What Are Scleral Contact Lenses?

In the beginning…of contact lenses…there were scleral lenses…only.

In the year 1887 a great gift was given to the world of sufferers of distorted vision resulting from corneal tissue that was irregular in shape from disease or trauma.
scleral lenses

The contact lens was invented nearly simultaneously by physicians working separately in Germany and in France. Working from drawings of Leonardo da Vinci (1508) and ideas of the British astronomer Sir John Herschel (1828), August Müller and separately Adolph Fick and Eugene Kalt blew glass shells to fit the outer eye and to some extent remedy their visual difficulties. These lenses rested on the conjunctiva of the eye above the sclera or white of the eye and were thus the first scleral contact lenses — the first contact lenses of any sort.

What are Scleral Contact Lenses?

The design and manufacture of scleral lenses has been a story of technological development significant for improvement in comfort, material, and affinity for the ocular surface.

For many years the lenses were partially molded and partially ground from the material of which hard contact lenses are made: PMMA (poly-methyl methacrylate) known as Plexiglas or Perspex. To form these lenses, like tooth implants, a plaster cast is made from a negative mold prepared from dental impression putty. The plastic would be heated and given the shape of the fitting surface of the lens from the plaster cast and then the power and edge curves would be ground onto the outside surface of the lens. Later came preformed trial sets not unfamiliar to those which we use today.

The current generation of scleral lens fitting began sometime in the last fifteen years with the mating of advanced corneal topography measurements, computer driven lathes and the observations of some very clever contact lens scientists. Proprietary designs of scleral lenses offering a variety of diameters, fitting philosophies, and multiple parameters are filling the gaps contact lens specialists have been wrestling with using smaller corneal contact lens designs for decades with less than optimal results. Most recently a firm has begun manufacturing lenses with a 3-D printer from an image generated from the eye. One eye…one lens, the lens is meant to fit like a fingerprint.

When discussing contact lens treatment, experts are experts because they agree that, any sort, size, or design of lens will have both positive and negative effects on the eyes and the tissues surrounding them. While it is true that many of the fitting and comfort issues confronted with corneal lenses of any size and design can be managed well with scleral designs, the scleral lens can also be difficult for some patients; for some eyes; for some conditions.

From the outset the larger size of the today’s scleral lens provides comfort on par with soft contact lenses for exactly the same reason: their size. Also, like soft contact lenses the scleral will not move around on the surface of the eye allowing the wearer a much more relaxed contact lens experience — there is no necessity to balance small corneal lenses between tense eyelids – vision can be enjoyed in any direction of gaze. The lenses will not fall off the eye and the increased size is a clear plus in finding a dropped contact lens.

On the other hand the quality of vision gained with scleral lenses specifically in cases of distorted corneae is far more comparable to that achievable with corneal GP lenses than with soft contact lenses in most cases.

Over the years my keratoconus patients have benefited from a series of contact lens breakthroughs that have variously improved the quality of their vision, their comfort with contact lenses, or in some other way the health of their eyes. Some years ago I “re-invented” the piggy-back system of contact lens wear which I summarized in 2008 in an article published in the Contact Lens Spectrum. Piggy-backers would place their vision restoring firm contact lens on top of a disposable daily wear lens of minimal focusing power. The soft lens would reduce the sensation of the firm lens while in many cases preventing the contact lens from abrading the cornea. More recently I have been successfully moving patients to scleral lenses because there is certainly less bother (only one lens per eye) and far less worry over corneal abrasions as the lens rests on the conjunctiva over the sclera and maintains a fluid cushion over the cornea itself.

Scleral lenses are finding their place in the world of contact lens fitting primarily to remedy vision problems from very irregular or otherwise damaged corneae both those caused by developing disease and trauma through injury or surgery. More and more, these lenses are requested by patients with normal eyes who want to enjoy the benefits provided by these lenses while participating in sports or other activities.

Scleral lenses are renowned for their greater comfort. In many cases a correctly fitted lens can be worn for many waking hours. Many patients have found that they benefit from exchanging the fluid from the reservoir from time to time throughout the day. The fluid that fills the lens-cornea space is sterile, non-preserved normal saline or in some cases saline with a non-preserved tear substitute added when needed for improved comfort.

A proper care regimen for scleral lenses is not different from that for any other contact lens manufactured from a firm oxygen permeable material. The lenses require cleaning upon removal, soaking in a recommended solution appropriate to the material of the lens and a periodic treatment to remove protein deposits. Of course, the exact care specifications will vary from patient to patient according to the evaluation of their contact lens specialist.

Just like any lens modality, the fitting requires expertise. Many who fit and dispense contact lenses rely on boxed soft lenses for their patients. When corneae become distorted those lenses will hardly fill the need. Greater expertise is required to fit rigid corneal lenses needed for these more problematic surfaces. The decision of the corneal lens expert to move on to the world of larger lenses is not of the same magnitude as that from boxes to corneal GP lenses. The investment is more a matter of time spent in discussion with the manufacturer’s fitting consultants, some reading, a webinar or two and keeping up to date with the lens designs that are available.

I was not among the first to use the current generation of scleral lenses, but when the opportunity knocked some years ago, I realized the importance of this form of contact lens and I believe I have positively influenced the quality of life of many of my patients.

