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Scleral lenses: helping Veterans see clearly

Dr. Cara Smith helps Veteran Iona Trexler insert her scleral lenses to check for fit of the lens. Photo by James Arrowood.

What if you were never able to see clearly, or you were always uncomfortable with dry itchy eyes? The scleral lens may be the answer you’ve been looking for.

A scleral lens is a hard contact lens that is larger than soft contacts and sits on the white part of the eye, the scleral. Its shape creates a fluid reservoir over the cornea.

Dr. Cara Smith, Ralph H. Johnson VAMC optometry resident, fits these lenses for Veterans, helping to improve their vision and comfort. Since July 2017, Dr. Smith has held a full day clinic on Thursdays at the medical center, and has already helped nearly 50 Veterans with the lens. Patients are referred to her throughout Charleston VAMC’s catchment area, from Myrtle Beach, South Carolina, all the way to Hinesville, Georgia.

In general, patients with chronic/severe dry eye, cornea ectasias, those who are experiencing vision difficulty after cataracts surgery, and those who cannot completely blink, benefit from the scleral lens.

“The optics through scleral lenses is preferred over glasses,” said Dr. Smith. “Patients are blown away when they realize they can see 20/20, and for the patients with dry eye, they are impressed with the comfort of the lens.”

It can take several visits to get the fit of the lens just right, since the lens is more rigid than a soft contact lens. Dr. Smith has Veterans try different sizes for fit and can then adjust four different parameters on the lens to create a tailored fit unique to the Veteran’s eye shape.

Once properly fitted the Veteran keeps that lens for two years. The scleral lens is inserted daily with a small plunger and removed at the end of the day with another small plunger. To prevent bacteria from getting in the eye it is very important that Veterans not sleep in the lens or wear them to swim; they also need to be cleaned daily.

“The Veterans initial reaction is that they don’t think they can insert the lens,” said Dr. Smith. “Most of my patients have never tried contacts before and were not getting great vision with their glasses. I can help them get the contact in the first time by numbing the eye and inserting the lens. The numbness quickly goes away and they are surprised at what they can see.”

U.S. Army Veteran James Huckfeldt was diagnosed with keratoconus, a cornea ectasia, in 1997. After hitting a small tree with his car that he was unable to see in 2012, Huckfeldt was fitted with glasses, and diagnosed legally blind without glasses in 2013. In 2017, he had an appointment with Dr. Smith at Charleston VAMC to try scleral lenses.

“I never thought I’d be able to see this quality again,” said Huckfeldt. “As a former sniper with the famous 506th infantry regiment, it was demoralizing, like a bad joke that this was happening to me.”

“Dr. Smith and her team improved my quality of life exponentially. My work has improved. My outlook has improved. My quality of life improved. She was able to give me one of my five senses back and I’m eternally grateful.”

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