7800 SW 87 Ave Suite B-270 Miami, FL 33173 305-271-8206

Category: scleral lenses

What Is The Best Scleral Lens?

What Is The Best Scleral Lens?

What Is The Best Scleral Lens?

Eye Freedom - What Is The Best Scleral Lens?

Occasionally I will be asked questions about scleral lens quality and about what is the best scleral lens. Many patients think about scleral lens technology like many of us think about cars or electronics. Most of us assume that a Mercedes Benz is a superior automobile compared to most other cars. This is not how it works when it comes to specialty contact lenses and specifically to scleral lenses.

Every eye is different and so is every patient. Not only that, every ocular condition comes with its own unique history. In addition to this, the shape and contour of every eye is different just like every face is different. Thankfully, today’s scleral lens technology allows us to create individualized scleral lens designs to better address the vision and comfort needs of every patient.

 

How Do You Determine The Best Scleral Lens Design For Each Patient?

When patient’s first come to visit our specialty lens practice, there are many things that we need to consider. These include the patient’s medical history, their visual acuity and comfort with their existing eyeglasses or contact lenses.

We also want to know what the patient’s goals are, what kind of work that they do, how they use their eyes. Before getting involved with any lenses, a careful eye health examination is done. Images and photos of all the ocular structures are taken and carefully documented.

Once we decide to fit a patient with a scleral lens, careful measurements are taken of the front surface of the eye. These include corneal topographies, and anterior segment OCT (optical coherence tomography) images. In addition a careful dry eye evaluation is done including images of the patient’s meibomian glands. These are the glands located within our eyelids and are responsible for keeping the ocular surface moist.

There are 3 methods that doctors use to design a scleral lens. These include:

  1. Conventional scleral lenses that are designed using a diagnostic scleral lens fitting set.
  2. Customized scan based technology using special imaging computers capable of measuring (virtually) every “hill and valley” of the ocular surface of the eye. The images taken are uploaded to a special lab that uses software compatible with our imaging computer to allow them to make a scleral lens with every aspect of the ocular surface embedded into the back surface of the scleral lens. In other words the scleral lens is designed to exactly fit the patient’s eye.
  3. Impression based scleral lens technology. This technology involves taking an impression of the front surface of the eye. It is a pain free procedure that takes about 3 minutes to do. The impression taken is sent to a special lab where 3-D printing technology is used to make a scleral lens where every “defect” along the ocular surface is embedded onto the back surface of the scleral lens.

With the scleral lens technologies explained above, almost all of our “hi need” patient population are comfortably wearing scleral lenses created by the last 2 technologies explained above.

 

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World Wide Eye Facts

World Wide Eye Facts

World Wide Eye Facts

Eye Freedom - World Wide Eye Facts
  • Globally at least 2.2 billions people have vision impairment, and of these at least 1 billions people have a vision impairment that could have been prevented or is yet to be addressed
  •  By 2050, 4.8 billions people (half of the world’s population) is projected to be nearsighted (myopic).
  •  Cataracts are the main cause of blindness worldwide  and impact 100 million people at the present time.
  • Diabetes is the leading cause of blindness in North America
  • Globally more than 340 million people suffer from dry eye disease (DED). Meibomian Gland Dysfunction is the leading cause of dry eye disease affecting 86% of patients suffering from dry eye disease.

 

Corneal diseases and conditions are a leading cause of blindness worldwide. These diseases and conditions include keratoconus, refractive surgical complications, corneal ectasia, complications resulting from corneal transplant surgery, ocular trauma, corneal scarring, corneal dystrophies and degenerations (ie Stevens Johnson Syndrome), complications resulting from autoimmune disease (ie rheumatoid arthritis), ocular surface disease resulting from chemotherapy, complications resulting from ocular plastic surgery, incomplete eyelid closure due to neurological complications and ocular surface disease to prolonged use of many medications and treatments.

 

Many of the patients with conditions described above suffer from both poor vision and severe ocular pain. Many of these patients are unable to completely close their eyes and as a result cannot sleep throughout the night due to the necessity of using ocular lubricants frequently. Our specialty lens practice has the technology to design and fit highly customized oxygen permeable scleral lens shields to protect the delicate ocular surface tissues and keep these tissues moist during sleep. We design these scleral shields with the aid of computers using proprietary software. These scleral lenses or scleral lens shields that we design for patients with chronic dry eyes due to eyelid closure issues are different from the scleral lenses that we design for patients without these issues.

 

In general, a scleral lens is a large diameter lens made of a highly oxygen permeable material. It does not move on the eye. It is not a contact lens in the strict sense of the word as it has no contact with the cornea. Instead, a liquid reservoir of sterile saline solution fills the space between the back surface of the scleral lens and the front surface of the compromised cornea. The liquid reservoir fills in the surface irregularities of the cornea allowing vision to be restored in a comfortable manner. The scleral lens and the liquid reservoir beneath it protect the cornea from exposure to the environment and the rubbing effects of the eyelids when blinking. This cushon of fluid beneath the scleral lens also provides oxygen to the cornea allowing the eye to undergo a healing process. The effect is to create a smooth optical surface over the diseased or compromised cornea that replaces the distorted corneal surface. In all of the patients who we have treated, vision and comfort have improved dramatically due to the life changing abilities of scleral lenses.

 

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What Is A Scleral Lens?

What Is A Scleral Lens?

What Is A Scleral Lens?

Eye Freedom - What Is A Scleral Lens?

A scleral lens is a large diameter lens made from an oxygen permeable polymer that is designed to vault over the front surface of the eye. A scleral lens is not considered a contact lens as there is no contact with the front surface of the eye, the cornea. Instead a scleral lens is designed to vault over the cornea and come to rest on the white portion of the eye, known as the sclera.