5/28/15

Bezalel Schendowich - scleral lensesBezalel Schendowich, OD
Medical Advisory Board of the National Keratoconus Foundation
Fellow of the International Association of Contact Lens Educators
Clinical Supervisor & Specialty Contact Lens Fitter, Sha’are Zedek Medical Center, Jerusalem, Israel

Traveling With Low Or No Vision

What Good is Sitting Alone in Your Room?

Traveling with low or no vision

There is a whole world out there to discover — regardless of whether you can see it all with your eyes. No one will tell you traveling with low or no vision does not present challenges, but there are precious few that cannot be overcome with planning, creativity and patience.
Traveling with low or no vision
A plethora of for-profit and nonprofit companies exist to help you navigate the complexities of traveling with a vision disability — from technology and websites, to travel agents and tour operators. And don’t overlook helpful — and free! — resources such as your friends and family, assistance pets and even complete strangers.

Travel Tools
Everyday tools become even more essential when you are traveling in unfamiliar surroundings. A mobility cane (consider a small travel version) will let you find your way more easily — and notify others of your vision issues. This is especially helpful for two reasons: Strangers are less likely to get in your way and more likely to help if you ask for it. In a recent DEF blog post (“Visual Aids and Techniques When Traveling”

Linda Becker, who has retinitis pigmentosa (RP) and travels primarily with her guide dog, is planning her next trip to Australia and New Zealand with Mind’s Eye Travel, a company that specializes in creating tours especially for people who are blind or visually impaired, as well as providing sighted guides. There are many such companies that will assist you with all facets of travel, from immigration documents to reservations to tour guides. Traveleyes offers discounts to sighted travelers in exchange for helping guide non-sighted travelers during group vacations around the world. DisabledTravelers.com is a good resource for companies that specialize in travel for people with accessibility issues. It includes reviews and recommendations on everything from airlines and cruises, to travel agents and hotels.

Plan, Prep, Pack
Ask any experienced low-vision traveler, and they will tell you planning, planning and more planning is the key to successful travel. Not only will it make your trip go more smoothly, it will give you peace of mind, as well as the ability to relax and enjoy yourself. The fewer surprises, the more confident and comfortable you will feel. And if something does goes awry, it is easier “go with the flow,” because everything else has been planned.

Right at the top of the list with planning is, well, making a list. Prepare a list of all the items you will need, then double it. That means if you wear contact lenses, pack at least one extra pair, as well as cleaning solutions. Same goes for glasses and sunglasses. Make sure you have plenty of the medications and other supplies you use on a day-to-day basis. Most seasoned travelers suggest you have multiples of all these stashed in different bags: your carry-on, your suitcase and a handbag of some kind that never leaves your side. This way, if one bag gets lost, you still have another one or two. Sample sizes may become your best friend!

Carolyn Hammett, an accomplished photographer and world traveler who has keratoconus (KC), advises: “Be prepared; having backups makes you more comfortable. Be ready to change contact lenses in public restroom if you need to. Have one of everything you need, vision-wise, with you at all times.” To learn more about Hammett and see what she packs for a two-week trip, see “Through a Lens with One Eye Blind,” a story from our recent e-newsletter focused on travel experiences and tips.

“Leave extra time, notify airlines or others in advance that you may need assistance, and don’t be afraid to ask for help,” says Adam Lawrence, who also has RP and travels regularly with his guide dog. (Read more about traveling with guide dogs in “Traveling Tails”, from an article in our recent e-newsletter.

Speaking of help, don’t forget the helper sitting next to you right now, whether it’s a spouse, a friend or a guide dog. Traveling alone can be vexing for people with full vision, so it’s natural for those with low vision to feel even more anxiety.

Dame Judi Dench, who has age-related macular degeneration (AMD), recently told Radio Times she no longer travels alone. “I need someone to say, ‘Look out, there’s a step here!’ or else I fall all over the place like a mad, drunk lady,” she said.

“Don’t travel by yourself the first time — go with someone you trust, and let them know how much help you want,” Hammett says. “I’ve gotten to the point where I tell my husband, ‘Don’t tell me anything until I screw up.’”

With planning, preparation and practice, you may get to a point where you feel comfortable traveling alone. You will only know your limitations if you try to stretch them.

“Just try,” Hammett says. “Do it once to find out if you can.”

Additional Resources

Access-Able Travel Source’s “Travel Tips for People Who are Blind or Visually Impaired”

Society for Accessible Travel & Hospitality

Transportation Security Administration’s “Passengers Who Are Blind or Have Low Vision”

5/14/15

LH1_RESCANLauren Hauptman
Lauren Hauptman INK

Selecting Your Best Vision Correction Options

Today technology has evolved to a point where patients either with normal refractive errors such as nearsightedness, farsightedness, astigmatism and presbyopia or those with ocular diseases that require specialized vision correction options such as those with keratoconus all have spectacular alternatives to maximize their visual performance. With the multitude of choices available, how does an individual make the decision which to take advantage of? Well let’s begin by saying that the input from your eye care professional is critically important. You need to be properly educated not only about the various options that are applicable to your individual situation but about the advantages and disadvantages of these options.eye glass fitting vision correction options

Normal Refractive Error Options

Let’s begin by discussing vision correction options available to those with normal refractive errors. Basically stated, these individuals have the ability to utilize spectacles, contact lenses or if they are appropriate candidates, consider the refractive surgical alternatives.

