What do I need? What might I need? What should I ask my doctor about?

<h2 id="isPasted">What do I need?</h2><p>Note: Not everyone needs <em>all</em> of these items, but this is an example of good practice with PROSE and scleral lenses. Consult your lens provider for specifics on what you need.</p><ul><li>HELPFUL: Hand soap that&#xA0;is free of moisturizers</li><li>MUST: Preservative-free saline for rinsing and filling</li><li>MAYBE: Preservative-free artificial tear to supplement the saline in the bowl of the lens.</li><li>MUST: &quot;Plungers&quot; for inserting and removing your lenses. Some people can use fingers for insertion, but almost everyone needs plungers for removal.</li><li>MAYBE: Digital (&quot;rub&quot; type) cleaner for removing any debris, mucous or buildup before disinfection. Not everyone uses these, but those with the most diseased eyes tend to need them the most.</li><li>MUST: Overnight disinfection solution. All contact lenses require disinfection after every use.&#xA0;</li><li>MAYBE: PROSE&#xA0;disinfection case IF&#xA0;using ClearCare and if your lenses are too large for the case included with ClearCare</li><li>MAYBE: Weekly enzyme cleaner (for some users) or periodic Progent cleaning - but NOT if you have Hydra PEG coated lenses.</li></ul><h2 id="soap-helpful">Soap (helpful)</h2><p>Oils or moisturizers will transfer from your hands to your lenses, where they can attract debris and cloud your vision. Use only moisturizer-free soap. We recommend <strong><a href="https://dryeyeshop.com/products/ocusoft-hand-soap">Ocusoft</a></strong>.</p><h2 id="preservative-free-saline-must">Preservative free saline (MUST)</h2><p>Never use anything with preservatives to fill your PROSE or scleral lenses. Consult your lens provider about the specific saline they want you to use. <strong><a href="https://dryeyeshop.com/pages/resources-preservative-free-saline-guide" rel="noopener noreferrer" target="_blank"><span style="background-color: #ffff00;">Click here</span></a></strong> for a detailed list if you wish to discuss options with your doctor.</p><h2 id="preservative-free-artificial-tear-maybe">Preservative free artificial tear (maybe)</h2><p>This is just for some users. People who have problems with chronic fogging and/or chronic discomfort with normal PF saline often benefit from adding some drops of <strong><a href="https://dryeyeshop.com/products/refresh-celluvisc">Refresh Celluvisc</a></strong> or another artificial tear. Ask your doctor.&#xA0;</p><h2 id="insertion-plungers-probably">Insertion plungers (probably)</h2><ul><li>Depending on your lens size, you may be able to use fingers instead.</li><li><strong><a href="https://dryeyeshop.com/products/dmv-scleral-cup" rel="noopener noreferrer" target="_blank">DMV Scleral Cup</a></strong> is the most widely used insertion plunger.</li><li>Some providers prefer the DMV Vented Scleral Cup (designed for hybrid lenses).</li><li><strong><a href="https://dryeyeshop.com/products/ezi-scleral-lens-applicator-ring">EZI Lens Applicator Ring</a></strong> is helpful for some users, especially those with arthritis or other manual dexterity issues interfering with gripping a plunger.</li><li><strong><a href="http://www.dalseyadaptives.net">Dalsey Adaptives</a></strong> lighted insertion stand and related products are valuable tools for many users as well.