A critical aspect of successful scleral lens wear is prescribing the correct combination of solutions for each individual patient. Although practitioners will have their go-to solutions, often adjustments need to be made to troubleshoot complications.
Scleral lenses are manufactured with GP materials; however, the unique fitting characteristics of scleral lenses typically require adjustments to prescribing habits as compared with corneal GP contact lenses. It is commonly accepted that there is little to no tear exchange of the reservoir fluid of a fit scleral lens. Preservatives from residual care products on the back of the lens bowl can cause a hypersensitive or toxic reaction (Figure 1). Therefore, soaking or multipurpose solutions should be rinsed with non-preserved saline prior to application.
Many practitioners now prescribe hydrogen peroxide care systems as a way of avoiding this potential complication, because the solution is neutralized during soaking. A rub step is essential for proper cleaning and disinfection when utilizing a peroxide care system.
A scleral lens may be used for one or more years by a patient and this can lead to the slow build-up of deposits on the lens surface despite proper nightly care with standard cleaning and disinfecting products (Figure 2). The amount of deposition can vary, depending on the patient’s tear chemistry and the material used for lens design. There are a variety of extra strength cleaners or treatments on the market that patients can utilize to keep their lenses clean.
If the lens looks visibly clean but surface wetting becomes an issue, then consider resending the lens back to the manufacturer for plasma treatment. Oxygen plasma super-cleans the surface of the lens and can help to restore the lens’ ability to wet.
Additionally, a relatively new 90% water polyethylene glycol (PEG)-based polymer surface coating can be added to help increase surface wetting of the lens. This coating can be damaged by enzymatic, abrasive, or alcohol-based cleaners. There are approved cleaners for use with this coating.
The bowl of a scleral lens has to be filled with saline prior to application. The fluid reservoir is not only necessary for optical correction, but is needed to achieve a semi-sealed fit. Scleral Lenses in Current Ophthalmic Practice: an Evaluation (SCOPE) data shows that a majority of fitters prescribe patients to fill scleral lenses with single-use 0.9% sodium chloride inhalation solution (off-label). This non-buffered and preservative-free option eliminates the risk of toxic or hypersensitive reactions to extended solution exposure. There are several other single-use options.
Many scleral lens complications can be avoided by prescribing solutions that keep lenses clean and the ocular surface healthy. CLS