Many of us have orientation dots on our scleral lenses that we have to place at the 12 o'clock (or 6 o'clock, depending on our instructions) position in order for our lenses to settle correctly into place. [NOTE: Not everyone has orientation dots; some people just have a dot to distinguish right from left lens. If you are unsure, please call your lens provider for clarification.]
However, if your vision is poor enough to need sclerals, it can be very hard to see them especially when they begin wearing off.
Reader CATHLEEN shared the following story and tip!
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Wanted to share with you all an insight that I discovered after many months of struggling with my scleral lenses!
I thought I had keratoconus at first, but I actually just have screwed up corneas, can’t remember name of exact diagnosis, but the scleral lenses have given me the ability to drive again and not feel like I’m going to hit someone because I can’t read road signs or see stoplights without seeing four or five iterations of them!
Unfortunately, the vision correction for reading in my sclerals did not work for me at all, so I have to use reader glasses to read phone, computer, books, papers, etc.
It took several months of struggling for sometimes 20 minutes to get used to putting the sclerals in my eyes AND finding the tiny dots on the lenses so I could make sure they were on the bottom.
All of a sudden one day I put on my readers to find the dots on the lenses, and I had an epiphany! That’s how I find the dots! Can’t believe it took me so long to figure that out!!!
So please tell all your new scleral folks out there that if they struggle to find the dots, to buy a cheap pair of readers, mine are 2.50 strength, and I bought them at the dollar store for $1.25! They made all the difference in the world in locating those tiny little dots! I just love your website Rebecca, and it has been a source of so much incredible information and encouragement to me and I can’t thank you enough!
Cathleen
]]>PROBLEM: Sticky adhesives that are terribly irritating to the eyelids.
SOLUTION: Put a skin product underneath it.
Your mileage may vary!
]]>Do you sometimes need to take your lenses out during the day for a little while, in order to:
Place your lenses in a case filled with a MULTI-PURPOSE SOLUTION
Due to acanthamoeba keratitis risk:
Never store your lenses in (or rinse them with) water
Never store your lenses in preservative-free saline (e.g. Scleralfil, Purilens, Nutrifill, VibrantVue, Lacripure, Addipak or any other sodium chloride 0.9% solution) or other filling solutions.
Dry storage is not suitable in between uses, only for long-term storage of non hydra-peg coated lenses; they need to be disinfected before next use.
]]>For some new scleral lens users, slightly warm saline may help with lens insertion, particularly when you’re struggling in the initial learning curve.
If you’re properly filling your lens, the saline touches your eye before the lens does. When your eye feels the saline, it will want to blink involuntarily - especially if you have a very strong flinch reflex, or have never before worn contact lenses. Even if you manage to get your lens in, you may have spilled too much saline in the process to get it in without bubbles.
Saline that is body temperature does not trigger the same response, and that can help you re-train your eye not to flinch.
Some people keep a saline vial (unopened only, of course!) in their pocket for a bit before starting, others have reported putting it in the microwave for a few seconds. Careful though, don’t overheat it!
When I was about 12 years old and first learning to play oboe, my teacher imparted this little bit of wisdom:
“If there is something really sticky on one spot on your hand, it doesn’t do you any good to just keep washing your hands over and over and over. You have to scrub the sticky spot. Similarly, if you keep tripping up on a specific phrase or note, it doesn’t do any good to keep going back and playing the whole piece (or the whole page), over and over. You've got to isolate the problem, no matter how small, and work it out until you’ve mastered it completely, then move on and put it back in context.”
For more tips, check out the GOALS section and the TROUBLESHOOTING section in our Scleral Lens User Tutorial Part 5 - Insertion to help you isolate what's tripping you up with lens insertion.
Above all, if you have persistent troubles inserting sclerals, request additional training time. You need expert eyes on your technique. You should never feel embarrassed or hesitant to ask; this is part of your provider's obligation to you.
]]>These days, most eye drop brands come in many varieties. Sometimes the variations under the same name are similar - but sometimes they're actually quite different. So If you've ever said to yourself "I like brand X" or "I tried brand Y and it didn't work for me", don't forget that you may only have tried one of many products that happen to be linked under the same brand family. This email series is to help demystify some apparently minor differences between drops and highlight things you may have glossed over in searching for The Next Drop to Try.
Note: This table does not cover most inactive ingredients. You can find all those in our ingredient guide (linked below).
Product |
Active Ingredient(s)
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Inactive ingredient(s) of interest |
Notes
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CMC ONLY |
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Carboxymethylcellulose sodium 0.5%
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-
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Least likely to blur vision? Same base as Celluvisc but half the concentration.
|
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Carboxymethylcellulose sodium 1%
|
-
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Thick!
Also popular with scleral lens users as a supplement "in the bowl". |
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CMC & GLYCERIN |
||||
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Sodium hyaluronate
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Only one with hyaluronate
Available in multi-dose preserative-free bottle |
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Carboxymethylcellulose sodium 0.5%
Glycerin 0.9%
|
-
|
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CMC, GLYCERIN, POLYSORBATE 80 |
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Carboxymethylcellulose sodium 0.5%
Glycerin 1% Polysorbate 80 0.5% |
Castor oil
|
Same as Digital
|
||
Carboxymethylcellulose sodium 0.5%
Glycerin 1% Polysorbate 80 0.5% |
Castor oil
Flaxseed oil |
|||
Refresh Digital
|
Carboxymethylcellulose sodium 0.5% |
Castor oil
|
Same as Optive Advanced
|
|
OTHER |
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Mineral Oil 42.5%
White Petrolatum 57.3% |
Lanolin alcohol
|
Very popular ointment. Less petrolatum than most others.
|
Read more about eye drop ingredients on our reference list:
Ingredient Guide for Drops, Gels, Ointments & Sprays
Also check out any OTC eye drop sold in the US at:
]]>Today's blog post was prompted by a question on last week's scleral lens survey. The question and answer are at the end of the post.