</li></ul><h2 id="removal-plungers-must">Removal plungers (MUST)</h2><ul><li><strong><a href="https://dryeyeshop.com/products/dmv-ultra-remover">DMV Ultra</a></strong> is the most commonly used.</li><li><strong><a href="https://dryeyeshop.com/products/dmv-45">DMV 45</a></strong> is handy for some users as you approach the eye at an angle rather than straight on.</li><li><strong><a href="https://dryeyeshop.com/collections/scleral-lens-care-kits/products/scleral-lens-emergency-kit" rel="noopener noreferrer" target="_blank">Emergency kits</a></strong> are handy and cheap, to help avoid finding yourself without a plunger when you need one.</li></ul><h2 id="daily-rub-cleaners-maybe">Daily &quot;rub&quot; cleaners (maybe)</h2><ul><li>Make sure to use a daily rub cleaner if your doctor recommended it.&#xA0;</li><li>Do not confuse cleaning with disinfection!&#xA0;</li><li>Make sure your cleaner is compatible with your lens type! Plasma treated lenses and Hydra PEG coated lenses have different requirements.&#xA0;</li><li>If your provider did not recommend a daily cleaner, but you are having issues with comfort, clarity, fogging or mucous build-up, talk to your doctor about the possibility of starting on a daily cleaner as this improves lens performance for many users with such issues. Make sure to get a specific recommendation that is compatible with your lensss.</li></ul><h2 id="overnight-disinfection-must">Overnight disinfection (MUST)</h2><p>All lenses need disinfection after use. This is not the same as using a cleaner.</p><p>We stock&#xA0;several in order to keep everyone happy, but if you ask us, we will always recommend Clear Care because it is preservative free and we know so many patients whose lens performance has improved after switching.&#xA0;NOTE: If you are purchasing Clear Care elsewhere, make sure you get the original version, NOT the &quot;Clear Care Plus&quot; version, which causes issues for some users. We only stock the original here.</p><p>If you&apos;re using ClearCare and your lenses are larger than 15.5mm, chances are you will need the PROSE Disinfection Case which&#xA0;is large enough to safely accommodate scleral lenses of all sizes. You will need to transfer the platinum catalyst disc from the Clear Care case into the PROSE case (where it will float in the peroxide). Beware: The PROSE case is a huge peroxide hog.</p><h2 id="weekly-or-other-cleaners-maybe">Weekly or other cleaners (maybe)&#xA0;</h2><p>Some users have persistent lens protein or other buildup issues and benefit from a weekly enzyme cleaner or from Progent cleaner (the latter is not sold here - talk to your lens care provider about it). Beware - enzyme cleaners cannot be used on Hydra PEG coated lenses.</p><h2 id="other-stuff-maybe">Other stuff? (maybe)</h2><p>You may want a conventional contact lens case to store your lenses&#xA0;in when not using or disinfecting. Check with your provider about the best way to store your lenses; plasma treated lenses are typically stored dry while Hydra PEG coated lenses are stored wet.</p><p>If you are inserting and/or removing your lenses over the sink, make sure you use a soft towel or a rubber catch mat to prevent breaking or loss from dropping your lenses.</p><p>High magnification mirrors can be helpful, especially if you are low vision or if you&apos;re still learning insertion and removal technique.</p>