Glasses
Today spectacle lens technology has evolved to the point where exceptional vision quality can be achieved with lens designs that allow for the selection of almost any frame size or shape. Thin lens technologies have enabled those with high prescription powers to not only see amazingly well, but to wear glasses that remain quite thin and attractive even with some of the most extreme prescription powers. Your eye care professional can discuss the various lens material options that best work for your situation. New high index materials are not only thin but are very light weight. A concern for some however can be the significantly higher costs associated with these lens materials. For those who need multifocals, new digital and free form progressive addition lenses (PALs) have dramatically increased the success rates associated with adaptation to PALs.

Contact Lenses
Contact lens alternatives for those with normal refractive errors have also dramatically developed technologically over the past years. Today virtually every patient with normal refractive error is a candidate to wear contact lenses. Developments such as astigmatic contacts, multifocal contacts, and hybrid (rigid center / soft periphery) contact lens designs along with the introduction and the tremendous growth in the use of single use daily disposable contacts has made one form or another of contact lenses something to consider for almost everyone. Today’s CLs are healthier, more comfortable and provide better vision than ever before. CLs have the advantage of superior peripheral vision, more natural vision “sensation” and obvious advantages for demanding physical activities. With contemporary contact lens materials and designs we have successfully addressed issues that limited many people in the past such as concerns of poor comfort due to dryness, contact lens vision instability and contact lens induced complications associated with over-wear and over-use of lenses. Your eye doctor should always present contact lens options to you regardless if you ask or not. So often patients think that they can’t wear contacts, so it does become the responsibility of your doctor to inform and educate you about CL alternatives.
contact lens vision correction options
Combination of Glasses and Contact Lenses
So how do you decide if you should be a contact lens wearer or a glasses wearer? Who said you have to? The two vision correction options are not mutually exclusive; in fact they are quite synergistic. All contact lens wearers should have an excellent pair of glasses to use. Contacts may be more cosmetically acceptable to many, they may be much better for various physical activities such as sports, however there are many times when glasses may be preferred such as at the end of a long day of contact lens wear, first thing in the morning before inserting your CLs, or on those days you just don’t want to bother with your CLs or simply prefer the look of your glasses for some situations. Today even the person who predominantly wears glasses can consider part time contact lens wear. Single use daily disposable (DD) CLs are the perfect option for such an individual. DD CLs are now even available in astigmatism and multifocal designs!

Refractive Surgery
Refractive surgery is also developing and is more effective and safer today than ever before. An experienced and skilled eye doctor is in the best position to consult with you in order to determine if you are an excellent candidate for the various refractive surgical options available. Again, having refractive surgery does not always eliminate your need for glasses or contact lenses. Although that would be the optimal outcome, many patients still use glasses and contact lenses after having refractive surgery. Typically the glasses and contact lenses are far less strong and are used significantly less often than prior to surgery. Some patients need them due to complications of surgery while others need them when outcomes did not perfectly correct vision and of course refractive surgery does not stop eyes from changing over the years, so many patients who had successful refractive surgery may experience vision changes years after surgery that require the use of glasses, contacts or both.

Irregular Refractive Error Options

Specialty Contact Lenses
Next let’s talk about choices in vision correction for those with irregular corneas and other conditions that are termed “medically necessary” vision correction cases. Individuals with irregular corneas such as those with keratoconus or post LASIK or other refractive surgery induced ectasias often require contact lenses that in essence “mask” the irregularity of the cornea. In the past this equated with the fitting of rigid corneal contact lenses, however today many other alternatives can be considered such as the fitting of scleral large diameter gas permeable contacts, hybrid CLs designed for irregular corneas and even combination systems of soft lenses with corneal gas permeable lenses (called “tandem” or “piggyback” CL systems). These CL alternatives provide advantages such as improved comfort, improved eye health response by limiting contact lens to cornea bearing, and improved contact lens positioning and stability which positively impacts visual performance.

Combination of Contact Lenses With Glasses
It should be clearly stated that spectacle lens alternatives still can have a significant role in the treatment of individuals with irregular corneas. Often glasses can be prescribed that provide adequate vision if even for part time and limited applications. While less severe cases may perform quite well with glasses as their primary modality of vision correction. Your doctor may need to modify the power of your glasses prescription in order for you to adapt to wearing glasses, however even a modified prescription power can frequently allow for some degree of visual function and allow for the ability to reduce the number of contact lens wearing hours during the day.

Surgical Procedures
Application of certain surgical and medical procedures such as intra-corneal ring segments (Intacs TM) or corneal collagen cross linking (CXL) for corneal irregularity can often help these patients in various ways and may allow for perhaps a less complex contact lens application or easier adaptation and improved function with glasses. Management of these diseases and conditions is quite complex and requires the expertise of doctors with extensive experience. Your doctor, if appropriately skilled and experienced can provide you with all of the required information and education so that you both can jointly decide on the best vision correction options for you.

In conclusion, patients today have numerous options for their vision correction. These options each have advantages and disadvantages but in most cases can be utilized synergistically. The role that your eye care professional plays in consultation and education of the vision correction alternatives applicable to you cannot be over stated. Vision is a precious gift and you should experience the highest quality of visual performance possible.

