About this tutorial, about scleral lenses, and about your fellow scleral lens users

<div><span>This is a living, growing handbook, modified constantly as products in the market change, standards of care evolve, and our conversations on&#xA0;</span><a href="https://www.facebook.com/groups/sclerallens/">our Facebook group</a><span>&#xA0;continue. We value&#xA0;input and feedback from doctors and patients alike! Reach out with suggestions and corrections any time.</span></div><h2 id="scleral-lenses-are-like-prosthetics-but-more-so">Scleral lenses are like prosthetics... but more so.</h2><p><img src="https://cdn.shopify.com/s/files/1/2575/9928/files/prosthetic.png?v=1590883265" alt width="242" height="161" class="fr-fic fr-dii"></p><p>They are not just fancy contact lenses. They require special medical skills on the part of your doctor, and special handling by yourself, and special types of supplies. They require ongoing care and monitoring. And nothing about them is cheap. Scleral lenses are not something you want to adopt casually as a minor upgrade from other contact lenses. They are an investment and commitment.</p><h2 id="scleral-lenses-come-in-many-sizes">Scleral lenses come in many sizes!</h2><p><img src="https://cdn.shopify.com/s/files/1/2575/9928/files/sizes_480x480.png?v=1590883318" alt width="136" height="136" class="fr-fic fr-dii"></p><p>What makes them &quot;scleral&quot; lenses is that they are rigid lenses that completely vault the cornea and hold fluid over it. But they may be anywhere from about 15mm (often called &quot;mini sclerals&quot;) to about 25mm and covering most of the eye.</p><h2 id="we-scleral-lens-users-are-a-diverse-community">We scleral lens users are a diverse community!</h2><p>We end up in scleral lenses for all different reasons and at all different times of life!</p><p><strong>AGE</strong>: From young children to age 90+!</p><p><strong>MOTIVATION</strong>: You may be motivated by VISION loss, ocular surface DRYNESS or exposure, or PAIN, or a combination of factors.<br><br><strong>CONTACT LENS HISTORY</strong>: You may never have worn any type of contact lens before. Or you may have worn every contact lens before. For example, if you have keratoconus, you may have graduated from soft lenses to soft torics to rigid gas permeable lenses to &quot;piggybacks&quot; (rigid lens over soft lens) to hybrid lenses (lenses with a soft skirt and rigid middle) and, finally, sclerals.<br><br><strong>MEDICAL FACTORS:</strong> You may have a corneal disease or dystrophy. You may be suffering from Sjogrens Syndrome or ocular GvHD or Stevens Johnson Syndrome or herpes zoster or keratoconus or pellucid marginal degeneration. You may have exposed corneas because of an eyelid surgery or an acoustic neuroma surgery. You may have Graft-v-Host Disease from a bone marrow transplant. You may have &quot;garden variety&quot; dry eye or meibomian gland dysfunction. You may have vision complications from an eye surgery such as RK, PRK or LASIK. You may have had a corneal transplant or two (or three)! These are just examples.<br><br><strong>REFERRAL</strong>: Your doctor may have recommended scleral lenses. Or you may have found them by doing your own research. Your cornea specialist may have referred you to an optometrist, or you may have sought out an expert on your own. Some of you have needed to track down a scleral lens provider who has specific expertise in your disease, and some of you pursued a scleral lens technology for your particular needs.</p><h2 id="you-see-weall-have-a-story">You see, we&#xA0;all have a story.</h2><p><img src="https://cdn.shopify.com/s/files/1/2575/9928/files/story.png?v=1590883495" alt width="242" height="161" class="fr-fic fr-dii"></p><p>What&apos;s yours? Come share it at <a href="http://www.dryeyestories.com" rel="noopener noreferrer" target="_blank">dryeyestories.com</a></p><h1 id><br></h1><h2 id="a-personal-note-from-rebecca"><span>A personal note from Rebecca...</span></h2><h3 id="to-my-fellow-scleral-lens-user-peeps"><span>...To my fellow scleral lens user peeps:</span></h3><p>I don&apos;t want to weigh you down with legalese. But it really is critically important to understand that you need ongoing medical advice, not just practical advice, for safe and successful scleral lens use. This tutorial is practical, NOT medical. I have no medical qualifications.&#xA0;<span style="background-color: #ffff00;">Involve your eye doctor in every decision. Talk to them about every concern and question.</span></p><p><span>My hope for this tutorial is to provide&#xA0;a framework for understanding the scleral lens experience, conversation prompts for your eye doctor appointments, and a plethora of practical tips for the non-medical aspects of life with scleral lenses.</span></p><p><span>What you are seeing now is the first draft of a series that I expect to evolve and improve over time. I spent just one week, mostly evenings, writing this start to finish... so I know there&apos;s probably still a lot missing!</span></p><p><span>You, my scleral lens community have been instrumental in this project. Most of what I share here, I have learned from interacting with you. I am looking forward to your feedback and suggestions for future &apos;updates&apos;!</span></p><p><span>May you all enjoy safe, comfortable vision with scleral lenses for a long time to come.<br></span></p><h3 id="to-the-optometrists-browsing-these-pages"><span>To the optometrists browsing these pages:</span></h3><p><span>I am so indebted to the many ODs I&apos;ve had the opportunity to learn from over the years, whether through conversations or studies published by leaders in the field, or simply information posted in our Facebook scleral lens group. Thank you for all your hard work advancing the science of scleral lenses!<br><br>Scleral lenses are a huge growth area in optometry right now. The advances are exciting, bringing huge potential for better vision and comfort for people with a variety of corneal diseases. But post-fitting patient care standards need to catch up and keep pace. I know some of you share my concerns about that. My vision for this peer-to-peer&#xA0;tutorial is to provide patient education that helps improve safety, success and satisfaction with scleral lenses; to support and improve patients&apos; relationships with their providers; and to help raise the bar in scleral lens patient care. I am eager for your feedback and constructive criticism at any time!<br><br>It&apos;s my honor to share&#xA0;everything I write freely. To the extent that you find any of what I have written worthy of sharing with your patients, I ask that you do&#xA0;me the courtesy of crediting your source.&#xA0;</span></p><p>--------------------------------&#xA0;</p><h2 id="important"><strong>IMPORTANT:</strong></h2><p>FOR INFORMATIONAL PURPOSES ONLY.</p><p>THIS GUIDE IS COMPRISED OF PEER-TO-PEER SUGGESTIONS, NOT MEDICAL ADVICE. CONSULT YOUR EYE DOCTOR&#xA0;WITH ALL&#xA0;YOUR EYE CARE AND LENS QUESTIONS.</p>

Part 1: Start here

What should I expect? What questions can I ask? How can I get the most from my appointment?

<p><br></p><h1 id="preparing-for-your-appointments">Preparing for your appointments</h1><h2 id="send-an-email-first">Send an email first</h2><div style="text-align: right;"><img src="https://cdn.shopify.com/s/files/1/2575/9928/files/Email_160x160.png?v=1596302892" alt="Send an email" width="160x160" height="160x160" class="fr-fir fr-dii"></div><p>All too often we forget important questions we wanted to ask. Make it easy on yourself and your doctor by writing down your most important questions and concerns and emailing them to the office the day before.&#xA0;</p><h2 id="take-copious-notes">Take copious notes</h2><p>No matter how good you think your memory is, be smart and write things down. No one remembers everything accurately afterwards, even if it seemed clear at the time.</p><h2 id="choose-your-time-of-day-for-follow-up-appointments">Choose your time of day for follow-up appointments</h2><p>Some users may experience issues that only arise after wearing the lenses for many hours. Schedule an end-of-day appointment so your doctor can see you under realistic conditions.</p><h2 id="bring-a-friend-or-family-member">Bring a friend or family member?</h2><p>Stressed? You&apos;re not alone! The scleral lens process can be taxing in many unrecognized ways. Bring someone along who can be your eyes, ears and support!&#xA0;</p><div style="text-align: left;"><br></div><h1 id="during-your-appointment">During your appointment</h1><h2 id="what-to-ask-when-youre-just-getting-started">What to ASK when you&apos;re just getting started</h2><p><img src="https://cdn.shopify.com/s/files/1/2575/9928/files/ask.png?v=1590884061" alt width="145" height="145" class="fr-fic fr-dii"></p><ul><li>What should I expect, in terms of how long it might take to get successfully fitted?</li><li>When you have to order more lenses, how long till the new ones come?</li><li>Who will train me on lens insertion, removal, and care?</li><li>Who do I call if I have questions or concerns?</li><li>Will I need to wear reading glasses (or progressives)?</li><li>Please explain my financial commitment. What happens if things don&apos;t work out as planned? Are there any manufacturer warranties that can reduce my cost?</li><li>How much will it cost to purchase a replacement or back-up set in case of loss or breakage?</li><li>When I take home my first lenses, how long can/should I wear them? How will I know if/when I ought to remove them?</li><li>What is the brand and diameter of the lenses you will be fitting for me?</li></ul><h2 id="what-to-tell-during-a-follow-up-appointment">What to TELL during a follow-up appointment</h2><p><img src="https://cdn.shopify.com/s/files/1/2575/9928/files/tell.png?v=1590884084" alt width="137" height="137" class="fr-fic fr-dii"></p><ul><li><strong>Changed any solutions?</strong> Did you start using a different filling, cleaning or disinfection solution, or rewetting drops? Tell your doctor.</li><li><strong>3R patterns:</strong> Are you having to remove, rinse and refill during the day? If so, how often and why?</li><li><strong>Insertion troubles:</strong> If it is taking you a very long time to put your lenses in, or if you can&apos;t get them in without bubbles, or if you have a lot of discomfort, redness, etc after the process, it is important that you tell your doctor so that they can help you improve your technique - bearing in mind that there is no single technique that works for everyone. &quot;Practice more&quot; is not always an acceptable answer. Without correct technique, you can get corneal abrasions or other injuries.</li><li><strong>Removal troubles</strong>: If your lens does not come out readily, and/or if you have pain or excessive redness after removal, this could indicate your fit needs to be re-assessed. Make sure you schedule an afternoon appointment so they can see the fit after you have been wearing the lenses for several hours, unless instructed otherwise when making the appointment. If you ever have a serious concern about the appearance of your eye(s) after lens removal, take a picture with your phone and email it or bring it to your appointment.</li></ul><h2 id="what-to-expect">What to EXPECT...</h2><p><span>...and why, and what to do if you need more help than you&apos;re getting.</span></p><h3 id="written-instructions"><strong>Written instructions</strong></h3><p>Scleral lenses are complicated, and learning to use them can be stressful. Written instructions are essential. These instructions should include:</p><ul><li>all steps in cleaning, disinfection, rinsing and filling</li><li>a list&#xA0;of the supplies you will need and what each is for</li><li>instructions for lens insertion and removal</li></ul><p><strong>If you are not provided with written instructions, ask for them,<span>&#xA0;</span></strong>and/or bring a pen and paper and insist on enough time to write everything down. Everything you are told will probably make perfect sense while you are&#xA0;there, but after you get home, well, many of us just blank out!</p><h3 id="training"><strong>Training</strong></h3><p>Some people find scleral lens application and removal easy - but many people struggle with the learning curve or have special challenges. It&apos;s not just about practice at home. It&apos;s about supervised practice and training sessions to help troubleshoot technique issues and, where appropriate, find the right tools for you. Don&apos;t hesitate to advocate for yourself if you feel that you need more training.</p><h3 id="guidance-on-who-to-call-and-when"><strong>Guidance on who to call and when</strong></h3><p>What issues warrant a phone call? Should you ask for the doctor, or contact lens technician? You can get lots of tips from your Facebook group, but only your doctor knows your whole picture and what constitutes a serious enough concern to call before a scheduled follow-up appointment. You should feel comfortable calling their office if you have concerns. If a follow-up appointment is needed, they&apos;ll tell you. Ask them to clarify whether you should continue wearing the lenses till that appointment or not.</p><h1 id="worries-doubts-or-concerns">Worries, doubts or concerns?</h1><p><img src="https://cdn.shopify.com/s/files/1/2575/9928/files/worried.png?v=1590884219" alt width="315" height="210" class="fr-fic fr-dii"></p><p>Maybe it&apos;s taking a lot longer to get a successful lens fit than you expected.<br><br>Maybe you&apos;re just not getting the hang of lens insertion, and are so frustrated you wonder whether it&apos;s worth continuing.<br><br>A little perspective:</p><p>Scleral lenses are emerging medicine. The diseases that scleral lenses are being used to treat are complicated. Not very many optometrists fitting scleral lenses are seasoned experts in every possible disease. No one has all the answers, and no one can get from 0 to 60 in no time flat. So you may need to cut your doctor some slack or talk yourself into some patience if things aren&apos;t moving along as efficiently as expected.<br><br>On the other hand, if you don&apos;t feel your questions or concerns are being addressed, you may need to firmly advocate for your needs. And if you seem to have reached a dead end, it may be time to seek expertise from an optometrist with more specialized skills and experience relevant to your specific needs.</p><h1 id="what-if-you-cant-see-your-doctor">What if you can&apos;t see your doctor?</h1><p>You&apos;re isolating because of coronavirus. Or your doctor is too far away and you don&apos;t have transportation. What do you do?</p><ul><li><strong>CALL:</strong> When you have a concern and need to talk with your eye doctor, call. Don&apos;t be intimidated. If your doctor is not available when you call (very likely), ask to speak with a contact lens technician, or ask the receptionist to have the doctor call you back, and ask for&#xA0;specifics on when to expect a call. If your doctor is away or unable to speak with you soon enough, find out who is covering for them and ask for a callback from them.</li><li><strong>EMAIL:</strong> Not all doctors email with their patients, but many do. It never hurts to ask!</li><li><strong>SEND PHOTOS:</strong> This really does help! But some guidance on how to take good photos for your doctor is in order. Check out the following video by Dr Daddi Fadel for some practical instructions on how to get a great set of photos for your doctor. Dr Fadel, by the way, has published some of the most wonderful studies on the purely practical aspects of using scleral lenses.</li></ul><p><iframe width="560" height="315" src="https://www.youtube.com/embed/kzlnEp6_NQk?start=25" frameborder="0" allowfullscreen></iframe></p><p>---------------------------------</p><h1 id="important-note"><span style="font-weight: 400;"><strong>IMPORTANT NOTE</strong></span></h1><p><span style="font-weight: 400;"><span>FOR INFORMATIONAL PURPOSES ONLY. THIS GUIDE IS COMPRISED OF PEER-TO-PEER SUGGESTIONS, NOT MEDICAL ADVICE. CONSULT YOUR EYE DOCTOR&#xA0;WITH ALL&#xA0;YOUR EYE CARE AND LENS QUESTIONS.</span></span></p><h1 id><br></h1>

