Scleral lens application can be a challenge. Successful application of scleral lenses requires eyelid control as well as manual placement of the lens on the eye. The lens is filled with preservative-free saline or filling solution, and patients must position themselves face down to avoid spillage. Loss of saline or improper positioning can result in air bubbles or in an off-centered application of the lens.
Difficulty with application or removal of sclerals is the most commonly cited reason for patients to discontinue wear (Macedo-de-Araújo et al, 2019; Kanakamedala et al, 2019; Barnett et al, 2016; Weyns et al, 2013). One study on scleral lens success reported that 35% discontinued sclerals due to handling issues, and 13% required > 60 minutes for training (Macedo-de-Araújo et al, 2019). In fact, discontinuation from handling difficulties is more common than is discontinuing from either discomfort or visual outcomes; patients who have significant vision loss or poor dexterity may even require a family member’s assistance to apply and remove the device (Macedo-de-Araújo et al, 2019; Kanakamedala et al, 2019; Barnett et al, 2016; Weyns et al, 2013).
Scleral Application Methods
Scleral lenses can be applied with or without an application device. A lens can be balanced on the tips of two or three fingers, then filled with saline or filling solution (Arnold et al, 2019). Getting this to work is a hurdle, and most patients will likely need an application device.
For patients who are used to applying soft lenses perched on their finger, one option is a lens application ring. Worn on the end of a finger, the ring has a bowl attached for the lens to sit in. The lens stays balanced on the device, and patients can use both hands to hold their lids. The rings come in various sizes and are made of medical-grade plastic. Some patients also do well using a #8 O ring (available at hardware stores) or an orthodontic rubber band to balance the lens on their finger.
The most well-known scleral lens application tools are plungers, which are available with or without a vent (to prevent or provide suction, as needed). Similar to a standard plunger is a silicone scleral cup, which is handled the same way but is a latex-free option.
Another option is a double-sided, 3D molded contact lens handler. A suction cup on one end is specifically designed for applying lenses. The other end is designed for lens removal. It features a safety release to detach from the lens during removal if the lens is adhered to the eye.
Patients can experience issues with holding the plunger and lids at the same time; fortunately, several devices are available that can aid with these difficulties. A more involved device uses a PVC plastic stand with a hole to hold a plunger. This frees both hands to keep the lids open while patients lower their eye to the lens. This device is also available with a green fixation light that attaches to the plunger cup to provide a visual target for patients. The stand and lighted option can be used together or independently.
A new device that just launched is the S5 Mini from Augmented Vision Labs. It includes a smaller, portable stand than the original product’s telescoping stand, and it features a USB-charged light source. This provides the stability and fixation capabilities of other devices with the added benefit of a portable carrying pouch and rechargeable light source. The stand utilizes a suction base that can stick to any hard surface whether at home or away.
Consider All of the Options
When training patients on scleral lens wear, especially new wearers, watch for patient difficulties with traditional application methods, and consider alternative devices to improve patients’ handling, safety, and comfort. Links to the manufacturer websites for the devices discussed in this article are available in the list of article references. CLS
For references, please visit www.clspectrum.com/references and click on document #294.