2/26/15


Barry Eiden OD, FAAOS. Barry Eiden, OD, FAAO
Medical Director, North Suburban Vision Consultants, Ltd.
NSCV Blog: www.nsvc.com/blog
President and Founder, International Keratoconus Academy of Eye Care Professionals

Cataract Surgery and Keratoconus

1/8/15

The eye works like a camera, specifically a digital camera. There is the front lens of the camera (cornea), the aperture (iris), the film (retina), and a cable to take the image to the brain (optic nerve). This “camera” also has an additional lens – the natural crystalline lens, which lies behind iris. This natural lens is flexible when we are young, allowing us to focus at distance then instantaneously up close. Around age 40-45, this natural lens starts to stiffen, necessitating the need for reading glasses for most people. This stiffening is the beginning of the aging process that eventually leads to formation of a cataract. We refer to the lens as a cataract when it becomes sufficiently cloudy to affect ones quality of vision.cataract surgery and keratoconus-Cataract diagram In general, cataract surgery is one of the safest and most successful of all surgeries performed. The basics of cataract surgery in eyes with keratoconus is very similar to non-keratoconic eyes.

Keratoconus (KC) affects this “camera” by causing the front lens (cornea) to bulge. This causes the optics to be distorted. In many cases, this can be corrected for with hard contact lenses (CL) or spectacles; in other cases a corneal transplant may be necessary. When it comes time for cataract surgery in the setting of KC, there are several factors that need to be considered.

Corneal Stability
The first thing to be considered is the stability of your cornea. In general, KC progresses more in your late teens to early twenties, and then stabilizes with age. A very exciting treatment for KC is collagen crosslinking. This treatment is meant to stiffen the cornea to prevent instability that is inherent to KC. This treatment promises to stop the progression of KC at a young age. Fortunately, with age, the cornea naturally crosslinks and stiffens, therefore when it comes time for cataract surgery, there is little chance of the progression of KC. Your doctor needs to choose the appropriate intraocular lens (IOL) to refocus your eye after surgery. Two of the most important factors in IOL selection are the length of your eye and the shape of your cornea. Long term CL wear can mold your cornea. It is important to assure that you stay out of your CLs long enough for your cornea to reach its natural shape. Depending on how long you have worn your CLs, it may take several months for the cornea to stabilize. This time can be challenging as your vision will be suboptimal (because you can’t wear CLs), and will be changing (as your cornea reaches its natural shape). When your cornea does stabilize, it is important to determine whether the topography (shape) is regular or irregular. This “regularity” is also known as astigmatism. If the astigmatism is regular, light is focused as a line – generally, this distortion can be fixed with glasses. However, if the astigmatism is irregular, light cannot be focused with glasses, and hard CLs are needed to provide optimal focusing. If you have had a corneal transplant, I generally recommend all your sutures to be removed to allow your new cornea to reach its natural shape.

IOL Selection
The second thing to be considered is the type of IOL. IOLs allow your doctor to refocus the optics of your eye after surgery. In many cases, the correct choice of IOL may decrease your dependence on glasses or CLs. There are several factors that are important when considering the correct IOL for a keratoconic patient. The amount and regularity of your astigmatism plays a very significant role in IOL selection. In general, there are four types of IOLs available in the US – monofocal, toric, pseudo-accomodating, and multifocal. In general I do not recommend multifocal IOLs in patients with KC. These IOLs allow for spectacle independence by spitting the light energy for distance and near, however, with an aberrated cornea (which is what happens in KC), these IOLs do not fare well. If there is a low amount of regular astigmatism or irregular astigmatism, your best bet is a monofocal IOL. This is the “standard” IOL that is covered by your health insurance. If you have higher amounts of astigmatism that your doctor determines is mostly regular, you may benefit from a toric (astigmatism-correcting) IOL. These IOLs can significant improve your uncorrected vision and really decrease your dependence on glasses. It is important to realize that monofocal and toric IOLs only correct vision at one distance. With a monofocal IOL you still can wear a CL to fine-tune your vision, however, with a toric IOL, in general you will need glasses for any residual error. There is a pseudo-accomodating toric IOL available, and this may be a good option if you are trying to decrease your dependence on glasses and correct some of your astigmatism. These IOLs are relatively new to the US market.

If You Had A Corneal Transplant
In the setting of a corneal transplant many of the same factors need to be considered – stability of the graft, choice of IOL, etc. In addition, the health of the graft has to be judged. Prior to cataract surgery in my patients with corneal transplants, I make sure to remove all of their sutures and give the cornea time to stabilize (just as if they were a CTL wearer). If you are a CL wearer, the same rule of being out of the TL until the topography is stable applies. The health of a transplant needs to be established prior to undergoing cataract surgery. The cornea has five main layers to it –cataract surgery and keratoconus-corneal structure the back layer (inside) is called the endothelium. This layer is responsible for “pumping” fluid out of the cornea, allowing it to stay clear. In all eyes there is a loss of endothelium cells with cataract surgery. I generally perform a “specular microscopy,” which allows me to visualize and quantify the corneal endothelium prior to surgery. This allows me to risk stratify you before your surgery. It is important to realize that corneal transplants have a lifespan and may have to be repeated in the future.