WHY A SCLERAL LENS AND NOT EYEGLASSES OR REGULAR CONTACT LENSES?

A scleral lens is intended to restore vision to patients who have lost quality vision and comfort due to ocular diseases, chronic dry eyes, ocular trauma and unanticipated ocular surgery complications. When treating an eye with a damaged cornea, eyeglasses will not provide functional vision. Almost all of the eyes that we see with damaged ocular surfaces cannot tolerate a conventional contact lens. This is because conventional contact lenses, both soft and rigid, rest on the corneal surface. While vision improvement may be achieved upon inserting these lenses, comfort readily decreases after a very short wearing time. In addition, conventional contact lenses can cause further damage to the highly compromised ocular surfaces of these eyes. We have to appreciate the fact that a preservative free saline reservoir exists between the back surface of the scleral lens and the front surface of the eye. This preservative from the liquid reservoir helps to provide nutrients to the cornea and allows a healing process to take effect. In other words, in addition to providing our patients with quality vision, we are helping the damaged ocular surfaces to heal.

WHAT ARE THE PRIMARY INDICATIONS FOR SCLERAL LENSES?

The primary indications for scleral lenses are corneal irregularities due to cornea diseases and conditions such as keratoconus, corneal ectasia, chronic dry eyes, complications resulting from refractive surgery such as LASIK, a variety of corneal degenerations and dystrophies, ocular trauma, corneal transplant surgeries and many other conditions. In effect, a well designed and fit scleral lens replaces the cornea as an optical surface. The resulting improvement in vision and comfort is almost always dramatic and can be very emotional for the patient. Over the years we have had many patients break down in tears upon receiving their scleral lenses and experiencing the dramatic improvement in vision.

I have been using scleral lenses for over 25 years to treat some of the most complicated and challenging ocular conditions. One example would be a patient who we treated who lost the upper eyelid of one eye due to flying glass from a car accident. Because he could not close this eye, the cornea soon began to degenerate due to prolonged exposure to the atmosphere. We fit this eye with a very thin, highly oxygen permeable scleral lens designed to both protect the ocular surface and to provide vision during a 12 month long eyelid reconstruction period where multiple eyelid surgeries were performed. There are also diseases and conditions of the inner lining of the eyelids that can create a painful eye. Many of these eyelids will scratch the cornea every time a patient blinks. The scleral lens will protect the ocular surface from the blinking action of these eyelids and also allow the ocular surface to heal.

HOW HAVE SCLERAL LENSES CHANGED THE WAY WE TREAT PATIENTS WITH OCULAR DISEASE?

Scleral lenses have dramatically changed the way we treat and manage patients who have lost vision due to corneal disease, surgery and ocular trauma. Scleral lenses have helped to reduce the need for surgical intervention and have significantly improved the quality of life for hundreds of thousands of patients especially those suffering from severe ocular surface such as Stevens-Johnson Syndrome, grafts host disease, neurotrophic keratitis, exposure keratitis and neuropathic pain. Because of the exciting and innovative improvements in scleral lens designs, the number of patients undergoing corneal transplant surgery in the United States has declined dramatically over the last 10 years.

WHAT ARE THE ADVANTAGES OF SCLERAL LENSES?

The main benefit of scleral lenses is that they can be designed to accommodate any degree of corneal steepness or shape. Scleral lenses provide better centration and stability than conventional contact lenses and they are more comfortable because the conjunctival tissue on which the scleral lenses rest is less sensitive (has fewer sensory nerves) than corneal tissue.

Furthermore, in patients who have experienced damage to corneal tissue, scleral lenses do not touch the cornea but rather bathe it continuously in preservative free saline so that scar formation is not encouraged and a healing process can take place.

ARE THERE DIFFERENT TYPES OF SCLERAL LENSES AND IF SO WHICH SCLERAL LENS IS BEST?

When our specialty practice introduced scleral lens technology to Florida in the early 1990’s, there was only one scleral lens design and only one scleral lens laboratory in the United States. Since then there has been an “explosion” of scleral lens materials and designs. It would be best to consider these different scleral lens designs as treatment options instead of pieces of plastic. Sophisticated computers using proprietary software are now used in both the manufacture of scleral lenses and in the designing and fitting of these lenses in the doctors’ office. Certain lens designs, materials, shapes and diameters may work well with one eye but not with the other eye. We have many patients using a scleral lens made by one laboratory on one eye and another scleral lens design made by a different laboratory on the other eye. It is definitely not one size and one design fits all.

WHY IS THERE SUCH A LARGE VARIATION IN THE COST OF SCLERAL LENSES?

What must be appreciated is that every patient is different and unique. Some ocular conditions are extremely complicated and may require a great deal of time to arrive at a successful conclusion. In addition, the laboratory costs of scleral lenses can vary widely due to materials and technology used in manufacturing these lenses. Therefore, the cost of the scleral lenses and the professional fees charged can vary for these reasons. What is most important is to find a doctor willing to spend whatever time is required to make sure that a successful outcome is achieved. Scleral lenses are a life changing technology that has positively affected the lives of hundreds of thousands of patients.

 

 

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Frequently Asked Questions About Scleral Lenses

Frequently Asked Questions About Scleral Lenses

Frequently Asked Questions About Scleral Lenses

Eye Freedom - Frequently Asked Questions About Scleral Lenses

1. WHAT IS A SCLERAL LENS AND WHY DOES IT WORK SO WELL TO TREAT MANY OCULAR CONDITIONS?

A scleral lens is a large diameter lens made of highly oxygen permeable material. It does not move on the eye. A scleral lens is not a contact lens in the strict sense of the word as the scleral lens has no contact with the cornea. Instead, a liquid reservoir of sterile saline solution fills the space between the back surface of the scleral lens and the front surface of the cornea. This liquid reservoir fills in the surface irregularities of the cornea allowing vision to be restored in a comfortable manner. The scleral lens and the liquid bandage beneath it protect the cornea from exposure to the environment and the rubbing effects of the lids against the compromised ocular surface. This liquid bandage beneath the scleral lens also provides oxygen to the cornea allowing the damaged ocular tissue to undergo a healing process. The effect is to create a smooth optical surface over the diseased or compromised cornea that replaces the distorted ocular surface with a distortion free optical surface. Almost always, a well designed and fit scleral lens will dramatically improve vision and comfort.

