Mini Sclerals lens fitting

[Alan]

Hi,
My ophthalmologist is encountering endless problems with removing a big bubble
between the mini scleral lens and the cornea. Amongst many lenses
he made he tried to change the diameter ,height , base curve etc...
have you experienced this probe?
can anyone provide some professional assistance in this regard?
I can not use small diameter lens nor proper scleral lens.
other than this major issue of the bubble - the fitting is perfect and the tip of cornea does not touch the lens which was the major probe prior to the bubble issue.
thx ,
Alan[color=blue][/color]

[Susan Mason]

Alan
I cant give u any professional advice, however from a personal point of view, (currently wearing scleral lenses) - I can say that even after 12 months with lenses, I still get some bubbles & more often than not, need to allow about 1/2 hour to put my lenses in to be on the safe side.

I expect that lots of others will find amusement with this and to some of the postions I have at times adopted to get the little horrors in. In fact, I am currently trying storing them wet to assist with dryness and also try yo reduce the number of bubbles I was getting, especially with the left eye on not-so-good days. When recently the left eye was swopped as I needed a different fit, the bubbles issues once again became more frequent and also on the larger side ( I had managed to get them down to a pinhead size previously). I am also strange in the fact that I seem to be able to put my lens in which may feel ok for a few minutes, then after several blinks, a bubble will appear, even if at times this will start as a small pinhead, it will after a few more blinks increase in size to the point where i have to start again!

Have u had any more success than ur optician when putting lenses in?

Susan.

[John Smith]

This may just be a coincidence, but with my scleral, which I fill with either Amidose or Celluvisc, I never get bubbles with the Celluvisc, but regularly do when using Amidose.

Why the two solutions? Well, I tend to use Celluvisc when preparing for a "long wear day", as I do seem to get a longer, more comfortable wear when doing so (though I still suffer the consequences the following day!).

Celluvisc is very viscous, and that probably helps prevent bubbles, but it could also be the simple fact that as Celluvisc comes in small phials, the scleral lens is only generally half full. An Amidose day completely fills the lens.

[Alan]

Susan and John - thx , very interesting.
I must add that I am a guinea pig in a way on a new type of Mini
Sclerals , I do not use any liquid to fill in the lens , and there are holes in the lens to allow for air to flow in and out , mainly out.
(although I wet the lens with the Boston solution which is a very "thin" solution) -
they r of a special type of
high gas permeable material , I will find out the type...
(btw I visited a top clinic in Boston Mass. USA for a 5 days lens fitting Marathon
in 2001 and they had a similar lens filled in with solution similar to the ones u have)

Yet to reduce the bubble prob my ophthalmologist "drilled" 3 holes
close to the rim , as far as possible from the cornea tip .
He was not happy in making more holes as this make the lens " flatter"
and the huge bubble was reduced to a smaller one , However vision is still blurry.

I belong to the group of KC'ers who prefer not have the lens filled in with liquid, and to wear them as if they were normal gas permiable lenses.
Any suggestions?

[John Smith]

Hi Alan,

Ken Pullum has asked me to post this: (If you weren't aware, "Fenestrations" are the holes your practitioner drilled in your lenses.)

I have to try to avoid being overbearing, but it could be the clinic is just not looking at the obvious (and usual) option. Fenestrated sclerals were necessary in the old PMMA days to let in some oxygenated tears. However, they also let in air bubbles, hence the discussion. It was not so bad with PMMA because some corneal contact was usual, and not always a problem, but contact with GP sclerals is much worse than PMMA. The great majority are fitted without fenestrations, and mostly keep the pre-corneal reservoir air free. The obvious next step for Alan is to try non fenestrated sclerals. The fenestrations are not needed in most cases for oxygen access via tear exchange, but there is still a prevailing view in some quarters disagreeing with this. Disagreement is great, because it promotes corner fighting, which spurns developments, but irrational objections are very counterproductive. We (practitioners) can have and promote our preferences, we all do that, but also need to be receptive to all options to achieve a result.

If Alan's practitioner has not tried the simple way, ie non fenestrated, he should. If he has already, John's suggestion of Celluvisc is well worth a shot, and if that fails, the final option of impression moulded GP sclerals remains to be tried. Impression sclerals are a more cumbersome production process, but definitely can be made when necessary, and we are becoming better at it all the time.

[Shirley O'Donnell]

I would just like to endorse what Ken/John said about sclerals. Some time ago my eyes could no longer tolerate corneal lenses and I tried mini sclerals. Although these were comfortable i could not wear them for any length of time due to the bubbles which quickly formed and through which it was impossible to see anything. Finally I had a full size impression moulded scleral made for my right eye. I can wear this all day and even if sometimes one or two bubbles do form they seem to get lost somewhere in the size of the lens and do not effect my vision at all. Hope this helps!