Care of Scleral Lenses

Scleral contact 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

Orthokeratology is a safe, reversible 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 house
  • Inspect lenses for scratches, chips or cracks as these can provide surfaces for bacteria to grow

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


Step 1
Remove lenses from the cleaning solution case and rinse with saline. If using hydrogen peroxide solution a minimum soaking time of 6 hours is required for the acid to neutralise to saline.

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 lens, use saline solution to rinse. Place the lens in the palm of your hand and rinse thoroughly for 5 seconds.

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

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 – 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 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, squeeze the tool and gently push inward to adhere the lens to the cup
  • Pull the lens from the eye to remove
  • After removal from the eye, carefully slide the lens sideways off the suction tool and it will come off easily

CAPTION: Different suction tools available for scleral lenses.

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 multiple types cleaning solutions: Peroxide based systems like AO Sept and multipurpose rigid lens solutions like Menicare and Boston Simplus. There are several steps involved in cleaning and storing scleral lenses that vary depending on the system.

Peroxide cleaner (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. 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 at our shop here.

Multipurpose solutions (Menicare and Boston Simplus)

  1. To clean: Place a few drops of multipurpose 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. Whilst Ortho-K lenses are strong, with incorrect technique or too much force they can break.
  2. 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. NEVER rinse or store your lenses in tap water, as micro-organisms are plentiful and can cause infections in your eyes.

Regular protein removal (Progent)

To clean and maintain the wettability of your lenses use intensive cleaner, such as Menicon Progent. Place the lenses into the 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. Lenses can now be worn or soaked in your daily cleaner. (please note that this product may not be available in all countries, ask your practitioner).

Risk of breakage

Scleral 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 fortnightly 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. If you break a lens within 18 months of its original purchase/fit then we are happy to offer 50% off the price. Outside of this 18 month period the lens will be full-price.

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. 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!

  • 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 gas permeable 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