2. WHAT EYE CONDITIONS ARE BEST TREATED WITH A SCLERAL LENS?

There are a number of eye diseases and conditions that are best treated with a scleral lens. What must be appreciated is that a well designed and fit scleral lens is a medical device and a therapeutic device all in one. The lenses that we design can be made to fit virtually any eye shape and any degree of visual error while at the same time allowing the diseased or injured eye to heal. The common ocular conditions that we treat with scleral lens include:

Keratoconus

Pellucid Marginal Degeneration

Post-refractive surgical complications due to LASIK, Radial Keratotomy surgery, PRK, ALK, CK, and so on. Many of these complications include distorted and fluctuating vision, halos, light sensitivity, reduced vision at night and indoors, halos, starbursts, double vision, ocular pain and chronic dry eyes.

Complications resulting from corneal transplant surgery such as irregular corneas, chronic dry eyes, and unstable vision.

Post-Lasik corneal ectasia. At one time it was thought that corneal ectasia was a rare risk factor for LASIK. In reality, we are seeing more and more patients suffering vision loss due to LASIK induced corneal ectasia and many other side effects that can occur many years after the LASIK surgery was performed.

Chronic dry eyes due to systemic disease, medications and a variety of ocular conditions.

Many auto-immune conditions such as Stevens Johnson Syndrome, Sjogren’s Syndrome and corneas damaged as a result of ocular trauma, corneal degenerations and dystrophies, chemical and burn injuries to the eye and adjacent ocular structures, eyelid abnormalities, aniridia and many other diseases and conditions.

3. MY PRESENT LENSES HURT AND VERY OFTEN POP OUT OF MY EYE. WILL THIS HAPPEN WITH SCLERAL LENSES?

No. When properly designed and fit, a scleral lens will not dislodge or pop out of your eye. This is because scleral lenses are large and come to rest on the white portion of the eye. Scleral lenses do not move on the eye and the edges of the scleral lens fit under the eyelids.

For this reason scleral lenses are very stable and extremely comfortable. Will virtually every one of our patients, the comfort of our custom made scleral lenses is equal to or better than the comfort patients experience with a soft contact lens.

4. ARE SCLERAL LENSES DIFFICULT TO INSERT AND REMOVE?

No. However, everyone has to be taught. The teaching session that we provide to our scleral lens patients typically lasts about 20 minutes.

Like anything else, there is a learning curve. Almost all of our patients manage this within a very short period of time.

5. WHAT CAN I EXPECT TO TAKE PLACE ON MY INITIAL VISIT TO THE GLOBAL VISION REHABILITATION CENTER?

The initial visit will include the following:

 A careful and comprehensive health history including your ocular and family history

A comprehensive eye health examination involving both the anterior and posterior ocular tissues (cornea, retina, optic nerves etc) A number of instruments and computers will be used to image all of these ocular structures.

A careful examination of the eyelids and ocular glands responsible for maintaining a healthy pre-corneal tear film. In addition, a careful and detailed dry eye evaluation will be done.

Computerized corneal topography will be done on both eyes. This technology is essential for measuring the curvatures of the front surfaces of the eye (the cornea). The information that this technology provides us is invaluable in helping us to design the proper scleral lenses needed for your eyes.

Optical Coherence Tomography (OCT) allows us to evaluate the integrity of your corneas and also to examine the relationship of the scleral lenses and the ocular surfaces of your eyes. With OCT we can measure the clearance (to within 4 microns) between the back surface of the scleral lens and the front surface of your eyes. OCT allows us to obtain a level of precision in scleral lens fitting not possible until now.

Your scleral lenses will be ordered at the end of the initial visit. New lenses almost always arrive the next day. Please know that the procedures described above will be repeated during follow-up visits to make sure that all of the ocular structures are maintaining their integrity and that no changes are taking place in the scleral lens– cornea relationship.

6. WHY ARE YOU SO PASSIONATE ABOUT SCLERAL LENSES?

For over 30 years, I have been intimately involved with the design and manufacture of many scleral lens designs. Our newest design scleral lenses have proven to be so effective in treating the many vision disorders and conditions of our “hi need” patient population that we named the scleral lens after our practice: The Global Vision Rehabilitation Center” hence, the GVR scleral lens.

In North America, there are millions of patients that have ocular conditions that cannot be properly addressed with eyeglasses or contact lenses. It is only the scleral lens made from a highly oxygen permeable material that has the ability to dramatically restore quality vision and ocular comfort to this very special “hi need” patient populations.

I believe that the quality of our lives is directly related to the quality of our vision. If a person has lost vision due to keratoconus, LASIK, ocular trauma etc. Then all other aspects of that person’s life are also negatively impacted. There is no greater reward for me than to be able to play a part in the restoration of a patient’s vision. That is what our specialty practice is all about and it is also what I am about, professionally.

 

 

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What Is Dry Eye Disease Or Dry Eye?

What Is Dry Eye Disease Or Dry Eye?

What Is Dry Eye Disease Or Dry Eye?

