UK Keratoconus Self-Help and Support Association

HI All.

Some advice please.

I have worn a RGP lens in one eye for years now but it has caused my lid to drop significantly so have just been prescribed with a thick Scleral lens which has opened the lid up with my vision remaining the same. That is the good news.

I have only been wearing the Scleral lens now for two days but very quickly after insertion (10 or so minutes) my eye becomes very dry. I did not suffer with dry eyes with my RGP and without the lens I produce enough tears. Is it normal for the Scleral to dry the eye out? Do I just need to get used to the news lens?

Secondly, when I take the lens out I have a distorted hazy patch that appears over my eye. It goes after 10 or so minutes. Is this also normal with Scleral lenses because of their suction like fitting on the eye?

My theory for what it's worth - I have had little sleep recently and my eyes have been very tired. Also the weather here in London has gone from very wet to quite humid. May be I am being too positive about things though and this new lens is not right.... ?

All the best

Jay

Jay

It is possible that tired eyes do dry out more quickly than bright and well rested ones!

How are you inserting your scleral? I always filled mine with saline (or sometimes artificial tears) and held it so that the fluid completely filled the crucible. I would then look directly down into the lens and lower my eye into the cool fluid (actually that bit was quite nice).

When the rim of the lens touched my lower eyelid, I would pull the eyelid downwards and tuck the rim under the lower lid. I would then draw my upper lid 'upwards' and slip the lens under. A blink would complete the process.

My lens had a fenestration (a little hole) drilled next to the bit that fitted over my cornea. This meant that, if I timed my blind right, I could squirt a tiny stream of fluid, sometimes hitting someone nearby. Well, amusement when fitting a contact lens is not that easy to find and the child in me is never far from the surface.

I would then lubricate the lens and my eyelids with hourly applications of an artificial tear. Check with your optometrist what sort of tears you ought to try.

All the best

Andrew

Hi.
Congratulations on your new scleral lens.
I've never had problems with dry eyes (apart from a brief encounter with aircon...) but then I do drink like a fish. Water, I mean, not strong liquor!
Are you cleaning the lens thoroughly before each time you put it in?
I'm presuming this is an RGP (rigid has permeable polymer) scleral not one made of perspex in the old style? - I'm presuming also that you're storing them dry, and getting the dry olens ou of its case and applying wetting solution to put it in.
The RGP sclerals are very sensitive to being 100% cleaned before you try putting them in , or the wetting solutions don't wet as well as they might, and leave not-properly-wetting patches. When you're in the process of putting them in, and have wet fingers and saline filling them up, this can be masked, and when the excess saline starts to run away down the tear ducts, the not-so-well-wetting patches dry out as the fluid pulls away and you have dry lenses.
Suggestion: before you putthe lens in, and before filling it with saline, turnit this way and that and check yu can't see any dry patches where the wetting is pulling away. If you do see any, don't just dump on more wetting fluid. Dry the stuff you've got on it off with a tissue, and CLEAN it again. DON'T stint the cleaner, and DO!! rinse the cleaner off thoroughly. Then try wetting it again and try again.
I had this problem a lot when I first moved to the RGP material sclerals - the older Perspex ones where much less sensitive to any scrap of stuff, because of different surface characteristics of the material (at the microscopic level). Basically, I'd been scrubbin gmy old perspex lenses with washing up liquid every week or so, but can't get away with that with the RGP ones, they have to be done every time I've worn them, before I put them in again.
Hpe this makes sense.
As regards fuzzy patches when you take a scleral out - I find that the vision is always fuzzier in an eye I've just taken a lens out of than that eye is when I haven't had a lens in it for some time. It does go back to "normal" though I've never tried to test and time its return - though it does seem worse and last longer when I've had the lens in too long and made the eye get sore.
Never really bothered too much about why - though apart from pressure of plastic on eye ball, it could be related to lack of oxygen supply getting to the eye from the air as there's been a chunk of plastic int he way.
Can't say I've ever worried about it too much, I have to admit....
Hope this makes sense and is some help.
Rosemary

Thanks for the advice.

I put the lenses in at 6ish tonight after drinking plenty of water today and my eyes feel far less dry than the previous two days. Whilst I am writing this though I am noticing the clarity is not as good as it was earlier so it may be what you said Rosemary or simply that i have to graduatlly get used to them.

Confort wise - great. Vision - not so great. The best why i can describe the vision is it is like looking through a steamed up window. I clean them properly before insertion, store them as described, insert them with plenty of saline as per Andrew's method (air bubbles do get on my nevers but that is just practice!).

I really do think it is a case of me being patient with them though and getting use to the lens and its handling process. It seems I am doing everything right though so I will give it a month or so and if I see no improvement I will head back to Moorfields.

Thanks for the help.

