  • Updated lenses may be over-refracted by another eye care professional (I am less than a year out and have not done this yet).

Despite the time and expense, and even though I was relatively successful with rotational scleral lenses, I would do LaserFit again in a heartbeat. Sclerals rock, and Dr. G is a rock star!

Have Scleral, Will Travel

This post marks the final installment of my thrilling scleral lens trilogy, following The Eyes Have it and My Dry Eye Triumph. Even as you read this, my agent is negotiating a movie deal; optimally this segment can be split into Parts 1 and 2 for a four-film series. Rumor has it many Hollywood A-list actresses are interested in playing me, that is until they find out that the role will entail extensive Botox injections on just the left half of the face to replicate facial paralysis. Filming will have to be carefully coordinated to take advantage of the right level of weakness.

Ordinarily I would toss out a disclaimer at this point, something along the lines of “But, I digress.” However, in this case, everything after the first sentence is pure and simple fiction, so instead we are interrupting this fantasy to return to your regularly scheduled programming.

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Like many a good title, this one has dual meanings. My primary intent is to pass along travel-related scleral care tips and hints gathered during my trip to Costa Rica earlier this summer. More on that later.

The underlying secondary message has to do with the origin of the phrase “Have (insert gun, tux, or another term, say . . . scleral), will travel,” particularly as it relates to employment. Here’s the deal: if I could make a living as a goodwill ambassador for sclerals, I would. My wish is that everyone who suffers from facial paresis-related dry eye would find the same relief that I have. I am not exaggerating – it’s been a life changer for me. I would be happy to test any lens, try any product, make endorsements, write reviews, attend conferences, oversee a clinical trial, zipline, parasail, skydive, what-have-you. If you know of such a job, please let me know. Of course, I am willing to travel!

Which provides a lovely segue to traveling with scleral lenses (in my case just one, but for those who wear two – double the fun!).

Preparation

Once the initial thrill of returning to Costa Rica dissipated, one of my first concerns was traveling with a scleral lens. My biggest fear was losing or breaking the lens, so I contacted my optometrist about taking my initial lens (which is a step too loose) along. He agreed to do this as long as I was willing to put down a deposit on the lens. Seemed like refundable insurance to me, so I was happy to comply. (Thankfully, I never had to use the backup.)

About the same time I sent an inquiry to the manufacturer of my scleral lens about cleaning procedures for protein deposits. A few days later I got a response from Keith Parker, president of Advance Vision Technology, suggesting that we speak in person rather than try to answer multiple questions via e-mail. Once we were able to coordinate a time to talk, we had a lengthy conversation covering both the deposit issue and my upcoming travel. I am going to keep this post travel related and defer the deposit issue to a future post. (Ha! It’s going to be a four-parter after all!)

Mr. Parker assured me that suction keeps scleral lenses in place even during extreme sports. He approved of my cleaning and soaking routine and asked if I rinsed my lens in tap water between cleaning and soaking (yes, I do). He recommends rinsing in tap water in the United States – the water pressure rinses more debris from the lens – but never in a foreign country where bacteria might be an issue. Finally he informed me of a sister website, MyEyeSupply.com, for eye care supplies, including a line of solutions developed for the AVT contact lens line.

My major fear allayed, I assembled eye care products for travel:

scleralcomplianceScleral Compliance Pack – This kit contains nearly everything needed to travel with scleral lenses. Leave the 12-ounce bottle of RDS (Rinsing, Disinfection & Storage solution) at home. Take the rest – a 2-ounce bottle of RDS, a 1-ounce bottle of GP daily cleaner, wetting drops, a contact case, a lens inserter, a lens remover, and saline – along in the handy zippered bag. I chose the non-buffered kit that includes 50 5ml vials of sterile saline (Addipak). There is also a buffered option with a 3-pack of Unisol 4 instead of the Addipak vials. I prefer inserters that are hollow all the way through, so I had to snip off the end of the one from the kit, but fortunately the remover is the classic one that I like.