Eye Freedom - What Is Dry Eye Disease Or Dry Eye

Dry Eye can be a complicated and challenging condition for most patients. There is not always a simple “fix” to treat a patient suffering from a chronic dry eye. There are literally hundreds of treatment options currently on the market including over the counter eye drops, eye vitamins, prescription medications and a number of medical devices in doctors’ offices designed to treat patients suffering from dry eye. There is not one treatment or therapy that will address the needs of every patient suffering from a dry eye.

The main cause of a dry eye is an unstable tear film that degrades or evaporates too quickly leaving areas on the ocular surface dry. When this occurs, the result can be blurred or fluctuating vision along with ocular discomfort and pain. The near cause of this is abnormally thick or a reduced amount of oils in the tears due to blockages in the oil glands within the eyelids, known as the meibomian glands.

HOW IS DRY EYE TREATED?

To unclog the oil producing glands within the eyelids, and to provide comfort to patients suffering from dry eyes  we use a technology known as ILUX. This technology allows us to apply regulated heat to the inner eyelid with an on and off messaging action draining oils from the blocked meibomian glands. This draining or cleaning action encourages the more natural production of oils needed to stabilize the tear film. ILUX is just one of the technologies that we use to treat a dry eye. One of the most effective technologies that we use to treat a patient suffering from a chronic dry eye where previous medications and therapies were ineffective is a well designed and fit scleral lens. I will explain this in more detail shortly.

WHAT ARE THE SYMPTOMS OF A DRY EYE?

  • Stinging, burning and itchy eyes
  • A gritty sensation when blinking or the feeling of a foreign body in the eye
  • Red eyes
  • Ocular discomfort and/or eye pain or a constant burning sensation
  • Difficulty driving at night
  • Inability to read or perform near vision tasks for any length of time
  • Inability to wear contact lenses
  • Blurred or fluctuating vision

WHAT ARE SOME OF THE CAUSES OF A DRY EYE?

  • Aging
  • Medications such as antihistamines, antidepressants, or hormone replacement therapy.
  • Medical conditions such as high blood pressure, Sjogren’s Syndrome and thyroid disorders.
  • Exposure of smoke, wind or dry air.
  • Prolonged reading or computer work
  • Ocular trauma
  • Elective eye surgeries such as LASIK and Radial Keratotomy surgery.
  • Corneal transplant surgery
  • Autoimmune conditions resulting from chemotherapy and other medical treatments.

HOW DO YOU DIAGNOSE DRY EYE?

  • Patient history
  • Examination of the ocular surface with a slit lamp using special dyes
  • Evaluating the tear film break up time and the statue of the meibomian glands using the keratograph.

WHY A SCLERAL LENS FOR DRY EYE TREATMENT WHEN OTHER TECHNOLOGIES ARE INEFFECTIVE?

There are millions of patients throughout North America who suffer from chronic dry eyes. Many of these people are suffering from a dry eye due to ocular surface disease. Others have dry eyes due to the medications that they are taking. A chronic dry eye can also be a symptom of a system disease such as lupus, rheumatoid arthritis, rosacea or Sjogren’s Syndrome ( a triad of dry eyes, dry mouth and rheumatoid arthritis).

Millions of post-refractive surgical patients who underwent ocular surgery such as LASIK and Radial Keratotomy are suffering from dry eyes. The main reason for this surge in dry eyes in this particular population is the irregular compromised ocular surface caused by these surgical procedures. Many of these patients still have open corneal wounds which never healed completely. Needless to say, many of these patients have suffered significant pain which resulted in severe depression and the many ramifications of severe depression. These include loss of work, inability to study, family strife and so on. In addition the vision in this patient population is not stable even with eyeglasses and conventional contact lenses. Conventional contact lenses may provide clear vision for a brief period of time but significant discomfort and pain will occur within a very short amount of time.

Over the years our specialty lens practice has treated thousands of patients who have suffered for years with chronic dry eyes caused by a host of diseases, dystrophies, medications, and ocular surgeries. Almost all of these patients are now functioning on a much higher level because of the customized scleral lenses that we provided. This particular scleral lens design protects the ocular surface from the environment and the blinking action of the eyelids. These lenses do not touch the compromised dry ocular surface.Instead, the scleral lens vaults over the front surface of the eye (the cornea) and rests on the white portion of the eye known as the sclera. A liquid reservoir exists between the back surface of the scleral lens and the front surface of the eye. In other words, the dry eye ( the ocular surface) is always in a moist environment. Most of the dry eyes that we have treated have undergone a healing effect after having worn our life changing customized scleral lenses. Dry irritated ocular tissues often have a more robust appearance when viewed under the ocular microscope. The comfort patients experience with these customized scleral lenses is excellent. Most patients will have no sensation of a lens on their eye.

In addition to the therapeutic effect of the scleral lens, the vision provided by this unique technology is almost always excellent. The compromised corneal surface is in effect replaced as an optical surface by the scleral lens. In addition to the newly achieved vision that the scleral lens provides, the improved vision will be stable and will not fluctuate and patients will be able to wear these lenses for almost all of their waking hours. Because of these life changing scleral lenses, thousands of patients over the years have avoided undergoing a corneal transplant surgery.

Eye Freedom - What Is Dry Eye Disease Or Dry Eye 2
Eye Freedom - What Is Dry Eye Disease Or Dry Eye 3
Eye Freedom - What Is Dry Eye Disease Or Dry Eye 4
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Scleral Lens, How Does It Differ From A Conventional Contact Lens?

Scleral Lens, How Does It Differ From A Conventional Contact Lens?

What Is A Scleral Lens And How Does It Differ From A Conventional Contact Lens?

Eye Freedom - What Is A Scleral Lens And How Does It Differ From A Conventional Contact Lens

A Scleral lens is a large diameter lens made of a highly oxygen permeable material that is designed to vault over the damaged or diseased cornea. scleral lens is not a contact lens in the strict sense of the word as there is no contact with the cornea. Instead a liquid reservoir exists between the back surface of the scleral lens and the front surface of the cornea.

