Scleral Contact lenses
What Are Scleral Contact Lenses?
Scleral lenses are large-diameter rigid gas permeable lenses that are designed to completely cover the cornea (the transparent dome in front of the eye) as well as extend onto the sclera (the white portion of the eye). This type of specialty lenses are ideal for various ocular conditions that are not compatible with traditional soft contact lenses. Scleral lenses are ideal for patients who have the following conditions: keratoconus, Pellucid marginal degeneration, Post surgical corneas (INTACS, corneal transplants, or LASIK), Corneal scarring, Corneal dystrophies, dry eye syndrom and Chronic inflammatory conditions such as Stevens Johnson syndrome.
How to Handle and Care for Your Scleral Lenses
Congratulations at becoming a scleral lens wearer! Your scleral lenses will provide you with exceptional vision and comfort. The contact lens will maintain a liquid filled vault between its back surface and the front surface of your cornea. This soothing environment will maintain comfort throughout your wearing time and provide a healthy environment for your cornea.
Applying and Removing Your Lenses
Before You Apply the Lens
You will be removing the lenses from the case that has been used to disinfect the lenses. Just prior to handling the lenses, it is important that you wash your hands. The soap that you use needs to be free of lanolin, lotion or perfume. These additives can transfer to the surface of the lens and cause it to become non-wettable. Dry your hands with a lint-free towel.
Applying Your Scleral Lens
There are many methods that can be used to apply your scleral contact lens. A popular method is to use an application device, sometimes referred to as a plunger.
Application Device (plunger)
Key Points for Applying Your Scleral Lenses
The Lid Spread is Everything
Incorrect! Fingertips are not centered. Lid spread is not a perfect circle!
Incorrect! Lids slipped from fingertips. Lids are not open wide enough.
Perfect! A perfectly round opening has been created with plenty of clearance for a scleral lens.
The lens needs be completely full of non-preserved saline and then some. You will notice the solution becomes rounded as you overfill the lens.
Applying Your Scleral Lens Using A Plunger
Alternate methods for holding the lens:
Check for Application Bubbles:
If the lens does not stay full of saline during application, you may find that you have air bubbles under the lens. The bubbles will not go away you must remove the lens and reapply. Signs of a bubble will be slight discomfort and or blurred vision. You may be able to see the bubbles if you look in a mirror.
Removing Your Scleral Lens
With a plunger: The removal plunger is smaller than the application plunger and will not have a hole in the center of the device.
How to Remove Your Scleral Lens without a Plunger
Solutions and Disinfection
To maintain the health of your eyes and to prevent infections, the scleral lens must be cleaned and disinfected each time they are worn. The solutions recommended to you could vary from those of another person wearing scleral lenses based on your specific needs. Some of the solutions recommended for proper care may be Boston Simplus®, Boston Advance or Optimum by Lobob®, CLEAR CARE Plus® by Alcon, and AddiPak® Unit Dose Vials of Sterile 0.9% Inhalation Saline (Amazon.com). Biotrue™ by Bausch and Lomb may also be used to promote lens surface wetting.
Caring for your Scleral Lenses
To enhance the wetting of the lens surface, Biotrue® Multipurpose Solution by Bausch and Lomb can be used. After removing the scleral lens from the disinfecting solution, place the lens in your hand and squeeze a generous amount of Biotrue® on the surface. Rub the solution on the lens for several seconds until the solution starts to become soapy and/or pasty. Rinse again with Biotrue™ and then fill the bowl with the non-preserved saline and apply to the eye.
RSVP
Redness; Soreness; Vision loss; Pain
If at any time during lens wear you notice and unusual redness, the eye becomes sore, your
vision changes or decreases or you experience pain – REMOVE your lenses and call Corona Optometry!
Where do I buy solutions?
Application and removal plungers are available from your eyecare professional or can be purchased at www.thedryeyeshop.com.
Non-preserved saline SCLERALFIL will be available through BauschSVPstore.com, but can also be purchased through Amazon.com.
