FAQ & Training

The name Laserfit was chosen because of the laser-based scanning technologies used to fit and make them. A low-coherence FDA-approved diode laser is used in the optical coherence tomographer which maps the eye. Another FDA-approved laser device called a ray-tracing aberrometer is used to map the optics of the eye. These are Class I FDA approved devices.

Making scleral lenses from impression molds of the eye is an old art. It requires putting a molding substance in the eye and allowing it to set from a putty-like state to a solid before removal from the eye. With Laserfit, the eye is directly scanned with an OCT, and other than retracting the eyelid to expose the sclera, the process is non-invasive. The process is relatively quick, easy, and pleasant for the patient as well as the doctor or technician.

The eye is not a solid, but a hollow fluid-filled spheroid, and the surface is easily deformed by touch or pressure.  Many of the corneas we see are very thin. Therefore, great care is taken to avoid altering the shape of the eye by touching or with the finger, speculum, or retractor.  Many patients we see have deep-set eyes in which the upper eyelid cannot be retracted enough to see the sclera.  The Laserfit process allows the patient to look in any position of gaze to expose the sclera to the scanner.  This allows us to capture as much scleral area as we need to design a lens of any size.

Dr. G. was the first to use a "tomographic" image instead of a topographical image to measure the eye.  The device is called an optical coherence tomographer, or OCT.  The sclera of the eye is relatively “rough” and non-reflective. Non-reflectivity often means missing data. The sclera is actually covered by two other layers - the outermost conjunctiva and the inner episclera.  The conjunctiva is relatively loosely adherent and can swell and forms folds or wrinkles, leading to a difficult-to-measure surface.  The presence of "bumps" called pterygiums or pingueculas on the scleral surface can also interfere with fit and comfort. The Laserfit approach using optical coherence tomography allows us to capture the surface of the eye very consistently and very effectively in high contrast and with minimal surface distortion. The resulting images look similar in appearance to CAT scan images, and are converted into 3D images using special software.

Another advantage of using optical coherence tomography is that all of the eye’s internal anatomical features are captured including the iris and pupil and the junction between the cornea and the sclera called the limbus. This facilitates image alignment and accurate registration of the images in order to obtain the accurate 3D model and well-fitting lens.

In 2007, the only high-quality instrument available for taking these scans was the VISANTE OCT from Carl Zeiss.  For many years it served us quite well, and continues to be used.  Many lens fitters have used one to document their scleral lens fits.

In late 2024 the FDA approved the latest swept-source anterior segment OCT scanners, and we quickly acquired the ANTERION from Heidelberg Engineering.  This amazing and multi-faceted instrument is a valuable addition to any practice.  We have already completed our in-house feasibility study to make sure the results are comparable to those from the Visante.  But, more importantly, it is the best and most up-do-date OCT technology available.

Dr. Gemoules published his first paper mentioning wavefront aberrations in post-LASIK eyes in 2005.  The sample size was very small, but the technology was just emerging.  There are several types of aberrometers: Hartmann-Shack, Ray-Tracing, Tscherning, and scanning-slit.  Most aberrometers used today are Hartmann-Shack.  Each type has its strengths and weaknesses.  In the early days of Laserfit, Dr. Gemoules would send his patients - usually post-LASIK - to the medical center to be scanned with their aberrometers.  Many of these patients had aberrations so elevated that they could not be scanned.  In talking with other ophthalmologists who were treating these problems, he learned that the ray-tracing aberrometer was able to scan many types of eyes no matter how elevated the aberrations, and also had many analytical features.  The iTrace is the only example of ray-tracing technology available and Dr. Gemoules has found it to be extremely reliable and it has played a key role in Laserfit's stunning success.

However, this leads to another very important point.  We are open to using any instrument we think will provide the best possible results for our patients.  If a better instrument becomes available, we will be on it.  This policy does have its drawbacks, in that we have a cost-no-object approach.  Dr. Gemoules has received advance training using the special lens design software.  He loves creating lenses for his patients and to see the results the next day on their eyes.  For Dr. G., this is the essence of patient care. He enjoys problem-solving, and no monetary value can be assigned to the satisfaction this brings.

It is true that our studies have shown up to 16% of our patients have been able to resolve 20/10 letters with Laserfit lenses. This is a result of pursuing great optics and and reducing the higher-order-aberrations, and not anything that we purposely have tried to achieve. It is difficult to predict who can be improved to that degree, as tissue quality is so variable in the population. In other words, our aim is to achieve the best possible optics and not to make unfounded guarantees about a specific result.

Laserfit can often help restore vision lost through corneal disfigurement. The reason is that that corneal scarring is often accompanied by an irregular corneal surface. Unfortunately, the scar tissue creates another type of light scatter or diffusion that cannot be fixed with a lens, and so the improvements in these cases are always somewhat limited. However, it is not something that can always be predicted with certainty, and sometimes the results are surprisingly better than expected.  However, beware of doctors who will advertise that wavefront is always the best option for corneal scars.  One should try a standard lens first and then try try the wavefront version.

Cataracts create a type of light scatter and diffusion that cannot be completely corrected with lenses. While other aspects of vision can be greatly improved, the presence of a cataract will limit that improvement because of random light scatter.

The answer is no. Dr. Gemoules is a pioneer in the use of digital imaging in designing and fitting scleral lenses and has patents on the process. Others use OCT devices for various reasons such as documenting the lens on the eye, but it is not remotely similar to the process that Dr. Gemoules has created as a better way to design a lens.  Optical Coherence Tomography is the gold standard for imaging of the human eye, and has gone through major technological innovations since the founding of LASERFIT.

