Steps in lens cleaning and disinfection

Like so many other things about scleral lens use, cleaning and disinfection processes vary a lot from user to user! Here's a quick snapshot of how it all hangs together:

Step 1: Rub cleaning

Rub cleaning removes any grime and deposits on your lenses. It's done between lens removal and putting the lenses to soak in your disinfection solution.

Why rub?

Imagine if you used hand sanitizer frequently but never actually washed your hands with soap and water. Thorough cleaning really does require rubbing.

Here's a recent study in case you're interested.

How to rub?

Most people place the lens in their palm, add a few drops of cleaning solution and rub it thoroughly on both sides.

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.

Which solution do I use?

Alas, the perenially popular Lobob ESC was discontinued in 2019.

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:

Sereine ESC

Miraflow

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.

• Your doctor should recommend a specific cleaning solution.
• 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.
• Be careful not to get any "red cap" solutions in your eyes!

Confused about solutions?

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:

• CLEANING ONLY, e.g. Lobob ESC (currently out of production): Red-cap cleaners that are used only for "rub" 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.
• 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.
• DISINFECTION ONLY: Hydrogen peroxide systems, e.g. Clear Care. Of course, these *can* be used to rub clean a lens, it's just that they aren'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.

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). Click here for details. Not sure if your lenses have this coating? Ask your doctor!

Step 2: Overnight disinfection

In between uses, scleral lenses MUST always go through a complete disinfection cycle in an approved disinfection solution.

Option A: Hydrogen peroxide systems

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.

Clear Care Pointers

• How it works: 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.
• Clear Care Triple Action vs Clear Care Plus with HydraGlyde: 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's no data, so the jury's out. Go with what your doctor's recommending, but if you're having comfort or clarity issues, it may be worth asking if you can try the other.
• 6 hour minimum. That's how long the disinfection takes to complete, so don't skimp! If you don't have six hours to spare, consider a multi-purpose instead, as they only require four hours.
• Lens size matters! 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 "bowl depth" may also determine which case you can safely use. Also, be forewarned, the PROSE case is quite large and a hog for solution.
• Careful with the baskets! With both case types, pay close attention as you're closing a lens in the basket to avoid sudden movements that can damage your lens. 

Lens pictured: 18.5mm scleral lens Left: Clear Care case Right: PROSE Case.

Option B: Multi-purpose solutions (MPS)

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.

Again, please be mindful of Hydra PEG compatibility if applicable to your lenses! Each of the solutions pictured is compatible with all types.

User mistakes

• Leaving lenses overnight in preservative free saline
• Using water to rinse off a cleaning solution
• Breaking a lens in a basket case
• Cleaning, but not disinfecting

Step 3: Optional extras for a deeper clean

If you are a "heavy depositor", there are some extra deep cleaning options that your doctor may recommend or that you may wish to ask them about. (Sorry - neither of these is Hydra PEG compatible!)

• Boston One Step: Sold in single-use vials, this enzyme cleaner can be added to your overnight disinfection solution.
• Menicon Progent: This is a more complicated deep cleaning regimen that you should only do with your doctor's approval and carefully following the instructions. A "Progented" lens is as clean as a lens will get! 

How do I know my lenses are getting clean enough?

That is a great question to ask your eye doctor! They can examine your lenses for deposits.

Stubborn deposits can actually "etch" a lens. If you are scrubbing and scrubbing but still see "white stuff" on your lens, take it in for your eye doctor to examine.

What about my lens case and plungers?

Soap, water and thoroughly air dry, unless your doctor instructs you otherwise.

Don'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 'self-policing'. Plungers can be kept as long as they work, as long as you are cleaning them frequently.

Don't forget: No tap water!

IMPORTANT NOTE: 

FOR INFORMATIONAL PURPOSES ONLY. THIS GUIDE IS COMPRISED OF PEER-TO-PEER SUGGESTIONS, NOT MEDICAL ADVICE. CONSULT YOUR EYE DOCTOR WITH ALL YOUR EYE CARE AND LENS QUESTIONS.