Websites to visit: please purchase the recommended items before you come for your follow up visit
https://sclerallens.org/for-patients/patient-faqs/
https://sclerallens.org/for-patients/patient-videos/
https://dryeyeshop.com/
DMV Scleral Cup-purchase 2-3 of these
DMV 45 angled lens remover-purchase 2-3 of these
LENS SOLUTION, CLEANING, AND HANDLING QUESTIONS:
Do I need to clean and disinfect my lenses every night?
Yes! Cleaning the lenses with an approved solution removes deposits from the lens surface and kills microbes that potentially cause eye infections.
Why do I need to use preservative-free solutions to fill the lens?
There is minimal tear exchange when the lens is on the eye. Long-term exposure to preservatives can cause a sensitivity or toxicity to the cornea resulting in redness and irritation.
Can I rinse my lenses with tap water?
No. Even tap water can harbor pathogens including Acanthamoeba, the dangerous amoeba that can cause painful, vision threatening eye infections. It is recommended to rinse lenses with sterile saline.
Can I use eye drops with my lenses in?
If you require eye drops for conditions such as glaucoma or allergies, it is recommended they be instilled at least 5 minutes prior to application of the lenses or after lenses are removed.
Can I wear makeup or face creams or lotions with my lenses?
Yes, but apply lenses prior to using makeup or facial products. If these products come in contact with the lens surface, it can disrupt the quality of vision.
How long do my application and removal plungers last for?
Plungers should be replaced every 3 months, or sooner as needed.
I cannot find my lens care products at the store. Where else can I order solutions or extra plungers?
Solutions and plungers can also be found at www.bauschsvpstore.com or the Dry Eye Shop (www.dryeyeshop.com). Certain products like Menicon’s Unique pH and LacriPure or Bausch and Lomb’s ScleralFil can be purchased from the company web stores.
LENS WEAR QUESTIONS
How many hours per day is it safe for me to wear my lenses?
After an initial adaptation period when you are gradually building up your wear time, the lenses can be worn for the full day. Keep in mind that every person is different, and no lens should be worn if it becomes uncomfortable, painful, or if the eye becomes red and irritated. Ultimately, your wear time should be determined by you and your eye doctor.
How do I know if there is an air bubble under the lens?
If you apply the lens an notice that your vision is blurry or the lens feels uncomfortable, you may have an air bubble trapped underneath. Sometimes you can see the bubble if you look in the mirror, but other times you cannot. If you think there is a bubble, remove the lens and reapply it.
What if my vision is foggy or cloudy?
Foggy or cloudy vision is often attributed to two causes. First, there may be mucous or debris trapped between the lens and the cornea. This can occur when the lens does not align properly to the eye. Second, the front surface of the lens may not be wetting well. There are multiple reasons for this including poor tear film chemistry, improper cleaning, or lens surface breakdown. On rare occasions, foggy vision can also occur when the cornea becomes edematous (swollen). If your vision is still foggy after removing the lens, please inform your eye care practitioner. It is strongly recommended that any foggy or cloudy vision be addressed with your eye care practitioner.
Is it safe for me to sleep in my lenses?
No. Sleeping in lenses reduces oxygen transmission to the eye. This can cause swelling of the cornea and the abnormal growth of blood vessels into the cornea.
LENS REMOVAL QUESTIONS
What do I do if I cannot remove the lens from my eye?
First of all, try not to panic. We understand it is stressful not being able to get a lens out of your eye, but if you remain calm and are careful with your placement of the plunger you will almost always be able to remove the lens. Be sure that you are placing the plunger peripherally on the lens, remembering that you should not have to pull very hard on the plunger once it has established suction. If you have trouble establishing suction with the lens, try wetting the end of the plunger.
If you still cannot get the lens off using this method, use your finger to push on the white part of your eye, just adjacent to the lens edge. This will usually create an air pocket in the lens and should make it much easier to remove with the plunger.
A third method that you can try is to actually slide the edge of the plunger underneath the peripheral lens edge, and use it as a lever to dislocate the lens. If you resort to this third method, the lens may flip out of the eye and fall, so be sure to have a good method of catching the lens (ie. soft clean towel on counter).
If you have tried these removal techniques and still cannot remove the lens, you may need to call your closest eye doctor for professional assistance.
