Troubleshooting scleral lens insertion

Posted by Rebecca Petris on

1. Technique

You have options. There are many techniques. The "right" one is the one that works for you.

Training matters. Did you get training from your lens provider? If not, and you find yourself struggling, call your doctor's office and ask for more help. BE FIRM. Your lens provider and their staff have an obligation to provide the training you need to make it possible for you to wear the lenses they are dispensing, and scleral lens insertion is a challenge for many new users.

YouTube. There are a ton of videos. Here's one example. Here's another. The insertion method in the first one is pretty much what I do. But it's helpful to just go to YouTube and search on "Scleral Lens Insertion" and watch several as you'll see it from different angles and get new ideas.

A helper. Some people need their lenses inserted by someone else. BostonSight has some helpful instructions for this: BostonSight PROSE Treatment Assisted Prosthetic Device Application

My way, personally? I use a DMV Scleral Cup, with suction applied to the lens to hold it firmly in place. I insert my lenses standing at my bathroom counter... many people find a table more suitable though. I overfill the lens (VERY important) so the saline is much higher than the lens. Then it's time for the lid spread. With my left hand, I use the index finger to pull the upper lid up by the lashes and the middle finger to pull down the lower lid. I'm facing down so my face is parallel with the counter. With my right hand I'm raising the scleral cup with my lens up to my eye. The solution hits my eye first but I don't let go of anything... I push very firmly before releasing the suction on the scleral cup. I don't loosen my grip on my lids till I am confident it's in place. - Back in the days when I sometimes didn't get it in the first time, I would dry my eyes and hands very carefully before trying again so things didn't get too slippery. - Oh, and a towel underneath, and washing hands with oil-free soap like Ocusoft before anything else. I know many other people use a magnifying mirror - I don't personally. This is just me. It would take more than my fingers and toes to count all the insertion methods I've seen or heard of.

 2. Tools

Different tools for different people! If your lens provider did not tell you that there's more than one type of inserter, please consider educating them... this is important. For some people, the tool makes all the difference in whether they can successfully insert a lens.

Here's all the possibilities I know of:

Fingers (tripod method). Never done it myself - not sure it can be done with lenses as big as mine, but apparently lots of people do it with mini-sclerals. Search it on YouTube.

Orthodontic ring: Here's a video example. This is probably best suited for smaller sclerals (16mm and smaller?). The idea is just something that will stabilize the lens on your finger. 

DMV Scleral Cup: This is the most common inserter. Most users of PROSE and other large (eg 17mm and up) lenses use the DMV Scleral Cup. It has a hollow shaft but is solid at one end. You squeeze it a little to put your lens on it and the suction holds it in place till you release it.

DMV Vented Scleral Cup: Same thing, with end chopped off so it's hollow all the way through. Incidentally, they're sold this way, so you don't have to chop it off yourself. (Same price.) Since it's hollow the light comes through the other end, which may help with centering the lens. 

Applicator ring: They look like the plastic base of a ring pop candy. You stick them cup-side up on your index finger (palm up). It makes it possible to insert your lens 

Dalsey lens insertion stand: Instead of putting the lens on your eye, you put your eye on the lens. Then the only role for your hands (after setting things up) is holding your lid open. 

Dalsey lens insertion stand with light: Ditto, but it has a light to guide you for centration. Very helpful to the severely visually disabled or patients with one seeing eye.

There's a couple of other innovative lens insertion implements I've come across - none that I know of that are commercially available yet though. If you know otherwise please let me know.

3. Temperament

Repeatedly trying to insert your lenses is very trying to the nerves! The harder we try, and the more we fail, the more anxious we get... and it becomes a vicious cycle. It turns into an ordeal to be dreaded every morning. Not good.

Deep breath. 

And a few more deep breaths!

First... if it's that hard, first, circle back to review techniques and tools. Something may need tweaking. Persistence on its own without more information and guidance could actually hurt you. Read up, call up your eye doctor, and get some help.

Second... Know that it won't always be this hard, and that TODAY will be the first better day! Focus on what you can do for your mental state before starting the insertion process, so that you can be more relaxed.

I remember when I was first fit with PROSE back in 2006 in Boston. Seemed like a piece of cake. No problem. Then I got home. I got so frustrated so fast. How was it possible that I had no trouble at the clinic, but at home I just could never seem to get my lids spread wide enough... and no matter what I did they were too slippery... Looking back, I know I got myself into a real anxiety loop. But it didn't last forever. It got better soon.

Third... SAFETY FIRST. Read on.

4. KNOW WHEN TO STOP!

I have fielded an awful lot of calls from people who are spending an hour or two every morning trying to get their lenses in. Some of them ended up with serious corneal abrasions. Trying the same thing over and over and over is not necessarily a good idea.

If your lenses are very difficult to put in and require repeated efforts for a long period every day, you need to circle back to your doctor and get more help because this is NOT normal, NOT okay, and may not be safe. If you feel your doctor is not providing enough support (unfortunately, I have had many reports of this) you need to take a firm position and make your needs clear to them, and if they do not redress the situation, you may need to change lens providers. Providing all necessary training is an obligation of any doctor dispensing scleral lenses. This is not the sort of thing where it's OK to just send the patient away to watch YouTube (although the videos can be helpful, of course).

5. Don't let it get you down!

Lens insertion needs vary greatly from person to person. If you're struggling, it's not because there's something wrong with you! It means you haven't yet got the information and training and practice that you need, or some impediment just hasn't yet been clearly identified and addressed. Patience, persistence, etc... it's a process! 


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2 comments

  • Thanks for the guidance and support. I’ve experienced most of the situations you describe, and now know to be patient and take it one (lens insertion) day at a time.

    Melanie Dzwonchyk on
  • Nice Blog. Thanks for sharing the very effective techniques to inset scleral lenses in troubleshooting situation. Keep up to the great work

    Jose Washburn on

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