Airline regulations allow for a reasonable amount of medications in addition to the one-quart bag allowed for carry-on liquids, so I kept my contact paraphernalia separate. I printed up a couple of cards that read Medically Necessary Liquids and popped one in each side of the bag. I had no problems at any airport security checkpoint.

cleanerpadsCleaner Pads – I found this product at MyEyeSupply.com and thought it would help with the protein buildup (again, more on that in a future post) and added them to my order. Great find! These pads are designed to be used for a week and discarded. Since I wear a single lens, I cut them in half. My rule while traveling was to change every 4 days and discard if I happened to drop one (which I did). I took along two pads (four halves) for a 9-day trip, which turned out to be just right.

sinkmat

Drain Mat – This product is from my friends at the dry eye shop. It was originally an add-on item to qualify for free shipping, but it turned out to be invaluable since many of the sinks in Costa Rica did not have a stopper. Particularly that one morning when I was still so tired that I dumped the soaking solution into the sink before removing the lens.

night

Usual Nighttime Stuff – My favorite lubricating drops (and I have tried all that I can find) are TheraTears Liquid Gel vials. Unfortunately I can only find them locally at WalMart, but they are worth an occasional foray into the Evil Empire. At home I will recap a vial and use it for two or three applications, but when I travel I use them once and discard the rest.

I have both a pair of clear Quartz and dark Onyix eye shields from the dry eye shop, but I fashioned a custom shield using the left eyepiece from a Quartz shield and a Croakie-type glasses strap. One of these days I’ll post a tutorial because I like it much better than having both eyes covered.

Airline Travel

Scleral lenses are perfectly designed for airline travel, combating dry eye from pressurized cabin air with a fluid reservoir over the surface of the cornea, I had one tiny problem: our travel group was leaving at 1:00 in the morning to catch a red-eye international flight. My optometrist gave me strict instructions to wear the lens no more than 14-16 hours daily and soak it for a minimum of 8 hours. I could have disrupted my routine to wear the lens during the flight, but then I would have to go without the lens for a while once in Costa Rica. I opted to forgo the lens on the plane, which led to a second decision – how to keep my cornea lubricated.

The failsafe approach would have been to use Refresh PM ointment on the airplane, but that would have caused blurry vision that continued for at least the first few hours of wearing the lens. Instead, I opted to add another tool to my arsenal:

WileyXcurveWileyX Curve With Clear Lenses – I found these glasses, actually climate-controlled motorcycle goggles, on clearance from dryeyeshop.com. They are no longer available there but plenty of other vendors carry them, including amazon.com. There are other moisture chamber options, including less expensive Dustbusters and Onion Goggles (heck, even swim goggles would work in a pinch). I found the motorcycle goggles to be a better choice because they are sturdier, seal better, and are slightly less geeky looking.

Used in conjunction with generous applications of my regular nighttime TheraTears Liquid Gel drops, the WileyX glasses is an acceptable travel protocol. The seal on the glasses is not quite tight enough so I experienced a bit of low-grade dry eye discomfort, but when that happened I just popped in more drops. Our travel itinerary from St. Louis to Liberia, Costa Rica included an hour-long layover in Miami. By that time my contact had soaked the requisite eight hours and I decided to insert it before boarding the second flight. Public restrooms are not my favorite place to deal with my lens and while I was in there I missed seeing members of the Miami Heat pass our group on their way to the NBA playoffs, but those were small prices to pay for increased comfort and clearer vision.

I had absolutely no problems on the second flight or the return flights back to St. Louis. I ended up wearing the lens slightly under 18 hours due to a bus ride that got us home just before midnight, but that turned out all right too.

