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.
Scleral Lenses FAQs
Scleral lenses FAQs 1: What is a scleral lens and why does it work so well with many ocular conditions?
A scleral lens is a large diameter lens made of a highly oxygen permeable material . The scleral lens does not move on the eye.
A scleral lens 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 unpreserved 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. This cushion of fluid beneath the scleral lens also provides oxygen to the cornea allowing the compromised cornea to heal. The effect is to create a smooth optical surface over the diseased or compromised cornea that replaces the distorted corneal surface. Almost all the time, excellent vision and comfort are restored and improved dramatically.
Scleral lenses FAQs 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 the fact that a scleral lens, when designed and fit correctly is a medical device and a therapeutic device all in one. The scleral lenses that we design can be fit to virtually any eye shape and for any degree of visual error while at the same time allowing the diseased or injured eye to heal.
Common conditions include but are not limited to:
- Pellucid Marginal Degeneration
- Post-refractive surgical complications due to LASIK, Radial Keratotomy (RK), PRK, CK, and so on. Many of these complications include distorted fluctuating vision, halos, light sensitivity, reduced vision at night and indoors, glare, star bursting, ocular pain, chronic dry eyes and so on.
- Complications resulting from corneal transplant surgery such as an irregular distorted cornea, chronic dry eye and unstable vision.
- Post-LASIK corneal ectasia. At one time it was thought that corneal ectasia was a rare risk factor for LASIK surgery. In reality, we are seeing more and more patients suffering vision loss due to corneal ectasia and other complications from LASIK many years after the surgery was done.
- Chronic dry eye due to systemic disease, medications and a variety of ocular conditions.
- A variety of corneal and ocular conditions such as Stevens-Johnson Syndrome, Sjogren’s Syndrome, 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 ocular diseases and conditions.
Scleral lenses FAQs 3: I suffer eye pain and poor vision because of a chronic dry eye condition. Can scleral lenses help me?
A well designed and fit scleral lens replaces the cornea as an optical surface. In effect, a scleral lens is like giving you a new cornea. As far as dryness issues are concerned, the bowl of the scleral lens is filled with unpreserved saline solution. When the scleral lens is placed on your eye, the lens does not touch your cornea. A liquid reservoir of sterile unpreserved saline solution fills the space between the back surface of the scleral lens and the front surface of the cornea. In other words, your dry corneas are always in a moist environment.
Scleral lenses FAQs 4: My present contact lenses hurt and often pop out of my eyes. Will this happen with scleral lenses?
No. When properly designed and fit, scleral lenses will not pop out of your eyes. This is because the lenses are large and come to rest on the white portion of the eye. The lenses do not move on the eye and the edges of the scleral lens fit under the eyelids. Because of this, scleral lenses are stable and extremely comfortable. With all of our patients, the comfort of our custom designed scleral lenses is comparable to that of a soft contact lens. In many cases, patients’ comfort with their scleral lenses exceeds the comfort that they experienced with their prior soft contact lenses.
Scleral lenses FAQs 5: What is different and unique about the scleral lenses that you design? What is involved with obtaining the optimal fit?
We use special computers using proprietary software to design our lenses. Some of the lenses that we design are made using 3D printing technology. Many of the lenses that we design are made after 3D computer images are taken of the entire front surface of the eye. However, what is most important is our commitment to your visual welfare. We will spend whatever time is needed to see our visual journey together to a successful completion.
Scleral lenses FAQs 6: Are scleral lenses difficult to insert and remove?
No. However, all of our patients are taught how to do this. It usually takes a 30 minute session to teach a new patient how to insert and remove a scleral lens. Like everything new, there is a learning curve to this. All of our patients manage to do this within a very short period of time.
Scleral lenses FAQs 7: How long can I expect my scleral lenses to last?
On average, you can expect your lenses to last 3 or more years. Of course, a great deal depends on how you take care of them. Like everything else about our bodies, our eyes and our prescriptions can change. Over the years nothing stays the same. This is also true about our eyes. This is the reason that an annual comprehensive eye, vision and scleral lens evaluation should be done every year. It is also very important to contact our office if you should notice any change in your vision or ocular comfort.
Scleral lenses FAQs 8: How many hours a day can I wear my scleral lenses? Can I sleep with them?
The great majority of our scleral lens patients wear their lenses all of their waking hours. We do not recommend that you sleep with your lenses when you go to bed for the evening. However, many of our scleral lens patients do wear their lenses when they take a nap during the day.
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.
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.
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.”