Do sclerals heal dry eye?

[cristinalatina]

Hi friends,

long time no see!

I am here because I am a long time dry eye sufferer since my LASIK 7 years ago.

I had very severe dryness and was prescribed Restasis about a year ago, which improved my tear production significantly, as measured in the doctor's office.

I have discontinued it recently to start trying for my first baby!

I am interested in a more lasting solution for my permanent dry eye problem, aside from limiting activities that make it worse, such as internet time.

I am considering sclerals after I give birth and breastfeed, to allow my corneas to settle down.

My question is, do sclerals heal dry eye? Meaning, those of you who use it in daytime, do you still exhibit dry eye symptoms and signs, say, next morning?

If a doctor examined you when you take them off, would you still have dry spots on the cornea after removing them, say, to sleep?

I have SPK (dry spots) on the cornea in each annual doctor visit, and don't want to risk living with this condition otherwise untreated, I'm only 30 years old so I'd like to do the right thing as early as possible.

Please let me know if sclerals heal SPK, if only temporarily! I would definitely be interested not only for comfort, but also for therapeutic reasons long term!

Thank you in advance

[Lacrima]

Hi,

I had an appointment with a lens expert to try Boston mini sclerals. He told me they don't 'heal' anything as such. They just make sure the eye stays moistened at all times. However, it creates an environment where the abnormality of one tear component doesn't affect the other. By eliminating this imbalance during wear, you are encouraging better healing.

[Rebecca Petris]

Hey that's exciting!! Good for you!!

I am considering sclerals after I give birth and breastfeed, to allow my corneas to settle down.

My question is, do sclerals heal dry eye? Meaning, those of you who use it in daytime, do you still exhibit dry eye symptoms and signs, say, next morning?

If a doctor examined you when you take them off, would you still have dry spots on the cornea after removing them, say, to sleep?

You might want to re-post this in the PROSE forum too fyi...

I have just a couple of comments:

1) For me personally: When I wear sclerals (mine are PROSE) my eyes are much better for a time after removing the lenses. Whether they're better the next morning than they would be otherwise I can't really say for sure (and note that I like other people who wear them need night time dry eye protection strategies) but I think probably so. I certainly can't imagine having SPK or basically any severe signs of dryness shortly after removing them. Eye's just been too wet too long for that. If I am out of lenses altogether for say a week, I'm pretty sure I'm back to my baseline dryness overall. But short term, are there benefits extending into non lens wear time, absolutely.

2) I know though not in much detail that they are sometimes used for shorter term healing situations.

[cristinalatina]

Hey that's exciting!! Good for you!!



1) For me personally: When I wear sclerals (mine are PROSE) my eyes are much better for a time after removing the lenses. Whether they're better the next morning than they would be otherwise I can't really say for sure (and note that I like other people who wear them need night time dry eye protection strategies) but I think probably so. I certainly can't imagine having SPK or basically any severe signs of dryness shortly after removing them. Eye's just been too wet too long for that. If I am out of lenses altogether for say a week, I'm pretty sure I'm back to my baseline dryness overall. But short term, are there benefits extending into non lens wear time, absolutely.

Thank you, Rebecca. That's exactly the information I was looking for, and my specific goal too (finding a practical way to decrease SPK, increase comfort, and maybe night time vision that's aberrated by LASIK).

I didn't post in the PROSE forum because I'm in the UK, so I didn't think it would be relevant.

Many hugs from your Greek friend!!!

[littlemermaid]

Hello Christinalatina, I was wondering if you had got a Moorfields view on this, partly because you've still got SPK after all these years and are just being seen once a year. I understand many ophth here in UK use bandage contact lenses and Moorfields are good at this but I would think someone there in the cornea team might be interested in helping you think about what's possible, partly because you sound like a very lovely person with such promising times ahead. Although I'm not in a position to give information because we haven't been this route, being paediatric, I'd be tempted to ask Valerie Saw what she thinks in private practice, if the cost is justified for you. It's just giving up the anti-inflammatory that's been helping so much that scares me. Also SPK means there's chronic keratitis inflammation that should be treated, I think. Have you got double-plugs? I'm so not in a position to say anything but can't stay quiet because I wonder if you could be helped more here while you're thinking about Boston.

[cristinalatina]

Hello Christinalatina, I was wondering if you had got a Moorfields view on this, partly because you've still got SPK after all these years and are just being seen once a year. I understand many ophth here in UK use bandage contact lenses and Moorfields are good at this but I would think someone there in the cornea team might be interested in helping you think about what's possible, partly because you sound like a very lovely person with such promising times ahead. Although I'm not in a position to give information because we haven't been this route, being paediatric, I'd be tempted to ask Valerie Saw what she thinks in private practice, if the cost is justified for you. It's just giving up the anti-inflammatory that's been helping so much that scares me. Also SPK means there's chronic keratitis inflammation that should be treated, I think. Have you got double-plugs? I'm so not in a position to say anything but can't stay quiet because I wonder if you could be helped more here while you're thinking about Boston.