Extreme Activities

The trip to Costa Rica was a 9-day environmental education tour with plenty of adventure activities mixed in. Here’s how I managed my scleral lens during the most extreme activities:

Beach – Still tired from travel, I chose to stroll on the beach and wade in the surf. Even with a spare lens and assurances that it wouldn’t pop off, I did not want to risk sea water on or under the lens.

beach

Snorkeling – No worries. The mask provided a watertight seal, protecting the lens. I was more concerned about the waterproof case for my camera but that worked out just as well.

snorkel

Rain forest hike – It rained. I wore a hat.

rainforest

Ziplining – Here’s where the suction of the lens faced its biggest challenge. There was a lot of wind whistling past my face. No sunglasses allowed and just as well – they probably would have fallen off. Fourteen exhilarating zip lines and one Tarzan swing later, I was a happy camper – scleral lens intact.

Sara, 2014

Horseback ride/La Fortuna Falls hike – This is a picture of me and my horse Gugi. None of the other horses liked Gugi much, but that is a story for anther time. I wore sunglasses on the ride but never felt that I needed them for eye protection. At the waterfall I climbed out on some boulders but again opted not to submerge while wearing the lens.

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Whitewater rafting – On the bus ride to Rio Sarapiquo, our whitewater guide warned us not to take phones, cameras or sunglasses as they would surely get lost during the float. During Q&A I asked about wearing a pair of swim goggles that I had brought along specifically for whitewater rafting. The guide wanted to know if they were prescription; when I said no he responded that I would be better off leaving them behind because they would fog up and diminish my enjoyment of the float. When I told him I wore a contact lens, he suggested closing my eyes if water was splashing. I gave his advice serious consideration for about ten seconds. First, wouldn’t shutting my eyes also diminish my enjoyment of the float? Second, the goggles were fog-resistant. Finally and most important, losing a $750 contact lens would flat out eliminate any enjoyment of the float.

I wore the goggles. They did not fog. I was swept off the raft and submerged. I did not lost my scleral lens. My enjoyment of the float was immense.

rafting

And there you have it. Research, preparation and common sense prevail. Have these and a scleral lens, will travel.

My Dry Eye Triumph

I discovered Dry Eye Talk forums when I was researching scleral lenses as a result of conversations at the ANA Eye Issues Forum. It’s part of the very helpful site Dry Eye Zone, which also hosts news items pertaining to dry eye, an encyclopedia of dry eye topics, a computer blink reminder, and a Dry Eye Shop.

I never knew there were so many causes of dry eye, or that LASIK was one of them. As a extremely nearsighted, middle-aged woman with large pupils, I am fortunate to be a LASIK success story. However, thanks to post-surgical facial paresis, I became all too familiar with the pain and misery of dry eye. Early on I got a platinum eyelid implant. It aided nighttime closure but still left an incomplete blink.

One of the forum categories at Dry Eye Talk is Our Dry Eye Triumphs. After more than five years, I feel that I have finally arrived at that point. The remainder of this post is a before and after comparison of my dry eye care routine.

Before

refresh_pm

I tried every type of eye drop, gel and ointment I could find. Eye drops and gels, no matter how thick, gave only a fleeting moment of relief. Standard eye ointments containing about 15% mineral oil and 85% white petrolatum offered 15-20 minutes of relief before I needed to reapply. Refresh PM, with a higher proportion of mineral oil (42.5%), gave me much longer relief. I always applied it before bedtime and first thing in the morning. During the summer that might be all I needed; during the winter I usually required a mid-afternoon application as well. Although some less expensive store brands, such as Walmart and Walgreens, contain the same proportion of ingredients, they did not work as well for me.

My eyes felt pretty good, but the vision on the left side was blurry, like looking through a lens smeared with vaseline. My brain learned to compensate, relying more on the clear vision in my right eye while utilizing the images from the left eye for depth perception. My overall vision was similar to this image, courtesy of Visionsimulations.com:

blurry
My vision fluctuated between 3 and 4 on this blurry vision scale.

