contact lens care
Scleral GP Contact Lens Care
BY MICHAEL A. WARD, MMSC, FAAO
A 65-year-old female presented with granular corneal distrophy. She underwent phototherapeutic keratectomy in her right eye many years ago in an attempt to smooth the anterior corneal surface and improve her vision. She was left significantly hyperopic with a nine-diopter anisometropia. She successfully wears a soft contact lens over the operated eye in conjunction with spectacles to manage the anisometropia.
However, the granular dystrophy in her unoperated left eye has been much more of a lens fitting challenge. She previously failed in GP and tandem GP/soft lens combinations in her left eye. I recently fitted her with a scleral lens (Figure 1) that's working well. She now wears a HEMA soft lens (8.6mm base curve, 14.5mm diameter, +13.00D) in her right eye and a 15.8mm scleral GP lens in her left eye.
What lens care regimen might be used for both contact lenses?
Caring for Both Lens Types
We prescribed the following lens care regimen.
- Clean lenses with Miraflow Extra Strength Daily Cleaner (CIBA Vision).
- Rinse thoroughly with sterile non-preserved aerosol saline.
- Store in Clear Care (CIBA) overnight.
- Rinse thoroughly with aerosol saline.
- Wet lens surfaces with Refresh Plus (Allergan)
- Fill lens reservoir with unit dose non-preserved saline.
- Apply lenses.
Discussion Both soft and rigid lenses may be cleaned using a five-second rub with Miraflow Extra Strength Daily Cleaner. Patients may also use Lobob Laboratories' Optimum Extra Strength Cleaner (ESC) as an alternate product to clean scleral lenses, but not soft lenses. Tap water should be avoided, especially in the morning following lens disinfection. Thorough rinsing with sterile non-preserved aerosol saline is preferred.
Figure 1. Scleral lens over granular distrophy.
Both lens types may be disinfected with hydrogen peroxide. The Boston Scleral Lens Foundation (www.bostonsight.org/patinfo.htm) recommends using commercial 3% hydrogen peroxide in a deep well case, followed by a thorough saline rinse in the morning. Our patient had been using Clear Care for many years, and her 15.8mm scleral lens fits in the Clear Care lens holder. If her lens had been too large for this holder, we would have used a deep well case with ophthalmic grade peroxide disinfection. Because GP lenses don't absorb the storage solution, patients can safely rinse peroxides from the lens surfaces. However, when possible I prefer to prescribe ophthalmic grade peroxide disinfection and neutralization systems such as Clear Care or Oxysept (Advanced Medical Optics).
In the morning, patients can wet the lens surfaces by rubbing them with preservative-free artificial tears. Unit dose preservative-free saline or preservative-free artificial tears may be used to fill the lens reservoir prior to application. We've found unit dose preservative-free saline in 3ml and 5ml sizes labeled for inhalation therapy at various medical suppliers; this is simply non-preserved sterile saline in one-time use vials, which is perfect for our purposes.
With scleral lenses we want to eliminate or minimize any use of preservatives that may be harbored in the tear reservoir between the lens and cornea. Therefore, patients should not use preserved products to avoid potential toxicities. Patients should also practice good hygiene including hand washing and lens case care. CLS
Mr. Ward is an instructor in ophthalmology at Emory University School of Medicine and Director, Emory Contact Lens Service.