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/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/tangible-fill">Tangible Fill</a></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% solution</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> and <a href="https://dryeyeshop.com/search?type=product&amp;type=pages&amp;type=articles&amp;q=purilens+saline" target="_blank" rel="noopener noreferrer">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.&#xA0;</p><p>Unbuffered salines (<a href="https://dryeyeshop.com/products/lacripure">Lacripure</a>, <a href="https://dryeyeshop.com/products/tangible-fill">Tangible Fill</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 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/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/tangible-fill">Tangible Fill</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 are also believed to 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>5mL</td><td><a href="https://dryeyeshop.com/products/lacripure">LacriPure</a>, <a href="https://dryeyeshop.com/products/vibrantvue-scleral-saline">VibrantVue</a>, <a href="https://dryeyeshop.com/products/tangible-fill">Tangible Fill</a></td></tr><tr><td>10mL</td><td><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-saline-2-oz-size?variant=41422168719403" target="_blank" rel="noopener noreferrer">Purilens Mini</a> (not pictured)</td></tr><tr><td>4oz</td><td><a href="https://dryeyeshop.com/products/purilens-pf-saline-4oz?variant=41422163017771" target="_blank" rel="noopener noreferrer">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 dr&#x2202;yeyeshop.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

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

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 and Purilens Plus. Another way to modify the filling solution is to add preservative free artificial tears (see also &quot;filling solution viscosity&quot;, below).</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. <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. <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. <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. <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 <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

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> </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> vials or <a href="https://dryeyeshop.com/products/purilens-plus-saline-2-oz-size?variant=41422168719403" target="_blank" rel="noopener noreferrer">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

Part 3: Rinsing & filling

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

Part 7: Cleaning and disinfecting scleral lenses

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

Part 10: Traveling with sclerals