When a scleral lens patient presents with complaints of redness or irritation, do you have a default plan? Contact lens manufacturers can now provide practitioners with an amazing ability to alter lens parameters, including lens design and material. If it is not the lens, multiple examples demonstrate that ocular surface issues can contribute to adverse events with scleral lenses.

That being said, a default plan is very difficult to employ. Clinical experience shows that a unique approach is often needed each time. With our patients, we are often reminded that even though we have access to the latest equipment and lens design technology, nothing can take the place of a simple case history.

One of the most common noninfectious inflammatory adverse events seen at contact lens practices is a hypersensitivity reaction (Urgacz et al, 2015). Inflammatory complications can present as an acute red eye and commonly present with various forms of conjunctivitis. When dealing with scleral lens patients, the best way to avoid these issues is to ensure the patient is using the proper solutions, especially during lens application.

When it comes to fitting scleral lenses, we recognize the importance of properly educating patients on both filling and cleaning/disinfection solutions. As revealed by the Scleral Lenses in Current Ophthalmic Practice (SCOPE) study, there is a reasonable degree of consensus on solutions used for lens application (Harthan et al, 2018). The study found that 60% of the practitioners use single-use vials of non-preserved saline to fill the bowl of the lens prior to application. Using proper products, and knowing that there are commercially available options that have received U.S. Food and Drug Administration approval, allows eyecare practitioners to create a process that can limit opportunities for hypersensitivity complications.

With a specific education process for patients that may include exam room conversations, application and removal training, take-home materials, and even follow-up or telemedicine evaluations, there may still be instances in which patients slip through the cracks. In my experience, it’s not the new patients that practitioners have to worry about, it is the existing ones.

Out of convenience, patients may switch filling solutions. This might be a financial decision, or they may have no specific motivation at all. With patients that you have been seeing for years, don’t take for granted that they are doing what they were initially taught years ago. I recently found myself in an uncomfortable situation experimenting with parameter changes, only to later find out that the problem wasn’t the lens at all. Despite having years of experience, the patient decided to deviate from our original lens care process.

This case teaches a good lesson: Patient reminders are just as important as the initial patient education. It is interesting that such a potentially serious finding is not even diagnosed with a slit lamp or any other technical instrumentation. Processes are now in place to constantly remind patients (even the “seasoned” ones) of our recommendations. CLS

References

1. Urgacz A, Mrukwa E, Gawlik R. Adverse events in allergy sufferers wearing contact lenses. Postepy Dermatol Alergol. 2015 Jun;32(3):204-9.
2. Harthan J, Nau CB, Barr J, et al. Scleral Lens Prescription and Management Practices: The SCOPE Study. Eye Contact Lens. 2018 Sep;44 Suppl 1:S228-S232.