Part 2: Appointments with your lens provider

What can I use to fill my scleral lenses? What CAN'T I use? How do I choose? What are the differences between all these salines? Where can I purchase them?

<p><br></p><h1 id="aboutsolutions-for-filling-scleral-lenses">About&#xA0;solutions for FILLING scleral lenses</h1><p>Finding the right solution to fill your lenses can be surprisingly complicated! There are safety issues, and issues affecting vision and comfort for some users. Then there&apos;s availability, cost, shipping and more!</p><h2 id="choose-preservative-free-only">Choose preservative-free ONLY!</h2><p>Make sure you only use preservative-free solutions in your lens.&#xA0;All preservatives, no matter how mild, are toxic to the cornea. The solution(s) you put in your lens will be held against the eye all day long.</p><table width="100%"><tbody><tr><td style="width: 42.1034%;"><span style="color: #000000;"><strong>YES: Preservative-free</strong></span></td><td style="width: 53.8966%;"><span style="color: #000000;"><strong>NO: Preserved</strong></span></td></tr><tr><td style="width: 42.1034%;"><ul><li><a href="https://dryeyeshop.com/products/nutrifill"><span style="color: #000000;">Nutrifill</span></a></li><li><a href="https://dryeyeshop.com/products/lacripure"><span style="color: #000000;">Lacripure</span></a></li><li><a href="https://dryeyeshop.com/products/scleralfil"><span style="color: #000000;">Scleralfil</span></a></li><li><span style="color: #000000;">Purilens Plus</span></li><li><span style="color: #000000;"><a href="https://dryeyeshop.com/products/vibrantvue-scleral-saline">VibrantVue Scleral Saline</a></span></li><li><span style="color: #000000;">Sodium chloride 0.9% (e.g. Addipak)</span></li><li>Lubricant eye drops in single-use vials or special preservative-free bottles</li></ul></td><td style="width: 53.8966%;"><ul><li><span style="color: #000000;">&quot;Sensitive Eyes&quot; salines such as Bausch &amp; Lomb Sensitive Eyes or generic brands</span></li><li><span style="color: #000000;">Multi-purpose contact lens solutions&#xA0;such as BioTrue, PureMoist, Unique pH, Boston Simplus, Tangible Clean</span></li><li><span style="color: #000000;">Lubricant eye drops in conventional bottles</span></li><li><span style="color: #000000;">Lubricant gels in tubes</span></li></ul></td></tr></tbody></table><p>&#xA0;</p><h3 id="tips">Tips:</h3><ul><li>If it&apos;s preservative-free, it will ALWAYS say so on the front of the box!</li><li>Preservative free saline solutions are usually not sold in drugstores.</li><li>Preservative free salines can be used for filling lenses, but NOT for soaking or storing lenses. We&apos;ll discuss that more&#xA0;in Topic 7.</li></ul><h3 id="caution">Caution:</h3><p>Multi-purpose solutions are not labeled with scleral lenses in mind. Sometimes people get confused by the instructions on those solutions, and think that it&apos;s saying they can use it on the lens immediately prior to insertion.</p><p>Keep it simple - stick with preservative-free only.&#xA0;</p><h2 id="buffered-or-unbuffered">Buffered or unbuffered?</h2><p>Buffered salines (<a href="https://dryeyeshop.com/products/scleralfil">ScleralFil</a>, <a href="https://dryeyeshop.com/products/nutrifill">Nutrifill</a> and <a href="https://dryeyeshop.com/search?type=product&amp;type=pages&amp;type=articles&amp;q=purilens">Purilens</a>) have additives that raise the pH to match the pH of the eye. For many users, buffered salines are more comfortable, fog less, and for some, seem to provide better vision. The very newest saline on the market, <a href="https://dryeyeshop.com/products/nutrifill">Nutrifill</a>, also contains added electrolytes.&#xA0;</p><p>Unbuffered salines (<a href="https://dryeyeshop.com/products/lacripure">Lacripure</a>, <a href="https://dryeyeshop.com/products/vibrantvue-scleral-saline">VibrantVue</a>, and sodium chloride 0.9% sold for other medical purposes) are acidic and contain only sodium chloride and purified water. They are commonly used with success by many scleral lens users.</p><h2 id="on-label-vs-off-label">&quot;On label&quot; vs &quot;off label&quot;</h2><p>Scleral lenses are specialty lenses - a relatively small niche in the contact lens world. As a result, not many&#xA0;products are designed, tested and labeled specifically for use with scleral lenses yet.&#xA0;</p><p>A solution is considered &quot;off label&quot; when it is being used for something other than the purpose for which it has been tested and labeled to the FDA&apos;s satisfaction. Many products are used &quot;off label&quot;. If you are using something &quot;off label&quot;, make sure your doctor has approved your use of it.&#xA0;</p><table width="100%"><tbody><tr><td style="width: 47.0054%;"><strong>&#xA0;Labeled for filling scleral lenses</strong></td><td style="width: 50.0907%;"><strong>&quot;Off label&quot;&#xA0;</strong></td></tr><tr><td style="width: 47.0054%;"><ul><li><a href="https://dryeyeshop.com/products/lacripure">Lacripure</a></li><li><a href="https://dryeyeshop.com/products/nutrifill">Nutrifill</a></li><li><a href="https://dryeyeshop.com/search?type=product&amp;type=pages&amp;type=articles&amp;q=purilens+plus">Purilens Plus</a></li><li><a href="https://dryeyeshop.com/products/scleralfil">Scleralfil</a></li><li><a href="https://dryeyeshop.com/products/vibrantvue-scleral-saline">VibrantVue</a></li></ul></td><td style="width: 50.0907%;">Everything else.</td></tr></tbody></table><p>&#xA0;</p><h2 id="scleral-lens-cocktails">Scleral lens &quot;cocktails&quot;</h2><p>Some scleral lens users add one or more drops of a preservative-free lubricant drop (a/k/a artificial tears) to the saline in their lens. Some even use preservative-free lubricants to completely fill the lens. That&apos;s an expensive approach,&#xA0;but sometimes it&apos;s just all about what works.<br><br>Why do people do this?</p><ul><li>To prevent debris from collecting under the lens</li><li>To prevent midday fogging</li><li>To improve vision</li><li>To improve comfort.</li></ul><p>Using artificial tears in the lens is not guaranteed to do any of these things, but this kind of use is widespread because it does seem to work for a lot of people. The most popular &quot;supplemental&quot; drop of this type over the years has always been Refresh Celluvisc, but these days people are using many others, including some of the brands with sodium hyaluronate such as Oasis.</p><p>If you are considering this approach, please talk to your eye doctor, and remember that this is an off-label use of lubricant drops.</p><h2 id="when-to-discard-your-vials-or-bottles">When to discard your vials or bottles</h2><p><strong>Single-use vials:</strong> Discard same-day. Not only are these vials easily contaminated, but if they are the unbuffered type, they&#xA0;are also believed to&#xA0;become more acidic after opening. Refrigeration isn&apos;t a fix.<br><br><strong>Purilens bottles:</strong> We recommend getting specific guidance from your doctor on how long you can use Purilens bottles for filling.&#xA0;</p><h2 id="package-sizes">Package sizes</h2><p>Preservative-free salines are available in the following sizes:</p><table width="100%"><tbody><tr><td><strong>&#xA0;Size</strong></td><td><strong>Brands</strong></td></tr><tr><td>3mL</td><td>Addipak&#xA0;</td></tr><tr><td>5mL</td><td>Addipak, Modudose, <a href="https://dryeyeshop.com/products/lacripure">LacriPure</a>, <a href="https://dryeyeshop.com/products/vibrantvue-scleral-saline">VibrantVue</a></td></tr><tr><td>10mL</td><td><a href="https://dryeyeshop.com/products/nutrifill">Nutrifill</a> (not pictured), <a href="https://dryeyeshop.com/products/scleralfil">Scleralfil</a></td></tr><tr><td>15mL</td><td><a href="https://dryeyeshop.com/products/modudose?variant=6852789633067">Modudose</a></td></tr><tr><td>2oz</td><td><a href="https://dryeyeshop.com/products/purilens-plus-mini-saline-2oz-6-pack">Purilens Mini</a> (not pictured)</td></tr><tr><td>4oz</td><td><a href="https://dryeyeshop.com/search?type=product&amp;type=pages&amp;type=articles&amp;q=purilens">Purilens Plus</a></td></tr></tbody></table><p>&#xA0;</p><div style="text-align: start;"><img src="https://cdn.shopify.com/s/files/1/2575/9928/files/Saline_sizes.png?v=1596305592" alt width="449" height="223" class="fr-fic fr-dii"></div><div style="text-align: start;"><br></div><h2 style="text-align: start;" id="shopping-locally">Shopping locally</h2><p style="text-align: start;">Since 2016, no preservative-free contact lens salines have been sold in drugstores. However, you may purchase sodium chloride 0.9% vials in drugstores with a prescription. Also, some lens providers stock salines in their practice for their patients&apos; convenience.</p><h2 style="text-align: start;" id="shopping-online">Shopping online</h2><p style="text-align: start;">That&apos;s our specialty, of course, and we&apos;re always here to help at dryeyeshop.com. Preservative-free salines are our most popular subscription items.</p><p>&#xA0;</p><h1 id="aboutsolutions-for-rinsing-scleral-lenses">About&#xA0;solutions for RINSING scleral lenses</h1><h2 id="when-dowe-rinse">When do&#xA0;we rinse?</h2><p>Here are the three&#xA0;times we most commonly want to rinse our lenses:</p><ul><li>Rinsing off disinfection solution in the morning before filling and insertion</li><li>Rinsing lenses while removing and re-applying during the day due to fogging or mucous in/on the lenses</li><li>Rinsing off cleaning solution&#xA0;after rub cleaning, before placing the lenses in&#xA0;a case for overnight disinfection</li></ul><p>Not everyone needs this much rinsing. Not everyone uses a rub cleaner, for one thing. And many people who use Clear Care overnight don&apos;t bother to rinse it off because after the neutralization process it&apos;s basically been converted to preservative free saline.&#xA0;</p><h2 id="what-can-we-safely-rinse-our-lenses-with">What can we safely rinse our lenses with?</h2><h3 id="1-preservative-free-saline">1. Preservative free saline</h3><p>Using preservative free saline for both rinsing and filling is a good option because it keeps things simple and safe.</p><p>However, it&apos;s expensive!&#xA0;</p><h3 id="2-preserved-saline">2. Preserved saline&#xA0;</h3><p>Many scleral lens users are able to economize by using preserved saline such as Bausch &amp; Lomb Sensitive Eyes Saline Solution. This can be used for rinsing lenses prior to disinfection or rinsing off cleaning solutions. However, prior to re-inserting your lenses, you should do a final rinse with preservative free saline to&#xA0;remove any preserved saline from the bowl of the lens.</p><h3 id="3-preserved-multi-purpose-solution">3. Preserved multi-purpose solution</h3><p>Similarly, multi-purpose solutions such as Unique pH can be used for most rinsing. Again, do a final rinse with preservative free saline to remove any preserved solution from the bowl of the lens.</p><h3 id="4do-not-rinse-scleral-lenses-with-water">4.&#xA0;DO NOT RINSE SCLERAL LENSES WITH WATER.</h3><p>Due to risk of acanthamoeba infections, please don&apos;t ever use water to rinse your lenses, not even if you are going to disinfect them afterwards, because common disinfection solutions haven&apos;t actually been proven to neutralize acanthamoeba.</p><div style="text-align: start;"><img src="https://cdn.shopify.com/s/files/1/2575/9928/files/Slider_for_DEZ_Squarespace_9_d927a8ba-4a47-4d08-8959-a746e6e8ecdf.png?v=1568481466" alt="NO TAP WATER" width="416" height="234" class="fr-fic fr-dii"></div><p>&#xA0;</p><h1 id><br></h1><h2 id="-1"><br></h2><h2 id="-2"><br></h2><h1 id="important-note">IMPORTANT NOTE:&#xA0;</h1><main class="wrapper main-content"><div class="grid"><div class="grid-item large--two-thirds push--large--one-sixth"><div class="rte"><p><span>FOR INFORMATIONAL PURPOSES ONLY. THIS GUIDE IS COMPRISED OF PEER-TO-PEER SUGGESTIONS, NOT MEDICAL ADVICE. CONSULT YOUR EYE DOCTOR&#xA0;WITH ALL&#xA0;YOUR EYE CARE AND LENS QUESTIONS.</span></p></div></div></div></main><h1 id="-3"><br></h1>

