There are people in this world whose dry eye is so severe they cannot open their eyes from the pain. A similar fate afflicts those with severe scarring of the cornea or keratoconus — a condition that deforms the eye and destroys vision.
“They come into your office with two pairs of sunglasses and a visor hat, because bright lights cause extreme pain. It’s hard even to examine them, they are in so much pain,” says Wilmer optometrist Anisa Gire, O.D. She is an expert in a surprisingly little-known device known as PROSE — prosthetic replacement of the ocular surface ecosystem. PROSE helps these patients when nothing else will. The devices are made of a gas-permeable material and act like a protective, transparent shield over the damaged eye, floating on a thin layer of saline. They are typically inserted daily and removed nightly.
“It’s instantaneous impact. You put these devices on and it's like magic. Patients just sit up, and they can take off their sunglasses and their hats and they can go outside. The pain is gone,” Gire says. Even after years of working with PROSE, she is almost as surprised by the transformation as her patients. Not every person will have such astonishing results, which is why specially trained doctors are the key to success. Their experience allows them to carefully select which patients are good candidates.
Wilmer is just one of 14 eye clinics in the country equipped and trained to administer PROSE. Gire trained with the product’s inventor before coming to Wilmer and is now one of three PROSE-qualified optometrists at Wilmer.
Michelle Hessen, O.D., is another provider who specializes in PROSE and other types of scleral lenses. The lenses are custom-fitted to a patient’s eyes, filled with saline and placed onto the surface of the eye, where they hold fluid against the eye throughout the day. The saline relieves dry eye, and for patients with deformations or injuries, the fluid fills in the surface irregularities, and the lens creates a new smooth surface that protects the eye and improves vision.
“They're able to go back to their daily activities and have significantly better quality of life,” Hessen says.
Another Wilmer optometrist, Jeremy Goldman, O.D., specializes in what is known as “medically necessary” contact lenses. These are specialized lenses custom-made for people whose, a glasses are not effective, often due to corneal imperfections. Scleral lenses, such as the PROSE lens, fall into this category, along with several other types of specialized, custom-designed lenses.
“For many of these people, glasses are not helpful,” Goldman says. “These rigid, gas-permeable contact lenses focus light in a way that the patient's own cornea can't, because it has been misshapen or injured from surgery or disease.” The lenses become, in effect, the artificial surface of the eye.
So why aren’t devices like PROSE, and the lenses that Goldman prescribes, better known? Possibly because of their cost. PROSE runs just over $5,500 per eye. The lenses that Goldman prescribes cost significantly less, but the cost is still prohibitive for many of his patients. While some insurance plans will cover the cost of these devices, Medicare and Medicaid do not. Low-income and elderly people on fixed incomes who are most in need of these transformative products are often unable to afford them.
So all three optometrists have developed fundraising approaches to purchase the products for those who cannot afford them. Goldman calls his program G-SLAM — the Goldman Specialty Lens Assistance Method. It’s a pay-it-forward model in which patients who can afford to make a gift are encouraged to do so, to help those less fortunate to afford the lenses.
Sharon Morris is one of those donors. She came to see Goldman after nearly two years in bed, trying to protect a delicate corneal transplant that left her unable to close her eyelids. She was unable to drive, unable to work, unable to do much of anything. Goldman prescribed scleral lenses for her. Since she began wearing the specialized lenses, she has gotten her life back: She can once again drive and work.
Morris became a donor and was eager to contribute to G-SLAM, where her gifts are helping people afford specialized lenses that are not covered by their insurance plans. “Dr. Goldman is such a perfectionist in everything he does. More people should know about him,” Morris says. “It’s like giving people the miracle of sight.
”Debbie Colson is a patient of Gire’s. A lawyer by profession, she suffers from keratoconus, for which she received corneal transplants in both eyes, one in 1982 and the other in 1998. After the surgeries, Colson tried using hard contact lenses but experienced constant discomfort that made it difficult for her to travel for work, among other problems. She’d almost given up when she came to see Gire, who fit her with scleral lenses.
“Not everyone is as patient and knowledgeable as Dr. Gire. She saved my vision by fitting me with the scleral lenses when I could not tolerate a standard hard lens,” says Colson, who now serves on Wilmer’s Board of Governors and has become a donor to a special fund that helps less fortunate patients afford sight-saving scleral and PROSE devices. Colson says it’s a small token of appreciation for the difference Wilmer made in her life.
“I couldn’t do what I do without my medically necessary contact lenses,” Colson says.