Which Potion is in Your Bowl?
Scleral lens solutions…you have heard about this topic incessantly. Solutions are a common question and area of discussion amongst practitioners and patients alike. This topic is still highly pertinent for scleral lens practitioners as evidenced by two patients that were recently examined. Which solution do you recommend?
A Tale of Two Scleral Lens Wearers
First, a long-time scleral lens wearer presented with new eye irritation in both eyes, both with and without scleral lens wear. She was treated by another practitioner with topical steroids four times a day without improvement. After reviewing the chart note and speaking with the patient on the phone, I asked her to come in to be evaluated. Interestingly, she had bilateral corneal infiltrates. My in-depth questioning began and I discovered that preservative-free solution was being reused over two to three days. She stated, “There is so much solution in that vial!” Correct, but it is preservative-free and needs to be disposed after a single use. Topical antibiotics were started and symptoms quickly improved, then resolved.
Second, a previous scleral lens wearer who presented for a new fitting reported that his vision could be better in the left eye. There were no comfort issues in either eye and vision was good in the right eye. No spherical nor cylindrical over-refraction was present in either eye. No lens flexure was present in either eye. Both scleral lenses fit well. After lenses were removed, corneal staining was present in both eyes, left eye more than the right eye. My in-depth questioning began once again and I discovered that preservative-free solution in a bottle was being used. Notably, the open bottle was used for longer than the recommended replacement schedule. Once the regimen was changed to preservative-free vials with daily replacement, vision improved in the left eye. Additionally, higher viscosity solution along with preservative free vials was added to use as needed.
Fortunately, in both cases, disinfection was performed properly.
It is critical to prescribe a specific application solution for each scleral lens wearer. Currently available solutions are listed in Figure X. What is the future for application solutions? Will there be specific solutions for different ocular conditions? Will medicinal solutions be available with additive properties? In my option, there is a significant opportunity for new scleral lens formulations.
1. Recommend specific application and disinfection solutions.
2. Ask each patient at every visit which solutions are being used for application and disinfection and how they are being utilized.
3. Confirm that preservative-free solutions in a vial are being disposed (or recycled) after a single use.
4. Offer additive higher viscosity solutions for scleral lens application.
Dr. Melissa Barnett is a Principal Optometrist at the University of California Davis Eye Center in Sacramento, specializing in anterior segment disease and specialty contact lenses. Dr. Barnett is the Past President of The Scleral Lens Education Society. She lectures and publishes extensively on topics including dry eye, anterior segment disease, contact lenses and creating a healthy balance between work and home life for women in optometry.