This liquid reservoir fills in the surface irregularities of the ocular surface allowing vision to be restored in a comfortable manner. The scleral lens and the liquid bandage beneath the scleral lens protect the cornea from exposure to the environment and the rubbing action of the eyelids against the cornea from blinking. This liquid cushion beneath the scleral lens provides oxygen to the cornea allowing the damaged tissue to heal. In addition, the scleral lens creates a smooth optical surface over the compromised cornea. Almost all the time patients’ vision and comfort are improved dramatically.

What Eye Conditions Are Best Treated With A Scleral Lens?

There are a number of eye diseases and conditions that are best treated with a scleral lens. In fact, a scleral lens is medically indicated in most of these conditions as a first choice treatment option. What must be appreciated is the fact that a scleral lens, when fit correctly, is a medical device and a therapeutic device all in one. The scleral lenses that we design can be designed to fit virtually any eye condition and shape and virtually any degree of visual error while allowing the diseased or injured eye to heal. Many of the ocular conditions and diseases that we use our customized scleral lenses to treat include:

Keratoconus

Pellucid Marginal Degeneration

Post-Refractive surgical complications due to refractive surgeries such as LASIK, Radial Keratotomy (RK), PRK, ALK, CK that include chronic dry eye, ocular pain, light sensitivity, reduced night vision and scratchy, irritated eyes.

Vision distortions created by the above conditions are known as “higher order aberrations” also known as “HOA’s. HOA’s include distorted and fluctuation vision, glare, starbursts, double vision, halos and loss of contrast sensitivity. In addition, many of these patients also suffer from ocular pain and reduced night vision. Many of these patients are also so light sensitive that sunglasses must be worn indoors. A well designed and fit scleral lens will eliminate all of these symptoms that so many of these patients are experiencing. We recently introduced an aberrometer to measure and quantify all of these aberrations and have this information embedded into our highly customized scleral lenses.

Complications Resulting From Corneal Transplant Surgery.

These include blurred and unstable vision due to a distorted, dry and irregular cornea It could take up to a year after the transplant surgery is done for the cornea to stabilize. We try to fit the eye with the corneal transplant about 3 to 6 months after the surgery is done. Almost all of the ocular surfaces of these eyes are so distorted and a scleral lens is the patient’s only option to obtain clear vision and ocular comfort once again.

Corneal Ectasia resulting from LASIK and other refractive surgical procedures such as Radial Keratotomy. A well designed and fit scleral lens is medically indicated for restoring quality vision and ocular comfort to an eye with corneal ectasia. The ocular surface of these eyes is extremely distorted and dry. A scleral lens is the only non-invasive therapy that can restore quality vision and ocular comfort to this patient population. At one time it was thought that LASIK induced corneal ectasia was very rare. However, in recent years we have been seeing many patients with this condition. All of our patients who have lost quality vision due to post LASIK corneal ectasia are doing very well with their scleral lenses.

Chronic Dry Eye Due To Systemic Disease, medications and a variety of conditions. An example of a systemic disease that can cause a chronic dry eye is arthritis, which is essentially an autoimmune disease. Also many medications can cause a dry eye such as allergy medications, sleeping pills and medications used to address emotional and psychological issues.

There are a variety of corneal and ocular conditions such as Stevens-Johnson Syndrome, Sjogren’s Syndrome and corneas damaged as a result of trauma, corneal degenerations and dystrophies, chemical and burn injuries to the eye and adjacent ocular structures and eyelid abnormalities. Scleral lenses have the ability to change the lives of so many of these patients.

Why Am I So Passionate About Scleral Lenses

For over 30 years I have been intimately involved with the design and manufacture of scleral lenses. The latest scleral lens designs that we are using have been extremely effective in treating so many of the diseases and conditions mentioned above. In North America alone, there are millions of people who are living “in the shadows” due to corneal disease. Many have lost their occupations, cannot continue their education and have difficulties maintaining relationships due to blinding corneal conditions. This does not have to be. For many years I have been working closely with a number of scleral lens laboratories helping to make their lenses more effective and comfortable. The scleral lenses that we are now using have changed the lives of thousands of our patients. That is why I am so passionate and proud to be a part of this amazing life changing technology.

Why Are Scleral Lenses More Comfortable Than RGP Contact Lenses

There are a number of reasons for this:

a. Scleral lenses do not move over the compromised cornea. RGP contact lenses do move over the compromised cornea and can lead to significant ocular discomfort, pain and irritation.

b. Because the scleral lenses fit beneath the eyelids, there is no lid awareness when blinking as the eyelids pass over the surface of the scleral lens.

c. Because so many of the compromised eyes that we treat are very dry and irritated, corneal contact lenses can make these conditions worse. This is due to the fact that a corneal contact lens is in constant contact with the irritated corneal surface. When a well designed and fit scleral lens is on the eye, this ocular surface is not in contact with the back surface of the scleral lens. Instead, a liquid reservoir of sterile unpreserved saline solution exists between the back surface of the scleral lens and the front surface of the diseased or traumatized cornea. Comfort and vision is almost always excellent.

I Have Had Difficulties Removing My RGP Lenses. Will I Have A Problem Removing A Scleral Lens

No. I have fit thousands of patients with scleral lenses over the years and I cannot recall a single instance where removal of a scleral lens was ever a problem. We allow a great deal of time teaching patients how to insert, remove and take care of their scleral lenses. In addition, there are many patients with physical disabilities who may have difficulties handling these lenses. We have a number of easy to use technologies to make scleral lens insertion and removal effortless.

