Seated next to me is 12 year old Ali, who recently visited us from Dubai. Ali was born with a very rare genetic corneal dystrophy known as “Gelatinous Drop-Like Keratopathy”. Both of Ali’s corneas are extremely dry and distorted. Over the past 3 years Ali underwent 2 corneal transplant surgeries in each eye. When we first met Ali last January, his visual acuity was essentially finger counting. Over the past year Ali was being treated by a team of corneal specialists at a major eye institution who referred Ali to our specialty practice. In February we began fitting Ali with oxygen permeable scleral lenses. This lens fitting “journey” was very trying for Ali but eventually he mastered inserting and removing these lenses rapidly and with little effort. This past week we finished our work with this very special young boy who for the first time in years can see significantly much clearer and with all day lens wearing comfort. Ali will have to be watched and monitored carefully for the rest of his life to make sure his transplanted corneas do not fail. The photo below was taken yesterday and is the first time since January that I have seen Ali smile. Standing on the left is our student extern Amanda Bancroft who will be receiving her doctorate next May.
Over the past 25 years, a number of gas permeable and soft specialty lens designs have been developed to address
an large number of eye conditions. These conditions include:
Keratoconus and Pellucid Marginal Degeneration.
Corneal transplant surgery
Chronic dry eye due to disease, medications, chemo and radiation therapies, surgery and trauma.
Corneal dystrophies and degenerations including Fuchs’ Dystrophy and Stevens-Johnson Syndrome.
Chronic eye pain due to refractive eye surgeries including LASIK, R-K and PRK.
Post-LASIK complications such as post-LASIK ectasia.
Post Radial Keratotomy complications such as distorted and blurred vision, fluctuating vision and ocular pain.
Corneal and intraocular defects due to ocular trauma and eye surgery.
Congenital ocular defects such as Peters’ Anomaly and Cicatricial Pemphigoid
In my opinion, the most important ophthalmic device that address the many eye issues facing millions of patients in the U.S. and elsewhere is the gas permeable scleral lens. Very rarely does a medical device come along that has the ability to change a person’s life. Scleral lenses are made from a highly oxygen permeable material that does not touch the injured or diseased cornea. A well fit scleral lens will vault over the compromised cornea and come to rest on the white portion of the eye known as the sclera. A liquid reservoir exists between the back surface of the lens and the front surface of the cornea. In other words, the compromised cornea is always in a liquid environment. Vision and comfort is almost always excellent.
After having used these very unique lenses on several thousand patients suffering from a multitude of of eye conditions, I named this lens after the “Global Vision Rehabiltiation Center” hence the name “GVR Scleral lens” which has been registered with the U.S. Patent Office. Our practice uses a unique technology known as “Ocular Surface Tomography” and proprietary software designed by Zeiss Optical which allows us to create our GVR Scleral lens with the proper diameter and curvature needed for each individual eye.
This technology permits us to determine within microns the necessary clearance required to vault over the cornea.
The GVR 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 or injured eye to heal. Because of the specialized equipment needed to fit these lenses, the large amount time required over weeks or months to achieve the optimum fit and the steep leaning curve required of doctors to develop expertise, very few doctors are willing to get involved with scleral lens technology. It also must be appreciated that over a period of several weeks or months,
depending on the complexity of the eye and the condition of the ocular surface, several changes to the lens parameters may be needed.
This will require additional lens changes to be made.
Our scleral lens designs are unique for each individual 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 rubbing action of the eyelids against the irritated cornea.
4. To eliminate the need for corneal transplant surgery which has the potential for serious complications,
a long healing period and an uncertain vision outcome.
The following images will help explain the part scleral lens play in the rehabilitation of the compromised eye
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.