Product selection tips

Compare key features of the preservative-free filling solutions - buffered versus unbuffered, package sizes, etc.

<h2 id="isPasted">What brand of preservative free saline should I get?</h2><p>NOTE: This video is a bit outdated as it was made before Nutrifill was launched.&#xA0;</p><p><iframe width="560" height="315" src="https://www.youtube.com/embed/QGTY_FwAmgI" frameborder="0" allowfullscreen></iframe></p><h2 id="overview">Overview</h2><table height="329" style="width: 611px;"><tbody><tr><td style="width: 80px;">&#xA0;<strong>Product</strong></td><td style="width: 75px;"><p><strong>Buffered*?</strong></p></td><td style="width: 81px;"><strong>Size&#xA0;</strong></td><td style="width: 268px;"><strong>Notes</strong></td></tr><tr><td style="width: 80px;"><br></td><td style="width: 75px;"><br></td><td style="width: 81px;"><br></td><td style="width: 268px;"><br></td></tr><tr><td style="width: 80px;"><strong><a href="https://dryeyeshop.com/search?type=product&amp;type=pages&amp;type=articles&amp;q=purilens+saline">Purilens Plus</a></strong></td><td style="width: 75px;">Yes*</td><td style="width: 81px;"><p>4oz bottles - box of 3 or 12</p><p>2oz travel bottles - sold in box of 6 (&quot;Mini&quot;)</p></td><td style="width: 268px;"><p>Economical packaging for heavy users</p><p>Too much for people who only use a little</p><p>Similar to&#xA0;the former Unisol 4</p><p><strong>Ask your eye doctor</strong> how long it is safe to keep this open for filling sclerals - due to potential bottle contamination, many doctors do not support the use of this product up to the manufacturer&apos;s &quot;use within&quot; limit of 14 days.&#xA0;</p></td></tr><tr><td style="width: 80px;"><a href="https://dryeyeshop.com/products/nutrifill"><strong>NutriFill</strong></a></td><td style="width: 75px;">Yes*</td><td style="width: 81px;">Box of 35 10mL vials</td><td style="width: 268px;"><p>&quot;Electrolyte-enriched&quot;</p><p>Considered the &quot;top of the line&quot; scleral lens filling solution.</p></td></tr><tr><td style="width: 80px;"><strong><a href="https://dryeyeshop.com/products/scleralfil">ScleralFil</a></strong></td><td style="width: 75px;">Yes*</td><td style="width: 81px;">Box of 30 10mL vials</td><td style="width: 268px;"><p>Handy size for travel</p><p>Labeled for use with scleral lenses</p></td></tr><tr><td style="width: 80px;"><strong><a href="https://dryeyeshop.com/collections/preservative-free-salines/products/lacripure">LacriPure</a></strong></td><td style="width: 75px;">No*</td><td style="width: 81px;">Box of 98 5mL vials</td><td style="width: 268px;"><p>Vials are easier to open than Addipak &amp; Modudose<br>Labeled for use with scleral lenses</p></td></tr><tr><td style="width: 80px;"><a class="fr-strong" href="https://dryeyeshop.com/products/vibrantvue-scleral-saline" rel="noopener noreferrer" target="_blank"><strong>VibrantVue Scleral Saline</strong></a></td><td style="width: 75px;">No*</td><td style="width: 81px;">Box of 100 5mL vials</td><td style="width: 268px;">Vials are similar to Modudose<br>Labeled for use with scleral lenses</td></tr><tr><td style="width: 80px;"><p><strong>Addipak,&#xA0;</strong></p><p><strong>Modudose</strong><strong>&#xA0;etc</strong></p></td><td style="width: 75px;">No*</td><td style="width: 81px;"><p>Box of 100 5mL vials, or</p><p>Box of 24 15mL vials</p></td><td style="width: 268px;"><p>Acidic! pH believed to be 5.5 or less.</p><p>Sold for respiratory therapy. Use with scleral lenses is off-label and should only be done on doctor&apos;s recommendation.</p><p>If you purchase these from a pharmacy rather than online, they will require a prescription.</p></td></tr><tr><td style="width: 80px;"><br></td><td style="width: 75px;"><br></td><td style="width: 81px;"><br></td><td style="width: 268px;"><br></td></tr></tbody></table><p>&#xA0;</p><h2 id="buffered-or-unbuffered">Buffered or unbuffered?</h2><p><iframe width="560" height="315" src="https://www.youtube.com/embed/1HZU79rqC8o" frameborder="0" allowfullscreen></iframe></p><p>Unbuffered salines have two ingredients: Purified water and sodium chloride (a/k/a salt). These are often labeled as sodium chloride solution.