For a very long time, some people have added one or more drops of Refresh Celluvisc to the bowl of their scleral lens before insertion.
A key motivation for the original "Celluvisc trick" was specifically to impede debris/mucous from migrating underneath the lens.
The classic situation was patients with serious ocular surface diseases (Stevens Johnson, GvHD, Sjogrens, OCP, etc) whose corneas needed the fluid reservoir that a scleral provides but whose conjunctiva were constantly producing more mucous, which would creep under the lens and lead to cloudy vision as the day progressed. The addition of Celluvisc, for some reason, seemed to help keep their lens reservoir clearer.
Fast-forward to today. In the past 20 years, scleral lenses have transformed from almost unknown to very popular for many corneal diseases, including, increasingly, dry eye. (They are now also being promoted to many people with healthy eyes, but that's another story.)
And lots of people getting sclerals translates into a wide variety of experiences and issues - particularly as regards lens fogging, deposits, and lens comfort. So there has been a lot of experimentation, to the point where we sometimes joke about all the "cocktails" people are mixing up in their lenses.
Possibly. Here's my suggestion of a little practical test.
In other words, IF you're having issues, and IF you've ruled out other obvious causes. Honestly, this is pretty cheap and easy to try, so I would think of it as a "can't hurt, might help" type of thing. If you're struggling with persistent midday fogging, don't forget to check out our tutorial.
Please understand that there are NO lubricant eye drops (a/k/a "artificial tears") at all that are labeled for the purpose of filling scleral lenses. I'm not sure there ever will be, either, because this is such a "niche" need.
So, putting lubricant drops in your lens is an "off label" use of the drops and should - like ALL your scleral lens solutions, be cleared with your eye doctor. In the scleral lens world, over the years, "off label" has been the norm for many of our solutions - from Unisol 4 to Addipak and others. There are certain usages that have gradually come to seem generally accepted as safe practices That doesn't mean your eye doctor will necessary consider them appropriate for you or helpful for you, so don't forget to have that conversation.
Anyway, on the basis of that "off-label" understanding, here are some "guard rails" for using drops in your lenses:
Bit of a mystery. No one really knows for sure. We know Celluvisc is one of the thickest preservative-free drop on the market, and it may have been the only thick one on the market when this whole idea got started. Some feel that the viscosity helps keep any debris from migrating under the lens. It's also probably affecting the pH of the solution, which could conceivably have an effect on fogging or comfort, though who knows what the resulting pH of it is considering people historically add different amounts of drops to different types of saline.
In recent years, many people have reported using other preservative free tears in their saline. The one I have personally heard about most is Oasis Tears (or Oasis Tears Plus), though honestly, people are experimenting with a wide variety of tears now in the quest for comfort and clarity.
At the end of the day, Celluvisc still appears to be by far the most popular drop for this purpose. We will run a survey about this soon to get a better handle on current trends!
This is the reader question that originally prompted this blog post!
Unfortunately, I don't have a short answer. But I do have some thoughts to share.
My first thought is always this: what is the reason for this need, and is the doctor in the loop (in case there's a medical piece that needs addressing)? Maybe the problem is allergy and it can be helped with allergy drops. Maybe it's blepharitis and an eyelid wipe used night and morning could help.In fact, I think another person commenting on the survey described a regimen that includes both of these. But these are just examples. There are so many possibilities.
My second thought is to make sure you've tried the buffered PF saline brands first (particularly Nutrifill and Scleralfil). I know those are more expensive than most unbuffered salines, but even a more expensive saline is cheaper than having to buy both artificial tears and saline for the lenses.
Next, about alternative lubricants. Since we don't necessarily know why lubricant drops help, it's very difficult to identify good alternatives. But if we assume that Celluvisc helps, at least in some cases, because of how thick it is, then I would suggest drops that are thick but NOT OILY - and make sure they are also not preserved. You might find our ingredient guide helpful.
The drop I most frequently hear about people using in sclerals, other than Celluvisc, is Oasis. But that's more expensive rather than cheaper! - Unless, of course, you get the multi-dose preservative-free bottle. This has a lot more drops than a box of 30 vials, and it has the advantage that you aren't tempted to stretch out a preservative free vial day after day leading to non-sterile drops.
...Which leads me to my net-to-last point, which is that MDPF (multi-dose preservative free) bottles are definitely the way to go for cost savings of any lubricant drop that you add to your sclerals, assuming you are just adding a few drops at most per day. Don't forget, though, most brands of MDPF bottles need to be discarded 90 days after opening.
Finally, as regards decent PF drops at low cost, Refresh Plus is available in bulk at Costco. Depending on the specific need, this may or may not work well enough. But Refresh Plus is the same active ingredient as Celluvisc, just a lower concentration, so it may be worth a try.
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