Not doing too well with a scleral

[Andrew MacLean]

Dear all

Just to recap: I had a cornea graft in my right eye in December 2003. i still have 8 stitches in place, and these seem to be holding the cornea in a quite irregular shape, giving me no useful sight in that eye.

I wear a scleral in my left eye. This has never been comfortable much beyond a couple of hours at a time, but recently my eye has started to hurt a great deal when the lens is removed (I am down to about an hour of wearing time a day).

Is this consistent with the experience of other scleral wearers?

Andrew

[Susan Mason]

Hi Andrew

My sclerals started to give me problems back in April 2004. First the left one shortly folloed by the right.
Initially in both cases wearing them was uncomfortable, however not really painful. My eye would get a red ring around it's iris and after removing the lens the eye was painful for a while (daft really as whilst the lens was in it just felt uncomfortable not painful)
It turned out my eye had changed shapr and the lenses needed to be refitted and over a period of 7 months I had both lenses refitted.

Could it be your lens needs refitting?

best wishes Susan

[Andrew MacLean]

Thanks Susan

I was at the optometerist who originally fitted the scleral and she said that there was no change in the "fit". My eye has always grown "tired" with the scleral in place, but it is only when the lens comes out that it is sore.

So I am left without any useful sight, apart from the period of up to an hour each day when I can wear the scleral (I was building up in ten minute increments from half and hour a day after my last optometerist appointment, and got to an hour which seems to be the limit of my tolerance). With the scleral in I can see the top line, without it I have "waving hand" sight.

Yours aye

Andrew

[Dave Dale]

Can I ask a question?

What are the symptoms of intolerance to contact lenses?

It may seem a daft question but what happens? Does th eye water loads with excessive pain or does it just have no benefit to vision?

Thanks.

Dave.

[Lynn White]

Andrew....

As you may have seen, I am an optometrist who has dealt a lot with keratoconus. I am not sure if you have exhausted all posibilities?? It seems to me that with one hour of useful vision you are at a real disadvantage!!

You are having these symptoms because your eye cannot tolerate the oxygen deficiency that the scleral creates. Have you been through the route of RGP's, soft perm and soft lenses already?? If not, then it may well be worth pursuing. You really have not got a lot to lose. Plus what is being done about the right graft - have you investigated about having stitches removed?

If you give me more information I may have a clearer picture and be able to give you more advice.

Dave - intolerance symptoms can often be hard to explain. Yes you do sometimes get a lot of watering - often, with GP's it just feels like having half a brick in your eye. With sclerals, your eye often feels hot and "achy" and you just want to get the lens out. If you get oxygen deprivation, the vision can go misty and "smoky" as well - this is caused by oedema or swelling of the cornea.

When you remove the lens, the oedema rapidly goes away, as the cornea sucks in oxygen from the atmosphere really quickly. However, the sensation comes back with a vengeance - a bit like pins and needles in a hand or arm you have leant on too hard. This is why people complain its uncomfortable with it in but then painful when it comes out.

Lynn

[Andrew MacLean]

Dear Lynn

Thank you! Yes, I have run the full gambit of lenses and the scleral was the last ditch.

As to my graft eye: they had booked me in for the removal of the remaining eight stitches on February 4, but decided not to proceed. The sight in my graft eye actually got quite a bit worse when they took out the first eight stitches. i reckon that I am now back to the position I was in before surgery.

My scleral was taken away to have a fenestration drilled, so it has been adapted to allow oxygen to pass onto the cornea, but my eyes tend to be dry, and it may be that there is no film of fluid that will allow the oxygen to dissolve. On removing the lens I ply my eye with various artificial tears: Hypermelamose and Carbomer (spelling?)

Yours aye

Andrew

[Lynn White]

OK Andrew...

Ahhhh right, I understand your position. Forgive me for pursuing this a bit further - but did they actually try the Kerasoft on you? In my experience you can get longer wearing time than a scleral with this lens.

As far as dry eye drops - the new Alcon product Systane works much better than the ones you are currently using - try them out. Also - do you try filling the lens with a non preserved comfort drop like Refresh before insertion?

As to the graft - yes well.. the vision can often go worse on stitch removal because the corneal shape "relaxes" and changes as the tension from the stitches is released. This is why people who have had grafts often have to go back to CL's afterwards.

Again, while in Trinidad I fitted a lot of post grafts with kerasoft - even with stitches still in there.

Have you also tried an "Apex" lens?? This is a very large RGP - typically 12.00 mm in diameter which can sometimes bridge the gap between normal RGP's and sclerals.

Sorry to ask so many questions but I never like to give up!!

Lynn

[Sajeev]

Lynn....you sound like an optometrist that REALLY cares

[Andrew MacLean]

Dear Lynn

Never apologize for asking the right questions.

Yes they did try me with Kerasoft lenses on the way through from RGP Corneals to Sclerals. They also tried me with what I take to have been the Apex lens you describe. They said it was "half way to a haptic".

I'll give Systane a swing! I do fill the scleral with refresh just as I put it in. the problem with my fenestration is that whenever I blink the fluid filling the lens is forced out (a bit like a whale blowing ... I have this silly idea that somebody standing too close will be soaked by the little jet of fluid that probably streams no further than my nose!)

The surgeon who did my graft does not seem too alarmed at the poor vision in my right eye. In fairness he did say that the recovery period would be up to two years, and if I have to wear lenses again in that eye after the whole process is over, I'll not be too disappointed.

In the meantime I usually find it easier not to try too hard to see things. When I do not have my scleral in my left eye I get about more-or-less well, and I am able to continue in full time work. With my lens in I can busy myself with the stuff that is helped by some vision, but as I can only see the top line with the lens in even this is fairly limited.

I do miss reading, and I miss driving, but talking books and a computer that reads things out loud go some way to mittigating both of these effects. I love art and look forward to being able again to visit favourite galleries.

Thanks again for your interest.\

Andrew

[Lynn White]

Ahhh yes.....

I can see you have been there and done that !! If your ophthalmologist is cool about your other eye then it is probably just taking time to settle...

I think I saw you said on another thread that your grafted eye was -16D . If that is the case, then you are not seeing because it needs a high power lens to bring the vision up rather than there being any problem with the graft. This may well alter when they sort the stitches.

Lynn