I can see a ring where the lens was on my eye after I remove the lens. Is this normal?
Yes, it is normal. We call it an impression ring. Similar to when you remove a watch or a pair of socks, there is often an impression in the tissue due to the placement of a device. This is not a problem and should disappear within about 5 minutes. If, however, you experience a significant amount of redness in this area after removing the lenses, especially if it persists after a few minutes, talk to your eye doctor, as this may indicate that the lens is fitting too tightly.
Scleral lenses are large-diameter rigid gas permeable lenses that are designed to completely cover the cornea (the transparent dome in front of the eye) as well as extend onto the sclera (the white portion of the eye). This type of specialty lenses are ideal for various ocular conditions that are not compatible with traditional soft contact lenses. Scleral lenses are ideal for patients who have the following conditions: keratoconus, Pellucid marginal degeneration, Post surgical corneas (INTACS, corneal transplants, or LASIK), Corneal scarring, Corneal dystrophies, dry eye syndrom and Chronic inflammatory conditions such as Stevens Johnson syndrome.
How to Handle and Care for Your Scleral Lenses
Congratulations at becoming a scleral lens wearer! Your scleral lenses will provide you with exceptional vision and comfort. The contact lens will maintain a liquid filled vault between its back surface and the front surface of your cornea. This soothing environment will maintain comfort throughout your wearing time and provide a healthy environment for your cornea.
Applying and Removing Your Lenses
Before You Apply the Lens
You will be removing the lenses from the case that has been used to disinfect the lenses. Just prior to handling the lenses, it is important that you wash your hands. The soap that you use needs to be free of lanolin, lotion or perfume. These additives can transfer to the surface of the lens and cause it to become non-wettable. Dry your hands with a lint-free towel.
Applying Your Scleral Lens
There are many methods that can be used to apply your scleral contact lens. A popular method is to use an application device, sometimes referred to as a plunger.
Application Device (plunger)
Key Points for Applying Your Scleral Lenses
- Your eye must be open wide -the lid spread is everything!
- The approaching scleral lens and plunger must be centered within that opening. Use the center hole in the plunger as your reference point.
- The plunger must be vertical. Your scleral lens must retain the non-preserved saline to avoid bubbles.
- Overfill your scleral lens to improve your chances of a bubble-free application.
The Lid Spread is Everything
Incorrect! Fingertips are not centered. Lid spread is not a perfect circle!
Incorrect! Lids slipped from fingertips. Lids are not open wide enough.
Perfect! A perfectly round opening has been created with plenty of clearance for a scleral lens.
The lens needs be completely full of non-preserved saline and then some. You will notice the solution becomes rounded as you overfill the lens.
Applying Your Scleral Lens Using A Plunger
- Attach the scleral lens to the plunger. Wet the tip of the plunger with non-preserved saline. Place the scleral lens on the plunger in a centered position. A suction will be created that will hold the lens to the plunger. You can confirm that the lens is centered on the plunger using the hole in the plunger as a reference point.
- Fill the scleral lens with non-preserved saline to the point of being overfull.
- Bend your head over the mirror and tuck your chin down toward your chest so that your face is parallel to the floor.
- Grasp your upper eye lid with the index finger of you free hand, holding the edge of the lid just under the lashes. Hold your lower eyelid open with you thumb and keep both of your eyes open as wide as possible. Look into the mirror as you place the scleral lens directly on the surface of your eye. Apply the lens.
- You will feel the fluid, but you are not there yet. Gently press the lens onto the eye.
- Release the scleral lens from the plunger by squeezing completely. Maintain the upward pressure against the eye, while squeezing to release the lens.
- The scleral lens has now been released into your eye! Stay squeezed while you retract the plunger away from the eye.
Alternate methods for holding the lens:
Check for Application Bubbles:
If the lens does not stay full of saline during application, you may find that you have air bubbles under the lens. The bubbles will not go away you must remove the lens and reapply. Signs of a bubble will be slight discomfort and or blurred vision. You may be able to see the bubbles if you look in a mirror.
