Preservative-free saline guide

What brand of preservative free saline should I get?

NOTE: This video is a bit outdated as it was made before Nutrifill was launched.

Overview

Product	*Buffered?**	Size	Notes

Purilens Plus	Yes*	4oz bottles - box of 3 or 12 2oz travel bottles - sold in box of 6 ("Mini")	Economical packaging for heavy users Too much for people who only use a little Similar to the former Unisol 4 Ask your eye doctor how long it is safe to keep this open for filling sclerals - due to potential bottle contamination, many doctors do not support the use of this product up to the manufacturer's "use within" limit of 14 days.
NutriFill	Yes*	Box of 35 10mL vials	"Electrolyte-enriched" Considered the "top of the line" scleral lens filling solution.
ScleralFil	Yes*	Box of 30 10mL vials	Handy size for travel Labeled for use with scleral lenses
LacriPure	No*	Box of 98 5mL vials	Vials are easier to open than Addipak & Modudose Labeled for use with scleral lenses
VibrantVue Scleral Saline	No*	Box of 100 5mL vials	Vials are similar to Modudose Labeled for use with scleral lenses
Addipak, Modudose etc	No*	Box of 100 5mL vials, or Box of 24 15mL vials	Acidic! pH believed to be 5.5 or less. Sold for respiratory therapy. Use with scleral lenses is off-label and should only be done on doctor's recommendation. If you purchase these from a pharmacy rather than online, they will require a prescription.

Buffered or unbuffered?

Unbuffered salines have two ingredients: Purified water and sodium chloride (a/k/a salt). These are often labeled as sodium chloride solution.

Buffered salines have four ingredients: Purified water and sodium chloride PLUS two ingredients for buffering purposes: sodium borate and boric acid.

Why add buffers to salines? The reason for buffers is to raise the pH to more closely match the pH of our natural tears, and to stabilize the pH so that it doesn't get more acidic after opening the way simple unbuffered saline can.

What's the pH thing all about? The pH of the human eye tends to be around 7. Straight sodium chloride solution (i.e. unbuffered preservative free saline) is acidic, with a pH around 5.5 - or less. Furthermore, without buffers, the pH can drop lower after opening, which doesn't necessarily matter if you're using single-use vials and use them immediately after opening, but for larger packages or bottles, it matters more. Buffered salines aim for a pH around 7, just like the eye, on the assumption this will be more comfortable in the eye.

Based on years of purely anecdotal evidence from scleral lens and PROSE users... for many, the absence or presence of buffers does not seem to make any difference at all and they've happily used Addipaks off-label for forever.

However, for some users, particularly those with dry or sensitive eyes and/or with an extensive history of corneal disease, the acidity of unbuffered saline seems to cause eye irritation, a burning sensation, and/or a tendency to lens fogging. Fogging is an especially pervasive and frustrating problem for scleral lens users.

Therefore, historically, those with the most complex medical histories have tended to prefer buffered salines for use with PROSE and full size scleral lenses. (Unisol 4 and Simply Saline, both now discontinued, were buffered salines as well, with the exact same ingredients as Purilens Plus and ScleralFil.) On the other hand, some doctors may have concerns about the buffers themselves being an irritant for some patients. As with all solutions for scleral lenses, discuss your choice with your doctor, for sure!

Why isn't this better known?

Unfortunately, there is very little published literature about the question of buffered versus unbuffered salines. Here's an article from May 2019 that's worth reading. It reports a case series in which four out of five scleral lens users with dry eye preferred buffered saline.

What size?

Many patients, especially those fitted with standard scleral lenses and using ClearCare as their only cleaning regimen, do not need a lot of saline to fill their lenses. In those cases, the 5mL sizes such as LacriPure tend to meet their needs the best. For those who do a lot of rinsing, for example, rinsing daily cleaners off PROSE, or rinsing cleaners or disinfection agents off Hydra PEG coated lenses, Purilens Plus tends to be more practical as it has the lowest cost per volume and it's the only one in a bottle you can keep for awhile. Additionally, many people use Purilens at home and single use vials when traveling.

Don't forget!