GP Insights

Optimizing Scleral Lens Handling

By Edward S. Bennett, OD, MSEd, & Stephanie Woo, OD

It is evident that scleral lenses are more popular for many good reasons. The challenge when incorporating them into contact lens practice is how to educate patients to master application and removal of larger lenses.
Here is an easy four-step process.

The Four Steps

1. Application Have the patient place the lens on a large DMV Scleral Cup (DMV Corp.) (Figure 1) or a scleral ring (Figure 2) and fill it to the brim with nonpreserved solution such as Optive Refresh Sensitive (Allergan). We have found the latter, the EZi Scleral Lens Applicator (Q-Case Inc.), to be most preferred by our patients for ease of application.

Figure 1. DMV scleral suction ring.

Figure 2. Scleral ring.

When applying the lens, the patient's face must be parallel to the ground, preferably over a mirror on a flat surface. With one hand, retract both lids, with the forefinger beneath the upper lashes and the thumb over the lower lashes. With the other hand, hold the suction cup to apply the lens. Once the lens is applied, the patient should release the lids before removing the suction cup. If a staff member is applying the lens, the patient can retract the upper lid while the staffer retracts the lower and applies the lens.

If the lens is tilted or has insufficient solution in the well, it is likely that bubbles will form and the lens should be reapplied. The patient should also have a towel over his lap for any spillage.

A third successful application method is via the use of a size 8 O-ring available from a hardware store (Figure 3).

Figure 3. An O-ring.

2. Removal In the traditional removal method, the forefinger and middle finger of the opposite hand (left hand for right eye) retract the upper lid. The same two fingers of the other hand (right hand for right eye) retract the lower lid against the eye and then push the lid up to eject the lens. A second method is to use a smaller DMV and have the patient place it on the lower lens edge and then pull down and out with the eye wide open.

In both cases, advise the patient to first instill a few rewetting drops and then nudge the lower lid against the lens edge to break any adherence that may be present before removing.

3. After Removal Instruct patients to use a GP multipurpose solution (MPS) to clean the lenses before storing in the MPS.

4. Before Leaving Advise patients to never use a preserved solution for lens application as it can be toxic to the eye. One option is to prescribe or have the patient purchase a 0.9% sodium chloride inhalation solution (3ml tray of 100 vials). Tell patients that this is an off-label use of this product, which is customarily used for respiratory therapy.

Easier With Education

Scleral lens handling can be as easy as handling other lenses with education. A beneficial education guide is available from the American Optometric Association's Contact Lens and Cornea Section at http://fs.aoa.org/email/clcs/CLCS0211S7b.pdf. CLS