MY EXPERIENCE WITH BOSTON SCLERALS: The first six weeks
As some of you already know, in late June I went to the Boston Foundation for Sight to be fitted with scleral lenses. This is a summary of my experience to date, which I am sharing both for the benefit of patients who may be interested in this kind of treatment, and for the benefit of physicians who may be interested in hearing about the efficacy and the practical details of this particular application of sclerals. If you have any questions, please don't hesitate to ask. You can always email me privately but for efficiency's sake I prefer that questions be posted in our Sclerals forum on Dry Eye Talk so that others can read the answers too.
PART 1 - Background
What are sclerals? Scleral lenses are basically overgrown gas permeable lenses that restore vision and protect the surface of the eye by holding a constant fluid reservoir against the eye. They were originally designed for keratoconus patients. In recent years they have increasingly been used for patients with other types of advanced corneal disease or injuries, such as Stevens Johnson Syndrome. Most recently, there have been attempts to expand their application to cases with potential for substantial but less dramatic benefits, such as patients with partially disabling photophobia, dry eye or refractive surgery complications who have not been helped with any other treatment modality.
Why did I try sclerals and what am I hoping to achieve? In a nutshell, I am just trying to achieve a sustainable solution for my vision problems. Sclerals seemed like the safest and best way to resolve my vision problems without compromising my ocular surface, and with the side benefit of actively helping my dry eyes.
Long version... I do not have any of the obvious indications for sclerals. However, I do have two problems, both dating to my LASIK surgery back in 2001:
Poor vision: about 20/70 BCVA (meaning best vision achievable with glasses), plus multiple images, grossly reduced contrast sensitivity, and some other special effects, resulting primarily from central "islands" somehow induced by the surgery.
Dry eyes: Not bone-dry like someone with Sjögrens - I don't have much aqueous deficiency, but I exhibit the symptoms of dry eye - pain, stinging, burning, epiphora, photophobia, and so on. I suffer in some degree or another from MGD, slight lagophthalmos, and - I suspect - a mucin layer not working very well.
For me, the vision problem has always been uppermost, but the dry eye problem causes me a lot of pain and has been an important hindrance to getting any solution for the vision. My vision can only be corrected with some kind of gas permeable lens, and while fitting my eyes with a gas perm is challenging enough on its own that I have had to work long-distance with a specialist for years, the dryness makes it even more of a challenge.
After two years of fitful, aborted attempts at getting an RGP resolution that would allow me to drive and work regular hours, in early 2004 I finally got into a pair of specially designed Macrolenses that gave me functional vision and that I could wear for enough hours to make them valuable. This is thanks to Greg Gemoules OD, an optometrist near Dallas who has made a specialty of therapeutic lens fitting for people with complications from refractive surgeries such as RK and LASIK. I have continued to wear these lenses pretty successfully for two and a half years.
Meantime, to keep my eye surfaces in good enough shape to tolerate the lenses and to keep them in decent comfort, I have had to use several tools, including: Dwelle, Dakrina or NutraTear eyedrops as needed; occasional saline rinses (Unisol); lid hygiene (no baby shampoo for me... just lid wipes with Unisol); heat treatment for MGD (rice bag); Panoptx wraparound eyewear for daytime supplemented by Wiley-X for driving; TranquilEyes hydrating goggle at night; and fish or flaxseed oil supplements. I have seen consistent benefits from each of these over time, enough to motivate me to continue, though my need of each individually has its ups and downs.
Fast-forward to February 2006. I had invited the Boston Foundation for Sight to send a speaker to our first annual dry eye conference in Safety Harbor, Florida. Their executive director Mark Cohen kindly joined us and spent quite a bit of time answering the myriad questions from patients during the weekend. Since then I've been getting more familiar with the work they've been doing and the types of patients they've been helping and eventually concluded it might be worth trying for myself.
While I've considered myself a successful Macrolens wearer in terms of the vision and comfort they give me while the lenses were in, I experience a lot of pain after removal and anytime not wearing them. I also worry about my tolerance for Macros long-term. It just seems like having something resting, even if only slightly, on my fragile corneas cannot be a good thing. And my needs in terms of wearing time are pretty rigorous, something I could not achieve with Macros without vision declining and comfort declining noticeably towards the end of the day. The idea of having my corneas bathed in fluid all day long was hugely attractively to me IF that could be combined with vision good enough for driving standards, e.g. 20/40.
For me, trying Sclerals was not an exercise in trying to achieve perfection - just trying to achieve functional vision on a sustainable basis, and if I could get some dry eye relief thrown in as well, that's pretty compelling for me.