Part 3: Rinsing & filling

How do I prepare my space (and my hands) to keep my lenses safe? What will I need for my 'application station'? Why is water a problem for scleral lenses?

<p><br></p><h2 id="soap-and-water">Soap and water</h2><p><img src="https://cdn.shopify.com/s/files/1/2575/9928/files/soapandwater.png?v=1590884370" alt width="239" height="169" class="fr-fic fr-dii"></p><h3 id="no-moisturizers-in-your-hand-soap">No moisturizers in your hand soap!</h3><p>Moisturizing soaps contains oils that will transfer to your lenses and can affect your vision and comfort. Hand soaps for contact lens users, such as <a href="https://dryeyeshop.com/products/ocusoft-hand-soap">OcuSoft</a>, are great, and there are many other options, such as Neutrogena, or Dial bar soap.</p><h3 id="towel-dry-after-washing">Towel-dry after washing!</h3><p>Drying your hands is also important. Due to <a href="https://dryeyeshop.com/blogs/news/safety-alert-dont-rinse-your-sclerals-with-water" rel="noopener noreferrer" target="_blank">acanthamoeba</a> risk, you don&apos;t want tap water getting on your lenses, so towel-dry.</p><h2 id="sit-or-stand">Sit or stand?</h2><p><img src="https://cdn.shopify.com/s/files/1/2575/9928/files/sitorstand.png?v=1590884516" alt width="222" height="157" class="fr-fic fr-dii"></p><p>Follow the training given you at the doctor&apos;s office. Then, if something is not working for you, it&apos;s worth experimenting. Some people find it works best for them if they are seated at a table with a towel and a mirror laid flat on the table. Others do all their lens care at the bathroom counter.&#xA0;</p><h2 id="preventing-loss-and-breakage">Preventing loss and breakage</h2><p>You need a safe space for lens application and removal. Proverbial prevention is better than costly cure.</p><p><img src="https://cdn.shopify.com/s/files/1/2575/9928/files/lostlens.png?v=1590884635" alt width height class="fr-fic fr-dii"></p><h3 id="spread-a-towel">Spread a towel!</h3><p>Scleral lenses bounce, fly, drop, roll, and get scratched or cracked or even shattered. There is nothing quite like the sensation when you drop a lens worth hundreds - or in some cases thousands - of dollars and have no idea where it ended up. And at the risk of stating the obvious, you may have a hard time finding a small, transparent object when you can&#x2019;t see without it.</p><p>A towel can &apos;catch&apos; a lens, give it a soft landing and hold it in place till you find it.</p><h3 id="cover-that-drain">Cover that drain!</h3><p>If you handle your lenses at the sink, use a sink strainer or (better yet) a towel. You wouldn&apos;t believe how many of us have lost a lens down a drain, or dismantled a drain in the attempt to retrieve a lens.</p><h3 id="lost-it-despite-best-efforts">Lost it despite best efforts?</h3><p>If your lens was lost or broken, and you purchased it relatively recently, call your doctor&apos;s office. Sometimes it&apos;s possible for them to provide a warranty replacement.</p><h2 id="common-new-user-mistakes">Common new user mistakes</h2><ul><li>Using soap with moisturizers</li><li>Losing lenses down the drain</li><li>Dropping a lens on the floor or carpet</li></ul><h2 id="things-you-may-need-in-your-kit">Things you may need in your kit</h2><ul><li>Non-moisturizing hand soap</li><li>Lint free towel</li><li>Rubber sink strainer</li><li>3x magnification mirror</li><li>Alcohol prep pads</li><li>Nail trimmers</li></ul><h2 id="important-note"><span style="font-weight: 400;"><strong>IMPORTANT NOTE</strong></span></h2><p><span style="font-weight: 400;"><span>FOR INFORMATIONAL PURPOSES ONLY. THIS GUIDE IS COMPRISED OF PEER-TO-PEER SUGGESTIONS, NOT MEDICAL ADVICE. CONSULT YOUR EYE DOCTOR&#xA0;WITH ALL&#xA0;YOUR EYE CARE AND LENS QUESTIONS.</span></span></p><h1 id><br></h1>

Part 4: Prep, setup and safe lens handling

Lots of video examples. What can I use besides a standard plunger, if I'm having difficulty? Why am I having a hard time learning? Does practice make perfect?  What do I do if I just can't get my lens in?

