scleral lens help

[DrG]

So, I've updated my stats on the results of wavefront-guided lenses on our latest half-dozen keratoconus patients.

When it comes to reducing higher order aberrations - those are what causes glare, halos, and doubling of letters - the scleral lenses alone reduce them by about 60% on average.

By adding wavefront guided optics, those aberrations can be reduced by another 50% on average, with some up to 3 times as much, which brings them into the range of normalcy.

Those results are consistent with the papers that have been published.

The results with the wavefront-guided sclerals are far and away better than can be achieved with any of the soft lenses that I have yet measured.

[CrippsCorner]

I wonder, why does no one ever reply to this thread, is there something I'm missing?

Decided to do some Googling around and it certainly makes for interesting reading. I'd love to know of some kind of technology that was 'up and coming' been on the bald forums a few times lol and there's a whole section dedicated to the future. Is this a similar kind of thing?

http://www.edinburgh-eyetests.co.uk/2020.htm

It seem that they're already available. Also, of course I understand that we KC's can't just get laser treatment, but wouldn't wavefront-guided treatment help at all? Found a great explanation of how it works but I seem to have lost the link for the time being.

[DrG]

I have of course wondered the same thing. After all, the people who are doing this work seem to have KC sufferers in mind. In fact one of them indeed has keratoconus. Some say that the technology is too complicated for widespread use, at least at this time. Unfortunately, we all seem to have the silo syndrome...work in our own isolated areas. I routinely produce these lenses and they uniformly result in improved vision by whatever metrics one wants to use. Furthermore, I have distilled it down to a routine for the most part. I have them manufactured nearly every day.

This website http://www.edinburgh-eyetests.co.uk/2020.htm has evidently been up for a long time, and some of the information is outdated. For example, the contact lenses do not exist. The discussion of the theory and the graphics are valid, but the product doesn't exist.

There have been a few attempts to commercialize wavefront-guided soft lenses. The IZON company was one of them but abandoned it. IZON is now defunct. There is a company in the Western U.S. called Wave-Form who is manufacturing some type of soft lens. I have no experience with it and cannot find much on it. There was a company called WaveTouch who manufactured another wavefront-guided soft lens (I think under license from the Wave-Form people), but I haven't heard of anything from them in a number of years. Presently, the thrust seems to be with producing a wavefront-guided scleral lens because the optics are better suited. The results are very consistent.

In the final analysis, those lenses will not be for everyone. In our times, not all opticians have corneal topographers, let alone the aberrometers and other equipment that is necessary to produce these custom lenses. Many early KC sufferers will still be able to get along with conventional lenses for the foreseeable future. Besides, eye aberrations do change, and lenses would need to be updated at some determined interval.

I look forward to more discussion if anybody has the interest.

[Amarpreet]

Hi,

I currently use regular scelral lenses given to me by the NHS. I'm just wondering what the difference is between regular scelrals and these wavefront scelral lenses. Sadly I will probably never be able to come to the US just for treatment, but I would like to think that these lenses may make their way to the UK at some point!

Also, I had a partial corneal transplant in my left eye a few years ago, and to date, my hopistal hasn't been able to fit me with a lens that fits properly (they're great, but the gap between appointments is very long). Do you have any testimonials or case studies of these lenses being used on eyes with transplanted corneas?

Thanks in advance
Amarpreet

[DrG]

Amarpreet,

I have been using wavefront technology in scleral lenses for several years now for all sorts of conditions, including corneal transplants. In fact, just this week a patient with keratoconus and penetrating graft returned after 2 years for a lens upgrade. He lives in Dubai. His case study is on my website http://www.laserfitlens.com, as are a number of others. While I do keep a log of results, they have not yet been published. However, a couple of authors have published their results. They are in academe, and their results mirror mine. The incorporation of wavefront technology in my practice came about as a result of my practice specializing in highly aberrated eyes, and finding that regular contact lenses just fell short in too many cases. I am one of the early pioneers in the adaptation of wavefront technology to scleral lenses. The bottom line is that vision improvements are achieved in the vast majority of cases with this technology. It can be difficult and time consuming, but the results are often worth it.

However, you seem to be concerned about the fit, which is a separate issue from the optics. Another technology that is a precondition to being able to do wavefront optics, is that of conforming the lens to the shape of the individual eye, as this creates a lens without rotation. In days gone by, this was done by taking impression molds of the eye. My contribution was to use a digital scanning process to create a virtual impression of the eye. This process almost always results in a perfectly fitting or nearly perfectly fitting lens for any eye.

As to when this comes to the UK, I can't say. As of this writing no UK optometrist has contacted me. I think that the general attitude is one of skepticism, which is understandable. However, I might schedule a trip to the UK in the near future to explore the possibility.