My method of applying ointment was a bit unconventional. Instead of squeezing it onto my eye from the tube, I put a small amount on my ring finger and applied it to the sclera below the iris, then closed my eye to distribute it over the cornea. I’m sure ointment manufacturers and eye care professionals alike would be appalled, but it worked for me. For nearly five years, 24/7 application of Refresh PM ointment comprised my eye care routine.

For a while, the absence of dry eye pain compensated for the loss of crystal clear vision. But over time I began to experience mental fatigue from the continuous effort of concentrating on my right-side vision. That, with the nearly constant nuisance of extra ointment under my eye – which also made wearing eye makeup an impossibility – led me to begin researching scleral lenses in earnest.

After

scleral-lens
The miraculous scleral lens.

A scleral lens is much larger than a standard gas permeable contact and vaults the cornea, allowing a pool of saline to remain between the lens and the surface of the eye to combat dryness. Scleral lenses are more expensive because they require a precision fitting process. In my case, the first lens turned out to be too loose, but the second one is just right.

Here is the rest of my new eye care routine. Yes, it costs more and takes more time.

solutions

Solutions:

  • Scleral lenses must be filled with preservative-free saline prior to insertion. Large bottles of saline contain preservatives, which leaves the more expensive option of individual vials. There are many brands with varying levels of lubricating agents added. Individual vials contain 2-3ml of fluid, which is just enough to fill a scleral lens. I found a much more cost-effective option to be sterile saline vials manufactured for nebulizer use. They are available in 3ml, 5ml and 15ml sizes. They contain no lubricating ingredients, and the lid can’t be snapped back on once opened. I prefer the 5ml size because it contains enough to both rinse and fill the lens. Beginners often need more than one attempt at insertion, so there is extra to allow for that. Any extra saline can either be discarded or used at the end of the day to rinse the lens after removal, but should not be kept for use the next day. I’m fairly sure 5ml would still be sufficient for two scleral lenses. Amazon.com has the lowest prices I’ve found for nebulizer saline. I usually buy 100 vials for around $15, but they are also available in quantities of 1000 for about $125.
  • At the end of the day when I remove my lens. I use a daily cleaner called Lobob ESC to remove surface dirt and oils.
  • I prefer UniquePH multipurpose solution for soaking and disinfecting. It is not available locally (at least here) and is sometimes hard to find online, in which case I use Lobob CDS but I don’t like it as well.

utensils

Tools:

  • DMV Lens Insertion Tool – there is a great YouTube video that shows techniques for manual insertion and removal of scleral lenses, but I don’t like the thought of it, plus there is the possibility of getting skin oil or soap/lotion residue on the lens. I prefer to use an insertion tool, like the one pictured at left.
  • DMV Removal Tool – the thought of breaking the suction between the lens and my eye using my fingers just gives me the creeps. I very very very very much prefer to use a removal plunger, pictured at right. There is also a plain suction cup without a hollow, but I prefer the way this one allows suction to be started and stopped by squeezing the bulb.
  • Mirror – I place a hand mirror on the bathroom counter during lens insertion. The insertion tool is hollow all the way through, so I line up the reflection. When I can see the excess fluid spilling out, I know the lens is in the right place. I use the regular bathroom mirror during removal to find the right spot to apply the suction cup.

Tips:

  • During insertion, tuck your chin toward your chest until your eye has to look slightly up toward the mirror. That keeps the lens level and the fluid in the cup through the insertion process.
  • Blink hard a few times after insertion to help center the lens. You will notice your vision getting appreciably clearer with each blink.
  • If you see ghosted images after insertion, too much fluid was displaced and there is an air bubble in the lens. Take it out right away to refill and reinsert, because in just a few seconds it will begin to smart like crazy.
  • During removal, apply the suction cup to the outer edge of the lens. If the suction cup is in the middle of the lens, it will increase rather than break the suction. Placing a drop of saline on both the contact and the removal tool helps a lot. If the suction is still hard to break, try gently moving the edge of the lens slightly back and forth with the suction cup before trying again.
  • If your vision starts to blur during the day, apply a drop of saline over the lens and blink a couple of times. If this doesn’t help, remove the lens, refill with fresh sterile and reinsert. Blink hard a few times to recenter the lens.

