Confused about bandage lenses

[piot0020]

Hi, I have lasik induced dry eyes and I went to the eye doctor today to ask about bandage lenses. My eye doc told me they are the same as regular contacts but no Rx in them. I am so confused! How are these helpful for dry eyes? Can someone explain this to me?

[Rebecca Petris]

Bandage lenses are not a dry eye treatment per se.

Bandage lenses (and yes they are just ordinary soft lenses but used as a bandage rather than for vision) are usually used after corneal surgery to aid in surface healing, and they're also used to protect the eye while healing from an injury. They drape over the cornea and shield it and help keep it from drying out too badly. In some special situations they're used by dry eye patients especially if they get corneal erosions at night. Some people with dry eye can tolerate them and some can't.

[piot0020]

Thanks for your reply. So what are scrleral lenses? I am reading a lot about them but I thought these were the same as a bandage contact lense?

[mgshutterbug]

Hi Rebecca, after a 9 month hiatus, I'm once again getting RCEs, have increased corneal pressure. I have no idea why - no different medicine, change of climate, nothing I can think of to explain it. I was so bummed out by it, I didn't rush an appt with a new eye doc because I kept thinking they'd go away. I'd made the appt. a month before, when I wasn't having erosions. I'd been having them 3 weeks straight before I saw my eye doc. Turns out she specializes in dry eye, and appeared to be very knowledgeable. She said both eyes are in very rough shape, even the one not having RCEs. I knew they were both in the severe category of dry eye, but to tell the truth, the eye bothering me the most consistently has always been the left eye, the one that got botched in the TN neurosurgery. I was not happy to find that the other is only a hair better. She placed a bandage lens on the eye with the RCEs and said that I'd need to wear it at least 7 weeks, maybe longer. She said she believes I'm a good candidate for sclerals, she has a number of PROSE Pts. But she said the insurance companies won't pay for them until you've run the full gamut of their insane hoops to jump through. I would have to try Restasis for 6 mos (I'd tried for 3 mos - nothing), steroid drops, punctal plugs (already had them for 6 mos, were always very uncomfortable, eventually caused considerable pain. The did make my eye a teensy tiny bit more comfortable, but I will never wear them again.). Lastly, then lacriserts. From my own experience, and that of others on the forum, so much of all this just seems a waste of time and money. And steroid drops can increase cataract development, and I already have a cataract developing in the eye that has the RCEs. I haven't read about anyone having any luck with lacriserts. Do you know if Major Medical pays for part of the cost of sclerals ever? Am I correct in recalling that steroid drops increase cataract development? With all the surgeries I've had to have, I do not want another.

With the bandage lens I can't use Sochlor ointment, so when I wake up in the a.m., my eye is bone dry, my bandage lens is bone dry, my vision is horribly blurry, and light causes tremendous glare. The blurriness lessens as I replenish the tears with Soothe, or something else preservative-free, though it never gets nice and crisp. I'm hoping that the cornea heals all the way, and I'm not left with vision chronically blurry. But as long as the eyes are so dry, I know my vision never will be acute again. How can the bandage lens be kept hydrated over nite when ointment can't be used? I can't use Onyx goggles overnite because I have to use a full face mask for my sleep apnea. Can't wear the much smaller nasal pillows to deliver the air because of nerve damage to my nose from that old neurosurgery, and the newer one. I'm about to tear my hair out.

Anyone have any suggestions?

Maria

[SAAG]

How can the bandage lens be kept hydrated over nite when ointment can't be used?

Maria

Hi Maria,

I know this won't be an appealing option at all, but if the usual tactics like tranquileyes goggles, saran wrap etc. don't work, maybe you could set your alarm to go off every few hours overnight so you could re-apply drops and then go back to sleep? Prior to using ointment, I went through a phase of having my alarm go off every 2-3 hours so I could reapply drops... wasn't ideal, but no worse than having a newborn baby to wake up for all the time

[Rebecca Petris]

So what are scrleral lenses? I am reading a lot about them but I thought these were the same as a bandage contact lense?

Very different from bandage lenses. Bandage lenses are a soft lens that drapes across the cornea. Sclerals are gas permeable (i.e. hard) extra large sized lenses that vault the cornea and limbus and their edges rest on the sclera (white of the eye). They hold fluid over the cornea either for vision reasons or as a treatment for extreme dry eye.

[mgshutterbug]

Thanks SAAG, I will try your suggestion. I've been worried that the bandage lens will just end up all wrinkled and stuck to the cornea when I wake up in the a.m. I'm thinking that's not too far from the truth when I wake up in the morning and my vision is so impaired, and the glimmer of light behind the vertical blinds is all bright white glare. My photophobia is out of sight. I'll let you know how it works - it can only help. Many thanks.

[Rebecca Petris]

(((((Maria)))))
I'm so sorry to hear about this latest setback

But she said the insurance companies won't pay for them until you've run the full gamut of their insane hoops to jump through....

Are your examples (Restasis six months etc) specific to your insurer? After everything you've been through already it seems to me like you ought to be a slam dunk for approval - The Restasis part doesn't surprise me too much but I don't know about the others.

Do you know if Major Medical pays for part of the cost of sclerals ever?

Certainly. Medicare does. Vast majority of patients go there with insurance coverage as far as I know. A lot of people who need PROSE treatment need it because of systemic diseases (SJS, GvHD etc) by the way, and the reason more and more insurers are embracing it is that PROSE is a lot cheaper for the insurer than a corneal transplant with all its aftercare and risks of rejection. I'd call & have a chat with the insurance point person at BFS as they may be able to give info specific to individual insurance companies.

Agree with SAAG re alarm....

To be honest I can't imagine wearing a bandage lens continually because I don't think my eyes would take it (not sure of course). Does anybody have dailies that they can change out? I'd be curious to know.

How can the bandage lens be kept hydrated over nite when ointment can't be used? I can't use Onyx goggles overnite because I have to use a full face mask for my sleep apnea.

How about the old standby, Glad Press'n'Seal?

Doesn't the Onyix fit with your mask?? Thats surprising, I thought they were compatible with virtually all of them. Mind if I ask what model you use?

Hugs
Rebecca

[mgshutterbug]

Rebecca,


"To be honest I can't imagine wearing a bandage lens continually because I don't think my eyes would take it (not sure of course). Does anybody have dailies that they can change out? I'd be curious to know. "

So are you saying that the bandage lens normally isn't worn non stop? That would make sense - if the problem is that the eye gets even more bone dry at nite, that would make the lens do exactly what it does: get sort of opaque and my acuity is non-existent... I did ask this doc if she meant for me to wear it continuously, and she said "yes", that my cornea would not heal without it...but this does not seem to be working..


"How about the old standby, Glad Press'n'Seal?"
Didn't know that would stick to your skin, your eyelids?

By the way, your other comments/suggestions were very helpful, thank you. I will follow through with those.

Maria

"Doesn't the Onyix fit with your mask?? Thats surprising, I thought they were compatible with virtually all of them. Mind if I ask what model you use?"

I use the Mirage Quattro that fits high up over the crest of my nose, almost even with my eyebrows.