Last spring, Contamac launched Nutrifill into the market. Nutrifill is a patented, preservative-free lens application solution that the company says is specifically designed for scleral lens wearers and the wearers of hybrid and GP contact lenses. It has been physiologically formulated to mimic the body’s natural tears, according to Contamac.

Nutrifill contains sodium, phosphate, potassium, calcium, and magnesium, which are all essential ions found in the tears. Contamac states that Nutrifill is the only FDA-cleared application solution containing the four additional electrolytes calcium, magnesium, potassium, and phosphate. The environment under a scleral lens provides little to no tear exchange for many hours, and it is believed that using strictly sodium electrolytes can potentially provide stress on the corneal epithelial cells, according to the company. By including the additional electrolytes, Contamac says that Nutrifill is designed to minimize that potential stress on the cornea.

Along with these five electrolytes designed to help contribute to a healthier ocular environment during lens wear, Contamac says that Nutrifill has a pH (7.4) and osmolality (300) to simulate the natural tear. Nutrifill is supplied in cartons of single-use 10ml ampoules for both wetting the lens surfaces and filling the lenses. Ralph Stone, PhD, is the inventor, patent holder, and developer of Nutrifill.

I recently had the pleasure to speak with two practitioners who are actively prescribing Nutrifill in their practices. This article will share their clinical experiences.

Please tell us about your general experience with Contamac’s Nutrifill.

“I have been fitting scleral lenses for almost 15 years, and I have never been happier with an application solution than I am with Nutrifill,” says Lynsey Bigheart, OD, who owns a private practice in Tulsa, OK. Dr. Bigheart explained that years ago, they used inhalation saline in her practice for the application of scleral lenses. More recently, before Nutrifill, they were using two other U.S. Food and Drug Administration (FDA)-approved solutions indicated for use with scleral lenses depending on the patient. “Both of these application solutions are good, but I still battled fogging or diffuse corneal staining with some scleral lens wearers,” she says. She has seen improvement with both of these conditions with the use of Nutrifill.

Stephanie Woo, OD, who owns a practice completely dedicated to specialty lens fitting in Las Vegas, has had similar experiences with Nutrifill. “Overall, my experience has been very positive. It is a great option for many patients and has also helped solve many issues related to scleral lens fogging, dryness, and decreased wear time,” she says.

Who are the best candidates for this product and why?

Dr. Woo states that any patients who wear specialty contact lenses such as scleral lenses or hybrid lenses are excellent candidates for Nutrifill. “Nutrifill is different from other products on the market because of the additional electrolytes such as potassium, calcium, and magnesium. When tested on rabbit corneas, researchers found less corneal edema when using Nutrifill compared to using preservative-free saline (Fogt et al, 2020),” she says. First-time scleral lens users are also good candidates for Nutrifill, according to Dr. Woo. “Each vial is 10ml, whereas some of the other options of nonpreserved saline may come in 3ml or 5ml vials. Patients just learning how to apply scleral lenses often go through a lot of saline in the beginning, and having a larger vial prevents them from having to open so many vials during the process,” she says.

Dr. Bigheart says that every scleral lens wearer is a good candidate for Nutrifill, but the best candidates are those who battle fogging throughout the day or patients who show diffuse punctate corneal staining after scleral lens wear. “Nutrifill has a pH and osmolality that simulate natural tears. It is also the only FDA-cleared application solution that contains four additional electrolytes,” she says. With so little tear exchange happening under scleral lenses, a filling solution that is more like natural tears may help prevent some complications with scleral lens wear.

Tell us about the prescribing process and what has worked best for you.

“At this time, all of my new scleral lens patients are prescribed Nutrifill, and I switch established patients to Nutrifill when I see them in-office for their routine visits,” says Dr. Bigheart. She always specifically prescribes the solutions and artificial tears that she wants her scleral lens patients to use, and those solutions and artificial tears are stocked in-office. “At each routine visit (about every six months for scleral lens wearers), we check with patients and make sure that they are continuing to use the solutions and artificial tears that I have prescribed,” she says.

Dr. Woo explains that for patients who already have compromised ocular health (corneal transplant, graft-versus-host disease, pemphigoid, etc.), she usually recommends Nutrifill right away. “Other patients often want to use their insurance benefits for the 0.9% NaCl inhalation solution, so we try that first. We will then use Nutrifill for troubleshooting when needed,” she says.

How has Nutrifill helped with troubleshooting for particular patients? Tell us about any success stories in that regard.

Both Dr. Bigheart and Dr. Woo noted that Nutrifill can help patients who experience midday fogging with scleral lens wear. “We’ve had some success with fogging. Some patients experience less fogging during scleral lens wear when they are switched to Nutrifill,” says Dr. Woo. “It doesn’t work for every patient, so we always explain to patients what they might expect when they switch to Nutrifill rather than promising results that we can’t deliver,” she continues.

Dr. Bigheart shared that before Nutrifill, she had a handful of patients who seemed to develop midday fogging regardless of what changes she made to the fit of the scleral lens. She instructed these patients to either insert a few drops of a more viscous preservative-free artificial tear with their application solution and/or to remove their lens midday and put in fresh solution. “Using the more viscous artificial tear in this way can become rather pricey, and removing the lens midday can be an inconvenience to many patients,” she says. “I have switched a majority of these patients who battled fogging to Nutrifill alone and have had great success. These patients are no longer spending their money on the thicker artificial tear or their time on lens reapplication,” she states.

Dr. Woo notes that some patients report extra hours of wearing time when they use Nutrifill. “I’ve had several patients comment that they could wear their scleral lenses for one-to-two hours longer after switching to Nutrifill,” she says.

Dr. Woo continues, “If a patient is having an issue that could be filling solution-related, I always try to switch them from what they are using to a different product to see if that solves their problem. Switching to Nutrifill has helped many of these patients enjoy more successful lens wear.” CLS

For references, please visit www.clspectrum.com/references and click on document #305.