Keep in mind, there is some uncertainty in biometry (the process of selecting an IOL) in all eyes – this error can be higher in keratoconic eyes. This highlights why assuring stability is important. Equally important is picking the correct IOL for your situation. Also, keep in mind that I have discussed generalities in this article. Your individual case could be different. This is a conversation best left between you and your surgeon. In general, cataract surgery and keratoconus or a corneal transplant can be a very safe and effective way in restoring vision.

Sam Garg, MDSumit (Sam) Garg, MD
Interim Chair of Clinical Ophthalmology and Medical Director
Gavin Herbert Eye Institute at the University of California, Irvine

Living With KC Isn’t Easy

10/23/14

The Discovery Eye Foundation Fall 2014 e-newsletter focused on depression and eye disease. At the time we asked for people that were willing to share their stories. Jennifer Villeneuve is one of the many that responded. She is 26 years old and lives in Ontario, Canada. A participant in KC-Link, she talks about the emotional toll keratoconus has taken on her life and living with KC.
Villeneuve with child - living with KC
At age 13, I was diagnosed with keratoconus and given RGP lenses, with which I struggled intensely. ?I became very quiet, and my bubbly personality disappeared. The lenses often got irritated and made my eyes water and turn red, which made me look like I was crying. My doctor didn’t really give me much information on the disease. He just told me my corneas were the shape of footballs instead of circles.

I couldn’t be a normal teenager. I often squinted and had red eyes, which made me very self-conscious. I couldn’t wear makeup or have a free-for-all teenage life. I had to worry about my lenses and what people saw when they looked at me. Some people knew about my KC, but not many. I was just that quiet person who squinted. Because of this, my self-esteem got very low. All in all, my high-school life was hell.

Every time I went to the doctor, he said my pain is normal, the discomfort is typical, and I needed to get used to it. I was also diagnosed with two learning disabilities, in addition to my vision impairment. Throughout high school, I had major anxiety and depression, though I never wanted to admit it. A close teacher even spoke to my mom about the anxiety and low self-esteem. I got through high school, still with the depression being untreated — and still with the same doctor who never even sent me for a topography scan. Each time I went in, it was, “Yup your eyes the same; see ya.”

In college, I was diagnosed with depression and anxiety and was finally getting treated. ?I also went to the University of Ottawa Eye Institute of The Ottawa Hospital in Ontario, Canada. They did topographic scans; my KC had gotten significantly worse. My contacts’ sizing changed twice that year. Again, I couldn’t be normal. College students go out partying, but not me. I stayed in my room by myself. I worried whether I could see enough to go out. What if I drank too much and lost a lens? It wasn’t worth the risk, especially given how expensive they are. In college, I got great help and acceptance. My teachers all knew about my KC, and I was set up with the Centre for Students with Disabilities at Algonquin College in Ottawa. They were my backbone and my support.
Villeneuve with 2 children - living with KC
After my two years in college, I moved on to my career working with children. At each job, I had to explain why I always had a mirror and my contact stuff. At first, I was ashamed and almost embarrassed, explaining why I squinted and that I may not be able to read a kids’ book if the writing is too small. Not only did I get accepted by coworkers, but also by the kids. They knew my eyes were red from my contacts or that my tears meant something was in my eye. I began working in with special-needs children, which was incredible but also challenging — especially in ensuring my eyes were at their best.

At this same time, my vision had gotten worse. I went for corneal crosslinking (CXL) in one eye. I had to take? time off from work, which caused a lot of stress. Unfortunately, there were complications from the CXL. I had a scar in the same eye that caused the crosslinking to be difficult and not as successful. When it came time to do my other eye, I was hesitant, but I needed it. It worked, and the disease slowed down.

A year or so later, the disease had a spike and caused my eye to rub on a lens and make a blister. I had laser surgery to get rid of that and the scar, too. Because KC isn’t covered by insurance in Ontario, I had to pay for every lens, every $11 bottle of solution and countless eye drops. It was expensive, and money was a struggle. I still struggle with the costs of things.

I also have to worry about eye infections. Since I work with kids, they are easy to get, but if I get an eye infection, I can’t wear my contacts, which means no driving, which means no working, which means no money. Things can snowball so quickly.

My vision is up and down. My lenses don’t last as long in my eyes as they used to, and my nighttime vision can be scary. I have to be extra-vigilant. Again, I can’t be normal or go somewhere unfamiliar at night. I’m always concerned. My lens fitter recently recommended scleral lenses, but I can’t afford them. I barely could afford the $2,000 for the CXL.

Living with KC isn’t easy. I can’t help but wonder how long I’ll have the vision I have now. Am I going to be blind in a few years? If I have children, will they have this, or will I even be able to see them? Will I find a guy who would want someone with the possibility of losing vision? I have to stop myself from thinking ahead, or the anxiety gets the best of me.

Janet Villeneuve - living with KCJennifer Villeneuve
Keratoconus Advocate

Our Thanks to Guest Bloggers Continues

10/7/14

More Amazing Guest Bloggers

Last week I took the opportunity to thank our very first guest bloggers for helping us launch the Discovery Eye Foundation Blog. We are pleased that so many people appreciate the wide range of eye-related information from eye care professionals, as well as the stories from people that live with eye disease on a daily basis.
Thank you part 2
Here is a round-up of guest bloggers since June 2014 that shared their time, experience and/or expertise to provide you with the best eye-related information.