<p>&#xA0;</p><h1 id="always-prepare-your-space-first">Always prepare your space first</h1><ul><li>Prepare your space (towel or sink strainer) to prevent lens loss or breakage.</li><li>Wash and towel dry your hands with moisturizer-free soap.</li><li>Clean your plunger (if you&apos;re using one) with an alcohol prep.</li></ul><h1 id="whats-the-goal">What&apos;s the goal?</h1><p>For some people, getting a scleral lens onto their eye correctly is easy and intuitive. For others, it can take weeks or months. We&apos;re all different, and some of us have larger lenses than others.<br><br>For those who struggle, it&apos;s about finding a technique, and perhaps new tools, to meet your needs. So if you&apos;re having trouble mastering insertion, you may need to figure out what your specific challenges are, as this can point the way to new approaches:&#xA0;</p><table width="100%"><tbody><tr><td style="width: 51.9056%;"><strong>Successful&#xA0;insertion means this:</strong></td><td style="width: 45.1906%;"><strong>Challenges&#xA0;you&#xA0;may face:</strong></td></tr><tr><td style="width: 51.9056%;"><ul><li>You&#xA0;get the lens onto the eye</li><li>The lens is centered</li><li>There are no air bubbles</li><li>If the lens is non-rotational and has alignment dots, the dots are aligned correctly. (Not all lens dots are for alignment purposes. If yours are, your doctor will tell you if it should be at the top or the bottom.)</li></ul></td><td style="width: 45.1906%;"><ul><li>Spreading the lids wide enough</li><li>Keeping the lens full of saline till it is on the eye. (Tremor?)</li><li>Overcoming a strong &quot;flinch&quot; response</li><li>Knowing when to release</li><li>Detecting bubbles afterwards</li></ul></td></tr></tbody></table><p>&#xA0;</p><h1 id="tools-and-techniques">Tools and techniques</h1><p>Here are some of the many ways people insert their scleral lenses:</p><h2 id="1-no-plunger-methods">1. No-plunger methods</h2><p>These methods work best with&#xA0;small diameter sclerals, e.g. 15mm.</p><h3 id="tri-pod-method-balance-lens-on-three-fingers">&quot;Tri-pod&quot; method: Balance lens on three fingers</h3><p><iframe width="560" height="315" src="https://www.youtube.com/embed/LHILtoipEQc" frameborder="0" allowfullscreen></iframe></p><h3 id><br></h3><h3 id="o-ring-method-stabilize-lens-on-finger-with-small-rubber-ring">&quot;O-Ring&quot; method: Stabilize lens on finger with small rubber ring&#xA0;</h3><p>&#xA0;<iframe width="560" height="315" src="https://www.youtube.com/embed/q788-iDJx50" frameborder="0" allowfullscreen></iframe></p><h2 id="2-standard-dmv-scleral-cup">2. Standard DMV Scleral Cup&#xA0;</h2><ul><li>Applies suction to keep lens stable</li><li>Squeeze to attach, squeeze to release</li><li>Popular for all sizes of scleral lenses</li></ul><p>Example:</p><p><iframe width="560" height="315" src="https://www.youtube.com/embed/kEX-rxTjYIQ?start=120" frameborder="0" allowfullscreen></iframe></p><h2 id="3-dmv-vented-scleral-cup">3. DMV Vented Scleral Cup</h2><ul><li>Low vision? Hollow design allows you to see light through it, which may help with centering.</li><li>Best suited for small to medium. Larger lenses are more likely to need suction for stability.</li></ul><p>Example:</p><p>(Note - for some reason they call the tool a &quot;trimmed sucker&quot;, and&#xA0;clearly someone just hacked off the end of a regular scleral up, but you can buy them made this way. Pre-made ones are white.)</p><p><iframe width="560" height="315" src="https://www.youtube.com/embed/ApPpaCJgu1o?start=182" frameborder="0" allowfullscreen></iframe></p><h2 id="4-ezi-applicator-rings">4. EZI Applicator Rings</h2><ul><li>Lid spread: Helps by freeing up more fingers to hold the lids or from different angles</li><li>Arthritis: Helps those who cannot hold or squeeze a DMV scleral cup</li><li>Careful which size you choose!</li></ul><p>Example:</p><p><iframe width="560" height="315" src="https://www.youtube.com/embed/O2fZeuTHHkU?start=59" frameborder="0" allowfullscreen></iframe></p><h2 id="5-see-green-light--stand">5. See-Green Light &amp; Stand</h2><ul><li>Put your eye on the lens (not the lens on your eye)</li><li>Helpful if you have hand tremors, difficulty centering, nervousness, flinching, etc.</li><li>Can be used with DMV Scleral Cup, DMV Vented, or See-Green lighted inserter</li><li>Optional lighted system helps with centering</li></ul><p>Example:</p><p><iframe width="560" height="315" src="https://www.youtube.com/embed/hBPgK_cuvrg?start=22" frameborder="0" allowfullscreen></iframe></p><h2 id="6-see-green-lighted-inserter">6. See-Green Lighted Inserter</h2><ul><li>Helps with centering, especially for those with low vision</li><li>Can be used on its own for conventional insertion, or with stand</li></ul><div style="text-align: start;"><img src="https://cdn.shopify.com/s/files/1/2575/9928/files/Lighted_inserter.png?v=1596313832" alt width="368" height="245" class="fr-fic fr-dii"></div><h2 id="7-luma-serter-plus">7. Luma-Serter PLUS</h2><ul><li>Angled cup can be helpful for some low vision users</li><li>Fits on a penlight for light-guided insertion</li><li>Can be used on fingertip</li></ul><p><img src="https://cdn.shopify.com/s/files/1/2575/9928/files/Luma-Serter_Plus.png?v=1596313891" alt width="330" height="220" class="fr-fic fr-dii"></p><h2 id="8-s5-mini--s5-inserter">8. S5 Mini &amp; S5 Inserter</h2><ul><li>S5 Mini (pictured); S5 Inserter has a telescoping arm</li><li>Suction base to attach to counter or sink</li><li>Light unit</li></ul><div style="text-align: start;"><img src="https://cdn.shopify.com/s/files/1/2575/9928/files/S5.png?v=1596313972" width="458" height="305" class="fr-fic fr-dii"></div><h2 id="9-new-dmv-scleral-stand">9. NEW! DMV Scleral Stand</h2><p>DMV now makes an excellent low-cost stand, great started product! It is collapsible and comes with a DMV Vented Scleral Cup. You can shine a light at the clear base and tube for some light transmission through the scleral cup.</p><p><br><img src="https://uploads.gorgias.io/bgJ1Q6QWMP7vXKOM/DMV_Stand-c2924e4d-dac6-4548-97e6-129054212ea1.webp" style="width: 300px;" class="fr-fic fr-dib"></p><p><br></p><h1 id="troubleshooting">Troubleshooting</h1><ul><li><strong>Position:</strong> Are you tucking your chin, face parallel to the table/counter?</li><li><strong>Awkward:</strong> Do you feel like you&apos;re using the wrong hand, or your nose is in the way? Try switching hands. Some people use the same hand positions for both eyes, others switch.</li><li><strong>Stressed:</strong> Think positive, meditate, come to the scleral lens group for encouragement. You&apos;ll get there!</li><li><strong>Flinching</strong> <strong>(as plunger approaches):</strong> Calm self-talk and practice. Possibly consider Luma-Serter.</li><li><strong>Flinching (when saline hits eye):</strong> Warm the saline slightly - you won&apos;t be able to feel it when it touches the eye.</li><li><strong>Tremor:</strong> Use a stand.</li><li><strong>Bubbles?</strong> Usually from spilling saline due to either tremor or poor lid spread (see above for tips on both)</li><li><strong>Difficulty centering lens?</strong> Use a hollow inserter (eg vented) or an inserter with a light so that there is something to focus on.</li><li><strong>Saline spills,</strong> no matter what you do? Put something thicker in the lens (like a gel or geldrop) until your skills are more developed.</li><li><strong>Bubble confusion?</strong> Bubbles aren&apos;t always obvious. Using a high magnification lighted mirror, or possibly the i-Chek device (below) can help.</li></ul><h1 id="new-user-mistakes">&#xA0;New User Mistakes</h1><ul><li><strong>Trying the same technique over and over</strong> when it&apos;s not working. It&apos;s important to figure out what the problem really is (see &quot;Troubleshooting&quot; above) so that you can find another approach.</li><li><strong>Trying too hard for too long</strong>. Don&apos;t go on so long that your eyes or eyelids are getting sore. Take a break, research techniques, call your doctor&apos;s office.&#xA0;</li></ul><h1 id="struggling-keep-these-in-mind">&#xA0;Struggling? Keep these in mind:</h1><ul><li><strong>YOU&apos;RE NOT ALONE.</strong> Many people struggle learning to insert their lenses.</li><li><strong>ASK YOUR DOCTOR:</strong> You need support and training from your doctor&apos;s office. Some of you may need to be assertive and vocal about your needs.</li><li><strong>TRY ANOTHER TECHNIQUE:</strong> There is absolutely no one-size-fits-all approach to this problem.</li><li><strong>TRY ANOTHER TOOL:</strong> We provide lots of ideas in this tutorial, but make sure you involve your doctor in the process.</li><li><strong>WATCH ANOTHER VIDEO:</strong> Somewhere out there is a video of a technique that will work better for you.</li><li><strong>JOIN THE GROUP:</strong> Nothing like supportive friends in the journey so you can swap tips, commiserate about issues and celebrate the triumphs. Join My Big Fat Scleral Lens.</li></ul><h1 id="more-videos">More videos</h1><p>There are tons of videos. The ones above are just a few suggestions. Search YouTube on &quot;Scleral lens insertion&quot;. It can be very helpful to review many videos to get fresh ideas about hand and finger positioning. We are all different and face different challenges! Try videos on these pages:</p><ul><li><a data-cke-saved-href="https://www.youtube.com/watch?v=P0xO9bZsTnU" href="https://www.youtube.com/watch?v=P0xO9bZsTnU">Scleral Lens Education Society</a>&#xA0;</li><li><a data-cke-saved-href="https://www.youtube.com/watch?v=9C0rqOOB860" href="https://www.youtube.com/watch?v=9C0rqOOB860">Revision Optometry</a>&#xA0;</li><li><a data-cke-saved-href="https://www.youtube.com/watch?v=kEX-rxTjYIQ" href="https://www.youtube.com/watch?v=kEX-rxTjYIQ">LaserFit</a></li></ul><h1 id="ask-your-doctor">Ask your doctor</h1><p><strong>Speak up</strong> if things aren&apos;t working for you. Part of the scleral lens dispensing process must involve plenty of training until you are able to safely, consistently and successfully put your lenses in. Your lens provider bears&#xA0;</p><p><strong>Red or irritated eyes or lids&#xA0;</strong>from the insertion process? Let your doctor know.</p><p><strong>Can&apos;t get them in without bubbles?</strong> Let your doctor know.</p><p>&#xA0;&#xA0;</p><h1 id="important-note"><strong>IMPORTANT NOTE</strong></h1><p><span>FOR INFORMATIONAL PURPOSES ONLY. THIS GUIDE IS COMPRISED OF PEER-TO-PEER SUGGESTIONS, NOT MEDICAL ADVICE. CONSULT YOUR EYE DOCTOR&#xA0;WITH ALL&#xA0;YOUR EYE CARE AND LENS QUESTIONS.</span></p><h1 id="-1"><br></h1>

Part 5: Lens application (insertion) tools, techniques and troubleshooting

Video examples of techniques. What to do if I can't get my lens out? How do I remove my lens when I don't have a plunger?

<p>&#xA0;</p><h1 id="removing-your-lens-with-a-plunger">Removing your lens with a plunger</h1><p><img src="https://cdn.shopify.com/s/files/1/2575/9928/files/plungers_480x480.png?v=1593493619" alt width="133" height="133" class="fr-fic fr-dii"></p><h2 id="what-is-a-removal-plunger">What is a removal plunger?</h2><p>Usually when anyone refers to a removal plunger, they mean the <a href="https://dryeyeshop.com/products/dmv-ultra-remover" title="DMV Ultra">DMV Ultra</a>, which is by far the most commonly used type. There is also an angled version called the <a href="https://dryeyeshop.com/products/dmv-45" title="DMV 45">DMV 45</a>.</p><h2 id="basic-steps-in-plunger-removal-technique">Basic steps in plunger removal technique</h2><ol><li>Set up your space</li><li>Wash and dry your hands</li><li>Wet lens and plunger</li><li>Spread one or both lids (depending on your needs)</li><li>Attach plunger to edge, NOT center, of lens</li><li>&quot;Break the seal&quot; (suction) of the lens. This can be done with the plunger or with the fingers.</li><li>Lift the lens off the eye</li></ol><h2 id="video-examples">Video examples</h2><h4 id="two-hands-for-lid-spread">Two hands for lid spread:</h4><p><iframe width="560" height="315" src="https://www.youtube.com/embed/kEX-rxTjYIQ?start=160" frameborder="0" allowfullscreen></iframe></p><h4 id="another-example">Another example</h4><p><iframe width="560" height="315" src="https://www.youtube.com/embed/Y4nbkfyrnJg?start=158" frameborder="0" allowfullscreen></iframe></p><h4 id="breaking-seal-manually-first-">Breaking seal manually first <iframe width="560" height="315" src="https://www.youtube.com/embed/NZJlEgedY5w" frameborder="0" allowfullscreen></iframe></h4><h2 id="tips">Tips</h2><ul><li>Most people look straight out, but for some, looking down works better.</li><li>Experiment with the use of hands and the lid spread process that works best for you.</li><li>Don&apos;t forget to wet!</li><li>Twist and rotate the plunger slightly if your lens seems very &quot;stuck&quot;.</li></ul><h2 id="remember-were-all-different">Remember: We&apos;re all different!</h2><p>Many examples on YouTube show people with their arm over their head holding their upper lid up. I&apos;ve never done that and it feels extremely awkward to me. I always use the index and middle fingers of my left hand to spread my lids - on both sides. We are all different and there are no right or wrong answers.</p><h1 id="removing-your-lens-without-a-plunger">Removing your lens without a plunger</h1><p>If your sclerals are small relative to your eyes, removing them without a plunger is usually not difficult (assuming the lens is not too tight). The larger the lens, the more likely a plunger is the&#xA0;most practical method for daily removal. However, even if you normally use a plunger, knowing how to remove your lens without a plungers is helpful in emergencies.<br><br>Removal without a plunger is all about wedging your lower lid under the lens to &quot;break the seal&quot;.&#xA0;</p><h2 id="video-examples-1">Video examples</h2><h4 id="smallest-sclerals">Smallest sclerals</h4><p><iframe width="560" height="315" src="https://www.youtube.com/embed/YTYEEYQOMdg" frameborder="0" allowfullscreen></iframe></p><h4 id="a-little-larger">&#xA0;A little larger</h4><p><iframe width="560" height="315" src="https://www.youtube.com/embed/38nEUfWkcuo?start=61" frameborder="0" allowfullscreen></iframe></p><h4 id="full-size">&#xA0;Full size</h4><p><iframe width="560" height="315" src="https://www.youtube.com/embed/P0xO9bZsTnU?start=332" frameborder="0" allowfullscreen></iframe></p><h1 id="removal-technique-mistakes">Removal technique mistakes</h1><ul><li>Failing to get the lens &amp; plunger wet</li><li>Attaching plunger to the center of the lens</li><li>Pulling too hard and too long</li><li>Tugging hard without first breaking suction&#xA0;</li></ul><h1 id="help-what-do-i-do-now">HELP! What do I do now?</h1><p><strong>Lens won&apos;t come out:</strong> Don&apos;t panic. Relax - you&apos;ve got this, you really have! You&apos;ve gotten your lens out before and you can do it again. Take some deep breaths, go back to the beginning, and walk yourself slowly through the steps. If the plunger isn&apos;t working, try the manual method. If you are getting stressed, TAKE A BREAK.<br><br><strong>Lost my plunger: I</strong>f it&apos;s still business hours, find a local optometry office that has them. If that&apos;s not an option, use the links above to watch videos of the manual method of removal.<br><br><strong>There&apos;s a ring around my eye after removal:</strong> A slight compression ring is normal after removing scleral lenses. If you have concerns about whether your ring is &quot;normal&quot; or whether it&apos;s acceptable in your particular eye situation, take close-up pictures to send to your doctor.<br><br><strong>My eye is very red or painful after lens removal:&#xA0;</strong>Call your doctor&apos;s office. And take pictures. Do not continue wearing your lens without first getting your eye doctor&apos;s instructions.</p><h1 id="remember-youve-got-this">REMEMBER: YOU&apos;VE GOT THIS!</h1><p>Some people master it in days - for others, it takes months. We have different eye anatomy and a host of factors that affect our technique. Don&apos;t sweat if you don&apos;t pick it up right away. But do be assertive about getting extra help and supervision from your dr&apos;s office. &#xA0;</p><h1 id="are-we-there-yet">Are we there yet?</h1><p>If you have been properly trained in scleral lens handling and use, you will:</p><ul><li>Be confident that you can successfully insert and remove your lenses by yourself, even if it may take you some time at first;</li><li>Know what steps to follow for insertion and removal;</li><li>Know what not to do;</li><li>Know when to call the doctor&apos;s office.</li></ul><p>Scleral lenses are not like regular contacts. They are a medical treatment as well as a specialty lens. They have many special handling requirements, and these requirements may vary from person to person depending on individual medical considerations. There may also be important safety considerations that apply to patients with particular medical conditions. A professional scleral lens fitter should be investing plenty of time in your training and support and should not allow you to take your lenses home until you can meet established safety standards for ongoing use.&#xA0;</p><p>If you don&apos;t feel confident of your ability to take your lenses out safely, (1) don&apos;t wear them until you do, and (2) call your doctor&apos;s office to schedule more training time. If they are unwilling or unable to provide you with full support for this process, you may want to reconsider whether they are the right scleral lens partner for you.</p><h1 id="important-note"><strong>IMPORTANT NOTE</strong></h1><p><span>FOR INFORMATIONAL PURPOSES ONLY. THIS GUIDE IS COMPRISED OF PEER-TO-PEER SUGGESTIONS, NOT MEDICAL ADVICE. CONSULT YOUR EYE DOCTOR&#xA0;WITH ALL&#xA0;YOUR EYE CARE AND LENS QUESTIONS.</span></p><h1 id><br></h1>

