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1. EyeSpace Scleral Lenses Care and Maintenance

12. EyeSpace Scleral practitioner and patient resourcesCharl Laas

Safety and Hygiene

Scleral contact lenses are recognised as a safe form of vision correction. However, incorrect care of scleral contact lenses and solutions can increase the risk for eye infections and corneal ulcers. Risk factors for acquiring an eye infection include improper lens cleaning and disinfection, poor hygiene practices and smoking. Following your practitioner's hygiene regime, along with regular reviews, will minimise this risk.

Before handling, removing or inserting your lenses:

Always thoroughly wash your hands with an antibacterial or alcohol-based hand wash and dry them with a clean towel. Make sure to wash all parts of your hands including between the fingers and dry thoroughly.

  • Sit at a table or desk and place a lint-free cloth down to insert and remove lenses. Avoid bathrooms as they often contain more germs than any other room in the home.
  • Inspect your lenses for deposits and defects such as chips or cracks. If you notice scratches, chips or misplace a lens, do not wear the lenses and contact your optometrist for a replacement. If you are unsure whether your lenses are damaged, ask your optometrist to inspect them.

Warning

Your lenses should never come into contact with tap or bottled water. Water contains microorganisms like Acanthamoeba that can cause sight-threatening eye infections.

Removal

Step 1

Remove lens either manually or with the suction cup.

First, ensure you break the seal of your scleral lens. Do this by pressing firmly with your finger on your bottom eyelid just below the lower edge of the lens, then push upwards. This will break the seal of the lens creating a bubble under the lens and allow it to move on your eye, making removal easier. Creating a bubble will blur your vision.

Method 1- Manual removal

  • Insert a drop of preservative-free saline or artificial tears to loosen the lens.
  • To begin, look down over a horizontal mirror or towel.
  • Using your middle fingers, open the eyelids wider than the lens diameter.
  • Apply pressure to the middle of the lid margins (as close to the lashes as you can – you do not want to show any of the red inside surface of your lids), pushing in and together to move your lids under the lens and lever it out of the eye.

Method 2- Suction tool

  • While looking in the mirror in front of you, hold open your bottom lid. Wet the tip of the suction tool to allow for better adhesion and attach the suction tip to the bottom third of the lens.
  • Using the suction tool, remove the lens by tilting the lens up and out of the eye.

Step 2

Place the lenses in the supplied contact lens holder and proceed with the cleaning and disinfection process as instructed by your optometrist.

Cleaning

Peroxide cleaning systems

Place lenses in the supplied basket holder and fill the case with the hydrogen peroxide solution. If required add the neutralising tablet and replace the lid and tighten. It is imperative the lenses are not removed before the solution has had six hours to neutralise.

Daily two-step cleaner

As directed by your optometrist, some patients require a daily two-step lens cleaning system. Hold the lens in the palm of your hand and instil one drop of the daily lens cleaner into the back of the lens. Gently rub the lens until the liquid foams like soap. Then rinse off with saline and place the lens into the conditioning solution to store overnight.

Monthly intensive cleaner

To remove protein build up use a monthly intensive cleaner. Place the lenses into the contact lens case holders. Open vial A and B by twisting the cap and pour the contents into the contact lens case. Replace the lids of the contact lens case and tighten. Leave the lenses in the solution for 30 minutes. Remove lenses and rinse thoroughly with Saline. Lenses can now be worn or soaked in your daily cleaner.

Tip: The first thing you will notice about your lenses is they have different colours. Usually, the right lens is clear and the left lens has a blue tint. The different colours will ensure you don’t get the lenses confused. The way to remember is the second letter of blue is L for left!

Lens Handeling

Scleral lenses are manufactured from a durable gas permeable polymer which resists wear and tear during normal lens wearing circumstances. However, it is still important to handle them carefully.

Habits that may cause a lens to break include;

  • Pushing on the lens. If the lens lands on a mirror or flat surface. Gently slide it off to the edge of the surface or use a suction tool to remove it from the surface.
  • Pulling a lens too firmly from the suction tool. Slide the lens off the suction point instead.
  • Forcing the lens to bend excessively while cleaning. Some friction force is required to clean a rigid lens using your cleaning solution, but not too much. The resistance from your skin surface will be sufficient to clean the lens. If you are pressing down on both sides of a rigid lens, the lens will flex and eventually snap in half if too much force is applied.

Insertion

Step 1

Remove your scleral lenses from the cleaning solution case and rinse with saline. If you are using a hydrogen peroxide solution, you can only remove the lenses after a minimum soaking time of six hours.

Step 2

Either place the scleral contact lens between the middle, forefinger and thumb (known as the tripod method) or secure your lens to a suction tool.

Step 3

Half fill the bowl of the lens with a preservative-free saline solution to prevent air bubbles between your eye and the lens. Insert the scleral lens directly onto the centre of your eye in a face-down position. To save confusion, it’s a good idea always to insert the right lens first.

Step 4

If you happen to drop your scleral lens, use saline solution to rinse the lens clean. To do this place the lens in the palm of your hand and thoroughly rinse for five seconds.

Step 5

Dry and wipe out your lens case with a tissue. Leave the case lid off to air dry while wearing your lenses.

Normal occurrences on insertion:

During the first few weeks of wear, it is not unusual to have lens fogging due to an accumulation of lipid and mucus behind the lens. The lens fogging will improve over time. If a lens becomes foggy during the day, remove the scleral lens, rinse and re-insert back into the eye. Mix preservative free lubricating eye drops with the saline insertion solution to help reduce persistent fogging.

Abnormal occurrences on insertion:

If on insertion you experience stinging, burning or slight pain, remove the lens, rinse and re-insert. If the problem persists, remove the lens and see your optometrist at your earliest convenience.

During the first 2 weeks:

Normal occurrences include:

  • Foreign body sensation and slight discomfort whilst wearing lenses.
  • Mild burning, stinging and watering which resolves once the lens is removed, rinsed with saline and re-inserted.

Abnormal symptoms (contact us immediately) include:

  • Redness, discharge, pain, light sensitivity, burning, stinging, and excessive watering of the eyes which doesn’t resolve after lenses are removed.
  • Feeling like the lens is stuck to the eye and having difficulty removing.

Things to remember!

  • Make sure you attend your follow-up appointments – these will allow your optometrist to ensure your new scleral lens is performing as well as possible.
  • Initially, it is best to increase your wearing time gradually. Start with four hours on the first day and then add two hours each day after that.
  • Do not modify the recommended cleaning routine or solutions without consulting your optometrist. Other solutions may not be compatible with your eyes and lenses and may cause discomfort or allergic reactions.
  • Shortcuts with cleaning solutions may appear to save money but may ineffectively clean and disinfect the lens. Incorrect cleaning solutions may damage your lenses or lead to an eye infection which can result in losing vision.
  • Never clean or store your rigid lens with soft contact lens solutions. These products work in a different way to the rigid lens solutions and will not clean and condition your rigid lenses as well.
  • Replace your lens case every time you start a new bottle of lens cleaner to avoid microbial contamination and loss of effectivity.
  • To avoid contamination do not touch the tips of solution bottles. Replace caps after use.
  • If your eyes are very painful after hours, consult your local hospital or emergency eye clinic.
  • If you notice scratches, chips or misplace a lens, contact your optometrist for a replacement.
  • Remember your eye must;

    • Look good (no red eyes)
    • Feel good (no pain, discomfort or light sensitivity)
    • See good (no persistent blurry vision)
    • If in doubt, take them out and call your optometrist