AN INCREASING NUMBER of patients who have dry eye and ocular surface disease wear scleral lenses for symptom control. Due to advancing scleral lens technology and research, eyecare practitioners now can tailor scleral lens treatment for dry eye patients.

Scleral lens wear requires the use of filling solution, and one commonly prescribed option is nonpreserved 0.9% sodium chloride vials, also known as inhalation/nebulizer saline. These vials were not initially designed for ocular or scleral lens use, but their nonpreservative nature has made their use ubiquitous over the last 15 years. Many scleral lens patients do well with this filling solution, although some report lingering symptoms of dryness, blurred vision, irritation, fogging, and/or incomplete resolution of symptoms during scleral lens wear.

As scleral lens wear has become more common, new filling solutions specifically designed for scleral lens wear have become available in preservative-free vials in the United States. These vials have been tested to assess their effects on the ocular surface. According to Schornack and colleagues (Schornack, Fogt, et al, 2023), 67% of patients use some version of a nonpreserved saline vial. A later investigation revealed that 41% of practitioners recommended nebulizer saline vials, while 37% recommended specific scleral lens filling solution vials (Schornack, Nau, et al, 2023).

In addition to using different formulations of nonpreserved filling solutions, other options for filling the lens reservoir include the use of artificial tears and autologous serum as additives to saline filling solutions. Additionally, scleral lenses have been explored as a drug delivery device for severe dry eye and ocular surface disease (Figure 1).

A study by Tan and colleagues (2022) discussed the use of artificial tears mixed with saline in the scleral contact lens prior to application compared to saline alone. Their study demonstrated that patients who added artificial tears to saline showed improved symptoms compared to those who used preservative-free saline alone.

Vilares Morgado and coworkers published a case report on the use of autologous serum in a scleral lens reservoir to heal a persistent epithelial defect in an ocular surface disease patient. This method of delivery is unique in that the autologous serum drops contain epithelial growth factors and anti-inflammatory cytokines, stimulating corneal epithelial growth.

Cyclosporine has long been used as a drug of choice for dry eye treatment. A recent pilot study found that placing 1 drop of 0.05% nonpreserved cyclosporine in the lens reservoir and filling the remainder of the lens with nonpreserved 0.9% saline effectively improved Ocular Surface Disease Index (OSDI) score, fluorescein corneal staining, lissamine conjunctival staining, and conjunctival hyperemia after 1 month (Nakhla et al, 2024).

There are many options to consider when prescribing a filling solution that can be used for scleral lens application. The dry eye patient population may benefit from closer attention to which type of filling solution is used and what other products can be added to the tear reservoir to aid in symptom control.

References

1. Schornack MM, Fogt J, Nau A, Nau CB, Harthan JS, Cao D, Shorter E. Scleral lens prescription and management practices: emerging consensus. Cont Lens Anterior Eye. 2023;46(1):101501. doi: 10.1016/j.clae.2021.101501

2. Schornack MM, Nau CB, Harthan J, Shorter E, Nau A, Fogt J. Current trends in scleral lens prescription, management, and evaluation. Eye Contact Lens. 2023;49(2):56-62. doi: 10.1097/ICL.0000000000000957

3. Tan J, Peguda R, Siddireddy JS, Briggs N, Stapleton F. Subjective responses to various filling solutions in the posterior fluid reservoir of miniscleral lenses at application. Eye Contact Lens. 2022;48(2):73-77. doi: 10.1097/ICL.0000000000000855

4. Vilares Morgado R, Moura R, Moreira R, Falcão-Reis F, Pinheiro-Costa J. New promising therapeutic approach for refractory corneal epithelial defects. Cureus. 2023;15(5):e39324. doi: 10.7759/cureus.39324

5. Nakhla MN, Patel R, Crowley E, Li Y, Peiris TB, Brocks D. Utilizing PROSE as a drug delivery device for preservative-free cyclosporine 0.05% for the treatment of dry eye disease: a pilot study. Clin Ophthalmol. 2024;18:3203-3213. doi: 10.2147/OPTH.S487369