Clinical Report: Scleral Lens Filling Solution Guide and Corneal Health

Overview

Selecting the appropriate preservative-free saline solution for scleral lens filling is crucial for optimizing corneal health, patient comfort, and reducing complications such as midday fogging. Different saline formulations—nonbuffered, buffered, and electrolyte-enhanced buffered—offer varying benefits and costs, necessitating tailored recommendations based on individual patient ocular surface conditions and sensitivities.

Background

Scleral lenses require filling with preservative-free saline prior to application to maintain corneal hydration and comfort. However, multiple saline options exist, each with distinct chemical properties affecting pH balance and electrolyte composition. Recent manufacturing recalls and supply shortages have complicated patient access to preferred saline solutions. Incorrect use of preserved or reused saline can lead to corneal toxicity and microbial infections, underscoring the importance of proper saline selection and patient education.

Data Highlights

Three main categories of preservative-free saline solutions for scleral lens filling include:

• Nonbuffered saline: widely available, lower cost, variable pH, potential stinging in sensitive patients.
• Buffered saline: pH balanced to mimic tears, better comfort for pH-sensitive patients, higher cost, larger bottle size.
• Electrolyte-enhanced buffered saline: mimics natural tear chemistry, may reduce epithelial cell sloughing and midday fogging, most expensive option.

Key Findings

• Nonpreserved saline is essential for scleral lens filling to avoid corneal toxicity and discomfort.
• Buffered and electrolyte-enhanced saline solutions provide better pH and electrolyte balance, improving comfort and potentially reducing midday fogging.
• Patients with ocular surface disease benefit more from buffered or electrolyte-enhanced saline, while those with healthy ocular surfaces may tolerate nonbuffered saline.
• Cost considerations influence patient choice; nonbuffered saline is generally less expensive but may cause stinging in sensitive individuals.
• Reuse of single-use saline vials increases risk of microbial infection and should be discouraged.
• Practitioners should educate patients on saline options and provide samples when possible to optimize lens wear outcomes.

Clinical Implications

Clinicians should individualize saline recommendations based on the patient’s ocular surface health, sensitivity, and cost constraints. Emphasizing the exclusive use of preservative-free saline and discouraging reuse of vials can prevent complications. Providing patient education and access to various saline options may enhance comfort, corneal health, and scleral lens wear longevity.

Conclusion

Choosing the appropriate scleral lens filling solution is a personalized decision that significantly impacts corneal health and patient comfort. Tailored saline selection and patient education are key to successful scleral lens wear and minimizing adverse effects.

References

1. Jeong et al, 2021 -- Microbiological evaluation of opened saline bottles for scleral lens use and hygiene habits of scleral lens patients