Sumit “Sam“ Garg, MDwhat you should know about cataracts

Randall V. Wong, MDfloaters, causes and treatments

Roy Kennedyhis personal experiences with the miniature telescope implant

Sandra Young, ODthe importance of getting vitamins and minerals from your food and not just supplements

Jeanette Hassemanliving with keratoconus

Greg Shanetheater for the blind

Caitlin Hernandezblind actress and playwright

Jullia A. Rosdahl, MD, PhDlasers for glaucoma and genetics and glaucoma

Maureen A. Duffy, CVRTways to reduce harmful effects of sun glare

Kooshay Malekwhat is it like to lose your vision and being a blind therapist

Jeffrey J. Walline, OD PhDchildren and contact lenses

Robert Mahoneychoosing a home care agency

Robert W. Lingua, MDnystagmus in children

Buddy Russell, FCLSA, COMTcommon pediatric eye diseases, treatment options for children and pediatric contact lenses

NIH (National Institute of Health)telemedicine for ROP diagnosis

Harriet A. Hall, MDevaluating online treatment claims

Patty Gadjewskithe life-changing effects of a telescopic implant

Michael A. Ward, MMSc, FAAOproper contact lens care and wearing contacts and using cosmetics

Susan DeRemerSusan DeRemer, CFRE
Vice President of Development
Discovery Eye Foundation

Our First Three Months Of Eye Care

9/30/14

Discovery Eye Foundation Blog’s First Three Months

It is hard to believe, but this blog has been providing information and insights into eye disease, treatment options, personal experiences of living with vision loss, and other eye-related information for seven months.

All of this would not have been possible without the expertise of remarkable eye care professionals who took time out of their busy schedules to share information to help you cope with vision loss through a better understanding of your eye condition and practical tips. Since so much information was shared in the seven months, here is a look at the first three months, with the additional four months to be reviewed next Tuesday.
Thank You - first three months
I am very thankful to these caring eye professionals and those with vision loss who were willing to share their stories:

Marjan Farid, MDcorneal transplants and new hope for corneal scarring

Bill Takeshita, OD, FAAO, FCOVDproper lighting to get the most out of your vision and reduce eyestrain

Maureen A. Duffy, CVRTlow vision resources

M. Cristina Kenney, MD, PhDthe differences in the immune system of a person with age-related macular degeneration

Bezalel Schendowich, ODblinking and dealing with eyestrain

Jason Marsack, PhDusing wavefront technology with custom contact lenses

S. Barry Eiden, OD, FAAOcontact lens fitting for keratoconus

Arthur B. Epstein, OD, FAAOdry eye and tear dysfunction

Jeffrey Sonsino, OD, FAAOusing OCT to evaluate contact lenses

Lylas G. Mogk, MDCharles Bonnet Syndrome

Dean Lloyd, Esqliving with the Argus II

Gil Johnsonemployment for seniors with aging eyes

We would like to extend our thanks to these eye care professionals, and to you, the reader, for helping to make this blog a success. Please subscribe to the blog and share it with your family, friends and doctors.

Susan DeRemerSusan DeRemer, CFRE
Vice President of Development
Discovery Eye Foundation

Lens Care If You Wear Contact Lenses and Use Cosmetics

9/23/14

In a continuation from his article on Proper Contact Lens Care, Mr. Ward, Director of the Emory Contact Lens Service, also offers tips if you wear contact lenses and use cosmetics. Several of these pointers apply even if you don’t wear contact lenses, but want to protect your eyes.you wear contact lenses and use cosmetics

The Bullet List of Contact Lens Care For Users Of Eye Area Cosmetics

    • If possible look for eye makeup specifically labeled for use by contact lens wearers; use premium products.
    • Apply eye area cosmetics after inserting contact lenses (this will help prevent cosmetic contamination of lens surfaces from handling of cosmetics).
    • Remove lenses before removing makeup.
    • Remove makeup daily with mild soap and water; do not use oil or petroleum based make up removers; specifically, avoid moisturizing bar soap and an eye makeup remover that contains mineral oil and cocoa butter.
    • Choose water based makeup; avoid any oil based, or ‘waterproof’ eye area products (oils will travel across the skin and contaminate the tear film).
    • Avoid ‘lash-extending’ mascaras with artificial fibers, and apply mascara only to the end of lashes; do not apply mascara to the base of the eyelash or on the eyelid margin.
    • Do not apply oil-based moisturizers on the eyelids (oils can spread on the skin).
    • Do not apply any makeup to the eyelid margin (shelf), between the eyelashes and the eyeball.
    • Apply face powders sparingly; use pressed powder instead of loose powder; try to stay away from the eye area as much as possible; avoid frosted.
    • Choose liquid or gel eye shadows rather than powders.
    • Use caution with hair styling sprays. If possible, spray aerosols with eyes closed and step back out of the mist before opening the eyes. These gel/wax/lacquer type sprays can significantly coat your contact lenses.
    • Replace eye makeup at least every three months; do not share cosmetics.
    • And, please note that an automobile’s rear view mirror is not intended for makeup application while driving.

