Care of Scleral Lenses

Scleral lenses are a type of RGP (Rigid Gas Permeable) lens used for conditions such as keratoconus and pellucid marginal cornea degeneration. However, incorrect care of scleral contact lenses and solutions can increase the risk of eye infections and corneal ulcers. Risk factors for acquiring an eye infection include improper lens cleaning and disinfection, poor hygiene practices and smoking. Following your practitioner's hygiene regime, along with regular reviews, will minimise this risk.

Always thoroughly wash your hands with an antibacterial-based hand wash and dry them with a clean lint-free towel before handling, removing or inserting your lenses. Make sure to clean all parts of your hands, including between the fingers and dry thoroughly.

Safety & Hygiene

Scleral lens wear is a safe, and effective vision correction solution. However, incorrect care of contact lenses and solutions can increase the risk for eye infections and corneal ulcers. Risk factors for acquiring an eye infection include improper lens cleaning and disinfection, poor hygiene practices and smoking. Following your practitioner’s hygiene regime, along with regular reviews, will minimise this risk.

• Thoroughly wash hands and fingers with an antibacterial based hand wash
• Dry hands with a lint free towel
• Remove lenses while sitting at a table with a lint free cloth
• Avoid bathrooms as they contain more germs than any other room in the house³
• Inspect lenses for scratches, chips or cracks as these can provide surfaces for bacteria to grow^4,5

Always wash and rinse your hands thoroughly and dry them with a lint-free towel/tissue before handling contact lenses. All traces of soap, perfumes, hair-spray, creams and lotions should be removed from your hands and around your eyes. Your lenses should never come into contact with tap water as it contains dangerous microorganisms such as Acanthamoeba.^6,7

Insertion

Scleral Lens Insertion and Removal by EyeSpace Lenses

Step 1. Remove your scleral lenses from the cleaning solution case and rinse with saline. If you are using a hydrogen peroxide solution, you can only remove the lenses after a minimum soaking time of six hours.⁸

Step 2. Fill the bowl of the lens with a lubricating eye drop or saline solution. If using the tripod method, place the lens on the middle finger, index finger and thumb. If using a suction tool, place the lens on the tip of the scleral suction tool. Ensure you are facing down horizontally, looking into a flat mirror. Reach around with your dominant hand to lift up the top lid, and use your non-dominant middle finger to hold the lower lid open. Using the mirror, place the lens on the eye. The suction tool must be squeezed to release the lens. To save confusion, it’s a good idea to always insert the right lens first.

Step 3. If you happen to drop your scleral lens, use saline solution to rinse the lens clean. To do this place the lens in the palm of your hand and thoroughly rinse for five seconds.⁹

Step 4. Dry and wipe out your lens case with a tissue. Leave the case lid off to air dry while wearing your lenses.

Removal

Method 1 – Manual removal. Using your middle fingers, open the lids wider than the lens diameter. Apply pressure to the lid margins, pushing in together to move your lids under the lens and lever it out of the eye.

Method 2 – Suction tool removal. Using your middle fingers, open the eyelids wider than the lens diameter. With the suction tool between your index finger and thumb, align the suction cup so it is positioned in front of and parallel to the lens. When the suction cup touches the lens, apply gentle pressure to adhere the lens to the cup and remove the lens from your eye. After removal from the eye, carefully slide the lens sideways from the suction cup and it will come off easily.

Cleaning

An effective cleaning process is vital to ensure comfortable, hygienic and infection-free contact lens wear. With correct cleaning, contact lenses will feel better on your eyes, allow better eye health and vision, and dramatically reduce the risk of infection. Always clean your lenses after wear, and NEVER RINSE OR STORE YOUR LENSES IN TAP WATER.³ The acanthamoeba microorganism is plentiful in tap water and can cause a severe, painful and sight-threatening infection.

Peroxide cleaner (AOSept with Hydraglyde or Soleko)

These solutions work by having your contact lenses immersed and sterilised in 3% hydrogen peroxide. Over the course of a 6hour period the catalyst in the case converts the hydrogen peroxide into water and oxygen gas. This cleaning solution has the advantage that when your lenses are removed from the case, they require no rinsing as they are covered only in sterile, non-preserved water. They also generally require no rubbing step, which decreases the risk of accidental breakage. The case can be left to air dry when not in use and should be replaced with each new bottle of solution. AOSept now had the addition of Hydraglyde, an ingredient which improves the wettability of your contact lenses, making them more useful for scleral patients with long day-wear times.

• To clean, disinfect and condition: Fill the case up to the line, place your lenses in the correct cage-holder, then submerge the case and screw closed. Over the course of a 6 hour period the catalyst in the case converts the disinfecting hydrogen peroxide solution into water and oxygen gas. The solution also includes Hydraglyde, an ingredient which improves the wettability of your contact lenses.