In 2007 Dr. Gemoules chose the first high resolution anterior segment OCT from Carl Zeiss, called the VISANTE. It provided the clearest and widest images of the anterior eye including the sclera and has the ability to scan any eye no matter how difficult. At a conference in Vienna in 2018, Dr. Gemoules was able to see the latest in swept-source devices, the ANTERION from Heidelberg Engineering. But it took until late 2024 to be approved by the FDA for use in the U.S., and a few months later Dr. Gemoules traveled to Boston to demo it and brought it home to Laserfit. Thus far, the results are very encouraging and comparable to those obtained with the tried-and-true VISANTE. We are now in the process of working with image-processing professionals to update our software to fully integrate the ANTERION into our system.

With the advent of the modern anterior segment OCT, we found ourselves working with realistic images of the eye instead of abstract colored maps. The quality of the eye images are paramount to the success of the LASERFIT process.  As the saying goes: garbage-in, garbage-out.  Because LASERFIT is not tied to a specific brand or model, it can be upgraded to the latest technology when it becomes available.

Laserfit's business model is that of a professional service practice dedicated to solving difficult optical problems with customized scleral lenses of advanced design using advance software used by companies many times larger than Laserfit.  As with most specialties, additional training, skills, and experience are required.  Although there is no board licensed specialty recognized in this field, Dr. Gemoules has essentially created this niche over the period of nearly two decades, and has chosen now to limit his practice to treating these unique vision problems.  He has invested in expensive equipment and software that require advanced training and has been awarded 4 U.S. Patents in this field.  He recognizes that his method may not be suitable for the typical eye care practice, nor should that be expected. It is designed for a particular niche and by definition is needed by only a relatively small group of patients.  It is imperative that Laserfit have close proximity to a manufacturing facility for quick turnaround so our patients can be back to home and work in a matter of days. He believes strongly that this is the correct way to deliver this service and the results simply speak for themselves.  Most of our patients are successfully fitted in a matter of days instead of months.

It is not possible to write a prescription for our lenses. Although some of our lenses have standard “simple” lens powers like most other scleral lenses, the rest of the lens – the part that follows the contour of each individual eye – is designed using a special computer-aided-design program and translated to a special computer code that tells the manufacturing equipment exactly how to make the lens, down to the submicron level. Most of our lenses have complex wavefront optics which are proprietary and protected by several U.S. Patents.

Because of Laserfit's non-rotational properties, it can absolutely correct astigmatism, of any amount or axis, and prism in any axis.  Furthermore, it can correct both at the same time, as well as add HOA (higher order aberration) correction at the same time.

Whether Laserfit is covered depends on the diagnosis and the insurance company. If the lenses are deemed medically necessary by the insurance company, then they may cover a portion of or the entire fee. Our staff will provide you with supporting documentation to file a claim, but payment in full must be made to us at the time of service. We strive to keep our fees reasonable and we can only do that by being paid promptly and in full.

Our primary goal is to continue to be a leader in technological innovation and to give our patients the best possible vision and comfort. Laserfit requires sophisticated and expensive scanners and software which may not be practical for the typical eye care practice. The Laserfit process was designed by Dr. Gemoules and refined over a number of years so that he would have all of the tools necessary to accommodate any patient who arrived in his clinic from any part of the world with any possible condition requiring lenses. It is a no-holds-barred, cost-is-no-object invention made for a true specialist in vision correction and one who has undergone training in using sophisticated engineering software.

Our goal would be to make this technology more available via centers of excellence throughout the world and to develop a network of like-minded innovative individuals dedicated to excellence in lens design engineering and fitting using a process that is advanced and which can grow with improvements in technology.  Dr. Gemoules has spent most of his life challenging the status quo and being a leader in this new technology.

Laserfit uses a patented process to incorporate wavefront-guided optics into the lens optics to reduce or eliminate the higher order aberrations which cause visual distortions such as glare, halos, ghost images, etc. However, there can be a number of different causes of "visual noise" including loss of transparency of the media as with haze, scars, and cataracts that may be more difficult to correct with this technology.  While we do not exclude patients who have corneal scars or cataracts, we do advise those patients that the results may fall short of expectations because the issue is no longer a mono-chromatic optics issue but a light-scatter issue.

However, there is another point that should be made.  We are aware that some recommend centering the wavefront on the line-of-sight.  Others recommend that the wavefront be centered on the pupil.  When the wavefront is centered on the pupil, then it is possible to correct the wavefront out to the maximum diameter of the pupil.  When it is centered on the line-of-sight, then it will be smaller than the pupil diameter, which then may result in suboptimal results for the night vision disturbances.

The cost is determined by time and materials. Because we have long served an international clientele, that business has definitely shaped our processes and fees. Our goal has always been to complete our services as quickly as possible in order to minimize the personal and economic impact on our patients of being away from job, home, and family. Therefore, our minimum requirement is 5 business days in order to complete a fitting. This includes all lenses consumed up to the final pair. However, as Laserfit became more complex and offered more features such as wavefront optics, we found that it took longer in some cases to achieve the optimum results. In general, the optical situation will determine the length of stay more so than the fitting process. In some cases a few more days are necessary – at most 2 or 3 –and those are billed on a per-diem rate that is added onto the basic 5-day rate.

In a few cases a patient may find it necessary to return within a few weeks or months to have their fit adjusted. In those cases where the amount of work is expected to be minimal and of a short duration, we may elect to bill on a per-diem basis.