nightNighttime care: At first, I continued using Refresh PM whenever I was not wearing the scleral lens. My optometrist recommended using lubricating eye drops with a silicon eye shield at night, but I needed the security of my old method for a few weeks. I was extremely happy once I made the switch. The lens stays cleaner and my eyes feel even better in the morning. Often I can wait two or three hours before having to put in my scleral.

  • TheraTears Liquid Gel drops – I’ve tried a lot of different lubricating eye drops and this one is my favorite. It’s a thick solution and my eyes feel better in the morning than with any other drop I have tried. The top of these vials can be snapped shut, and although it is not recommended, I generally use a vial for two nights. Bonus: there is a $2 coupon good through 2013 available here and a $1 coupon good through 2014 available here.
  • Quartz silicon eye shield – also available in a dark version called Onyix. It was originally developed to combat dry eye among  CPAP users, and is made by the same manufacturer as another nighttime dry eye product, TranquilEyes. I have found a couple of drawbacks with the Quartz shield. First, it tends to leave marks on my cheeks that take up to an hour to fade. Also, the adjustable fabric band tends to slip so I use hair clips or bobby pins to keep it in place. Fortunately, that way it does not have to be as tight so the morning marks aren’t quite so bad. TranquilEyes are supposedly less likely to leave marks, but they are not available in a clear version so I will probably stick with the Quartz shield.

The vision in my right eye has slightly diminished to -1.0 since my LASIK surgery thirteen years ago. I am not currently wearing a contact on that eye. I wear a pair of prescription glasses with clip-on sunglasses to drive and sometimes at the movie theater or to watch TV. Since I ended up with classic monovision, I rarely need to wear readers to read or work on the computer. I will decide by my next scleral appointment, currently scheduled for July 2014, whether I want another lens for the right side or if I am content to continue this way.

I keep a a few necessities in my purse in case of emergency – a spare set of insertion and removal tools, contact case, saline and Thera Tears Gel vials, alcohol wipes, a compact mirror and a tube of Refresh PM. My new eye routine definitely requires more money, time and stuff. But is it worth it? Well, the optometrist tells me that my eye is healthier. I am less fatigued at the end of the day. I no longer have to worry about wiping extra eye ointment off my cheek. I can wear eye makeup when I choose to. And best of all, I now see like this:

clear
Hooray! A return to super sharp vision.

I am still waiting for the outcome of an appeal to my insurance company to cover the scleral lens as a prosthetic device for a nonfunctional eyelid. My argument is that it will decrease the possibility of corneal disease and accident. Whatever their decision, there is no question that the lens enhances my quality of life.

 

 

Read my next post on scleral lenses.

The Eyes Have It

Five years ago, on June 2, 2008, I underwent brain surgery: microvascular decompression of the seventh cranial nerve in an attempt to cure hemifacial spasm. Unfortunately my facial nerve was damaged during surgery and I awoke with left side facial paralysis; I could neither smile nor blink, and my eye no longer produced tears. In addition to the trauma of losing my pretty smile, I experienced extreme pain from dry eye. Over time the nerve healed. I have recovered quite a bit of facial function. My smile is not what it used to be, but most people don’t notice that anything is wrong. I’ve learned how to make a smaller smile to minimize the difference between sides. I now produce tears when I cry or eat spicy food, but not under normal circumstances. I have tried every type of eye drop and gel I could find, but Refresh PM ointment is the only one that keeps dry eye pain at bay. My brain learned to compensate for the blurry vision on the left side, but over time it became mentally exhausting. This is the story of my nearly lifelong quest for sharp vision. It’s long and a bit on the clinical side now and then, but I feel it is important to be as thorough as possible in case it can help someone else out there.

