contact lens care and compliance

Recommendations for GP Scleral Lens Care

BY MICHAEL A. WARD, MMSC, FAAO

The Global Specialty Lens Symposium (GSLS) took place in Las Vegas in January this year. This meeting was a gathering of scientists and clinicians interested in specialty contact lens fitting and management; it's a wonderful opportunity to share information with colleagues.

Scleral lens fitting appropriately occupied a significant portion of the agenda. Scleral lenses offer corneal protection and comfort to patients who have fragile corneal epithelia. Therefore, our choices of lens care products and procedures are critical to prevent epithelial compromise. Scleral lenses are manufactured from GP materials, therefore all approved GP lens care products may be used on scleral lenses. However, because of their fluid-reservoir nature and lack of significant tear exchange, our choices and recommendations for lens care take on even greater importance.

From conversations and lectures at the GSLS, it became apparent that a wide variety of lens care methods and patient instructions exists among scleral lens practitioners. Here I present our clinic's recommendations.

Cleaners

We recommend Miraflow Extra Strength Daily Cleaner (CIBA Vision), Optimum ESC (Lobob Laboratories) or Boston Advance Daily Cleaner (Bausch & Lomb) for daily cleaning after lens removal. Instruct patients to rinse their lenses thoroughly so that no chemical residue remains on the lens surfaces.

Disinfection and Storage

For overnight disinfection, we recommend hydrogen peroxide systems or chemical systems such as Boston Advance Conditioner (B&L) or Optimum CDS (Lobob).

Peroxides offer excellent disinfection without preservatives. Instruct patients to use such systems daily and to not store lenses for longer than a day. Peroxide-based systems are approved for longer storage times, but in reality they are deplete of any antimicrobial effect after a few hours. Because GP lenses don't absorb the storage solution, patients can safely rinse peroxides or chemical disinfectants from the lens surfaces. A morning saline rinse is recommended with all forms of disinfection.

Wetting and Fluid Reservoir

Patients may wet the lens surfaces by rubbing preservative-free artificial tears onto the surfaces before wearing. This helps create a wettable surface prior to filling the lens reservoir with saline.

Patients should fill the lens reservoir with unit-dose preservative-free saline or preservative-free artificial tears. We've found unit-dose preservative-free saline in 3ml and 5ml sizes labeled for inhalation therapy at various medical suppliers; this is simply non-preserved, sterile saline in one-time use vials, which is perfect for our purposes.

Instruct patients to not use preserved salines and MPS products to fill the lens reservoir, thereby avoiding chemical irritation of the ocular surface. Multidose non-preserved saline containers (e.g. Unisol 4 [Alcon] and PuriLens [The LifeStyle Company]) are prone to contamination, so we do not recommend their use with scleral lenses. Aerosol salines, though unpreserved, are not a good choice because nitrogen gas from the propellant may form bubbles under the lens as the gas comes out of solution.

Patients may use periodic enzyme cleaning provided that they follow it with thorough surfactant cleaning, rinsing and disinfection.

Advise patients that makeup and skin moisturizers easily contaminate lens surfaces. Proper lens care and patient instructions will maximize the significant benefits of scleral lenses. CLS

Mr. Ward is an instructor in ophthalmology at Emory University School of Medicine and Director, Emory Contact Lens Service. He is a consultant or advisor for B&L and AMO.