Contact Lens Care & Compliance
Removing Filmy Deposits From Scleral Lenses
BY MICHAEL A. WARD, MMSC, FAAO
An out-of-state patient recently returned for follow-up evaluation complaining of gradually decreasing, blurry vision and difficulty keeping her lenses clean. She is 71 years old, bilaterally pseudophakic, and is post-penetrating keratoplasty OS. She wears a scleral GP in her left eye.
Examination revealed slightly decreased vision and mild deposits on the anterior lens surface. Laboratory examination of her lenses also revealed significant filmy deposits on the posterior aspect of her scleral lens. This hard, grey-white film looked like the layered deposits that we occasionally see on corneal GP lenses in which a tight lens-to-cornea relationship exists with limited tear exchange. It’s not surprising that this is showing up with scleral lenses, which necessarily have limited tear exchange due to their fitting characteristics.
The Source of the Deposition
Crisp visual acuity and comfort are intimately associated with clean and smooth GP lens surfaces. GP lenses should be rubbed (all surfaces) and rinsed daily to remove dirt, tear debris, and cosmetics. Inadequate surface cleaning results in deposit formation and irregular, hydrophobic surfaces that attract more environmental debris, creating a cycle of more surface irregularity and debris accumulation that negatively impacts acuity, comfort, and wearing time (Ward, 2009). My patient has meibomian gland dysfunction, which contributed to her deposit buildup.
Her scleral lens care regimen consisted of daily cleaning with Optimum Extra Strength Cleaner (ESC) (Lobob Laboratories) at lens removal, Clear Care (Alcon) peroxide disinfection, and unit-dose, nonpreserved, sterile saline for rinsing and reservoir filling in the morning. She was not able to find her prescribed lens care products locally and substituted a multipurpose care solution (MPS) product that was recommended by her local pharmacist.
Proper Scleral Lens Care
MPS products alone are not adequate for daily cleaning of scleral lenses, in my opinion. Although slightly more steps are involved, GP care systems (separate cleaner and disinfectant) provide more thorough cleaning by using specific products for each care step.
Lens disinfection can be accomplished using hydrogen peroxide systems or any approved chemical system, or off-label use of soft lens MPS. Hydrogen peroxide disinfectants are my first choice. Peroxides offer excellent disinfection without preservatives and tend to keep the lens surfaces cleaner due to their oxidizing effect. Because GP lenses don’t absorb the storage solution, patients can safely rinse peroxides or chemical disinfectants from the lens surfaces. A morning saline rinse is recommended with all forms of disinfection (Gromacki and Ward, 2013).
Patients may wet their lenses by rubbing preservative-free artificial tears onto the surfaces before wearing. This helps create a wettable surface prior to filling the lens reservoir with saline. The lens reservoir should only be filled with unit-dose, preservative-free, sterile saline. It is very important that the saline not contain any additional chemicals (no preservatives or buffers).
Removing Deposit Buildup
I was able to remove the layered deposits from my patient’s lenses by using Boston Laboratory Cleaner (Bausch + Lomb) followed by chemical cleaning with Progent (Menicon). Select patients may use Progent at home. Her vision returned to 20/20 in both eyes, and she remains a happy scleral wearer. CLS
For references, please visit www. clspectrum.com/references.asp and click on document #215.
Mr. Ward is an instructor in ophthalmology at Emory University School of Medicine and Director, Emory Contact Lens Service. You can reach him at firstname.lastname@example.org.