Scleral lenses are a great technology for many reasons, but it comes with a lot of gear and things to keep track of. From plungers for removing to stands for inserting, and plethora of solutions for cleaning to those that fill the lens there is a lot to learn and for the novice the details can be overwhelming. This guide should help you navigate what your solution options are for your scleral lenses and what is best for your specific needs, without asking strangers online for help; if you have a lens coated in Hydra-Peg, it needs special care and has its own section below. If you want to learn about rinsing and filling options, see this article.
To remember the details of lens care, I created this acronym; the red cover reminds you every time you clean!
Remove lens –> Eliminate surface debris –> Disinfect and Condition overnight
–> Amply rinse & fill –> Place lens on eye
Keep them straight: is the solution safe for the eye?
For scleral lens solutions, there are 2 main solution categories: things that don’t touch the eye (think cleaners, disinfection or conditioning) and those that come in contact with your eye (think for rinsing or filling the lens). Most of products that shouldn’t go in the eye have red caps; these are made with surfactants like soap, or have isopropyl alcohol or hydrogen peroxide to disinfect the lens. These cause a chemical burn to the ocular surface (cornea, eyelids and conjunctiva) and can be very painful. Thankfully, the tissue heals quickly, but I don’t recommend the experience.
One advantage of any RGP (rigid gas permeable) lens is it can be rinsed and inserted without harming the eye. The material may be permeable to oxygen, but molecules much larger like hydrogen peroxide can’t get through. So your Clear Care solution won’t get absorbed like it does with a soft contact. If you need to use the lens before the solution is neutralized, just rinse with copious amounts of saline and you’re good to wear it.
Cleaner and Disinfecting options
There are a variety of different cleaners on the market and RGP wearers should avoid ones containing abrasive components; RGP materials got softer to let more oxygen pass through them. Abrasive cleans scratch the surface making the lens wet poorly (which makes your vision blurrier) and can actually change the prescription by grinding down the lens material. (Examples of cleaners to avoid: Boston Original Cleaner, Boston Advance Cleaner and Target’s RGP contact lens cleaner, step 1 or Wal-mart’s Equate Enhanced Contact Lens Cleaner, step 1).
Should I use 1 or 2 step system?
The 2 step systems have a bottle of cleaner and a bottle of soaking solution for conditioning. It’s more complex, but some patients feel it cleans the lenses better than a multipurpose or 1 step system. The multipurpose solutions are super easy and more popular, so they are easier to find in pinch and cost less.
Multipurpose solutions: Good option to start with
For many patients, everything about scleral lens can be daunting at first, so I usually start them with a simple scleral lens solution option like this. If they are having issues, we can refine the cleaning regiment to treat their specific needs (poor wetting, lots of deposits, film forms over time, etc.) These are very versatile solutions as they can be used daily alone, or used as the first step of a 2 step system. Some are safe for the eye but most aren’t, you should rinse them before putting your lens back in.
Examples of Multipurpose solutions: Boston Simplus, Unique pH, Tangible Clean, MeniCare Plus, Equate Multi-Action Solution. These only disinfect well for about 90 days.
With or without Hydrogen Peroxide?
Did you know you can clean your scleral lens with Hydrogen peroxide solution? You can and it works well. Some multipurpose solutions don’t disinfect as well as hydrogen peroxide or the 2 step systems do. Hydrogen peroxide solutions don’t have preservatives or allergens and are still simple to use, but need time to neutralize. These were designed for soft lenses and don’t condition the lens as well as products made for RGP materials; I don’t find it causes issues for most patients and is my go-to option for beginning scleral wearers.
Hydrogen Peroxide options compatible with RPG materials: Clear Care Original, Clear Care Plus HydraGlyde and PeroxiClear. In a pinch, you can use brown bottle 3% hydrogen peroxide to disinfect, but it doesn’t have any surfactants or conditioners like product designed for contact lenses. You may need a larger case for some sclerals, and is available at the dry eye shop; remember to twist while pulling on the disc to get it off the clear care case.
HydraGlyde in Clear Care solution can sometimes make a scleral lens more comfortable, but for some it can leave a white residue on the lens and is not as comfortable to wear. The HydraGlyde doesn’t appear to affect the wettability and is compatible with all scleral lenses, including Hydra-Peg coating.
Tip: Clear Care style cases with metal disc will stop working well around about 90 uses (think 3 months).
How to use Multipurpose Solutions
- Remove lens
- Apply a few drops to each side of the lens
- Rub for 30 seconds (lather it up)
- Rinse off residue with tap water
- Place lenses into a clean and dry case
- Cover with fresh solution… the Same Solution
- Soak overnight (or minimum recommended time)
- Rinse off completely with saline before inserting
The 2 Step (No, not the dance!)
Remember, the first step of these systems does not disinfect the lens; you need both steps to ready your lens for wear. The abrasive cleaners fall in 2 step system.
The 2 step systems I recommend for daily use are non-abrasive and use surfactants (aka soap) to remove deposits. It’s vital to rub the lens until there is a lather to remove deposits and debris so the disinfection and conditioning solution can get to the lens surface. Think of this like washing dishes; if you let them soak in soapy water, a lot of food will come off over time, but scrubbing removes much more. These can be used everyday and are best right after you remove the lens. (Examples: Lobob Optimum ESC – Extra Strength Cleaner, Sereine Cleaner.)