Eye Freedom - What Is A Scleral Lens And How Does It Differ From A Conventional Contact Lens 2
Eye Freedom - What Is A Scleral Lens And How Does It Differ From A Conventional Contact Lens 3
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Neuropathic Ocular Pain Poor Vision and Scleral Lenses

Neuropathic Ocular Pain Poor Vision and Scleral Lenses

Neuropathic Ocular Pain Poor Vision and Scleral Lenses

Eye Freedom - Neuropathic Ocular Pain Poor Vision and Scleral Lenses

Eye Freedom – Most pain sensations result in direct response of an injury, but neuropathic pain is somewhat different. Neuropathic pain results when nerve fibers send incorrect signals to pain centers in the body, sometimes without any obvious history. When neuropathic pain affects the eyes it is referred to as neuropathic ocular pain and without proper treatment it can be chronic.

Why Scleral Lenses for the treatment of this complex debilitating condition?

Ocular pain can be caused by refractive surgeries such as Radial Keratotomy (RK), LASIK, PRK and other refractive surgeries. In addition,  many corneal degenerations, and dystrophies such as Keratoconus and Stevens-Johnson Syndrome can create a dysfunctional ocular surface that can be very painful for a patient. In addition, many patients who have undergone cosmetic eyelid surgery may find themselves unable to close their eyes leading to a chronic dry eye.

A well designed and fit scleral lens will protect the compromised ocular surface from the environment and the blinking action of the eyelids. Because highly oxygen permeable scleral lenses have no contact with the cornea, a healing effect can take place. A well designed scleral lens will vault over the cornea and be supported by the white portion of the eye (the sclera). The space between the compromised ocular surface and the back surface of the scleral lens is filled with sterile, unpreserved saline solution. In other words, the scleral lens keeps the front surface of the eye in a moist environment.

Most patients with complicated surgical and ocular disease histories have compromised vision in addition to having severe ocular pain. In addition to allowing the cornea to undergo a healing process, a scleral lens will allow patients to regain quality vision and comfort once again.

Can I sleep with a Scleral Lens?

While we ask most of our “hi need” patients not to sleep with their scleral lenses, there are some patients who have suffered debilitating dry eyes due to trauma, partial and eyelid cosmetic surgery where closing the eyes during sleep is not possible. For these very special cases, we design scleral lenses using a special highly oxygen permeable material with a very thin lens profile that will allow them to get a good night’s sleep.

Is there more than one type of scleral lens?

There are many different scleral lens designs, laboratories and materials. It takes special instruments, computers and related technologies to properly fit a scleral lens. A specific scleral lens design may be most appropriate for a certain ocular condition such as keratoconus. For this reason, you should see a doctor who specializes in scleral lens technology.

Can I expect to be free from ocular pain after getting fit with a Scleral Lens?

While it is not possible to achieve 100% success with any medical endeavor, the overwhelming majority of patients who we have examined and fit with scleral lens have obtained significant relief from ocular pain while at the same time able to experience stable, comfortable vision. In addition, many patients who have been wearing scleral lenses have much healthier appearing ocular surfaces.

I was told that it can be difficult to insert and remove a scleral lens. Is this true?

Like anything else, some has to show you and teach you the proper way to insert and remove a scleral lens. Once you learn, it should not take more than a few seconds to insert and remove the scleral lens. Our youngest scleral lens patient was 6 years old when she first visited our office. Our oldest scleral lens patient was 90.

Why would a Scleral Lens be better for me compared with the small hard contact lenses that I am now using?

The small rigid (hard) contact lenses tend to rub against the compromised cornea making the situation of ocular pain worse. These small contact lenses can also pop out of the eyes. A well designed Scleral lens will not touch or rub against the compromised ocular surface. For this reason, the Scleral lenses that we design are medically indicated for the conditions mentioned above. In addition, there is no way that a scleral lens will pop out of your eye.

My previous eye surgeries left me with a great deal of pain and unstable vision. My vision often changes from morning till night. Will this happen with Scleral lenses?

A well designed and fit scleral lens will alleviate most if not all of the ocular pain you have been experiencing. In addition, while wearing your Scleral lenses, you will have stable, clear and comfortable vision. Scleral lenses will stabilize your post surgical corneas. Because Scleral lenses do not move on your eyes, your vision will be stable.

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Keratoconus case by Dr. Boshnick using Scleral Lenses - Angelique

Keratoconus case by Dr. Boshnick using Scleral Lenses

Standing in front of me and to my right is Angelique, a patient who recently visited us from the Cayman Islands. Angelique has an advanced case of keratoconus in both eyes. She was diagnosed with this condition when she was 12. For many years, Angelique suffered from extremely blurred vision which could not be corrected with conventional contact lenses or eyeglasses. We fit both of Angelique’s eyes with highly oxygen permeable scleral lenses which are providing her with clear (20/20) comfortable vision with all day lens wearing comfort. Before we met Angelique she and her family were worried that she might need to undergo a corneal transplant operation one day. Based on how she has been doing with her scleral lenses I don’t feel that any invasive procedures will ever need to be done to Angelique’s eyes. In this photo, standing on the left is our student extern Paige Paulas. On the extreme right is our other student extern Amanda Vessels. Both Amanda and Paige will be receiving their doctorate degree next May.

What Is Keratoconus?