This cleaning solution requires no rubbing step, which decreases the risk of accidental breakage. The lenses do not need to be rinsed after the clean, as the solution neutralises to sterile water. The case can be left to air dry when not in use, and should be replaced with each new bottle of solution. Take care when transporting the cases as sometimes the small gas-release hole can leak solution. Do not remove the lenses from the case before 6 hours, as the un-neutralised hydrogen peroxide in your eyes will sting painfully. If this occurs, rinse thoroughly with water and contact your optometrist if the pain persists or your vision is affected. Find Soleko and AOSept at our shop

Multipurpose solutions (Menicare and Boston Simplus)

• To clean: Place a few drops of rigid contact lens solution on the palm and the lens, then rub with your finger-pad for at least 10 seconds on each side. The back surface(concave) is best cleaned by moving your thumb across the surface. This step removes material that deposits on the lens during wear.
• To disinfect and condition: Place the lens in fresh solution in your lens case, ensuring the lens is completely submerged. This step kills microbes on your lenses and prepares the surface of your lens to stay wet throughout wear, increasing comfort. Store your lenses in this solution for at least 4 hours for the cleaning process to be complete.

Whilst scleral lenses are strong, with incorrect technique or too much force they can break, so take care during the cleaning step.

Regular protein removal (Progent)

• To use: Place the lenses into the Progent scleral contact lens case holders. Open vial A and B by twisting the cap and pour the contents into the contact lens case. Replace the lid and tighten. Leave the lenses in the solution for 30 minutes, then remove and rinse thoroughly with saline.

An intensive cleaner like Menicon Progent cleans and maintain the wettability of your lenses. After rinsing the lenses, they can be worn following this protein clean or can be disinfected with the daily cleaner.

Risk of Breakage

Scleral contact lenses are made of a strong polymer which resists damage in normal wearing circumstances. It is very rare for a lens to break in your eye unless something hits your eye or your removal technique is incorrect/very forceful. The solutions you use to clean your lenses will not weaken or degrade them ‒ not even the powerful Progent monthly deep cleaner. However, they can still break if mishandled. There are some tricks you can learn to minimise this chance.

Habits that may cause a lens to break include:

• Pressure on the lens. If the lens lands on a mirror or flat surface. Gently slide it off to the edge of the surface or use a suction tool to remove it from the surface.
• Pulling the lens too firmly from the suction tool. Slide the lens off the suction point instead.
• Forcing the lens to bend excessively while cleaning. Some friction force is required to clean a scleral lens using your cleaning solution, but not too much. The resistance from your skin surface will be sufficient to clean the lens. If too much force is applied on both sides of a scleral lens, the lens will flex and eventually snap.

 It is very rare for a lens to break in your eye unless something hits your eye, or your removal technique is incorrect/very forceful. The solutions you use to clean your lenses will not weaken or degrade them ‒ not even the powerful Progent fortnightly deep cleaner.

In case of breakage

We understand that when you are learning how to use your lenses you may be inadvertently forceful during insertion, removal or cleaning. Because of this we offer a 1 month manufacturer’s replacement warranty on accidental breakages. Outside of this period, your lens is not covered by a warranty and the lens will need to be replaced at your cost if damaged or lost.

Normally a lens will take less than one week to arrive from the lab when ordered. If you are very dependent on the lens, we will of course ask our lens company to manufacture it as soon as possible. Because of the inevitable waiting time, we encourage all scleral lens wearers to have a spare set of lenses available for a situation where a lens is lost or broken.

If you do lose or damage a lens, please don’t fret, just give our friendly team a call and we will arrange a replacement as quickly as we can.

Things to Remember!

• Do not modify the recommended cleaning routine or solutions without consulting your optometrist. Other solutions may not be compatible with your eyes and lenses and may cause discomfort or allergic reactions.
• Do not heat solutions.
• Shortcuts with cleaning solutions may appear to save money but can result in ineffective lens cleaning and disinfection. Incorrect cleaning solutions may damage your lenses or lead to an eye infection which can result in vision loss.
• Never clean or store your scleral  lens with soft contact lens solutions. These products work in a different way to the scleral  lens solutions and will not clean and condition your scleral  lenses.
• Replace the contact lens case every time you start a new bottle of lens cleaner to avoid microbial contamination.
• To avoid contamination do not touch the tips of solution bottles. Replace caps after use.
• If your eyes are very painful after hours, consult your local hospital or emergency eye clinic.
• If you notice scratches and chips or misplace a lens, contact your optometrist for a replacement.

Do not use your scleral contact lenses in the following cases:

• Acute inflammation or infection of the anterior chamber of the eye
• Any eye disease, injury, or abnormality that affects the cornea, conjunctiva or eyelids.
• Severe insufficiency of tears or inflammatory dry eye
• Corneal hypoesthesia (reduced corneal sensitivity)
• Any systemic disease which may affect the eye or be exacerbated by wearing contact lenses
• Allergic reactions to ocular surfaces or adnexa which may be induced or exaggerated by wearing contact lenses or use of contact lens solutions
• Allergy to any ingredient, such as peroxide and hydraglyde in a recommended cleaning solution
• Any active corneal infection (bacterial, fungal or viral)
• Red or irritated eyes

Remember, your eye must: look good, feel good, see good - if in doubt, take them out