There are extra strength cleaners that are alcohol based; these are great for removing oil (lipid) deposits, but it can lower the lens wettability if used daily. For patients who produce lots of oil deposits, I usually recommend using this a few times a week in addition to their daily multipurpose solution. (Examples: MiraFlow Extra Strength Daily Cleaner, Lens Fresh Extra Strength as well as Sereine Extra Strength Cleaner and Walgreens Extra Strength Daily Contact Lens Cleaner.)
Conditioning: TLC step
The second step in this system is for soaking overnight; it conditions the lens improving wettability as well as disinfects the surface. A conditioned lens is a comfortable lens. These solutions can go directly into the eye but it was designed for smaller lenses that would rinse the excess away after a few minutes. With a scleral lens wearer, there isn’t enough tear exchange to rinse this solution off and the scleral becomes less comfortable. Minimum disinfecting time is usually around 4-6 hours; your system will specify how long.
There are 2 products that are similar to the above but combined together. You’d use it similar to a multipurpose solution and must be rinsed off before re-inserting your lenses.
How to use Daily Cleaners:
- Remove lens (clean immediately after removing)
- Apply a drop of Cleaning Solution to each side of the lens (Red cap)
- Rub for 20-30 seconds (lather it up)
- Rinse off residue with water, then rinse with saline*
- Place lenses into a clean and dry case
- Fill case with fresh Soaking Solution (safe for eye)
- Soak overnight (or minimum recommended time)
- Rinse off excess with saline before inserting
*For my immune compromised patients or those with lower risk tolerance, I will recommend rinsing well with distilled water or saline rather than tap water, as a rare infection can occur from tap water. I feel the risk is low since the lens will be disinfecting overnight after this step. Some patients also rinse the lens with tap water to remove the soap, then rinse it briefly with saline; this is what I personal do unless its contraindicated for the lens or a patient is high risk for an ocular surface infection.
Options for a Hydra-Peg Coated Lens
Tangible Hydra-Peg is a hydrophilic coating that allows lenses to very slippery. This makes them very comfortable and are ideal for patients with dry eye, heavy depositers or those that fog the lens by midday. Annoyingly, they are harder to pick up due to being so slick. They also have limited options for solutions as the coating can be damaged or dissolved with abrasive or alcohol based cleaners. Progent or enzyme cleaners will also destroy it.
What can you use with it? Tangible Clean (designed specifically for the coating), Clear Care (with or without HydraGlyde), Boston Simplus or Menicon’s Unique pH. They don’t recommend using tap water on this lens at all; otherwise, you clean and disinfection it similar to any other multipurpose option. If you need to store this lens long term, you need to replace the solution monthly to ensure the coating isn’t damaged.
Scleral Lens Solution Special Mention
Menicon’s Progent is a very powerful cleaner that combines Sodium Hypochlorite + Potassiumm Bromide = hypobromide. Progent loosens deposit, and disinfects everything after 5 minutes. It’s important to follow the directions exactly. After, we recommend, rinsing with your normal conditioning solution for best comfort. We do this in our office, but it can be done at home. Menicon recommends doing this bi-weekly, but I don’t recommend doing this more than once a month; most of my patients benefit from this about 2-4 times a year. I find if you clean your lens well (aka rub every day), this is not needed much.
Tangible boost was created to help rebuilt the Hydra-Peg coating as life gradually wears on it. It has 2 vials you mix together similar to Progent (but its not the same! DO NOT use Progent on a Hydra-Peg coated lens it will dissolve it.) Let it soak for 30 minutes, rinse with multipurpose solution like Tangible Clean for 15-20 seconds then clean and disinfect like normal.
Boston Simplus has an enzymatic cleaner that helps remove proteins from the lens surface. You can also get it separately as Boston Liquid Enzyme Cleaner. To use: fill your case with soaking solution, add 2 drops to each side of the lens, and soak for at least 4 hours. Exact details are here.
Hypochlorous Acid cleaners
VibrantVue’s hand prep spray, hypochlorous acid and water, is an effective cleanser; it doesn’t need water after washing, and is safe to handle contacts; it’s alcohol free, and gentle on skin. This spray can be used in place of hand washing if you don’t have access to a sink. Using hand sanitizer right before handling lenses is not recommended.
Help! I don’t have 4 to 6 hours to disinfect!… Or I can’t find RGP solution!
Don’t have time to let a lens disinfect fully? In a pinch, rinse and rub with Clear Care or other solution to remove debris then rinse with copious amounts of saline to remove the hydrogen peroxide or other solvents. Don’t have saline, bottled water is usually available.
Solutions for your scleral lenses aren’t always available. If you find yourself in a place where you can’t find any solutions (think some places outside the US, or no pharmacy for miles), you can use 3% peroxide or soft lens solution to clean the lens, it’s better than tap water. It’s safer to store it dry than in tap water. (Acanthamoeba can live in biofilms on the lens and cause a devastating corneal infection.)
Clean your plungers
You have a clean lens but your inserting it with a dirty stand (large plunger with bottle cut off) or removing it with a oily plunger. We usually recommend cleaning your plungers with rubbing alcohol wipes (or on a cotton ball). Let it air dry for about a minute and its good to go for your next use. Some of my patients hydrate their plunger with artificial tears or saline to help remove the lens; I find if you need to do this every time you remove the lens, you should replace it. We sell them in the office or you can get them from dry eye shop. The recommendation is to replace them every 3 months.
Unsung hero: I couldn’t make this article without the dedicated teachings of Dr. Karen Lee, OD the past president of the scleral lens education society; not only does she do a great job of explaining this to her patients, she also educates doctors like me.