Removing Your Scleral Lens
With a plunger: The removal plunger is smaller than the application plunger and will not have a hole in the center of the device.
- Lubricate your eye thoroughly with preservative-free artificial tears or preservative-free saline.
- Wet a removal plunger with artificial drops or saline.
- Hold the plunger at a 45 degree angle, aimed at the 6 o’clock position of the scleral lens.
- Gently press the plunger against the scleral lens and rotate the plunger away. When the lower edge of the lens has broken suction, you can then slowly remove the scleral lens in a downward arc. DO NOT release the lids until the scleral lens is out of the eye.
- Remove the scleral lens from the plunger by twisting and removing it towards the edge of the lens until the plunger is free of the lens.
How to Remove Your Scleral Lens without a Plunger
- Wash your hands thoroughly with non-moisturizing soap and water and dry.
- Press the tip of the index finger on the very edge of the upper lid at the 12 o’clock position and gently push it into your eye just above the top edge of the lens.
- Block the lens from moving down by pressing the tip of your index finger of your other hand on the very edge of your lower lid just below the bottom edge of the lens.
- Look upward until you feel the lens being blocked by pressure on the upper lid margin.
- Scoop the upper edge of the lens off the eye with the upper lid margin, look up further and blink slowly to remove the lens.
Solutions and Disinfection
To maintain the health of your eyes and to prevent infections, the scleral lens must be cleaned and disinfected each time they are worn. The solutions recommended to you could vary from those of another person wearing scleral lenses based on your specific needs. Some of the solutions recommended for proper care may be Boston Simplus®, Boston Advance or Optimum by Lobob®, CLEAR CARE Plus® by Alcon, and AddiPak® Unit Dose Vials of Sterile 0.9% Inhalation Saline (Amazon.com). Biotrue™ by Bausch and Lomb may also be used to promote lens surface wetting.
Caring for your Scleral Lenses
- Place bowl side down on palm of hand & apply a few drops of cleaning solution. With pad of finger, rub back & forth gently.
- To clean the inside of the lens, rub from the center to the outer edge, outward at 12:00, 3:00, 6:00 & 9:00 o’clock.
- Tough spots can be cleaned with a Q-Tip & cleaning solution when necessary.
- Non-preserved saline solution such as Scleral-Fill or AddiPak will be used for filling the bowl & rinsing lenses as needed. Boston Simplus, Boston, Boston advance, will be used as a cleaning solution. (per doctors instruction)
- Store lenses in a clean and dry contact lens case in the recommended disinfection solution.
- Cases should be rinsed with hot tap water and allowed to air dry. Application and removal plungers should be cleaned with alcohol and allowed to air dry.
To enhance the wetting of the lens surface, Biotrue® Multipurpose Solution by Bausch and Lomb can be used. After removing the scleral lens from the disinfecting solution, place the lens in your hand and squeeze a generous amount of Biotrue® on the surface. Rub the solution on the lens for several seconds until the solution starts to become soapy and/or pasty. Rinse again with Biotrue™ and then fill the bowl with the non-preserved saline and apply to the eye.
RSVP
Redness; Soreness; Vision loss; Pain
If at any time during lens wear you notice and unusual redness, the eye becomes sore, your
vision changes or decreases or you experience pain – REMOVE your lenses and call Corona Optometry!
Where do I buy solutions?
Application and removal plungers are available from your eyecare professional or can be purchased at www.thedryeyeshop.com.
Non-preserved saline SCLERALFIL will be available through BauschSVPstore.com, but can also be purchased through Amazon.com.
Websites to visit: please purchase the recommended items before you come for your follow up visit
https://sclerallens.org/for-patients/patient-faqs/
https://sclerallens.org/for-patients/patient-videos/
https://dryeyeshop.com/
DMV Scleral Cup-purchase 2-3 of these
DMV 45 angled lens remover-purchase 2-3 of these
LENS SOLUTION, CLEANING, AND HANDLING QUESTIONS:
Do I need to clean and disinfect my lenses every night?
Yes! Cleaning the lenses with an approved solution removes deposits from the lens surface and kills microbes that potentially cause eye infections.