Part 6: Lens removal tips, techniques & troubleshooting

What's the difference between cleaning and disinfection? What solutions are appropriate? Why is it important not to rinse my lenses with water?

<p>&#xA0;</p><h1 id="steps-in-lens-cleaning-and-disinfection">Steps in lens cleaning and disinfection</h1><p>Like so many other things about scleral lens use, cleaning and disinfection processes vary a lot from user to user! Here&apos;s a quick snapshot of how it all hangs together:</p><table style="margin-right: calc(39%); width: 61%;" width="100%"><tbody><tr><td style="width: 23.1814%;"><strong>You MUST:</strong></td><td style="width: 76.7238%;">Disinfect <strong>daily</strong> in an approved disinfection solution after wearing. This usually takes 4-6 hours depending on the solution you will use.</td></tr><tr><td style="width: 23.1814%;"><strong>You PROBABLY SHOULD:</strong></td><td style="width: 76.7238%;">Digitally (&quot;rub&quot;) clean lenses <em>before</em> disinfection.</td></tr><tr><td style="width: 23.1814%;"><strong>You MIGHT NEED TO:</strong></td><td style="width: 76.7238%;">Use an optional extra deep-cleaning product periodically</td></tr></tbody></table><p>&#xA0;</p><hr><h1 id="step-1-rub-cleaning"><strong>Step 1: Rub cleaning</strong></h1><p>Rub cleaning removes any grime and deposits on your lenses. It&apos;s done between lens removal and putting the lenses to soak in your disinfection solution.</p><h2 id="why-rub">Why rub?</h2><p>Imagine if you used hand sanitizer frequently but never actually washed your hands with soap and water. Thorough cleaning really does require rubbing.</p><p><a href="https://pubmed.ncbi.nlm.nih.gov/31755140/">Here&apos;s a recent study</a> in case you&apos;re interested.</p><h2 id="howto-rub">How&#xA0;to rub?</h2><p>Most people place the lens in their palm, add a few drops of cleaning solution and rub it thoroughly on both sides.<br><br>There are some variations on this theme, such as using a cotton Q-tip or a lens cleaning pad. Ask your doctor for directions that are safe for your lenses.</p><h2 id="which-solution-do-i-use">Which solution do I use?</h2><p>Alas, the perenially popular Lobob ESC was discontinued in 2019.</p><p>There are a couple of other extra strength cleaners on the market, but these are now niche items and they are not labeled for gas perms and may not have appropriate instructions (Sereine, for example, says to rinse with water, which is a real no-no). But some people really, really need strong cleaners to get their deposits off. So here are two:</p><p><a href="https://dryeyeshop.com/products/sereine-extra-strength-daily-cleaner">Sereine ESC</a></p><p><a href="https://miraflow.com/">Miraflow</a></p><p>The other alternative is multi-purpose solutions. Some doctors will recommend a single multi-purpose solution for rubbing and soaking (disinfection), while others may have you use a MPS for rubbing but disinfect in Clear Care.</p><ul><li>Your doctor should recommend a specific cleaning solution.</li><li>Ask for an alternative, just in case you are not able to purchase their first choice. Some of these solutions are subject to shortages from time to time.</li><li>Be careful not to get any &quot;red cap&quot; solutions in your eyes!</li></ul><p class="p2">&#xA0;</p><h2 class="p2" id="confused-about-solutions"><span class="s1">Confused about solutions?</span></h2><p><span class="s1">For new users, solutions can get a little confusing. The types of solutions used for cleaning and disinfecting sclerals fall roughly into the following categories:</span></p><ul><li><span class="s1">CLEANING ONLY, e.g. Lobob ESC (currently out of production): Red-cap cleaners that are used only for &quot;rub&quot; cleaning, and must be rinsed off completely before putting a lens back in your eye. If you use this type, you must also use a disinfection solution.</span></li><li><span class="s1">CLEANING AND DISINFECTION MPS: Solutions like Unique pH, Boston Simplus and Tangible Clean. These can be used for both cleaning (rubbing) and disinfection (soaking), but some people use them only for one or the other. Examples: using Lobob to clean and Unique to disinfect; using Simplus to clean and Clear Care (see below) to disinfect.</span></li><li><span class="s1">DISINFECTION ONLY: Hydrogen peroxide systems, e.g. Clear Care. Of course, these *can* be used to rub clean a lens, it&apos;s just that they aren&apos;t very good at it. Generally speaking, when people refer to a rub cleaning process for sclerals, they are referring to something thicker that will work up a bit of suds.</span></li></ul><p class="p2"><span class="s1">Last, if you have HYDRA PEG COATING on your lenses, you must use solutions that are approved for Hydra PEG (unapproved solutions may damage the coating). <a href="https://tangiblescience.com/pages/care-tips">Click here</a> for details. Not sure if your lenses have this coating? Ask your doctor!</span></p><hr><h1 class="p2" id="step-2-overnight-disinfection"><span class="s1"><strong>Step 2: Overnight disinfection</strong></span></h1><p><span class="s1"><span>In between uses, scleral lenses <strong>MUST</strong> always go through a complete disinfection cycle in an approved disinfection solution.</span></span></p><h2 class="p2" id="option-a-hydrogen-peroxide-systems"><span class="s1">Option A: Hydrogen peroxide systems</span></h2><p><span class="s1"><img src="https://cdn.shopify.com/s/files/1/2575/9928/files/CLEAR_CARE.png?v=1596314865" alt width="239" height="159" class="fr-fic fr-dii"></span></p><p class="p2"><span class="s1">Clear Care is the gold standard for scleral lens disinfection in the US, and is usually recommended for nightly use, though some use it once or twice a week and use an MPS (see below) in between.</span></p><h3 class="p2" id="clear-care-pointers"><span class="s1">Clear Care Pointers</span></h3><ul><li><span class="s1"><strong>How it works:</strong> Clear Care comes with a little basket case containing a platinum disc that neutralizes the solution, that is, converts it from H2O2 to saline while also disinfecting. This is to prevent any risk of getting peroxide in your eyes. The disc lasts for 2-3 months. Each package of Clear Care comes with a case that has the disc.</span></li><li><span class="s1"><strong>Clear Care Triple Action vs Clear Care Plus with HydraGlyde:</strong> Is this a question of to-MA-to, to-MAH-to, or are there differences that matter? This is a debatable point. For as long as I have known, a majority of both patients and doctors that I have known seem to believe Clear Care performs best of the two. In our groups, many people have strong feelings one way or another. But, as with so many scleral lens questions, there&apos;s no data, so the jury&apos;s out. Go with what your doctor&apos;s recommending, but if you&apos;re having comfort or clarity issues, it may be worth asking if you can try the other.</span></li><li><span class="s1"><strong>6 hour minimum.</strong> That&apos;s how long the disinfection takes to complete, so don&apos;t skimp! If you don&apos;t have six hours to spare, consider a multi-purpose instead, as they only require four hours.</span></li><li><span class="s1"><strong>Lens size matters!</strong> The Clear Care case is recommended by the manufacturer only for lenses up to 15mm. (Do you know your lens size? If not, ask your doctor!) While many people with larger lenses still use Clear Care, you may experience increased risk of lens breakage. For larger lenses, consider the PROSE Case. Note also that lens &quot;bowl depth&quot; may also determine which case you can safely use. Also, be forewarned, the PROSE case is quite large and a hog for solution.</span></li><li><span class="s1"><strong>Careful with the baskets!</strong> With both case types, pay close attention as you&apos;re closing a lens in the basket to avoid sudden movements that can damage your lens.</span>&#xA0;</li></ul><table width="100%"><tbody><tr><td><img src="https://cdn.shopify.com/s/files/1/2575/9928/files/2_cases.png?v=1596315107" alt width="230" height="153" class="fr-fic fr-dii">&#xA0;</td><td><br><ul><li>Lens pictured: 18.5mm scleral lens</li><li>Left: Clear Care case</li><li>Right: PROSE Case.</li></ul></td></tr></tbody></table><p class="p2">&#xA0;</p><h2 class="p2" id="option-b-multi-purpose-solutions-mps">Option B: Multi-purpose solutions (MPS)</h2><p>Hydrogen peroxide may be best, but multipurpose solutions are the most convenient and cost-effective, and they can be used with a standard contact lens case, which in most cases is included with the solution.</p><p>Again, please be mindful of<span>&#xA0;</span><a data-cke-saved-href="https://tangiblescience.com/care-tips/" href="https://tangiblescience.com/care-tips/">Hydra PEG compatibility</a><span>&#xA0;</span>if applicable to your lenses! Each of the solutions pictured is compatible with all types.</p><p><img src="https://cdn.shopify.com/s/files/1/2575/9928/files/MPS.png?v=1596315232" alt width="348" height="232" class="fr-fic fr-dii"></p><h2 id="user-mistakes">User mistakes</h2><ul><li>Leaving lenses overnight in preservative free saline</li><li>Using water to rinse off a cleaning solution</li><li>Breaking a lens in a basket case</li><li>Cleaning, but not disinfecting</li></ul><hr><h1 class="p2" id="step-3-optional-extras-for-a-deeper-clean"><span class="s1"><strong>Step 3: Optional extras for a deeper clean</strong></span></h1><p>If you are a &quot;heavy depositor&quot;, there are some extra deep cleaning options that your doctor may recommend or that you may wish to ask them about. (Sorry -&#xA0;neither of these is Hydra PEG compatible!)</p><ul><li><strong>Boston One Step:<span>&#xA0;</span></strong>Sold in single-use vials, this enzyme cleaner can be added to your overnight disinfection solution.</li><li><strong>Menicon Progent:<span>&#xA0;</span></strong>This is a more complicated deep cleaning regimen that you should only do with your doctor&apos;s approval and carefully following the instructions. A &quot;Progented&quot; lens is as clean as a lens will get!&#xA0;</li></ul><h1 id="how-do-i-know-my-lenses-are-getting-clean-enough">How do I know my lenses are getting clean enough?</h1><p>That is a great question to ask your eye doctor! They can examine your lenses for&#xA0;deposits.</p><p>Stubborn deposits can actually &quot;etch&quot; a lens. If you are scrubbing and scrubbing but still see &quot;white stuff&quot; on your lens, take it in for your eye doctor to examine.</p><h1 id="what-about-my-lens-case-and-plungers">What about my lens case and plungers?</h1><p>Soap, water and thoroughly air dry, unless your doctor instructs you otherwise.</p><p>Don&apos;t forget to replace these things regularly. Conventional contact lens cases should be replaced every 1-2 months - and most multi-purpose solutions include a replacement lens, so this is &apos;self-policing&apos;. Plungers can be kept as long as they work, as long as you are cleaning them frequently.</p><h1 id="dont-forget-no-tap-water">Don&apos;t forget: No tap water!</h1><p><a href="https://dryeyeshop.com/blogs/news/safety-alert-dont-rinse-your-sclerals-with-water"><img src="https://cdn.shopify.com/s/files/1/2575/9928/files/Slider_for_DEZ_Squarespace_9_d927a8ba-4a47-4d08-8959-a746e6e8ecdf.png?v=1568481466" alt="No tap water" width="404" height="227" class="fr-fic fr-dii"></a></p><h1 id="important-note"><strong>IMPORTANT NOTE:&#xA0;</strong></h1><p><span>FOR INFORMATIONAL PURPOSES ONLY. THIS GUIDE IS COMPRISED OF PEER-TO-PEER SUGGESTIONS, NOT MEDICAL ADVICE. CONSULT YOUR EYE DOCTOR&#xA0;WITH ALL&#xA0;YOUR EYE CARE AND LENS QUESTIONS.</span></p><h1 id><br></h1>

