Contact Lens Care & Compliance
Handling and Care of Scleral GP Lenses, Part 2
By Susan J. Gromacki, OD, MS, FAAO
Previously (October 2011), I outlined how the design of scleral GP lenses dictates their handling and care. Here, I provide an overview of how patients should clean and disinfect scleral lenses.
A challenging aspect of scleral lens fitting and wear is the presence of air bubbles that can enter a lens upon application. Although older publications describe filling the central optic zone with lens solution before application, most experts today recommend filling the entire scleral lens to the edge or rim. This method ensures that enough solution remains in the lens to prevent bubbles, even if some fluid is pushed out as the patient tilts the lens or inadvertently places it in contact with his eyelid upon application. If a patient is instructed to fill only the bowl, he may underfill it by mistake or in an attempt to conserve lens solution, thus increasing the likelihood of air bubbles.
Some practitioners recommend partially or completely filling the lens with Refresh Celluvisc (Allergan) to prevent lens solution loss on application. Its increased viscosity helps prevent spillage (DeNaeyer, 2011). Currently, this is considered an off-label use in the United States.
Scleral Lens Care
Scleral lenses are fitted primarily for daily wear, and as such, should be cleaned and disinfected nightly. Cleaning is typically performed manually with a daily cleaner suitable for GPs, such as Boston Cleaner and Boston Advance Cleaner (both Bausch + Lomb [B+L]), Opti-Free Daily Cleaner (Alcon) or Optimum by Lobob Extra Strength Cleaner (Lobob). The latter—the least abrasive of the group—or an isopropyl alcoholbased cleaner sold at Walgreens may be preferred for high-Dk materials. Regardless of the cleaner used, a thorough rinse with nonpreserved saline solution is necessary to completely remove all cleaner from the lens.
Disinfection should be performed with a GP conditioning/disinfection solution, such as Boston Advance Comfort Formula Conditioning Solution or Boston Conditioning Solution (both B+L). If a patient's lenses deposit minimally, a multipurpose GP lens solution, such as Boston Simplus Multi-Action Solution (B+L), Menicon Unique pH (Menicon), Opti-Free GP (Alcon) or Optimum C/D/S (Lobob) may be used for cleaning and disinfection.
For patients with solution sensitivities, many practitioners recommend rinsing the lenses with nonpreserved saline before application. This removes any residual solution and preservatives left from the disinfection process, but it can also decrease wettability. Another cleaning and disinfection option for these patients is Clear Care (Alcon). For GPs, ClearCare (Alcon). For GPs, Clear Care's instructions include a digital rubbing step. Most scleral lenses fit well into the Clear Care lens basket, but a larger case (for lenses up to 30mm in diameter) is available online from the Dry Eye . The catalytic eutralization disc is not included with the case, so patients must transfer a disc from a Clear Care case prior to use.
Heavy depositors may require periodic protein removal with Boston One-Step Liquid Enzymatic Cleaner (B+L), Opti-Free SupraClens (Alcon), or Menicon Progent (Menicon). Previously available in the United States for in-office use only, Progent is now FDA-cleared for patients to use at home.
For lens-specific care recommendations, consult each scleral lens and/or material manufacturer. CLS
For references, please visit www.clspectrum.com/references.asp and click on document #194.
Dr. Gromacki is a diplomate in the American Academy of Optometry's Section on Cornea, Contact Lenses and Refractive Technologies. She is chief research optometrist at Keller Community Hospital in West Point, N.Y.