Why do I need to use preservative-free solutions to fill the lens?
There is minimal tear exchange when the lens is on the eye. Long-term exposure to preservatives can cause a sensitivity or toxicity to the cornea resulting in redness and irritation.
Can I rinse my lenses with tap water?
No. Even tap water can harbor pathogens including Acanthamoeba, the dangerous amoeba that can cause painful, vision threatening eye infections. It is recommended to rinse lenses with sterile saline.
Can I use eye drops with my lenses in?
If you require eye drops for conditions such as glaucoma or allergies, it is recommended they be instilled at least 5 minutes prior to application of the lenses or after lenses are removed.
Can I wear makeup or face creams or lotions with my lenses?
Yes, but apply lenses prior to using makeup or facial products. If these products come in contact with the lens surface, it can disrupt the quality of vision.
How long do my application and removal plungers last for?
Plungers should be replaced every 3 months, or sooner as needed.
I cannot find my lens care products at the store. Where else can I order solutions or extra plungers?
Solutions and plungers can also be found at www.bauschsvpstore.com or the Dry Eye Shop (www.dryeyeshop.com). Certain products like Menicon’s Unique pH and LacriPure or Bausch and Lomb’s ScleralFil can be purchased from the company web stores.
LENS WEAR QUESTIONS
How many hours per day is it safe for me to wear my lenses?
After an initial adaptation period when you are gradually building up your wear time, the lenses can be worn for the full day. Keep in mind that every person is different, and no lens should be worn if it becomes uncomfortable, painful, or if the eye becomes red and irritated. Ultimately, your wear time should be determined by you and your eye doctor.
How do I know if there is an air bubble under the lens?
If you apply the lens an notice that your vision is blurry or the lens feels uncomfortable, you may have an air bubble trapped underneath. Sometimes you can see the bubble if you look in the mirror, but other times you cannot. If you think there is a bubble, remove the lens and reapply it.
What if my vision is foggy or cloudy?
Foggy or cloudy vision is often attributed to two causes. First, there may be mucous or debris trapped between the lens and the cornea. This can occur when the lens does not align properly to the eye. Second, the front surface of the lens may not be wetting well. There are multiple reasons for this including poor tear film chemistry, improper cleaning, or lens surface breakdown. On rare occasions, foggy vision can also occur when the cornea becomes edematous (swollen). If your vision is still foggy after removing the lens, please inform your eye care practitioner. It is strongly recommended that any foggy or cloudy vision be addressed with your eye care practitioner.
Is it safe for me to sleep in my lenses?
No. Sleeping in lenses reduces oxygen transmission to the eye. This can cause swelling of the cornea and the abnormal growth of blood vessels into the cornea.
LENS REMOVAL QUESTIONS
What do I do if I cannot remove the lens from my eye?
First of all, try not to panic. We understand it is stressful not being able to get a lens out of your eye, but if you remain calm and are careful with your placement of the plunger you will almost always be able to remove the lens. Be sure that you are placing the plunger peripherally on the lens, remembering that you should not have to pull very hard on the plunger once it has established suction. If you have trouble establishing suction with the lens, try wetting the end of the plunger.
If you still cannot get the lens off using this method, use your finger to push on the white part of your eye, just adjacent to the lens edge. This will usually create an air pocket in the lens and should make it much easier to remove with the plunger.
A third method that you can try is to actually slide the edge of the plunger underneath the peripheral lens edge, and use it as a lever to dislocate the lens. If you resort to this third method, the lens may flip out of the eye and fall, so be sure to have a good method of catching the lens (ie. soft clean towel on counter).
If you have tried these removal techniques and still cannot remove the lens, you may need to call your closest eye doctor for professional assistance.
I can see a ring where the lens was on my eye after I remove the lens. Is this normal?
Yes, it is normal. We call it an impression ring. Similar to when you remove a watch or a pair of socks, there is often an impression in the tissue due to the placement of a device. This is not a problem and should disappear within about 5 minutes. If, however, you experience a significant amount of redness in this area after removing the lenses, especially if it persists after a few minutes, talk to your eye doctor, as this may indicate that the lens is fitting too tightly.