Part 7: Cleaning and disinfecting scleral lenses

How can I safely remove, rinse and re-insert my lenses? What might be causing my mid-day lens fogging or debris? What questions should I ask my doctor?

<p>&#xA0;</p><h1 id="what-is-mid-day-fogging">What is &quot;mid-day fogging&quot;?</h1><p><img src="https://cdn.shopify.com/s/files/1/2575/9928/files/midday_fogging.png?v=1596316109" alt width="324" height="216" class="fr-fic fr-dii"></p><p>First, let me say, it doesn&apos;t happen to everyone! If you&apos;re not having issues, you can probably skip this topic altogether, but it might be best to read the first section so that you&apos;ll recognize it if it happens to you.</p><p>The term &quot;mid-day fogging&quot; is kicked around constantly in the scleral lens online community. But it means different things to different people, it is described many different ways, and it has many potential causes.</p><p>So there is also no single solution. Addressing midday fogging is&#xA0;all about returning to your doctor, troubleshooting, trying things, and, in some cases, accepting tradeoffs such as removing, rinsing and refilling once or more during the day.</p><h2 id="examples-of-experiences-with-mid-day-fogging">Examples of experiences with &quot;mid-day fogging&quot;:</h2><ul><li>Your vision starts going a bit cloudy. Signs are harder to read and you&apos;re blinking a lot more.</li><li>You think the inside, or the outside, of the lens is literally looking foggy.</li><li>There is particulate matter collecting in the fluid in the lens.</li><li>You are getting a buildup of deposits on the inside or outside of the lens (note that this one can cause not just poorer vision but discomfort too).</li></ul><p>Whatever the case, you hit a point in the day when your lenses aren&apos;t doing their job.</p><p>Naturally, you want to know why this is happening and what to do about it.</p><h2 id="why-is-this-happening-to-me">Why is this happening to ME?</h2><p>There are a great many things that can contribute to lens fogging. They include everything from the lens itself, to your lens care routines, the solutions you use for cleaning, disinfection, filling and rewetting, what you use in your eyes overnight, your eye disease(s), and more.&#xA0;</p><p>Some of the causes are not well studied or well understood. So,&#xA0;as a practical matter, after the lens-related factors have been optimized, it may&#xA0;come&#xA0;down to trial-and-error with solutions and routines.</p><p>Following is a long list of potential contributors and potential solutions to explore. If you are having persistent issues, make sure your doctor is aware and involved in decisions about any steps you take.</p><h1 id="troubleshooting">Troubleshooting</h1><p>Probably the most common solution reportedly anecdotally in our Facebook group is modifying the solutions used - especially filling solutions, but also overnight disinfection. But it&apos;s important to understand that there are many more things that can cause lens fogging!&#xA0;Hopefully you will find this table helpful in conversations with your doctor.</p><table width="100%"><tbody><tr><td style="width: 22.8675%;">&#xA0;<strong>Cause</strong></td><td style="width: 74.2287%;"><strong>Potential solution(s)</strong></td></tr><tr><td style="width: 22.8675%;">Lens fit?</td><td style="width: 74.2287%;"><div><br></div><p>Return to doctor for assessment and fit tweaking if necessary (TIP: Get an appointment late in the day so they can see the problem while it&apos;s happening.)</p><p>In some cases it becomes&#xA0;necessary to explore another lens or lens fitting technology or seek a second opinion. If you get a second opinion, make sure it&apos;s from someone who has extensive experience with&#xA0;scleral lenses for your specific disease.</p></td></tr><tr><td style="width: 22.8675%;">Poor surface wetting?</td><td style="width: 74.2287%;"><div><br></div><p>Plasma treatment.</p><p>Hydra PEG coating.</p><p>It&apos;s important to note that Hydra PEG coating will restrict your choice of lens cleaning solutions, and comes off sooner for some users than others. Ask your doctor if your lens can be re-coated if it wears off prematurely, or if you will have to purchase a new lens.</p></td></tr><tr><td style="width: 22.8675%;">Hand soap containing moisturizers?</td><td style="width: 74.2287%;"><div><br></div><p>Switch to a non-moisturizing hand soap.</p><p>This is a frequently overlooked contributor!&#xA0;Scroll down for soap suggestions.</p></td></tr><tr><td style="width: 22.8675%;">Filling solution pH?</td><td style="width: 74.2287%;"><div><br></div><p>Try a different preservative free saline.</p><p>There is anecdotal evidence that changing the type of preservative-free saline may directly affect fogging. Usually (but not always) those who report improvement have switched from unbuffered saline to buffered saline. Buffered options include ScleralFil, Nutrifill and Purilens Plus. Another way to modify the filling solution is to add preservative free artificial tears (see also &quot;filling solution viscosity&quot;,&#xA0;below).</p><p>Nutrifill is a brand new ph-balanced and electrolyte-enriched preservative free saline and while there are no studies yet, there are anecdotal reports of it significantly improving fogging for some users.&#xA0;</p></td></tr><tr><td style="width: 22.8675%;">Filling solution viscosity?</td><td style="width: 74.2287%;"><div><br></div><p>Add or substitute preservative free artificial tears.</p><p>The conventional favorite for this over the years has been Refresh Celluvisc. More recently, we are hearing from people using many other types including Oasis Tears Plus, Refresh Relieva and Refresh Optive Advanced.&#xA0;</p></td></tr><tr><td style="width: 22.8675%;">Cleaning solution?</td><td style="width: 74.2287%;"><div><br></div><p>Try a different &quot;rub&quot; cleaning solution</p><p>There is some anecdotal evidence that for some users, certain cleaning solutions may cause more eye irritation and/or more midday fogging. Changing it up may be worth a try, but always check with your doctor to ensure you are using compatible solutions.</p></td></tr><tr><td style="width: 22.8675%;">Disinfection solution?</td><td style="width: 74.2287%;"><div><br></div><p>For overnight disinfection, switch from multi-purpose solution to hydrogen peroxide disinfection (e.g. Clear Care).</p><p>Switch from Clear Care Plus to regular Clear Care.</p><p>There is extensive anecdotal evidence that for some users, switching from a multi-purpose solution to hydrogen peroxide improves their lens fogging. Some users report poor results with Clear Care Plus (Hydraglyde) versus regular Clear Care.&#xA0;</p></td></tr><tr><td style="width: 22.8675%;">Protein remover?</td><td style="width: 74.2287%;">Many solutions claim to remove protein deposits - but not all&#xA0;so-called protein removers are equally effective. Ask your doctor for a recommendation. The gold standard protein remover is Menicon Progent.</td></tr><tr><td style="width: 22.8675%;">Are you a &quot;heavy depositor&quot;?</td><td style="width: 74.2287%;"><div><br></div><p>Viscous artificial tears in the lens to help keep out debris.</p><p>&quot;Squeegie&quot; the top of the lens (if deposits are on the outside) with a Q-tip (cotton only!) dipped in saline.</p><p>RRR (see below).</p><p>In some severe cases, your doctor may prescribe mucolytic eye drops.</p><p><em>Note: &#xA0;Some eyes are described as &quot;heavy depositors&quot; because they produce so much excess mucous which attaches to the lens.</em></p></td></tr><tr><td style="width: 22.8675%;">Adverse environments, high pollen counts, heavy screen use, etc.?</td><td style="width: 74.2287%;"><div><br></div><p>Dry eye glasses (e.g.&#xA0;<a data-cke-saved-href="https://dryeyeshop.com/collections/ziena-eyewear" href="https://dryeyeshop.com/collections/ziena-eyewear">Ziena</a>)</p><p>Lubricating drops &quot;over the top&quot; (e.g.&#xA0;<a data-cke-saved-href="https://dryeyeshop.com/products/refresh-relieva?" href="https://dryeyeshop.com/products/refresh-relieva?">Refresh Relieva</a>, Blink, etc)</p><p>Diligent compliance with&#xA0;dry eye treatments</p><p>Use of lid hygiene products, e.g. tea tree wipes</p><p>Seeking additional medical care for ocular surface disease(s).</p><p>This is a confusing area for many new users. Scleral lenses treat extreme surface disease/dryness&#xA0;by keeping the cornea covered with fluid. However, you can still be subject to ocular surface dryness at the interface between the top of the lens and your lids. This may require extra attention and care for best lens performance.</p></td></tr><tr><td style="width: 22.8675%;">Residue from overnight ointment?</td><td style="width: 74.2287%;"><div><br></div><p>Rinse eyes thoroughly and cleanse lid margins, lids and lashes with lid wipes (e.g.&#xA0;<a data-cke-saved-href="https://dryeyeshop.com/products/ocusoft-lid-scrub-eyelid-cleanser-pre-moistened-pads?" href="https://dryeyeshop.com/products/ocusoft-lid-scrub-eyelid-cleanser-pre-moistened-pads?">Ocusoft</a>).</p><p>Switch from petrolatum-based lubricating ointments to a polymer gel (e.g.&#xA0;<a data-cke-saved-href="https://dryeyeshop.com/products/genteal-gel?" href="https://dryeyeshop.com/products/genteal-gel?">Genteal Gel</a>). If you do not find gel strong enough for nighttime protection, consider additional non-ointment options such as&#xA0;<a data-cke-saved-href="https://dryeyeshop.com/collections/nights" href="https://dryeyeshop.com/collections/nights">moisture goggles</a>.</p><p>RRR (see below).</p></td></tr></tbody></table><p>&#xA0;</p><p>That is a VERY LONG LIST, and it&apos;s probably not exhaustive. But this also means that there are many possible solutions to explore. Please review these with your eye doctor to see which potential solutions are likeliest to help you.</p><h1 id="the-triple-r-routine-rrr">The Triple-R Routine (RRR)</h1><p><img src="https://cdn.shopify.com/s/files/1/2575/9928/files/RRR.png?v=1596316620" alt width="501" height="167" class="fr-fic fr-dii"></p><h2 id="when-to-do-it">When to do it</h2><p>When you need to, or when your doctor says you should.</p><p>For some users, there are additional medical reasons for the RRR routine, for example, patients who are especially vulnerable to the effects of hypoxia may need to have some &quot;breathing&quot; time for their eyes during the day.</p><h2 id="steps">Steps</h2><ul><li>Remove</li><li>Rinse</li><li>Use rub cleaner if needed</li><li>Re-fill</li><li>Re-apply</li></ul><h2 id="dont-make-these-common-rrr-mistakes">Don&apos;t make these common RRR mistakes!</h2><ul><li><span style="color: #ff2a00;">WRONG:&#xA0;</span>Washing your hands with whatever soap they have at the office. (Chances are, it contains moisturizers!)&#xA0;RIGHT: Bring your own soap!</li><li><span style="color: #ff2a00;">WRONG</span>: Failing to let your doctor know what&apos;s going on. There may be medical implications or lens fit implications that should be ruled out.&#xA0;RIGHT: Tell your doctor if you find yourself RRR&apos;ing more than once a day.</li><li><span style="color: #ff2a00;">WRONG</span>: Taking your lenses out for a break and putting them in a case with preservative-free saline till you&apos;re ready&#xA0;to put them back in.&#xA0;RIGHT: Put your lenses in a multi-purpose solution such as Unique pH or Simplus.</li></ul><h1 id="re-wetting-drops-and-scleral-lenses">Re-wetting drops and scleral lenses</h1><p class="p1"><span class="s1">Many people need to apply some kind of drop over their lens if their eyes feel dry or the top surface of the lens is getting a little uncomfortable during the day.&#xA0;</span></p><p class="p1"><span class="s1">So, what drops do you use on top of your lenses? Here are some options. Check with your doctor and get their advice.</span></p><p class="p1"><span class="s1"><strong>Contact lens wetting drops,&#xA0;</strong>i.e. drops that are specifically labeled&#xA0;for this purpose. However, there are two issues with these drops: (1)&#xA0;many of them aren&apos;t that good - in particular, they may be too thick to be practical on scleral lenses, and (2) they ALL contain preservatives, and&#xA0;some of us&#xA0;prefer to avoid all preservatives where possible.</span></p><p class="p1"><span class="s1"><strong>Preservative-free lubricant drops:</strong> These drops are never labeled for use with contacts (see below for the reason why). But the practical reality is that they are commonly used this way, and commonly recommended by optometrists for this use. Check with your doctor for a specific recommendation. Usually the limiting factors are how thick the drop is, and whether it contains any kind of oil, either of which can interfere with vision or lens comfort. You can also review eye drop ingredients on our <a href="https://products.dryeyeshop.com/en-US/ingredient-guide-for-drops-gels-ointments-&amp;-sprays-33748"><span class="s2">ingredient reference list</span></a> (oils are highlighted in blue).</span></p><p class="p1"><span class="s1"><strong>Preservative-free saline:</strong> Many people ask if they can just use their saline to get the lenses wet. It&apos;s not labeled for the purpose, but it&apos;s obviously being used in the eye all day long and it&apos;s not harmful. The practical limitation of saline is that it has no lubricating qualities, so other than briefly wetting the drops, it can&apos;t give you very much mileage.&#xA0;</span></p><p class="p1"><span class="s1"><strong>Why do my artificial tears say that I can&apos;t use them with contacts?</strong> Lubricating drops and lens wetting drops are regulated by different parts of the FDA - the former is considered a drug, and the latter is considered a device. So even if they both have the exact same ingredients, they are labeled very differently. Traditionally, manufacturers have never &apos;overlapped&apos; on these - although they may market the same product under two different labels. This is beginning to change as a few manufacturers are going through the testing process to be able to add language to drops indicating that they are contact lens compatible. As always, talk with your doctor about what is best for use with your scleral lenses.</span></p><h1 id="miscellaneous-daily-usage-tips">Miscellaneous daily usage tips</h1><h2 id="temporary-storage-never-in-saline"><span style="color: rgb(226, 80, 65);">Temporary storage: Never in saline!</span></h2><p>If you end up leaving your lenses out for a little while during the day, never store them in preservative-free saline. Instead, use a multi-purpose solution. Examples are Boston Simplus, Tangible Clean and Unique pH.</p><h2 id="wear-time">Wear time</h2><p>Your wear time may be determined by your doctor&apos;s instructions or, if they have not specified any limits to your wear time, simply comfort and vision. There is no &apos;normal&apos; for wear time, as you&apos;ll see from our survey results. If you have concerns, definitely check in with your doctor.&#xA0;</p><h2 id="bubbles">Bubbles</h2><p>Discomfort and/or vision issues can crop up during the day if you got a bubble under a lens during lens application. It is absolutely worth putting in the effort to check carefully for bubbles immediately after application. You can&apos;t always &quot;feel&quot; a bubble, and they aren&apos;t always obvious on a casual glance in the mirror. There is nothing quite like discovering that you might have a bubble at an inconvenient time - like driving in traffic, or the middle of a meeting.</p><h2 id="prescription-eye-drops">Prescription eye drops</h2><p>The same rule&#xA0;of thumb applies to scleral lens users as all other contact lens users: If you need to apply an eye medication, remove your lenses, apply the drops, and wait 10-15 minutes before re-applying the lenses (or as advised by your doctor).</p><h1 id="opinion-the-scleral-lens-balancing-act">Opinion: The scleral lens balancing act</h1><p><img src="https://cdn.shopify.com/s/files/1/2575/9928/files/balance.png?v=1596317001" alt width="440" height="293" class="fr-fic fr-dii"></p><p>No one should ever expect scleral lenses to be as simple as conventional contacts. They&apos;re just not. And since they&apos;re being used to treat complex diseases, it is absolutely to be expected that there may be tradeoffs and limitations. For some people, RRR for midday fogging is one of those tradeoffs.<br><br>Sometimes you and your doctor have done everything right that there is to be done. But you&apos;re still struggling with some limitations or lens performance issues that really bother you. At that point it comes down to a balancing act: figuring out if the lenses are giving you enough benefit to compensate for the drawbacks and practical challenges.<br><br>Those who have the most to gain - either in terms of vision, ocular surface disease, pain, or a combination - are usually by far the most philosophical about accepting tradeoffs and limitations. Six to eight hours of good, comfortable vision is a much-hoped-for miracle for many people with advanced corneal diseases. But to others, who have more nuanced issues and come to the table with higher expectations and needs, even twelve or fourteen of continuous wear may seem intolerably limiting under some circumstances.<br><br>What do YOU need from sclerals, and what are you willing to give up? If midday fogging is seriously cramping your style, it&apos;s time for a heart-to-heart with your eye doctor about your needs and whether they can be achieved.</p><h1 id="important-note">IMPORTANT NOTE</h1><p>FOR INFORMATIONAL PURPOSES ONLY. THIS GUIDE IS COMPRISED OF PEER-TO-PEER SUGGESTIONS, NOT MEDICAL ADVICE. CONSULT YOUR EYE DOCTOR&#xA0;WITH ALL&#xA0;YOUR EYE CARE AND LENS QUESTIONS.</p><h1 id><br></h1>

