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:
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.