</p><p>Buffered salines have four ingredients:&#xA0;Purified water&#xA0;and sodium chloride PLUS two ingredients for buffering purposes: sodium borate and boric acid.</p><p><strong>Why&#xA0;add buffers to salines?</strong> The reason for buffers is to <strong>raise</strong> the pH to more closely match the pH of our natural tears, and to <strong>stabilize</strong> the pH so that it doesn&apos;t get more acidic after opening the way simple unbuffered saline can.</p><p><strong>What&apos;s the pH thing all about</strong>? <a href="https://www.ncbi.nlm.nih.gov/pubmed/7469869" rel="noopener noreferrer" target="_blank">The pH of the human eye tends to be around 7</a>. Straight sodium chloride solution (i.e. unbuffered preservative free saline) is acidic, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3638298/" rel="noopener noreferrer" target="_blank">with a pH around 5.5</a> - or less. Furthermore, without buffers, the pH can drop lower after opening, which doesn&apos;t necessarily matter if you&apos;re using single-use vials and use them immediately after opening, but for larger packages or bottles, it matters more. Buffered salines aim for a pH around 7, just like the eye, on the assumption this will be more comfortable in the eye.</p><p>Based on years of purely anecdotal evidence from scleral lens and PROSE users... for many, the absence or presence of buffers does not seem to make any difference at all and they&apos;ve happily used Addipaks off-label for forever.</p><p>However, for&#xA0;some users, particularly those with dry or sensitive eyes and/or with an extensive history of corneal disease, the acidity of unbuffered saline&#xA0;seems to cause eye irritation, a burning sensation, and/or a tendency to lens fogging. Fogging&#xA0;is an especially pervasive and frustrating problem for scleral lens users.</p><p>Therefore, historically, those with the most complex medical histories have tended to prefer buffered salines for use with PROSE and full size scleral lenses. (Unisol 4 and Simply Saline, both now discontinued, were buffered salines as well, with the exact same ingredients as Purilens Plus and ScleralFil.)&#xA0;On the other hand, some doctors may have concerns about the buffers themselves being an irritant for some patients. As with all solutions for scleral lenses, discuss your choice with&#xA0;your doctor, for sure!</p><h3 id="why-isnt-this-better-known"><em>Why isn&apos;t this better known?</em></h3><p>Unfortunately, there is very little published literature about the question of buffered versus unbuffered salines. <a href="https://www.clspectrum.com/issues/2019/may-2019/contact-lens-case-reports?fbclid=IwAR2_Ye9uHJmtut8MBCAVGkreV2dVJ9z0yDmOGJOjAUc_hLvmpKAENBjW5KE" rel="noopener noreferrer" target="_blank">Here&apos;s an article from May 2019</a> that&apos;s worth reading. It reports a case series in which four out of five scleral lens users with dry eye preferred buffered saline.&#xA0;</p><h2 id="what-size">What size?</h2><p>Many patients, especially those fitted with standard scleral lenses and using <a href="https://dryeyeshop.com/products/clear-care-cleaning-disinfection-solution">ClearCare</a> as their only cleaning regimen, do not need a lot of saline to fill their lenses. In those cases, the 5mL sizes such as LacriPure tend to meet their needs the best. For those who do a lot of rinsing, for example, rinsing daily cleaners off PROSE, or rinsing cleaners or disinfection agents off Hydra PEG coated lenses, Purilens Plus tends to be more practical as it has the lowest cost per volume and it&apos;s the only one in a bottle you can keep for awhile. Additionally, many people use Purilens at home and single use vials when traveling.</p><h2 id="dont-forget">Don&apos;t forget!</h2><ul><li>Make sure your eye doctor is involved your saline decisions. This is especially important for PROSE and scleral lens users, and for anyone using products &quot;off label&quot;.</li><li>If you are using single-use vials, discard them the day you open them. It&apos;s not only about the risk of contamination (since they have no preservatives), but we are told that the pH of unbuffered salines drops rapidly after opening.</li></ul>