Part 8: "Midday fogging", rinsing and removal, and other practical daily tips

How do I safely store my lenses, short-term or long-term? How often do my lenses need replacement?

<p><br></p><h1 id="safe-practices-for-lens-storage">Safe practices for lens storage</h1><h2 id="what-lens-storage-is">What lens storage is:</h2><ul><li>Keeping lenses in a case temporarily while napping, showering, swimming, etc.</li><li>Keeping backup lenses</li><li>Keeping any lenses that you do not use regularly</li></ul><h2 id="what-lens-storage-isnt">What lens storage isn&apos;t:</h2><p>Putting lenses to soak overnight, if you are wearing them every day. That overnight soak is - or should be! - a disinfection cycle, and you should follow the instructions specifically for disinfection.</p><h2 id="temporary-storage">Temporary storage</h2><ul><li>RIGHT: Put lenses in a case and fill with a multi-purpose solution.</li><li>WRONG: Put lenses in a case with preservative-free saline solution (e.g. Purilens, Scleralfil, LacriPure, Addipak) or neutralized Clear Care.</li></ul><h2 id="long-storage">Long storage</h2><p>Step 1: Follow product label instructions &amp; doctor&apos;s advice.<br>Step 2: Put lenses through a disinfection cycle before your next use.</p><h2 id="about-dry-long-term-storage">About dry long term storage</h2><p>Most scleral lenses can and should be stored dry if they will not be used for lengthy periods. Clean and dry your lenses and put them in a clean, dry case. Disinfect them before your next use.<br><br><span style="background-color: #ffff00;">Exception:&#xA0;</span>Lenses with Hydra PEG coating should never be stored dry, according to the manufacturer.</p><h2 id="special-needs">Special needs</h2><p>Some people have special situations, such as rotating frequently between two pairs of lenses. Make sure you get your doctor&apos;s instructions on safe. appropriate lens care for your situation.</p><h1 id="lens-replacement">Lens replacement&#xA0;</h1><h2 id="when--why-you-might-need-to-replace-a-lens">When &amp; why you might need to replace a lens</h2><ul><li>Loss (forgot to cover the drain!)</li><li>Breakage (cracked on the sink, or it&apos;s just so old and worn that it was inevitable)</li><li>Discovered a hole or crack in the lens (it happens, usually with older lenses)</li><li>The surface has become &quot;etched&quot; by stubborn deposits, and you can&apos;t see as well or can&apos;t get it completely clean.</li><li>The coating has worn off, the lens isn&apos;t performing up to your needs, and you&apos;ve been told it cannot be re-coated.</li><li>And more!</li></ul><h2 id="how-often-will-my-lenses-need-replacing">How often will my lenses need replacing?</h2><p>This is one of the best questions you can ask as a new scleral lens user. The reality, though, is that it somewhat resembles the infamous question, &quot;How long is a piece of string?&quot;<br><br>Alas, gone are the days when it seems we could keep our lenses year after year and they did just fine as long as we were careful. At least that&apos;s what it seemed like at the time. But maybe it&apos;s a myth, like walking uphill through the snow to school?<br><br>At any rate, lens manufacturing seems to be changing, as well as provider- and manufacturer-specific policies about how much can be done to maximize the life of a lens that you have already worn for some time, such as re-treating or re-coating a lens.<br><br>We don&apos;t have answers. Focus on asking good questions. Which brings us to....</p><h2 id="questions-to-ask-your-provider-about-lens-replacement">Questions to ask your provider about lens replacement</h2><ul><li>How frequently should I expect to have to replace my lenses (barring loss or breakage)?</li><li>What factors lead to shorter lens life?</li><li>What steps can I take, if any, to prolong my lens life?</li><li>Is there any manufacturer warranty coverage if a pair breaks?</li><li>How much do you charge for replacement lenses?</li><li>Can I have the Hydra PEG coating re-applied if it wears off quickly?</li></ul><h2 id="and-just-a-few-more-questions">And just a few more questions!</h2><p>The following are questions we feel you should ask about every pair of lenses you receive, including replacements:</p><ul><li>What is the brand and diameter of my lenses?</li><li>Do they have Hydra PEG coating?</li><li>Will they fit safely in the Clear Care basket case?</li><li>Are there any special considerations or specific recommended solutions that I should know about?</li></ul><p>&#xA0;<strong>IMPORTANT NOTE</strong></p><p><span>FOR INFORMATIONAL PURPOSES ONLY. THIS GUIDE IS COMPRISED OF PEER-TO-PEER SUGGESTIONS, NOT MEDICAL ADVICE. CONSULT YOUR EYE DOCTOR&#xA0;WITH ALL&#xA0;YOUR EYE CARE AND LENS QUESTIONS.</span></p><h1 id><br></h1>

Part 9: Storage and replacement

Flying with sclerals: What should I take in my carry-on? What security restrictions do I need to plan ahead for (domestically, internationally)?

