It may be no mystery to you, but the utilization of scleral lenses has increased during the last handful of years.
While there are many reasons for this, the main storyline here is that scleral lenses are getting in more hands, which increases the load for us to be excellent communicators in the care of these specialty products.
Nailing down effective patient communication
Let’s be honest for a moment; scleral lenses can be a lot for a patient to comprehend, from how they work to how to take care of them. Whether they’ve worn soft lenses before, gas permeable lenses, or are completely new to contacts in general, the sight of a counter littered with lenses, plungers, and various solutions can be a lot to take in, if not a bit overwhelming.
This article aims to be a great resource for providers and their education to patients, as well as providing a quick reference guide for the different solutions on the market currently.
Note: Certain lens/solution combinations are not recommended and/or may have negative effects, and it is always best to verify these details with your provider or lens manufacturer.
Scleral lens materials and coatings
Some of the popular materials currently available come from Contamac, Bausch + Lomb, Micon, and Paragon. Depending on the lens and lab being used, some providers will opt to plasma treat or bind the lenses to additional coatings. Plasma-treated lenses undergo a process to essentially deep-clean them and leave the lenses in a condition that encourages wettability as well as resisting oils and deposits.1
“Other lens add-ons, like Hydra-PEG treatment provide similar benefits for the lens and patient, though the specific process that takes place is slightly different.”
It is important to note that lenses coated with Hydra-PEG should never be stored dry, as this can damage and deteriorate this layer. If these lenses are being stored on a more long-term basis, the storage solution should still be refreshed regularly to reduce the risk of contamination. If the lens is being utilized as a backup pair, it may be worth considering removing the Hydra-PEG layer altogether to allow for more convenient dry storage for the patient.
The amount of materials used for lens designs today are nearly endless and carries different oxygen transmissibility, wetting angles, UV protection, available colors, and many more options. These details can be of critical importance to maintain a proper fit and ensure good ocular health for the patient, but by and large, they will all require a system including disinfecting/cleaning solution, storage solution, a filling solution, in some cases, a proper conditioning solution, and some practitioners also incorporate specialty solutions.
Download the Guide to Scleral Lens Hygiene Patient Handout
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Guide to Scleral Lens Hygiene
This patient handout highlights tips for scleral lens insertion and removal, a quick guide to commonly-used solutions, and pearls for traveling.
Breakdown of solutions for scleral lenses
Filling solutions for scleral lenses
As one of the distinguishing factors with scleral lenses, the bowl of the lens must be filled with a solution before placing it on the eye. Since this layer has such prolonged contact time with the eye during wear time, a preservative-free solution should be chosen, with the exception of some medications that may be added for therapeutic purposes.2 If improper solutions are used, adverse events such as solution toxicity can also occur.3
There are many variations of these solutions, including Nutrifill, LacriPure, ScleralFil, PuriLens, and sodium-chloride salines. Each brand of scleral may have a unique recommendation for their lens and the solutions may have a benefit or formulation that separates it from the others. It’s important to understand the differences between these options and utilize the best one for your individual patient.
For example, some of the solutions listed above carry an FDA-approval as insertion solutions; Nutrifill contains added electrolytes, and PuriLens offers a larger multi-use bottle compared to individual vials. These non-preserved solutions are also intended as rinsing solutions following a disinfection or conditioning step. This helps remove any leftover debris or buildup that was loosened and rinses excess solution from the previous regimen.
Note: It’s always important to remember and reiterate to patients that water should never be used at any point in their care routine.
As previously mentioned, there also exists the possibility of using scleral lenses to deliver medication to the eye for extended periods of time. This opens up a whole realm of drops, therapeutics, lubricants, or cocktails that could be included in this category, but for the purposes of this article, we will just mention that this option exists for some patients but will be specifically tailored to each individual.
Disinfection and storage solutions for scleral lenses
A staple to any reusable-lens routine is the cleaning and disinfecting step. Similar to soft lens care, this step can be combined with storage using solutions such as CLEAR CARE, Tangible Clean, Unique pH, and Boston Simplus. A combo solution in this space can really cut down on the amount of bottles and solutions a patient has to keep on hand, especially when traveling/flying.
Again, it’s important to learn the intricacies of each cleaner and provide appropriate recommendations for their eyes, lens coatings and materials, sensitivities, etc. As with any multipurpose solution, the disinfection process will occur while the lens is stored in its case, but it can also be wise to rub both sides of the lens to dislodge debris.
“I like to think of this stage similarly to scrubbing my dishes before placing them in the dishwasher; it never gets everything, no matter what the commercials say.”
Lenses that are not cleaned or stored properly, as with any contact lens, lend themselves to a whole host of adverse events. These can include, but are not limited to, risks of infections, ocular inflammation, increased wear and deterioration of the lens itself, easier debris build-up, and more.
Conditioning solutions for scleral lenses
While multipurpose solutions have their advantages, some prefer to separate these steps into separate parts with the likes of Boston Advance or Boston Original. These setups would include one bottle for overnight storage and the other for manual cleaning and conditioning of the lens to improve wettability and comfort during lens wear.
It is thought that breaking up these solutions allows for each to be more efficient with disinfection and conditioning, respectively.
Specialty solutions for scleral lenses
As mentioned earlier, some lenses require a little more TLC. For those who have lenses coated with Hydra-PEG, Tangible Boost is a prescription solution that works to thicken or revamp the coating. This can help extend the comfort and durability of the lens during its lifetime and help protect the investment of a scleral lens.
Other specialty solutions can involve more intense or rigorous cleaners such as Progent or enzymatic cleaners. Again, caution should be used with these lenses, as they may strip or damage some plasma or Hydra-PEG coatings. These cleaners can be very useful for patients that build heavy deposits or debris on or under their lenses. Although they may not be necessary for daily cleaning, they certainly play a role in the upkeep of the materials.
Rounding it all up
With all of this information, one of the best things we can do for our patients is educate, educate, educate, and provide written material. Breaking down which solutions you recommend and what each should be used for is especially important to convey. Some reports have shown that there is a distinct separation between provider and patient perspectives on their care and hygiene compliance with their contact lenses.4
I also find that tips on having a watertight “go bag” with extra supplies for everyday carry or travel can also be very helpful for patients to have on hand. Also, providing resources for them to find and purchase these products shows you going the extra mile for your patients. Many brick-and-mortar stores or pharmacies may carry a few of the above solutions, but for those that prefer to shop online, Dry Eye Rescue, The Dry Eye Shop, or Amazon tend to be very useful resources.
In my career, I’ve found that specialty lens patients can be some of the most rewarding cases to manage. This specialty comes with the need for extensive fitting, material, and care knowledge, as well as great communication to truly be the resource for your patient.
