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

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

    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????

  • #2
    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!


    • #3
      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.


      • #4
        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 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.

        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.
        Last edited by Hokucat; 19-May-2017, 13:31.