Contact Lens Practice Pearls
Solutions to Filling Scleral Lenses
BY JESSICA H. MATHEW, OD, PHD, FAAO
With the growing popularity of scleral contact lenses and their acceptance by more and more practitioners, we need to understand the influence that lens solutions have on the lenses and on the health of the ocular surface. Unfortunately, there is not a true marketed scleral lens system—one for cleaning, disinfecting, and filling. Consequently, we tend to use a hodgepodge of things, which leaves our patients hunting the aisles for whatever we recommended.
There are many opinions about which cleaners are best, but I’ll leave that argument for someone else. Rather, I would like to focus on appropriate filling solutions for scleral lens wear. Scleral lenses allow for a fluid filled reservoir between the contact lens and the cornea, providing multiple functions: 1) creating a smooth refractive surface, 2) bathing/protecting the ocular surface, and 3) keeping the lens off of the cornea.
Little is actually known about the amount of tear/fluid exchange that occurs under the lens. And, while we believe some exchange does happen, the rate and quantity are not well established and likely vary from patient to patient and among lens designs.
Filling the Reservoir
In many patients, it is likely that this fluid layer remains largely intact without much turnover. Therefore, preservative-free filling solutions are ideal for minimizing irritation and maintaining the health of the ocular surface.
There are several preservative-free saline solution options available; however, they are not always easy for patients to locate. Unisol 4 (Alcon) saline solution was one that was relatively easy to find on the shelf of local stores, but since it was recently discontinued, we need to offer other alternatives. And, more importantly, we need to be proactive in making them available to our patients.
In January, Menicon introduced LacriPure, the first FDA-approved saline solution for scleral lens application. It is non-buffered, preservative free, and is packaged in single-use vials, making it safe for the ocular surface and convenient to use. All other solutions are considered off-label, as typically they are inhalation saline solutions.
When Supply Dwindles
As it turns out, neither of these types of solutions are that easy for patients to locate. They likely need to be pre-ordered, which puts patients at risk of being without the proper solution for any given length of time. During these times, they are likely to go to the pharmacist and ask what they can use to fill their scleral lenses. Many times, they are advised to use a soft contact lens disinfecting solution or another saline solution that contains harsh preservatives, which inevitably results in an acute toxic reaction to the cornea, causing extreme lens discomfort and eye redness.
To help our patients avoid running out, it is imperative that we offer these solutions for sale in our offices. That way, our patients know that they can always find the solutions in a pinch when needed. We also should be educating our scleral patients on the importance of preservative-free filling solutions and letting them know that, as a last resort, preservative-free artificial tears are the best emergency solution to use.
Lastly, providing an information sheet that details everything discussed, including where they can purchase the solutions you recommend, is helpful and will relieve stress for you and your scleral patients. CLS
Dr. Mathew is a research assistant professor at the University of Houston College of Optometry. She manages patients who have severe corneal distortions and require specialty contact lenses, and she is also involved in basic science and clinical trial research with The Ocular Surface Institute. She is a consultant or advisor to Alcon and has received research funding from Alcon, Johnson & Johnson Vision Care, Ocular Dynamics, and Shire. You can reach her at firstname.lastname@example.org.