<p><br></p><h1 id="you-can-do-it">You can do it!</h1><div style="text-align: left;"><img src="https://cdn.shopify.com/s/files/1/2575/9928/files/traveling.png?v=1596317746" alt width="231" height="154" class="fr-fic fr-dii"></div><div style="text-align: left;"><span>Traveling with scleral lenses presents challenges. But... you can do it! The most important thing is to understand what issues can arise and be prepared, and have a plan for how to get all your supplies safely to your destination.</span></div><div style="text-align: left;"><span>&#xA0;</span></div><ul><li><span class="s1">DON&#x2019;T let the prospect of traveling with scleral lenses intimidate you!</span></li><li><span class="s1">DO your homework first!</span></li><li><span class="s1">DO plan and pack carefully!</span></li></ul><h1 id><br></h1><h1 id="can-i-wear-my-lenses-in-flight">Can I wear my lenses in flight?</h1><p>Many of us do! But some planning is very helpful.&#xA0;Things to consider include:</p><h2 id="vision">Vision</h2><p>If your vision is not correctible with glasses, as is the case for many scleral lens users, just getting around in the airport is a problem if you do not wear your lenses at least as far as your departure gate. Personally, for long flights I tend to remove my lenses in the restroom closest to my gate, but for others with worse vision that may not be feasible.</p><h2 id="comfort-drink-up-lube-up-cover-up">Comfort: Drink up, lube up, cover up!</h2><p>Airports, with their dry air and fluorescent lights, are hard on people with dry eye disease whether or not they are wearing sclerals. &quot;Airplane air&quot; is almost as bad as it can get for the eyes. Some people cannot wear their lenses in flight because of the harsh environment, while others find the lenses help them tolerate it better.&#xA0;</p><p>If you have dry eye and don&apos;t plan to wear&#xA0;your lenses in flight, you&apos;ll want to max out on other forms of protection. If you are wearing your lenses in flight, they&apos;ll be much more liable to become dry, blurry and uncomfortable during the flight.</p><p>So: Stay hydrated, keep your eyes and lenses lubricated, and, if possible, wear dry eye glasses or goggles. These things will also help you in overheated or air conditioned hotel rooms and outdoors in dry climates.</p><h2 id="flight-length">Flight length</h2><p>Short flights (2-3 hours) may be fine. But on long flights, and especially overnight flights, chances are you will need to either fly without your lenses or remove them during the flight.</p><h2 id="lens-insertion-and-removal">Lens insertion and removal</h2><p><strong>At the airport?&#xA0;</strong>Where and when?&#xA0;Restroom near the departure gate? First restroom at the destination airport? Concerns include getting jostled in crowded restrooms, and taking precautions to cover the sink or counter space you&apos;re using.<span>&#xA0;</span><strong>TIP:<span>&#xA0;</span></strong>Look for a family restroom, or use a changing table.</p><p><strong>In flight?&#xA0;</strong>There is no good way to do this. And yet, you&apos;ll find a way if you need to,<strong>&#xA0;</strong>At your seat, as some do? In the lavatory? Both ways are challenging. Don&apos;t forget the towel!</p><h2 id="in-flight-napping">In-flight napping</h2><p class="p1">You really shouldn&apos;t sleep with your scleral lenses in.</p><p class="p1">If you want to&#xA0;nap during the flight, plan ahead for where and when to remove your lenses. Some people are comfortable removing lenses at their seat, others in the lav. But wherever you do it, make sure you have the proper equipment! As a minimum, you&apos;ll need a towel (the last thing you want is a lens bouncing) and of course your case and solutions, and possibly a mirror unless you&apos;re comfortable removing them without one.</p><p class="p1">What if I fall asleep without intending to? It&apos;s not the end of the world, but&#xA0;it&apos;s best to keep your lenses hydrated with some saline or drops, and remove and refill them at the first opportunity.</p><h1 id="carry-on-bags-whatto-take">Carry-on bag(s): What&#xA0;to take?</h1><h2 id="what-should-you-take">What SHOULD you take?</h2><ol><li>Anything you need in flight</li><li>Anything&#xA0;you can&apos;t live without if your checked baggage goes astray</li><li>Anything you can&apos;t readily replace at your destination</li></ol><h2 id="but-what-can-you-take-through-security">...But what CAN you take through security?</h2><p><span>This question is all about the liquids: drops, salines, and cleaning and disinfection solutions. There are size limitations and also substance restrictions.</span></p><p><strong>COMPLIANT LIQUIDS:</strong><span>&#xA0;</span>Within the<strong><span>&#xA0;</span><a data-cke-saved-href="https://www.tsa.gov/travel/frequently-asked-questions/what-3-1-1-liquids-rule" href="https://www.tsa.gov/travel/frequently-asked-questions/what-3-1-1-liquids-rule">TSA 3-1-1 rule</a></strong>, you can take multiple liquids in containers up to 3.4oz, all placed in a single quartz-sized clear plastic bag. However, it&apos;s important to note that hydrogen peroxide is considered an explosive and on this basis, sometimes TSA agents refuse to allow Clear Care solution through security, even though it is clearly labeled as a contact lens solution. As a result, we recommend traveling with multi-purpose solution instead and putting Clear Care in your checked baggage if necessary.</p><p><strong>MEDICAL EXCEPTION:</strong><span>&#xA0;</span>Under the<span>&#xA0;</span><strong><a data-cke-saved-href="https://www.tsa.gov/travel/special-procedures" href="https://www.tsa.gov/travel/special-procedures">3-1-1 Liquids Rule Exemption</a>,</strong><span>&#xA0;</span>you can take &quot;larger amounts of medically necessary liquids... in reasonable quantities... but you must declare them to TSA officers at the checkpoint.&quot; This means you can &quot;probably&quot; take them, but at the discretion of agents, so if you are risk-averse, it&apos;s better to stay within 3-1-1.</p><p><strong>INTERNATIONAL:<span>&#xA0;</span></strong>Once you&apos;re outside the USA, both the 3-1-1 rule and the medical exemption are completely irrelevant. It is very important that you research what&apos;s allowed in the countries you are traveling to or through. Some, like London Heathrow and Tokyo Narita, are notorious for grabbing those Purilens bottles or even smaller containers of saline.&#xA0;</p><p>Tips for international travel with sclerals:</p><ul class="ul1"><li class="li1">Contact the airline(s) you are flying with for country-specific restrictions, for any country you are traveling to or through.</li><li class="li1">We&#xA0;advise against traveling internationally with Purilens, ClearCare, or any bottled multi-purpose solutions in your carry-on.</li><li class="li1">Bring plenty of the smallest size unit-dose vials of salines in your carry-on, as well as artificial tears, for immediate needs.</li></ul><h2 id="exceptions-its-always-the-agents-call"><strong>Exceptions? It&apos;s ALWAYS the agent&apos;s call.&#xA0;</strong></h2><p><span>Ultimately, decisions about what will pass through security are at the discretion of the security agent. You can argue, but neither the rules nor your doctor&apos;s letter of medical necessity will guarantee success. This is why&#xA0;</span><strong>we recommend always complying with the 3-1-1 rule</strong><span>&#xA0;(or equivalent in the country to/through which you are traveling), unless you have an acceptable back-up plan.</span></p><h2 id="beware-of-unexpected-gate-checking"><span>BEWARE of unexpected gate-checking!</span></h2><p>What if your scleral lens supplies are in your carry-on, but at the last minute you are forced to gate-check it because there isn&apos;t room in the overheads? One of our members found himself in this predicament, and suggests that you make sure your essentials are in your &quot;personal item&quot;, not a checkable carry-on bag.&#xA0;</p><p><strong>Tip from a frequent flier:&#xA0;</strong>Tell the gate agent that your medical supplies are in your carry-on, so that they help ensure you can bring it on board.</p><h2 id="carry-on-checklist">Carry-on checklist</h2><p><em>This is our recommendation of what to take in your carry-on if you don&apos;t want to rely on a medical exemption. This assumes that any additional items are either put in checked bags or can be purchased at the destination. Long trips require more careful advanced planning and probably a lot of solutions in your checked baggage.</em></p><table width="100%"><tbody><tr><td><strong>&#xA0;Suggested solutions (1-quart bag)</strong></td><td><strong>Insertion/Removal</strong></td></tr><tr><td><p><a href="https://dryeyeshop.com/products/scleralfil">Scleralfil</a> or <a href="https://dryeyeshop.com/products/nutrifill">Nutrifill</a> vials or <a href="https://dryeyeshop.com/products/purilens-plus-mini-saline-2oz-6-pack">Purilens Mini</a> 2oz bottles, enough to last the trip</p><p><a href="https://dryeyeshop.com/products/unique-ph-multi-purpose-solution?_pos=1&amp;_sid=f75bc6b1b&amp;_ss=r&amp;variant=6744190844971">Unique pH 2.5oz</a> (or equivalent MPS under the 3.4oz limit)</p><p><a href="https://dryeyeshop.com/products/optical-soap">1oz Optical Soap</a></p></td><td><p>Insertion &amp; removal plungers</p><p><a href="https://dryeyeshop.com/products/alcohol-preps-box-of-200">Alcohol preps</a></p><p>Hand towel to cover workspace - or try dental bibs!</p><p>Small mirror</p></td></tr></tbody></table><p>&#xA0;</p><h2 id="backup-lenses">Backup lenses</h2><p><span>If you are dependent on your lenses for vision, and especially if you are going on a long trip, you&apos;d be wise to take a backup pair along in case of lens loss or breakage.</span></p><h1 id="what-about-my-checked-baggage">What about my checked baggage?</h1><h2 id="48-hour-rule">48-hour rule</h2><p>A&#xA0;helpful rule of thumb is not to put anything in your checked bag(s) that you will need during the first 48 hours of your trip. This allows&#xA0;at least some time for recovery of missing bags, or replacement of missing items. However, if you are traveling internationally, you may need to allow more time.</p><p>Otherwise, checked baggage is the best place for your Clear Care, Purilens Plus, oversize multipurpose solutions, or large quantities of individual saline vials.</p><h2 id="dont-rely-on-tsa-rules-beyond-usa-borders">Don&apos;t rely on TSA rules beyond USA borders!</h2><p>TSA rules only apply within the USA. A common mistake for American scleral lens users is to rely on these rules when traveling in Europe or Asia.</p><h2 id="-1"><br></h2><h1 id="can-i-buy-it-when-i-get-there"><span>Can I buy it when I get there?</span></h1><p>This depends, obviously, on where you&apos;re going and whether you&apos;ll have time. If you&apos;re flying to a port for a cruise, for example, and plan on picking up your supplies before boarding, make sure you allow time for flight delays just in case.</p><p>If you&apos;re traveling<span>&#xA0;</span><strong>internationally</strong>, some research is in order. Ask the Facebook scleral lens group about availability of equivalent products sold in local pharmacies. Depending on your specific needs, you&apos;re probably best off bringing it all with you in checked baggage if possible.</p><h1 id="a-useful-travel-blog">A useful travel blog</h1><p class="p1"><span class="s1">Check out <a href="http://www.sarahartman.com/have-scleral-will-travel/">Sara Lynn Hartman&apos;s blog.</a></span> Sara has blogged extensively about traveling with sclerals, including going on <a href="http://www.sarahartman.com/sclerals-on-safari/"><span class="s1">safari in Tanzania</span></a>. Her detailed account of what she took and why, and how things played out, is invaluable.</p><h1 id="important-note">IMPORTANT NOTE:</h1><p><span>FOR INFORMATIONAL PURPOSES ONLY. THIS GUIDE IS COMPRISED OF PEER-TO-PEER SUGGESTIONS, NOT MEDICAL ADVICE. CONSULT YOUR EYE DOCTOR&#xA0;WITH ALL&#xA0;YOUR EYE CARE AND LENS QUESTIONS.</span></p><h1 id="-2"><br></h1>

Scleral lens user tutorial