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I grew up nearsighted. In third grade I failed the school vision screening and made my first visit to an ophthalmologist. I remember leaving the optical shop after getting my first pair of glasses and marveling at seeing individual leaves on the trees. I was 8 years old. Thus began a progression of horrible nerdy glasses, the early ones complete with real glass lenses. Every year my vision got progressively worse and the lenses thicker. I disliked wearing eyeglasses, but couldn’t see without them.

cokebottleglasses
OK, they were never that bad. Or maybe they were. I am having trouble finding my grade school pictures, but when I do I will post one. Or not.

Those despised spectacles did provide some dramatic moments. Once during a bombardment game in elementary school PE, I got hit in the face with a beanbag. My glasses flew across the gym and the glass lenses shattered. I was blind for a week waiting for a new pair. In high school I was invited on a horseback ride. During the home stretch across a hayfield, the horses began to gallop and my glasses – new of course – flew off my face. The next day my friend’s father, a career military man, organized a search line. Miraculously we found the glasses. Fortunately for me, lens technology had progressed to thinner and lighter plastic with scratch resistant coating.

My senior year in high school, a miracle occurred. I had my annual appointment with the ophthalmologist, anticipating yet another pair of geeky specs. To my amazement, my mom and dad had decided to surprise me with contact lenses. I was fitted with soft contacts and was at long last able to forgo the coke bottle glasses. I could see better and looked better. Win-win.

By the time my three children had been born, my prescription was -7.5 on the left and -9.0 on the right.

nearsighted
A twilight driving scene as it appears to a person with normal vision, left, and to a severely nearsighted person like me, right.

Weary of glasses, contacts, and solutions, I also hated not being able to see my kids at the swimming pool. I had been monitoring the development of laser surgery, and it had finally progressed to the point where I felt comfortable asking my ophthalmologist about it.

In February of 2000 I had LASIK performed in Kansas City. My refractive surgeon was reputed to be one of the top three in the country. He gave me ten units of correction on the right eye (at that time, the most that he would do) and eight on the left. I had been warned that my level of correction would probably require an enhancement surgery a few months later, but I was fortunate not to need it. My eyes healed perfectly. (I do see halos and starbursts around light sources, but I had that before surgery due to extreme nearsightedness and large pupils, so it causes me no distress.) After some mild post-surgical dry eye that resolved after a few months, I never looked back.

lasikdiagram
How LASIK works. Take note of the change to the curve of the cornea after surgery. That will be important later in my story.

For eight years, I was able to take my vision for granted. Then came the microvascular decompression surgery and severe left side dry eye. I do not know how I was able to tolerate the plane ride home, but I made it somehow. After a few weeks of trial and error, I settled into a routine of applying Refresh PM ointment around the clock to keep my cornea moist. It gave me relief from dry eye pain, but also blurred my vision. In August I had a 1.8 gram platinum weight implanted into my eyelid to aid in closure. It helps to keep my eye shut at night, but unfortunately does not provide a complete blink.

In September 2008 I first asked my ophthalmic surgeon about the advances in scleral lenses being made by the Boston Foundation for Sight. Instead of resting on the cornea, the edges of these lenses extend to the sclera, or white of the eye, creating a moisture chamber on the surface of the eye, relieving dry eye pain while providing clear vision.

diagram

The surgeon dissuaded me, stating that the lens was only indicated for debilitating facial injuries such as Gulf War soldiers who had lost their eyelids altogether and had no protection for their eyes. I resigned myself to a lifetime of accepting less than optimal eyesight in exchange for keeping my cornea healthy and pain free. But it seemed to me that a scleral lens would be ideal for a situation such as mine, so a little more than a year ago, I brought the subject up again. I think the doctor realized I would not be giving up the idea, and reluctantly granted permission to find and consult with a specialist in contacts for dry eye. He warned me that my eye might be too sensitive to be fitted successfully.