[DrG]

I am posting the link for a patient who started out with keratoconus, had a penetrating graft, and then had LASIK over the graft. After seeing well for a number of years, his vision suddenly started to deteriorate. None could help him where he lived in Dubai. Since he could well afford to travel, he came to see me in 2012, whereupon I fit him with an 18 mm scleral lens designed from the OCT scans of his eye. Since he still had some residual vision issues, I applied wavefront-guided optics to achieve better results. This week he returned for a refitting because of some new technology I had. Because I had his eye images on file, I was actually able to fabricate a new lens using new software and the lens was a perfect fit. This gave me a head start on the fitting process, and we were able to craft a new lens with improved optics in less than 5 business days. With the new lens in place, he was sensitive enough to detect 0.25 diopters of astigmatism: the over-refraction was +0.25-0,25 x 75. On the next and final lens I was able to eliminate it, and he could tell the difference. This is the level of detail I am used to working with. Of course, not everybody gets the same results.

http://laserfitlens.com/wavefront-scler ... ase-study/

[Amarpreet]

Hello,

Thanks for the reply Dr G. I guess I will consider coming down to your clinic sometime in the near future for a lens or two. Gonna need to save up some money first though!

Thanks again
Amarpreet

[DrG]

Last week saw yet another keratoconus patient from the UK. He said he found me on some forum. He's one of those who finds help on a forum but doesn't post. So I'll post for him.

He got his KC symptoms after LASIK. He tried all the usual contact lenses, and finally got cross-linking. He came to me wearing a 16.5 mm mini-scleral lens. To make a long story short, he still wasn't happy with vision because of glare, shadow images, etc. I measured the aberrations with his current lens and they were high. It's in the record.

In a just a few days time we had his aberrations down to below normal levels - almost aberration free - and his visual acuities were 20/15 in each eye (he actually read some 20/10 letters). He said the results were "astounding" without any traces of glare or distortion in his worse eye. The lenses we fit him with were 18.0 mm in diameter with wavefront guided optics.

He's going to be here another week, but I'm not sure what we are going to do since we finished early. Maybe I can convince him to post here.

[DrG]

I saw my UK visitor for the last time today. He seemed very happy with his vision. He has submitted a registration form with this forum, so I am hoping he will at least validate my story. We were essentially finished within the first 5 days, but he had originally booked a two week stay, and so he gave me leeway to try anything I might wish to try on him just to see how far we could push the visual envelope. He settled for 20/15 and no glare or ghosting. At some point I should like to visit the UK again and visit some specialists.

[ax628]

Hi I’m the patient Dr G mentioned in the previous post. I returned home to the UK at the weekend after my visit to the clinic in Texas, and I am pleased to say I have had excellent results.

As mentioned I developed KC after lasik surgery which subsequently gave me a great deal of ghosting and starbursts, particularly in the right eye. After having cross-linking in both eyes I tried a huge variety of contact lenses which unfortunately did very little for the glare and starburst effects I was experiencing.

I then spent a long time doing my own online research into the options for better solutions to my ongoing condition. As part of this research I read many very positive responses about wavefront scleral lenses being developed in Coppell, Texas by Dr Gemoules. I then discussed my condition and the possibilities for a successful outcome online with Dr Gemoules. After much careful consideration I decided to visit the clinic there for treatment and set up the appointment. I settled in at the hotel at the weekend then on the Monday hopped on the free shuttle service the hotel provides to the clinic. On the first day Dr G performed comprehensive laser scans on my eyes. These involved machines I had not seen before in the UK which were able to measure the number of higher order aberrations in my eyes and the shape of my eyes. The computer scan from this process showed the exact ghosting/glare pattern I was experiencing. After the scans my first custom pair of scleral lenses was ordered to arrive for the next day.

On each subsequent day of my visit new scleral lenses were made, each improving on the last by reducing the starbursts and ghosting as well as dramatically improving my visual acuity. By the end of the first week most of my higher order aberrations were gone, and both my eyes could read 20/15 on the chart (it amazed me that I would ever be able to do this, particularly with my right eye which is a visual smeary mess without the lens in). Returning to the hotel room I was finally able to watch the television without the awful aberrations interfering with my vision. On a walk outside I was amazed that my night vision was clear for the first time in years, the light from car headlights was small once again and I did not experience the terrible glare from lamp post lights I would usually get. In the second week of my stay Dr G was able to improve my lenses even more.

I realise it’s a big step for a lot of people to fly all that way for contact lenses, but I’m extremely glad I did. I really think that this procedure, with its cutting edge technology and its individually customized lenses, should be the standard treatment for all KC sufferers and I hope that other people in my position can benefit from this too. The fact that I was returning to the clinic each day helped a lot as you can actually experience the incremental improvements to your vision as the days pass. It is also clearly evident that Dr G is passionate about treating difficult eye conditions like KC and will patiently work with you to get the best possible results.

I would be happy to reply to any question anyone may have about my visit to the clinic.