Hello sweetheart, thank you so much for your sweet and kind words. I have double plugs in both eyes, and I found Restasis exceptionally useful. However, a doctor I trust suggested I should discontinue for 3 months before trying for a baby. I have an appointment with an ophthalmologist in Ireland next month, who was recommended by my previous doctor, and find out how my eyes really are (sensation is not really accurate after LASIK). I think long term the sclerals would be a good solution that maintains health, and I think there is a scleral fitter in Moorfields. Do you go there for your child? Would you ming sharing (privately or not) your experience and approximate cost of the consultation? I am new in the UK and unsure whether I would need a GP referral, even though I don't mind paying out of pocket for a viable solution!

Thank you

[littlemermaid]

Hello Christinalatina, We don't have experience on scleral lenses through Moorfields but hopefully some people here will post up.

The Moorfields website is a start for information about what they actually provide. Scleral lenses are also used in some regional hospitals. Also maybe look at the UK Keratoconus Society forum for their experiences. Maybe talk to Mr Ken Pullum at his practice in Hertfordshire to find out what he does at Moorfields. From memory about chat here, the problems were all about getting a good fit.

Whereas in Boston - search dryeyetalk - people talk about service, adjusting the fit, and the cost of staying in Boston for a while during fitting. It is easy to approach them direct for advice.

Best to 'phone or email Moorfields Private and ask for quotes (ask what additional cost to expect for optometrist checks). Private prescription costs extra but you can shop around pharmacists. A consultation used to be about £135-180 but I've paid up to £300 - maybe someone could PM you with experience of different consultants. In the private sector, you don't need GP referral - you just 'phone the consultant's private secretary and make an appointment. It's useful to take a copy of your NHS notes for the history - request them to be copied from the hospital Medical Records department (although different health trusts have different views about this, it's UK law you can access your notes). I'm not sure Moorfields Private would give you a viable solution but you would get advice on what's currently possible in the UK.

Hope you get on well with your new specialist and that you can get the advice you need on the SPK there. If you are in N. Ireland, you could ask about the possibility of an NHS referral for lenses, although the NHS is a bit confused at the moment about what they are supposed to be paying for.

We're wondering too how much systemic absorption there is of steroid or immunomodulator if you're double-plugged. This is one of the questions my daughter has too now she's growing up and wondering what the future holds.

[cristinalatina]

Thank you very much for this information. I happened across a website about a lens practice in Birmingham that fits sclerals! http://www.thecontactlenspractice.co.uk/page/blog/ I sent a message about pricing and more info. I have heard the name of Ken Pullum too, with mixed reviews but the possibility to try the lens before committing. I am not in a hurry because I know that a cornea should not be fitted during pregnancy. However, I believe that a scleral lens could help me very much, long term. Boston is expensive and hard for me to approach right now, but any place in Europe would be a possibility. (I am in Belfast, NI).

I am sorry I can't say how much systemic absorption takes place with plugs in. I didn't dare question my doctor regarding the Restasis, even though I had spectacular improvement in tear quantity. I suppose there must be some. However, Restasis was of much help. The strange thing about me post-LASIK is that my eye gets progressively drier and I don't feel a thing. By the time I do, the cornea already has severe dry spots!

[littlemermaid]

In UK, we are indeed safer with cornea doctors in hospitals with lens specialists when there is a disorder like this. We look for optometrists who have a co-care treatment relationship with hospital specialists. Difficult to find because they need long experience working in specialist hospital clinics and further training in recognising disorders and disease, especially when the signs on examination are few, particularly with inflammation and tearing. Hope you can find the experience and skill you need.

We found similar, that the eye surface became desensitised and so the prompt that tears are needed is reduced. We got neovascularisation and pannus. We concentrate on maintaining the eye surface really well to allow healing even when there's no dry eye sensation. She does get burning pain in flareup but doesn't feel much on good days but still needs maintenance for healing. We use tear substitute eyedrops 6/day and more eg in airconditioning. We judge what's needed by looking closely at: tear film meniscus, bumpy orange-peel dry eye surface. Also, we press upwards gently with 2 fingers under the lower eyelash line and look for a row of tiny dots of oil along the eyelid margin next to the eye surface to see if the meibomian glands are working. We've found a good test of desensitisation/deenervation is to have a staring competition with a friend and compare what happens. Corneal sensitivity and nerve morphology