 

corneal ectasia, corneal ectasia topography, corneal ectasia symptoms, post lasik ectasia treatment, corneal ectasia post lasik, corneal ectasia causes, corneal topography, cornea transplant

DIAGNOSIS FOR KERATOCONUS TREATMENT

To diagnose keratoconus and properly seek Keratoconus Treatment, your eye doctor (ophthalmologist or optometrist) will review your medical and family history and conduct an eye exam. He or she may conduct other tests to determine more details regarding the shape of your cornea. Tests to diagnose and start keratoconus treatment include:

  • Eye refraction. In this test your eye doctor uses special equipment that measures your eyes to check for vision problems. He or she may ask you to look through a device that contains wheels of different lenses (phoropter) to help judge which combination gives you the sharpest vision. Some doctors may use a hand-held instrument (retinoscope) to evaluate your eyes.
  • Slit-lamp examination. In this test your doctor directs a vertical beam of light on the surface of your eye and uses a low-powered microscope to view your eye. He or she evaluates the shape of your cornea and looks for other potential problems in your eye.
  • Keratometry. In this test your eye doctor focuses a circle of light on your cornea and measures the reflection to determine the basic shape of your cornea.
  • Computerized corneal mapping. Special photographic tests, such as optical coherence tomography and corneal topography, record images of your cornea to create a detailed shape map of your cornea’s surface. The tests can also measure the thickness of your cornea.

KERATOCONUS TREATMENT

Your keratoconus treatment depends on the severity of your condition and how quickly the condition is progressing.

There is keratoconus treatment from mild to moderate that can be treated with eyeglasses or contact lenses. For many people, the cornea will become stable after a few years. If you have this type, you likely won’t experience severe vision problems or require further treatment.

In some people with keratoconus, the cornea becomes scarred or wearing contact lenses becomes difficult. In these cases, surgery might be necessary.

Lenses

  • Eyeglasses or soft contact lenses. Glasses or soft contact lenses can correct blurry or distorted vision in early keratoconus. But people frequently need to change their prescription for eyeglasses or contacts as the shape of their corneas change.
  • Hard contact lenses. Hard (rigid, gas permeable) contact lenses are often the next step in progressing keratoconus treatment. Hard lenses may feel uncomfortable at first, but many people adjust to wearing them and they can provide excellent vision. This type of lens can be made to fit your corneas.
  • Piggyback lenses. If rigid lenses are uncomfortable, your doctor may recommend “piggybacking” a hard contact lens on top of a soft one.
  • Hybrid lenses. These contact lenses have a rigid center with a softer ring around the outside for increased comfort. People who can’t tolerate hard contact lenses may prefer hybrid lenses.
  • Scleral lenses. These lenses are useful for very irregular shape changes in your cornea in advanced keratoconus. Instead of resting on the cornea like traditional contact lenses do, scleral lenses sit on the white part of the eye (sclera) and vault over the cornea without touching it.

If you’re using rigid or scleral contact lenses, make sure to have them fitted by an eye doctor with experience in keratoconus treatment. You’ll also need to have regular checkups to determine whether the fitting remains satisfactory. An ill-fitting lens can damage your cornea.

corneal ectasia, corneal ectasia topography, corneal ectasia symptoms, post lasik ectasia treatment, corneal ectasia post lasik, corneal ectasia causes, corneal topography, cornea transplant

KERATOCONUS TREATMENT

  • Corneal cross-linking. In this keratoconus treatment, the cornea is saturated with riboflavin drops and treated with ultraviolet light. Corneal cross-linking may help to reduce the risk of progressive vision loss by stabilizing the cornea early in the disease.

Surgery

You may need surgery as keratoconus treatment if you have corneal scarring, extreme thinning of your cornea, poor vision with the strongest prescription lenses or an inability to wear any type of contact lenses. Several surgeries are available, depending on the location of the bulging cone and the severity of your condition.

Surgical options include:

  • Corneal inserts. During this surgery, your doctor places tiny, clear, crescent-shaped plastic inserts (intracorneal ring segments) into your cornea to flatten the cone, support the cornea’s shape and improve vision.
    Corneal inserts can restore a more normal corneal shape, slow progress of keratoconus and reduce the need for a cornea transplant. This surgery may also make it easier to fit and tolerate contact lenses. The corneal inserts can be removed, so the procedure can be considered a temporary measure.

Cornea transplant.

If you have corneal scarring or extreme thinning, you’ll likely need a cornea transplant (keratoplasty).
Penetrating keratoplasty is a full-cornea transplant. In this procedure, doctors remove a full-thickness portion of your central cornea and replace it with donor tissue.


A deep anterior lamellar keratoplasty (DALK) preserves the inside lining of the cornea (endothelium). It helps avoid the rejection of this critical inside lining that can occur with a full-thickness transplant.
Cornea transplant for keratoconus generally is very successful, but possible complications include graft rejection, poor vision, astigmatism, inability to wear contact lenses and infection.     

                                                               

 

 SCLERAL LENSES

For over 30 years my practice has been devoted to the non-surgical treatment of patients who have suffered loss of vision and ocular comfort due to the following conditions:

  • Keratoconus and Pellucid Marginal Degeneration
  • Post-Refractive Surgical Complications such as Corneal Ectasia, Dry Eye and
  • Reduction in Quality Vision
  • Irregular and Compromised Transplanted Corneas
  • Stevens-Johnson Syndrome
  • Corneal Dystrophies
  • Compromised Corneas Due to Ocular Trauma

Over these many years, I have developed one of the largest specialty scleral lens practices in North America. Very often this unique technology is the only non-surgical treatment that will restore quality vision and comfort to these patients. If you have patients who you feel could benefit from my services and these materials, please consider my office as a referral source. Please know that all patients will be sent back to your office with a detailed report including anterior segment photos. In addition, please feel free to contact me if you need assistance with a patient suffering from any of the above conditions.

Below are ocular photos of some of my patients’ eyes with conditions which I have written about. All of these patients now have functional vision and comfort for the first time in many years. These patients are wearing gas permeable scleral lenses which I designed.

Our office uses Ocular Surface Tomography and proprietary software designed by Zeiss Optical which allows us to create Scleral Lenses with the proper diameter and curvatures needed for your eye. This technology permits us to determine within microns the necessary clearance required to vault over each individual cornea.