    Michael Ward - proper contact lens careMichael A. Ward, MMSc, FAAO
    Director, Emory Contact Lens Service
    Emory University School of Medicine

Proper Contact Lens Care Provides Best Vision, Comfort and Ocular Health

9/18/14

Proper contact lens care is essential for the best contact lens wearing experience. Mr. Ward, Director of the Emory Contact Lens Service has shared some valuable information about taking care of your contact lens in the article below. On Tuesday join us for additional tips for people who wear contact lenses and wear cosmetics.contact lens case - proper contact lens care

Contact lenses provide alternatives to spectacles, and contact lens wearers report better peripheral vision, depth perception and overall vision quality. Contact lenses can correct near-sightedness, far-sightedness, astigmatism and even correct the need for reading glasses. They are also used to manage some ocular surface diseases.

Contact lenses fall into two basic material types: soft contact lenses (SCL) and rigid gas-permeable (GP) lenses. Soft lenses account for the great majority of the contact lens market. GP lenses require more precise fitting and are often used as specialty devices to correct high prescriptions and/or to manage various ocular disorders and may require longer lens-adaptation time. Regardless of lens type, careful attention to lens care instructions can provide good vision and life-long lens wearing comfort.
Proper lens care depends on the lens type, wearing schedule and other factors. Single-use or daily-disposable soft lenses are prescribed to be worn once and discarded. This is theoretically the safest lens wearing modality in that no lens cleaning, lens care or storage case is required for this modality. Other daily wear soft lenses may be replaced every 2 weeks, monthly or by other schedule. Any and all lenses that are removed each day must be cleaned and disinfected prior to their reuse. Your eye care practitioner should provide specific instructions relative to your lens wear and care needs. General lens care instructions and Dos and Don’ts are bullet-listed below.

A word of caution –
Contact lens wear is quite safe as long as proper lens and storage case care are followed. However, improper lens wear and care can put the lens wearer at risk for serious consequences. Sight-threatening microbial keratitis (corneal ulcer) is the most significant adverse event associated with contact lens wear and is largely preventable. The contact lens storage case is the most likely potential reservoir for contact lens related ocular infections. Therefore, lens storage case care should be high on the list of important lens wearing instructions. Contact lens cases are not meant to be family heirlooms; cases should be replaced regularly, at least every 1-3 months.

The Bullet List of Contact Lens Care Recommendations

  • Hand washing: Always wash your hands before handling contact lenses. Use mild, basic soap and avoid antibacterial, deodorant, fragranced or moisturizing liquid soaps (many liquid soaps have moisturizers that can contaminate your contacts from handling).
  • Cleaning, rinsing, and disinfecting: Digital cleaning (rubbing the lens with your finger in your palm) removes dirt and debris and prepares the lens surfaces for disinfection. Rub & rinse thoroughly, even if the product is labeled “No Rub”. Lens storage solutions contain chemicals that inhibit or kill potentially dangerous microorganisms while the lenses are soaked overnight.
    • Contact lenses should be cleaned when removed from the eye.
    • Do not re-use old solution or “top-off” the liquid in the lens storage case. Empty the storage case daily and always use fresh solution.
    • Do not use lens care products beyond their expiration dates. Discard opened bottles after 28 days.
    • Do not allow the tip of the solution bottle to come in contact with any surface, and keep the bottle tightly closed when not in use.
    • Do not transfer contact lens solution into smaller travel-size containers.
  • Keep your contact lens storage case clean (inside and out).
    • All lens storage cases should be emptied, rinsed, wiped, and air-dried between uses.
    • Keep the contact lens case clean and replace it regularly, every one to three months.
    • Do not use cracked or damaged lens storage cases.
    • Take care to remove residual solution from surfaces of lens case and solution bottles.

Other Dos and Don’ts

  • Do not wear your lenses during water activities (swimming, hot tubs, showering, etc).
  • Soft contact lenses should not be rinsed with or stored in water. Soft lenses will change size and shape if exposed to water.
  • Do not put your lenses in your mouth.
  • Do not use saline solution or re-wetting drops in an attempt to disinfect lenses. Neither is capable of disinfecting contact lenses.
  • Wear and replace contact lenses according to the prescribed schedule.
  • Follow the specific contact lens cleaning and storage guidelines from your eye care professional.
  • Do not change lens care products without first checking with your eye care practitioner.
  • Spare rigid (GP) lenses should be stored dry for long term storage { clean, rinse, dry}. New or dry-stored GP lenses should be re-cleaned and disinfected prior to lens wear.
  • Do not store soft lenses in the storage case for an extended period of time. “Spare” soft contact lenses should be new and stored in their original and unopened packaging.
  • Do not sleep in your contact lenses unless specifically approved to do so by your eye care practitioner.