Extenuating circumstances kept me from pursuing it right away, but a few months ago I began to see an increasing number of posts on the Acoustic Neuroma Eye Issues Forum concerning scleral lenses. I live in a small city, so I was not surprised to find that my local ophthalmologist does not fit scleral lenses. I contacted the manufacturer of one of the lenses mentioned on the forum and received a referral to an optometrist in a nearby city.

I emailed a brief history to the doctor and received a reply that he believed he could help me. At my initial appointment he recommended that I try Restasis twice a day for a couple of months to see if it would give me relief without needing a lens. He also recommended eyeglasses because the vision in my right eye had degraded slightly, to -1.0.

Unfortunately, I did not do well at all with Restasis. Both of my eyes burned whenever I applied it, and I could hardly stand to wait for the required fifteen minutes to pass before I could apply drops or ointment. I did some research and discovered that Restasis was not effective for dry eye due to nerve damage and contacted the doctor to ask to discontinue the Restasis and proceed with a scleral lens fitting.

The first lens turned out to fit too loosely even though it looked perfect from the fitting kit. I brought it home so that I could practice inserting and removing the lens. I could only wear it an hour at a time because the lubricating drops slowly leaked out of the bottom of the lens making the lens uncomfortable and blurring my vision. I am currently testing a second lens with a tighter fit. If my eye doctor was 10% satisfied with the last lens, he is 80% satisfied with this one. We will decide at my appointment next week whether to tighten the fit a bit more as it still settles just under center. I can wear it for increasing lengths of time, starting with 3 hour increments and increasing by an hour every day.

On the right side, we tried several regular soft lenses, but my cornea is so flat post-LASIK (remember the diagram above?) that the lens slides and does not hold its shape. I can’t afford a second scleral lens at this time, so my doctor has recommended a custom soft lens to take into account my flat cornea and large pupil size. I’ll be able to try that next appointment also.

Update (07/15/13): The name of the custom soft lens I tried is SpecialEyes. I have also seen one called RevitalEyes. There are likely others as well; if you are interested I suggest googling for “custom soft contact lenses” or “post-LASIK soft contact lenses.” I did not keep the lens. As it turns out, the -1 in my right eye with the corrected vision from the left scleral gives me more-or-less textbook monovision. The increase in distance vision from the right lens was not enough to compensate for the loss in near vision.

Although I did not reach my goal of crystal clear vision for my fifth post-MVD anniversary, I am close enough at this point to celebrate. I am happy to report that – severe myopic, post-LASIK and post-MVD – there is light at the end of my tunnel.

dark-purple-divider-md

Here is a list of scleral lenses I have been able to identify. Let me know if I have missed any, and I will add them.

Some unusual cases and harder-to-fit eyes may require custom scleral lenses. Instead of starting with ready-made fitting kits, these lenses are custom designed for each eye. The fitting process requires approximately a week of travel to their location.

  • BostonSight PROSE – custom scleral lenses by the Boston Foundation for Sight. US providers are located in Needham, MA, Los Angeles and San Francisco, CA, San Antonio and Houston, TX, Chicago, IL, Ann Arbor, MI, Miami, FL, Baltimore, MD, and Great Neck and New York, NY. Overseas in India and Japan.
  • Global Refractive Solutions Laserfit – custom designed lenses using high resolution digital imaging. The design process was developed and patented by Dr. Greg Gemoules of Coppell, TX (Dallas area). Lenses are manufactured to his specifications by TruForm.

Update (09/17/14): I ran across this option that is manufactured to order by the manufacturer of AVT Sclerals (the lens that I wear):

  • EyePrintPro – Custom prosthetic scleral cover shells made using a direct impression of the surface of the eye. The developer of the scleral shell practices in Iowa City, IA. According to the website there are additional practitioners across the country, but I was unable to find a list on the website, though there is a contact form for questions or comments.

 

 

Read my next post on scleral lenses.