FAQ For Dry Eyes and Scleral Lenses

I suffer from chronically dry eyes due to arthritis and the multiple medications that I need to take to address other health issues. Every time that I blink, it feels like there is sandpaper rubbing against my eyes. Can scleral lenses help me with my eye comfort?

The answer to this question is yes. In addition to providing clearer vision, a scleral lens serves as a therapeutic device. The lens acts as a buffer between the dry, compromised cornea (the front surface of the eye) and the eyelids. When you blink, the eyelids will no longer be rubbing against the irritated, dry cornea but against the outside surface of the scleral lens. In addition, the scleral lens does not touch the cornea. Instead, the scleral lens vaults over the cornea and comes to rest on the white portion of the eye (the sclera). Pure, unpreserved saline solution acts as a liquid reservoir between the back surface of the scleral lens and the front surface of the cornea. In many cases, the irritated cornea will heal due to the protective nature of the scleral lens. Comfort and vision in almost all cases is excellent.

I was diagnosed with dry eyes and have difficulties wearing soft lenses. I have tried gas permeable lenses but can only tolerate them for a very short period of time. Will scleral lenses help me?

Yes. Almost all patients who have been diagnosed with dry eyes have issues with the tear film coating the cornea and protecting the cornea from the environment and the blinking action of the eyelids. All soft lenses act as sponges by soaking up the tear film on the corneal surface making your dry eyes even drier. Scleral lenses vault over the compromised cornea and come to rest on the white portion of the eye known as the sclera. The space between the back surface of the scleral lens and the front surface of the cornea is filled with sterile, unpreserved saline solution. In other words, your dry corneas are always in a liquid environment. The very special scleral lenses that we design serve 3 purposes: 1. Vision. Visual acuity with scleral lenses is almost always excellent and stable both during the day and at night. 2. Therapeutic. Because the corneas are always in a moist environment, the dry, irritated corneas have the opportunity to regain a much healthier appearance. 3. Protection. Most eyes that have been diagnosed as dry have a corneal surface that is irritated and compromised. Scleral lenses do not move on the corneal surface like a gas permeable lens does. In addition, the scleral lens protects the cornea from the environment and the blinking action of the eyelids.

I have read about dry eyes and how it can impact contact lens wear. Can you elaborate on this? Can scleral lenses address this issue?

The majority of contact lens problems, including intolerance and limited wearing time are related to the tear film lying over the cornea. These difficulties are caused by disruption of the tear film and increased evaporation of the tear film caused by the contact lens. In addition to contact lenses affecting the tear film, there are other causative factors including medications used by the patient, and medical conditions that may be affecting a patient’s tear film. In the strictest sense, scleral lenses are not really contact lenses in that there is no “contact” with the cornea. Because the scleral lens does not touch the cornea, there is no disruption to the tear film. In addition, because of the liquid reservoir between the back surface of the scleral lens and the front surface of the cornea, the cornea is always in a moist environment. One other factor to be considered by those suffering from dry eyes: Many corneas are not spherical or smooth but may be very irregular. The blinking action of the eyelids over an irregular corneal surface can create additional comfort issues for patients suffering from a dry eye. Scleral lenses have smooth surfaces. The blinking action of the eyelids over a scleral lens will not add to any corneal irritation already there. To the contrary, the scleral lenses will actually protect the dry cornea from the environment and the blinking action of the eyelids.

My eyes are always dry even at night. Can I wear scleral lenses while sleeping?

Scleral lenses have a therapeutic effect on a dry eye. Remember, scleral lenses do not touch your cornea but come to rest on the white portion of your eye known as the sclera. The space between the back surface of the scleral lens and the front surface of the cornea is filled with unpreserved sterile saline solution. In other words your corneas are always in a dry environment and your corneas are also protected from the blinking action of your eyelids. I prefer that my patients not sleep with their lenses overnight. However, if you wish to take a short nap with the lenses for about an hour, that will be OK to do.

The Wavefront Scleral Lens

The corneal irregularities created by refractive surgeries, such as LASIK and RK, are responsible for ghosting, halos, starbursting, and loss of contrast sensitivity. These "higher order aberrations" may exist on both the anterior and posterior. With aberrometry, the defects of the entire optical system can now be corrected by a scleral lens.

The Wavefront Scleral Lens

Autologous Serum for Dry Eyes

Dry eye conditions are among the most challenging conditions faced by refractive surgery patients. With autologous serum, blood is spun down to plasma, forming an eye drop that helps rehabilitate the cornea.

Learn More about Autologous Serum

Dr. Boshnick on CBS This Morning

See Dr. Boshnick and Dr. Morris Waxler (former FDA chief research scientist on refractive surgery) talk about bad LASIK

Optimum Infinite Gas Permeable Material

I am happy to announce that our Global Vision Rehabilitation Center will be designing and fitting all of our “high need” patients with the Optimum Infinite gas permeable contact lens material. The Optimum Infinite material is the most oxygen permeable material ever to be approved by the FDA. In addition, this newly FDA approved material includes a UV lens blocker. Now for the first time, with certain patients, wearing a scleral lens made with the Infinite material under extended wear conditions can be considered.

SMAP 3D Scleral Lens Design

NEW: Powerpoint presentation on SMAP 3D

Last year we introduced an exciting piece of technology that has allowed us to custom design a scleral lens much more accurately. It is the SMAP 3D, which is a computer attached to a dedicated camera that allows us to obtain a 3 dimensional image of the entire front surface of the eye, including the cornea and the surrounding white portion of the eye (the sclera). Up until now there has not been any technology that would allow us to measure the ocular curvatures outside the cornea. The SMAP allows us to do this. Read More

Have Twitter?

Follow @Boshnick or check https://twitter.com/boshnick

Have Instagram?

Dr. Boshnick on Instagram

Check out EyeFreedom.com



Blurred Vision, Burning Eyes: This Is a Lasik Success?

EyePrint Pro

EyePrintPro technology creates a scleral lens based on a mold of the cornea. The molding is accurate to 1 or 2 microns and fits perfectly because it exactly mirrors the irregularities of the individual corneal surface. The technology is well suited for post-Lasik, Keratoconus, RK, eye injury, and corneal transplant patients. Read More in this PDF about EyePrintPro Scleral Lens Technology

Watch Video at YouTube