Tuesday's favorite calls

A handful of the more interesting of my calls yesterday....

Floppy eyelid syndrome

This gentleman's doctor has been hassling him for five years, he says, to get some kind of goggle, and he finally gave in and called the number on the flier his doctor gave him. He is a bit frustrated as he feels he didn't understand anything about what it was all about or why, and why would he spend all this money on a goggle when he has bigger fish to fry with other medical issues? He suffers from sleep apnea and keeps waking up not breathing. He cannot afford CPAP. I probe for a few more details, then I find a pair of post LASIK goggles in our freebies and put it in the mail to him along with a bunch of Alcon eyedrop samples that we happened to have as it sounded like he's probably not using the drops he should either. My guess is that his doctor is seeing cornea scarring from continued rubbing of his corneas against the pillow. It happens a lot. The LASIK goggle is actually my favorite tool for that - not the most comfortable thing in the world, but it is sturdy and reliable with a secure strap. I tell this caller to call me back if the goggle doesn't fit so I can find him something else.

Photophobia and pain... but why?

Later that morning I speak with a lady with severe, constant pain and photophobia. She has a complex history of retinal surgeries with a host of complications all stemming back to a refractive lens exchange procedure. Everything from elevated intraocular pressure to macular edema in the mix. She has found almost by accident that goggles seem to help with the light sensitivity, so she's calling for help navigating goggles selections. I send her to 7Eye for a fitting set of 7Eye AirShields with the dark foam shields and tinted lenses. It's not at all clear to me how much of the issues are actually related to her corneas versus other eye issues, and while she's clearly very well read about corneal neuropathic pain treatments and such, I still find myself wondering what this all looks like from the perspective of the various subspecialties (retina, cornea, and neurophthalmology). I wish I could help more.

SoftSert

Feels like a weird fluke: For the second time in just a week or two, someone calls trying to track down this obscure contact lens insertion device that has been off the market for years. I'm wondering why it's coming up again now. I had stocked these devices for a brief while a few years ago... but they evidently haven't been manufactured in years. I dig around for awhile trying to find a source for my caller, but when there are no more even on eBay, it's probably really and truly gone. I make a note to self to add this one to the dry eye & scleral lens product encyclopedia we're hoping to create.

Lacripure substitutes

I have two callers almost back to back who, like so many others, are seeking advice on a temporary replacement for LacriPure while it's on backorder. The first  is a Menicon customer, for whom this backorder situation is a disturbing repeat ("Do they stop production every summer?") so I reassure him that this is simply market forces at work, that it's not the manufacturer's fault, just so much unpredictable growth in the scleral lens market and many factors outside anyone's control. I end up selling him a box of ScleralFil to tide him over the gap. The second is a DryEyeShop regular, who is frustrated with either lack of advice or contradictory advice from her various eyecare professionals and is bound and determined that she'll follow whatever advice I personally give, which naturally is terrifying as I am not the font of all knowledge and don't want to get it wrong! I probe a little further, and it sounds like she has used both buffered and unbuffered types of saline successfully, but after I realize she used Unisol 4 in the past, we eventually settle on a 3pack of Purilens as a one-time thing to see how it works out. I suspect it's too much saline. But, there is no 5mL individual use size of buffered saline on the market.