Clinical Scorecard: The Scleral Lens Vault: Scleral Lens Filling Solution Guide

At a Glance

Key Highlights

• Preservative-free saline is essential for filling scleral lenses to avoid corneal toxicity and discomfort.
• Three main preservative-free saline types: nonbuffered, buffered, and electrolyte-enhanced buffered saline, each with distinct properties and costs.
• Selecting the appropriate saline depends on patient ocular surface condition, pH sensitivity, and cost considerations.

Guideline-Based Recommendations

Diagnosis

• Assess ocular surface health and patient sensitivity to pH when selecting saline solution.

Management

• Use preservative-free saline exclusively for scleral lens filling to prevent corneal toxicity.
• Consider nonbuffered saline for cost-sensitive patients with healthy ocular surfaces.
• Recommend buffered or electrolyte-enhanced buffered saline for patients with ocular surface disease or pH sensitivity.
• Provide patient education on proper saline use and risks of using preserved multipurpose solutions or reusing single-use vials.

Monitoring & Follow-up

• Monitor for signs of corneal discomfort, toxicity, or midday fogging that may indicate inappropriate saline use.
• Evaluate patient compliance with saline use and hygiene practices.

Risks

• Using preserved multipurpose saline can cause corneal toxicity and discomfort.
• Reusing single-use preservative-free saline vials increases risk of microbial infection.

Patient & Prescribing Data

Scleral lens wearers with varying ocular surface health and cost sensitivity

Tailoring saline type to patient needs improves comfort, corneal health, and lens wear time; offering samples and education supports adherence.

Clinical Best Practices

• Always emphasize the importance of using preservative-free saline for scleral lens filling.
• Match saline choice to patient’s ocular surface condition and pH sensitivity.
• Educate patients on risks of improper saline use and hygiene to prevent complications.
• Offer information and samples of different saline options to optimize patient comfort and lens performance.

References

• Jeong et al, 2021 - Microbiological evaluation of opened saline bottles for scleral lens use