Vision looking like a steamed up window sounds like it could e:
air bubbles
dry patches on the surface where it didn't wet properly
or
hypoxia (cornea not getting enough oxygen fromt he air)

The first two may improve with practice. The third.... may improve as you get used tot he lenses, or may be a wear-time limiting factor. (I've been having something similar with the post-graft new lens - or was, before they put me on the anti-glaucoma drops tha make the ee too sore to want to put a lens in it).
When you get the misty vision, do you see rainbow-coloured haloes round light sources?
- if you do - that sounds very familiar! - and it may be a sign that it's time to be taking the lens out.
As long as the mistiness fades reasonably quickly once you take the lens out, it's probably not something to panic over. But definitely something to discuss with the fitter next time.
I mean, you don't want to be walking round seeig the world through a steamed up window!
Good luck with it.
Rosemary

I can rule out the air bubbles as I see them immediately.

It could be the dry patch but it sounds more likely to me being the oxygen theory.

What puzzles me is that I have just started wearing a scleral in my bad eye. It is the first time I have worn a lens of any sort in that eye and it is great and no problems, although it does take some time for my brain to get used to seeing out of two eyes again. Vision is a real privledge since I have had less than 20% in that eye for over 10 years.

It's my good eye though which I am having the problems I have discussed. I have worn an RGP in there for close to 12 years now and the only reason for cahnge was the dipping of my eyelid. I hope the vision with the scleral does improve in the right eye and this misty feeling after 4 or so hours of wear eventually goes and means I can wear them for 8-10 as I did with teh RGP. Hppefully day by day the hours of tolerance will increase. It is just frustrating though since it takes 2 hours for me to get used to seeing out of 2 eyes again and then just when I have that balance of vision the right eye seems to mist up. I do get those rainbow rings around light as mentioned and also the mistyness appears worse when looking at teh computer screen or bright colours on the TV. As I say though only after 4 or so hours of wear.

It is bothering me though as you can see by the time I am posting this! I am a stubborn old git and i hate things not working out when I want them to! Rome wasn't built over night though...

Yup, developing rainbow rings after 4 hours does sound like hypoxia.
It could be that it will improve as you get used to the lens.
It could be that your eye is more sensitive, ahving had a (corneal) lens in it for years whereas the other one is generally fitter not having had to put up with a lens for years.
Sclerals, I gather, are more prone to this just because they are bigger than the corneal lenses.
Good luck! - and do talk to your CL fitter about it.
As regards getting used to seeing with two eyes - Oh, yes, I can identify with that!!!!! - have been wearing one lens at a time for so many years I had no inocular vision and couldn't understand the results if I did put two lenses in together.
Then I had a graft ..... stilll only ever worn one lens at a time, but the grafted eye vision comes up not too bad through my (big, powerful) binoculars.
Which is OK until I tried to look through the binoculars with both eyes open...... I first tried this, with lens in ungrafted eye, and could see two copies of everything.
Like seeing double, side by side.....
Except they floated around relative to each other.
very surreal!!!
And one day - when a group of us from work went to Walthamstow dogs, as it happens, and I could see these two imaes swimming around across each other - and after a while, they two gradually swam closer and closer together and suddenly, click! there was just one - all in 3D and very surreal when I hadn't seen that for eyars and years.
Even odder was that I had to keep concentrating very hard, and it stayed as one image - but if I relaxed a bit, the two started to swim apart again and I could see two of everything again.
Very very odd.
I can now take myself and binocs to the (horse) races and watch the races down the binocs with (normally) lens in left eye and not in right (sometims have had no lens at all becuae of sore eyes) and can only see one picture.
Trouble is, it all looks rather fuzzy, becaue the grafted eye is much more shortsighted than the ungrafted eye with lens in, and binocs won't adjust enough to get botin focus at once.
Oh well, maybe one day....
Rosmary

Dazzabee

Mistiness, as you describe, with rainbows is a sign of oedema. Oedema is when the cornea suffers a lack of oxygen and, as a coping mechanism, absorbs fluid from the tears. This, in turn, disrupts the fibres of the cornea which then starts to lose its normal transparency and goes hazy... hence the mistiness. The rainbow effect is exactly the same as a rainbow in the sky - caused by light passing through a medium that scatters it... in the sky its moisture and in the cornea its haziness.

I would advise contacting your clinic for advice as I feel the fit of your lens needs looking at!

Lynn

If it is Oedema do you advise I leave the lens out until I see my my fitter?

Hmmm...

Until you contact the clinic, don't wear more than a couple of hours at a time. When you do contact them, explain you are getting misty vision after 4 hours with rainbow effect and ask their advice what to do.It sounds like the fit needs adjusting, so hopefully they will see you sooner rather than later!

Lynn