Vancouver eye patient Paula Hinton suffered chemical burns to both of her corneas in 2021. Before she visited Mt. View EyeCare in Vancouver, she used specialty drops prescribed by a different doctor, but she could only see colors and shapes.
“At that point, it was kind of a full-court press to save my vision,” Hinton said.
She went to see Dr. Nick Jankowski, lead optometrist at Mt. View EyeCare. His office is one of the few in Vancouver that specialize in fitting scleral contacts: a type of lens for people with eye conditions, such as keratoconus, where the cornea is a conelike shape, making it difficult to fit or see through regular contacts or glasses.
“I had my first appointment with Dr. Nick, and he told me my corneas were almost like gravel. But he popped one of the scleral contacts into my eye, and I was able to see for the first time in six months.”
Hinton said the scleral lenses came with a learning curve, but Mt. View ophthalmic technician Julie McCord taught her how to properly care for them, including how to disinfect and safely remove them.
“Scleral lenses are not a very common specialty lens. The technology is rapidly changing and adapting. It’s almost going through its own industrial revolution,” Jankowski said. “They have actually been around for the last 20 years, but in terms of what we can do with them, that has rapidly progressed in the last five years.”
Mt. View EyeCare, 1405 S.E. 164th Ave., is the only clinic in the metro area that uses a medical system called Ovitz, which analyzes and measures the eye to create the personalized lens. Mt. View optician Amanda Mullins said the next closest offices with the technology are in Seattle; Calgary, Alberta; and Utah.
Many people who use scleral lenses have underlying medical eye conditions, such as keratoconus, ocular surface disease or chronic dry eye. Scleral contacts, which are hard instead of malleable, rest on the sclera, or the whites of the eye. Because scleral lenses are gas permeable, they allow oxygen to reach your cornea for better eye health, Jankowski said.
“Scleral lenses themselves have technically existed since maybe the 1940s but were not really easily made or healthy enough for the eye due to the materials available,” Jankowski said. “I’ve had patients whose vision fluctuates so much that they need different pairs of glasses throughout the day, but with scleral contact lenses, they can actually see consistently for a whole day.”
Lack of access
On Friday morning, Jankowski prepared a scleral lens as he would for a patient.
To start the process, he analyzed the surface of the eye using Ovitz, which measures the entire visual system. The clinic then sends those results to its lab in Eugene, Ore., where the lens is designed in about three weeks.
The final result is a fully customized lens unique to each patient’s eye.
“Most people know about soft contact lenses, but I can’t really customize them,” Jankowski said. “With a scleral lens, I can essentially change every parameter of the lens, including the material, size, curvature and power.”
The lenses cost several thousand dollars to produce, but the clinic works with most patients’ medical or eye insurance. They can last up to two years with the proper care, Jankowski said.
The number of people with visual impairment or blindness in the United States is expected to double to more than 8 million by 2050, according to a study by the National Eye Institute, part of the National Institutes of Health.
In addition, economic barriers, such as lack of insurance, limited transportation options, the cost of eyeglasses, and vision-related screenings and services are constant barriers to eye care access, Jankowski said.
“Optometrists provide a large percentage of the country’s eye exams. We screen and treat for the ones we can, but there’s been a lot of issues with access to care, especially for the Medicaid population, where a lot of eye clinics don’t accept Medicaid,” Jankowski said.
Jankowski is a member of the Optometric Physicians of Washington, who work with legislators to improve access to eye care across the state.
In May of last year, the scope of practice for optometrists was updated when Gov. Jay Inslee signed the Access to Vision Care Act, authorizing optometrists to perform more specialized procedures that would not have previously been covered by Medicaid.
“We’re also working with our lab in Eugene to be able to offer these lenses to more patients more readily and for less, which would cost closer to the cost of regular contact lenses,” Jankowski said. “We’re excited that the bill is finally passed and signed into law.”
