Maria De Los Angeles Suarez
Source: J. Alberto Martinez, M.D.

The Boston Scleral Lens being
filled.
Source: Robert K. Smith,
clinic coordinator,
Boston Foundation For Sight

Illustration of the Boston
Scleral Lens.
Source: Robert K. Smith,
clinic coordinator,
Boston Foundation For Sight

Before 8-year-old Maria De Los Angeles Suarez’s scleral contact lens fitting last year, she was quiet, withdrawn, and sought out dark places.
The Bogotб, Colombia, native had good reason to act that way.
Maria suffered from Stevens-Johnson syndrome, an affliction likely born of a severe sensitivity reaction that first caused blisters to erupt all over her body, and later, chronic eye disease that blinded her. In addition, she suffered from severe, unremitting eye pain, and disabling photophobia. Maria had become a recluse.
“She needed the shelter and constant reassurance of her mother,” said Perry Rosenthal, M.D., founder and president of the nonprofit Boston Foundation for Sight, Chestnut Hill, Mass., founder of the contact lens service, Massachusetts Eye and Ear Infirmary, and assistant clinical professor, Harvard Medical School.
But after Dr. Rosenthal fitted her at the foundation with his invention, the Boston Scleral Lens, “the transformation was truly amazing,” he said.
“By the time she left, she had made friends with everyone, was outgoing, was opening her eyes in bright light, and was exploring everything around her,” said Dr. Rosenthal, who performed the procedure free of charge.
The Boston Scleral Lens sits atop the sclera, creating a space over the cornea that is filled with artificial tears. The fluid-filled space becomes “a liquid corneal bandage,” according to the foundation, that assists healing and diminishes pain and photophobia.
Because the lens also masks a cornea’s damaged irregular surface, it also can improve vision, officials said.
The lens, approved by the Food and Drug Administration in 1994 for the management of corneal disorders, is manufactured onsite by the Boston Foundation for Sight. Customizing its design to the unique geometry of each eye is a skill-intensive and time-consuming process requires two weeks or longer to complete. “This is not a commercial enterprise,” he said.
Until recently, health insurers refused to cover the procedure, which meant that no reimbursement was possible for ophthalmologists. As a result, although Dr. Rosenthal has achieved more than a 90% success rate with the technology, it has not spread beyond the doors of the Boston Foundation for Sight.
“Right now, we’re pretty much maxed out at doing eight per week,” Dr. Rosenthal said.
But that could be changing.
Blue Cross and Blue Shield of Massachusetts have agreed to cover the fitting procedure.
“This is a breakthrough for us because it sets a precedent,” said Dr. Rosenthal, who believes now other insurance companies across the United States may begin to cover the lens.
Dr. Rosenthal said the foundation plans to establish a network of at least six affiliated scleral lens clinics in tertiary eye centers in the U.S. (and more abroad).
Supported by a $240,000 Gift of Sight grant from Johnson & Johnson (New Brunswick, N.J.), the foundation has developed a three -week hands-on training program. Health insurance coverage for this procedure will remove a major disincentive for academic institutions that are interested in offering this technology to appropriate patients.
However, in order for this initiative to succeed, Dr. Rosenthal said that he needs to somehow reach the gatekeepers of patients with severe ocular surface or corneal degenerative diseases that are not candidates for traditional contact lenses with the message that there is an additional option for them.
“Without their referrals, the viability of our planned sister clinics will be in jeopardy,” said Dr. Rosenthal. “For many years, I felt as if we were offering a pay-what-you-can feast to starving people and nobody came” said Dr. Rosenthal.
He added that there are hundreds of thousands of people in this country that can benefit from these devices and is hopeful that their availability in other teaching centers will give the Boston Scleral Lens the credibility that publications in peer-reviewed ophthalmology journals, chapters in textbooks and numerous lectures over the years have not achieved.
J. Alberto Martinez, M.D., cornea specialist, Visionary Ophthalmology, Bethesda, Md., and a key player in getting Maria to the Boston Foundation for Sight for treatment, said the little girl is much happier now with the lenses.
“She’s more comfortable,” Dr. Martinez said.
Even so, Dr. Martinez, who has provided housing for Maria and her mother during their stay in the United States, said she still only has count-fingers vision.
As a result, Dr. Martinez was slated to attempt a limbal stem cell transplant on her in one eye to try to restore reading vision at the very least.
Nevertheless, Dr. Martinez called the contact lenses “amazing” and plans to have Maria refitted with one in the operated eye after surgery.
“The contact lens made a large difference with her,” Dr. Martinez said.

Editors’ note: Dr. Martinez has no financial interests related to his comments. Dr. Rosenthal is a paid employee of the nonprofit Boston Foundation for Sight and has no personal financial interest in the Boston Scleral Lens.