Care of Scleral Lenses

Scleral contact lenses are a type of RGP (Rigid Gas Permeable) lens. These are used for conditions such as keratoconus, pellucid marginal cornea degeneration and corneal grafts. They require careful cleaning, insertion and removal to ensure your eyes stay healthy and your treatment is effective.

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.

Insertion

  1. To avoid confusion, make a habit of inserting the same lens – generally the right lens – first.
  2. Minimise the risk of lens loss by plugging the sink or using a paper towel over the drainage opening.
  3. Place the contact lens between the middle and forefinger (two finger method) or with the thumb also (tripod method – see picture). Fill the lens with sterile non-preserved saline (eg Lens Plus) or non-preserved artificial tears (eg Thera-tears). This stops bubbles being trapped between the lens and your eye, which disrupts vision.
  4. While looking down at a horizontal mirror, place your left middle finger on the top lid and pull it open.
  5. Using another finger on the right hand open the bottom lid. Pull the lids apart and place the contact lens upwards onto to the cornea at the front of your eye.
  6. Blink gently. The lens should be centred on the eye.
  7. Rinse your case out with hot water, wipe with a tissue and leave to dry upside down on a clean paper towel.

You may experience some discomfort if the lens is not in place correctly on the eye or if a foreign body, such as an eyelash or make-up pigment, is trapped underneath the lens. If this is the case, remove the lens and reinsert.

CAPTION:Tripod method. A rubber inserter can also be used to hold the lens if dexterity is a problem – ask your optometrist about this.

Removal

Method 1: Suction Tool

  1. First ensure you break the seal of your scleral lens. To do this, press firmly with your bottom lid on the white of the eye, just below the edge of your lens, then push upwards. This will often create a bubble under your lens and allow it to move on your eye, making removal easier.
  2. While looking in the mirror in front of you, open your bottom lids as you did with insertion. Attach your suction tool to the bottom third of the lens, it helps if the tool is wet so that it sucks on well.
  3. Pull the lens up and out, tilting it out of the eye.

CAPTION: Different suction tools available for scleral lenses.

Method 2 : Manual Removal

If you do not have a suction tool you can remove the lenses manually:

  1. Look down to begin over a horizontal mirror or towel.
  2. Using your middle fingers as you did with insertion, open the lids wider than the lens diameter (about 16mm).
  3. Apply pressure to the lid margins (as close to the lashes as you can – you do not want to show any of the red inside surface of your lids), pushing in and together to move your lids under the lens and lever it out of the eye.

Cleaning

Always clean your lenses after wear. 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 bacteria and other contaminants. There are two types of scleral lens cleaning solutions: Peroxide base systems like AO Sept (with Hydraglyde), and multi-purpose solutions like Menicare and Boston Simplus. There are several steps involved with cleaning and storing scleral lenses depending on your system:

Hydrogen Peroxide (AO Sept with Hydraglyde)

These solutions work by having your contact lenses immersed and sterilised in 3% hydrogen peroxide. Over the course of a 6 hour 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. AO Sept 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 your lenses fill the case up to the line, place your lenses in the correct cage-holder. Most scleral lenses will generally fit into this case, ask your optometrist if the holder does not close easily. Then submerge the case and screw closed. Take care when transporting the case as sometimes the small gas-release hole can leak solution.

Care should be taken not to get the un-neutralised peroxide in your eyes as this will sting painfully. If this occurs rinse thoroughly with water and contact your optometrist if the pain persists or your vision is affected.

Find Aosept with Hydraglyde at our shop here.

Multipurpose Solutions (Menicare and Boston Simplus)

1: 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 deposited on the lens during wear. Whilst RGP lenses are strong, with incorrect technique or too much force they can break. Some patients benefit from using a dedicated detergent cleaner such as Lobob rather than their storage solution for this cleaning step.

2: Disinfect and Condition

Place the lens in fresh solution in your lens case, ensuring the lens is completely submerged (you can purchase a scleral contact lens case from our shop). 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. NEVER rinse or store your lenses in tap water, as micro-organisms are plentiful and can cause infections in your eyes.

Find Menicare from our shop here.

Regular Deep Protein Clean (Progent)

Scleral lens wearers are advised to use a deeper protein removal product like Progent every 2 weeks. To use Progent combine the A and B vials in a lens case and submerge your lenses in this for 30 mins. Ensure your lenses are thoroughly rinsed and cleaned after using Progent before inserting into your eyes. Find Progent at our shop here.

Risk of Breaking Scleral Lenses

Scleral contact lenses are made of a strong polymer which resists damage in normal wearing circumstances. However, they can still break if mishandled. There are some tricks you can learn to minimise this chance.

To increase comfort and oxygen permeability, scleral lenses are designed to be as thin as possible without compromising their structural integrity: most are 0.3mm thick. Because the lenses weigh very little, if you drop one it should not break unless it is then trampled on. If a lens falls on the floor, keep your feet still until you have spotted it. If you cannot see well without your lens, call to a friend or family member to help and remember to caution them to be careful where they tread!

The lenses can be prone to falling into difficult to retrieve places such as down the sink-hole! Especially when you are learning how to insert and remove your lenses, make sure you use your lenses in a controlled environment such as a quiet bathroom with the plug inserted, or on a table with a clean towel laid flat. This way, if your lens drops you can find it easily and reduce the risk of breakage.

The main handling habits that may cause a lens to break include:

  • Pushing down on the convex side of the lens. This can occur if the lens lands on a mirror or flat surface. Instead of trying to grab the lens, gently slide it off to the edge of the surface or use a suction tool to suck it off the surface.
  • Removing a lens too firmly from the suction tool. This is especially relevant for scleral lenses. Slide the lens off the suction point instead, or release the suction by squeezing the body of the suction tool to reduce pressure.
  • Forcing the lens to bend while cleaning. Some force is required to clean a rigid lens using your cleaning solution, but not much ‒ the friction of your skin surface will do most of the job. If you are pressing down on both sides of a rigid lens this will cause it to flex, eventually snapping if too much force is applied.

CAPTION: Mishandling a lens: Pushing down on the lens; Removing from suction tool too firmly; Forcing lens to bend while cleaning

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. If you break a lens within 1 year of its original purchase/fit then we are happy to offer 50% off the price. Outside of this 12 month period the lens will be full-price.

Normally a lens will take 1-2 weeks 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 rigid lens wearers to have a spare set of lenses available for a situation where a lens is lost or broken. We also offer 50% off the full price for a spare lens if purchased within 12 months of the original.

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!

  • Make sure you attend your follow-up appointments – these will allow your optometrist to ensure your new scleral lens is performing as well as possible.
  • Initially it is best to increase wear time gradually. Start with 4 hours on the first day, then add 2 hours with each day.
  • It is not unusual to have a slight mucous response to your new lens over a few weeks which may cause slight fogging. This should improve with time.
  • Do not modify the recommended cleaning/disinfection routine without consulting your optometrist.
  • Replace your lens case every 3 months to avoid microbial contamination
  • Short-cuts may save money, but may result in ineffective cleaning or disinfection. This could damage your lenses or lead to a potentially blinding infection of your eyes.
  • Always use the solutions you have been recommended. Other solutions may not be compatible and may cause discomfort or allergic reactions.
  • Never clean or store your rigid lens with soft contact lens solution. These products work in a different way to the rigid lens solutions and will not clean or condition your hard lenses as well.
  • To avoid contamination do not touch the tips of solution bottles to anything and replace their caps after use.
  • Stop lens wear if you experience persistent discomfort or redness – if in doubt consult your optometrist. If your eyes are very painful after-hours, consult the acute eye clinic at your local hospital.