For information from the Centers for Disease Control and Prevention, see:
www.cdc.gov/contactlenses/
www.cdc.gov/contactlenses/cdc-at-work.html

Michael Ward - proper contact lens careMichael A. Ward, MMSc, FAAO
Director, Emory Contact Lens Service
Emory University School of Medicine

 

Contact Lens Fitting For Children

8/26/14

Fitting Techniques

The techniques the contact lens professional utilizes to fit an adult with a GP lens must be altered to fit an infant or small child. The ability to capture a reliable image with a topographer or accurate keratometric readings is often impossible to obtain in small children. Keratometric readings obtained at the time of surgery or an exam under anesthesia should only be considered as a starting point or a guide to the initial diagnostic lens. The application and evaluation of a diagnostic lens is the best method to obtain an appropriate fit in small children. I utilize diagnostic lenses that do not have a UV filter.Contact Lens Fitting for Children I find these lenses allow me to better interpret the fluorescein pattern when using a handheld burton lamp or LED cobalt flashlight. Once the appropriate fit has been determined, the lens is remade incorporating a material that provides an ultraviolet filter. I find it easier to determine the approximate corneal shape and curvature initially with a relatively flat fitting lens on the eye. If the diagnostic lens being evaluated vaults the anterior corneal surface, the interpretation and extrapolation of corneal curvature is difficult if not impossible. As in any GP fitting, the goal is to equally distribute lens mass and provide peripheral fulcrums to maintain stability and a central position. This central position of the lens is especially important in higher powers to minimize spherical aberrations. In recent years, I have found myself fitting looser and larger GP diameters. A general rule to follow with small children and GP lenses is that a tight lens will tend to dislodge from the eye and a loose fitting lens will tend to displace off the cornea onto to bulbar conjunctiva.

As with GP fitting on small children, soft lens fitting techniques are also a bit different. In order to determine appropriate movement of a soft lens on a small child, the “spring back” test may be helpful. With the soft lens on the eye, digitally displace the lens off center. If the lens immediately “springs back” into place on the cornea, the lens may fit too tightly on the ocular surface. If the lens stays off center while manually closing the lids to mimic a blink, the lens may be fitted too loosely on the ocular surface. In addition, retinoscopy over the soft lens to determine if the reflex maintains clarity during the blink is a finding seen with a well fitting lens. If the reflex is clearer with a blink, the fit may be too steep. If the reflex is worse with a blink, the fit may be too flat. The reflex seen with a well-fitted soft lens will maintain the same clarity before, during and after a blink. The retinoscope is not only used to determine the final lens power with any type of lens but also an important instrument to guide you to the best cornea lens relationship. Pediatric fitters of contact lens should be proficient with a retinoscope.

Little Lenses for Little People?

The pediatric contact lens professional is not limited to “off the rack” products. In addition to custom GP lenses, there are many lens manufacturers of custom made soft and silicone hydrogel contact lenses that allow us the opportunity to provide any child any parameter. In addition, liberal exchange policies implemented by these manufacturers of custom products allow us to provide these products to the patients who require them in a fair and effective manner. However, the delay in time to deliver the product to a pediatric patient in an urgent situation is a potential problem. Any delay in optical correction and visual rehabilitation with a young pediatric patient may result in permanent loss in vision.

Silicone Hydrogel Custom Products

After many years of anticipation, in 2010 Contamac received FDA approval for Definitive, a latheable silicone hydrogel material. The Definitive material can be manufactured by a limited number of laboratories in the U.S. in virtually any group of parameters. This inherently wettable, high water content and low modules material has a DK of 60. While 60 DK is not as high as other “off the rack” silicone hydrogel materials, the effective DK in many of the parameters utilized in pediatric fitting is higher than the same parameters made in HEMA-GMA materials. While this material is a welcome addition to our armamentarium of contact lens options in our practice, my clinical experience specific to pediatric indications and this material has led me to two conclusions. The application of a lens to the eye of a small child manufactured in the Definitive material is more difficult than HEMA-GMA materials and the time delay of up to ten days is often too long in an urgent case common to the pediatric patient. In time, both of these concerns can be overcome with practice and improved efficiency on the part of the patient, the practitioner and the laboratory.

New News About an Old Lens

Silicone Elastomer (Silsoft) has a long and well-documented history of being the lens of choice for the majority of pediatric professionals to manage small children following cataract surgery. The truth is that there would be many “blind” children if not for this particular lens. Silsoft Super Plus contact lenses for pediatric aphakia (>20 diopters) are available with the following parameters: diameter, 11.3mm, base curves: 7.5 mm (45.00D), 7.7mm (43.75D), and 7.9mm (42.75D), optic zone of 7.0mm and powers ranging from +23.00D to +32.00D in 3D steps. The Silsoft material has an oxygen permeability (Dk) value of 340, with oxygen transmissibility (Dk/t) of 58 at 0.61mm. One of the concerns about Silsoft has been the limited availability of parameters. As a result of the tireless efforts of Joe Barr, O.D., B+L may ultimately decide to expand the parameters of their Silsoft Super Plus product. While this announcement is far from official at the time of this article, I would like to applaud Joe and encourage you to do the same. Whether you are a proponent or opponent of Silsoft, any improved technology to provide children with the opportunity to safely develop better vision is worthy of the efforts. On behalf of the industry, the children and their families, thank you Joe.

Conclusion

As contact lens professionals, we have the responsibility, opportunity and privilege to provide products and service to young patients and their families. These products and associated services are necessary to maintain and or develop possibly the most important gift one may ever possess, the gift of sight. Again I ask you, are you a “healer of children”?

Buddy Russell - pediatric contact lensesBuddy Russell, FCLSA, COMT
Associate, Specialty Contact Lens Service
Emory University Eye Center