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.
7800 SW 87 Ave Suite B-270 Miami, FL 33173
305-271-8206
Keratoconus case by Dr Boshnick using Scleral Lenses
Standing in front of me is Paola, a patient with keratoconus who recently visited us from El Salvador. For many years Paola struggled to see clearly without much success. Fearing that she might need to undergo a corneal transplant operation, she decided to visit our practice. This week we fit both of Paola’s eyes with scleral lenses which we designed with the aid of a computer. With her new scleral lenses Paola is seeing clearly (20/20) and comfortably again for the first time in many years. In this photo standing on the left is our student extern Amanda Bancroft and on the right our other student extern Emily Wong. Both Emily and Amanda will be receiving their doctorate degrees next May.
What is Keratoconus?
Keratoconus is a non-inflammatory ectasia or protrusion of the cornea. It is characterized by a progressive thinning and steepening of the cornea. As the cornea steepens and thins, the patient experiences a decrease in vision which can be mild or severe depending on the amount of corneal tissue affected. The onset of keratoconus usually starts in the teenage years or early 20’s. It rarely develops after the age of 30. In general, keratoconus develops asymmetrically with one eye more advanced than the other.
In the early stages of this condition, many patients will be able to see clearly with soft contact lenses or eye glasses. As keratoconus progresses, rigid gas permeable lenses are the first choice to correct vision. Most of the time this is a permanent remedy. Because keratoconus can progress it is important that the lenses are fitted with great care and are reevaluated at least annually by the eye doctor. The lenses that we use have a complex geometry that take into account the irregular corneal surface for all stages of this condition. The lenses that we design have multiple curves and are custom designed to fit each individual cornea correctly without traumatizing the delicate compromised corneal tissue.
Treatment of advanced cases of Keratoconus, Pellucid Marginal Degeneration and Post-Lasik Ectasia.
In the more advanced cases of keratoconus, Pellucid Marginal Degeneration and post-LASIK ectasia, small diameter lenses will not work. This is especially true when there is a degradation of the outer layer of the cornea known as the epithelium. When this layer of the cornea is compromised, the cornea will not be able to support any form of lens whether it be a soft lens, a hybrid lens or a gas permeable contact lens.
The only lens that will provide clear, comfortable vision will be a gas permeable scleral lens. This lens will work provide clear vision because it will not touch the cornea and will not pop out of the eye when the patient moves their eyes. The scleral lens vaults over the compromised cornea and is supported by the white portion of the eye known as the sclera. The space between the back surface of the lens and the front surface of the cornea is filled with sterile unpreserved saline solution. In other words, the compromised cornea is always in a liquid environment. Vision and comfort is almost always excellent.
Below are images of keratoconic corneas with and without specialty lenses.
This is an image of a cornea with keratoconus with a scleral lens over it. This image was taken with a new technology known as Optical Coherence Tomography. The two curved lines seen over the cornea represent the front and back surface of the scleral lens. The clear space between the back surface of the lens and the front surface of the cornea is a liquid reservoir filled will unpreserved sterile saline solution.
Why is it that I always have pain in my eyes and the sunlight “kills me?”
The lenses that you are wearing are probably not fit correctly. We see this often when the lenses are fit too flat, and the design of the lens is not appropriate. The lenses are moving excessively over the cornea with each blink causing abrasions to the apex of the cone. If this continues, irreversible scarring will result and visual acuity will diminish. When I get to see a cornea like this, I often have to refit with a new rigid lens over a special soft lens which acts as a bandage. The soft lens allows the cornea to heal, while the rigid lens provides vision. Typically, this “piggy back” combination lasts no more than a few weeks. As the cornea heals, new measurements of the corneal curves are taken. It is not unusual to encounter changes in the curves and contour of the healed cornea. As this takes place, new rigid lenses are ordered to fit the healed cornea.
GVR® 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.
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:
- To eliminate blurred and distorted vision resulting in restored ocular comfort once again.
- To promote and restore healing to the compromised irregular cornea and adjacent ocular tissues.
- To protect the compromised cornea from the environment and the eyelids.
Stevens-Johnson Syndrome
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.
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:
“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.”
Schedule Your Consultation
Please complete the form below to have a representative contact you promptly about our services.
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.