Doctor Boshnick designs Scleral Lenses to be unique for each individual patient and eye because no two eyes are the same and no two patients have exactly the same vision and ocular issues. our goals with these unique lenses are:

  1. To eliminate blurred and distorted vision resulting in restored ocular comfort once again.
  2. To promote and restore healing to the compromised irregular cornea and adjacent ocular tissues.
  3. To protect the compromised cornea from the environment and the eyelids.
GVR scleral lenses, scleral lenses, Scleral Contact Lenses
GVR scleral lenses, scleral lenses, Scleral Contact Lenses

Stevens-Johnson Syndrome

GVR scleral lenses, scleral lenses, Scleral Contact Lenses

Troy Thomas was blinded from Stevens-Johnson Syndrome from 1990 until August 2004. Troy is shown standing next to his beautiful bride Shay while holding up his Florida driver’s license and standing next to his new car. His corrected visual acuity with his scleral lens is 20/20.

GVR scleral lenses, scleral lenses, Scleral Contact Lenses

Stevens-Johnson patient Tiffany with her new scleral lens. Tiffany now has functional vision for the first time in 6 years.

Scleral lenses are a unique type of lens designed to treat a variety of eye conditions which do not respond to any other type of therapy. The new generation of scleral lenses being used today are made from a highly oxygen permeable polymer and are unique in that they are fit onto and supported by the sclera (the white portion of the eye).

Because these lenses vault over the compromised cornea and fit under the eyelids, they are extremely comfortable and are almost never dislodged accidentally.

The space between the front of the cornea and the back surface of the scleral lens is filled with artificial tears. This liquid reservoir fills in the surface irregularities of the cornea allowing vision to be restored in a comfortable manner. The lens and the fluid liquid bandage beneath it protect the cornea from exposure to air and the rubbing effects of blinking. This cushion of fluid beneath the lens also provides oxygen to the cornea allowing the eye to heal. The effect is to create a smooth optical surface over the diseased cornea that replaces the distorted surface to improve vision often dramatically.

Our unique proprietary scleral lenses can replace the need for corneal transplant surgery which has a potential for serious complications, long healing period and uncertain visual outcome. When corneal transplant surgery fails, our lens designs can enable patients to recover lost vision. In other words, these unique lenses provide a non-surgical means of restoring lost vision and act in a therapeutic manner.

Over the years, many patients have come to our office seeking relief from the following devastating vision and ocular disorders: keratoconus, corneal ectasia resulting from lasik, post refractive surgical complications, distorted corneal transplants, Stevens-Johnson Syndrome, Sjogren’s Syndrome, corneal degenerations and dystrophies, eyelid abnormalities, chemical and burn injuries to the eye, aniridia, and pellucid degeneration. Scleral lenses have been the therapy of choice in treating all of these conditions with an extremely high rate of success.

The Scleral Lens is, in fact, a medical and therapeutic device that can be fitted to virtually any eye shape and for any degree of visual error while allowing the diseased/injured eye to heal. It is important to understand that Scleral Lenses are custom made for each patient. Therefore, the ability of the doctor to fit these lenses demands greater experience and more time than fitting conventional soft or rigid gas permeable lenses. Computerized Topographical Maps of the entire corneal surface are generated to facilitate the lens size and fitting. In addition, several diagnostic Scleral Lenses of varying curvatures and diameters may be applied to the eye during the fitting process.

Depending on the complexity of the eye and the condition of the ocular surface, adjustments of the lens parameters may be needed. This will require additional lenses to be made and exchanged. The entire scleral lens fitting process can take several visits to determine the optimal lens for each eye.

The following are photos of some of my patients with various eye conditions who have benefited from scleral lenses:

GVR scleral lenses, scleral lenses, Scleral Contact Lenses

“This instrument is an Anterior Segment Ocular Coherence Tomographer (OCT) made by Zeiss Optical. We utilize this instrument to determine and measure the entire shape and thickness of the cornea and to evaluate the relationship of our scleral lenses with reference to the underlying cornea. With this instrument we can determine within 4 microns the clearance between the back surface of a scleral lens and the front surface of the cornea.”

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    Welcome to Global Vision Rehabilitation Center

    Dr. Edward Boshnick maintains a cutting edge practice devoted to the restoration of vision and comfort lost as a result of refractive eye surgery (including LASIK and Radial Keratotomy), keratoconus, corneal transplant surgery, pellucid marginal degeneration, extreme dry eye, corneal dystrophies, corneal trauma, lasik damage and Stevens-Johnson Syndrome.

    A few words about Dr. Edward Boshnick and his eye care practice:

    Dr. Edward Boshnick maintains a cutting edge optometric practice covering all types of vision care including non-surgical vision improvement, contact and scleral lens care, children’s vision and vision rehabilitation for the partially sighted. Dr. Boshnick received his B.A. degree from the University of Miami and his Doctorate degree was awarded in Optometry from Southern College of Optometry.

    Corneal Topography Miami, Eye Dryness Treatment Miami, Corneal Ectasia, Scleral Lenses, Radial Keratotomy, LASIK Damage, Keratoconus Treatment Miami, Ectasia Corneal, Dry Eye Treatment in Miami, Synergeyes Lenses, Orthokeratology, LASIK Complications, Reduced Contrast Sensitivity, Vitreous Floaters, keratoconus, Treatment For Color Blindness, Eye Symptoms, Dry Eye Symptoms, Common Eye Diseases, Corneal transplant, Optical Coherence Tomography, Lentes SynergEyes, Dry Eye Syndrome, cornea transplant

    “No effort will be spared and no expense avoided in order to provide the best vision care available to our patients.”

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