Preservative-free saline guide

Videos about preservative free salines and 'basket' cases for hydrogen peroxide

<p id="isPasted">Also visit our <a href="https://youtube.com/playlist?list=PLHL7BBXoabC9UfS6ywQ9UqxW7o5LI5uq4">YouTube playlist of scleral lens videos</a>.</p><h1 id="preservative-free-salines-buffered-vs-unbuffered">Preservative-free salines: Buffered vs unbuffered</h1><p><iframe width="560" height="315" src="https://www.youtube.com/embed/1HZU79rqC8o" frameborder="0" allowfullscreen></iframe></p><h1 id="preservative-free-salines-comparing-brands">Preservative-free salines: Comparing brands</h1><p><iframe width="560" height="315" src="https://www.youtube.com/embed/QGTY_FwAmgI" frameborder="0" allowfullscreen></iframe></p><h1 id><br></h1><h1 id="using-prose-disinfection-cases-with-clear-care">Using PROSE disinfection cases with Clear Care</h1><p><iframe width="560" height="315" src="https://www.youtube.com/embed/F33vnLB4pkI" frameborder="0" allowfullscreen></iframe></p>

Videos (scleral lens)

What PROSE users can do if PROSE cases are not available (due to backorder)

<p id="isPasted" style="margin: 0px 0px 1em; line-height: 1.4; color: rgb(0, 0, 0); font-family: &quot;Helvetica Neue&quot;, Helvetica, Arial, sans-serif; font-size: 15px; font-style: normal; font-variant-ligatures: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-align: start; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; text-decoration-thickness: initial; text-decoration-style: initial; text-decoration-color: initial;">&#xA0;</p><p style="margin: 0px 0px 1em; line-height: 1.4; color: rgb(0, 0, 0); font-family: &quot;Helvetica Neue&quot;, Helvetica, Arial, sans-serif; font-size: 15px; font-style: normal; font-variant-ligatures: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-align: start; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; text-decoration-thickness: initial; text-decoration-style: initial; text-decoration-color: initial;">FEBRUARY 2019 - The instructions below were provided by BostonSight for PROSE device users who do not have a PROSE case available at this time due to the manufacturer backorder, and we are posting them here as a courtesy. Please make sure to consult your lens provider about any changes to your device care.&#xA0;</p><p style="margin: 0px 0px 1em; line-height: 1.4; color: rgb(0, 0, 0); font-family: &quot;Helvetica Neue&quot;, Helvetica, Arial, sans-serif; font-size: 15px; font-style: normal; font-variant-ligatures: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-align: start; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; text-decoration-thickness: initial; text-decoration-style: initial; text-decoration-color: initial;">UPDATE APRIL 2023 - Because of the ongoing Clear Care shortages, we have heard of many similar alternative hydrogen peroxide protocols, but typically with fewer steps - for example, rinse, soak once in a screw top contact lens case filled with preservative free saline, rinse, fill and apply. <strong>Again, please contact your lens provider for approval of any change to your device/lens care routine.</strong></p><h2 style="margin: 0px 0px 1em; line-height: 1.4; color: rgb(0, 0, 0); font-family: &quot;Helvetica Neue&quot;, Helvetica, Arial, sans-serif; font-style: normal; font-variant-ligatures: normal; font-variant-caps: normal; letter-spacing: normal; orphans: 2; text-align: start; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; text-decoration-thickness: initial; text-decoration-style: initial; text-decoration-color: initial; font-weight: 400;" id="interim-cleaning-protocol-for-prose-devices"><strong><u>Interim Cleaning Protocol for PROSE devices</u></strong></h2><p style="margin: 0px 0px 1em; line-height: 1.4; color: rgb(0, 0, 0); font-family: &quot;Helvetica Neue&quot;, Helvetica, Arial, sans-serif; font-size: 15px; font-style: normal; font-variant-ligatures: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-align: start; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; text-decoration-thickness: initial; text-decoration-style: initial; text-decoration-color: initial;">Items needed:</p><ul style="color: rgb(0, 0, 0); font-family: &quot;Helvetica Neue&quot;, Helvetica, Arial, sans-serif; font-size: 15px; font-style: normal; font-variant-ligatures: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-align: start; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; text-decoration-thickness: initial; text-decoration-style: initial; text-decoration-color: initial;"><ul><ul><li>3 white screw top contact lens cases</li><li><s>Optimum Lobob ESC or</s> Unique pH</li><li>PuriLens Plus solution or 0.9% sodium chloride</li><li>Clear Care or Brown bottle 3% Hydrogen Peroxide</li></ul></ul><li>Clean PROSE device with <s>one drop Optimum ESC or</s> Unique pH or Boston Simplus (if Hydra-PEG device) per side and rub for 15 seconds. Rinse with PuriLens Plus solution or 0.9% sodium chloride.</li><li>Soak in white lens storage case number 1 filled with Clear Care or 3% brown bottle H2O2 overnight.</li><li>In the morning (or after 6 hours), remove from case # 1, rinse with PuriLens Plus solution or 0.9% sodium chloride and soak in lens case # 2 filled with PuriLens Plus solution or 0.9% sodium chloride for 5 minutes</li><li>Remove from case # 2, rinse again with PuriLens Plus solution or 0.9% sodium chloride and soak in lens case #3 PuriLens Plus solution or 0.9% sodium chloride for 5 additional minutes</li><li>Your PROSE device is now ready to apply</li></ul><p style="margin: 0px 0px 1em; line-height: 1.4; color: rgb(0, 0, 0); font-family: &quot;Helvetica Neue&quot;, Helvetica, Arial, sans-serif; font-size: 15px; font-style: normal; font-variant-ligatures: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-align: start; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; text-decoration-thickness: initial; text-decoration-style: initial; text-decoration-color: initial;">For questions, please contact your provider.</p>

About scleral lens products

Product selection tips

Preservative-free saline guide

Videos (scleral lens)

PROSE case alternative disinfection protocol