Scleral Lens Tutorial 4 - Rinsing & Filling
About solutions for FILLING scleral lenses
Finding the right solution to fill your lenses can be surprisingly complicated! There are safety issues, and issues affecting vision and comfort for some users. Then there's availability, cost, shipping and more!
Choose preservative-free ONLY!
Make sure you only use preservative-free solutions in your lens. All preservatives, no matter how mild, are toxic to the cornea. The solution(s) you put in your lens will be held against the eye all day long.
|YES: Preservative-free||NO: Preserved|
- If it's preservative-free, it will ALWAYS say so on the front of the box!
- Preservative free saline solutions are usually not sold in drugstores.
- Preservative free salines can be used for filling lenses, but NOT for soaking or storing lenses. We'll discuss that more in Topic 7.
Multi-purpose solutions are not labeled with scleral lenses in mind. Sometimes people get confused by the instructions on those solutions, and think that it's saying they can use it on the lens immediately prior to insertion.
Keep it simple - stick with preservative-free only.
Buffered or unbuffered?
Buffered salines (ScleralFil, Nutrifill and Purilens) have additives that raise the pH to match the pH of the eye. For many users, buffered salines are more comfortable, fog less, and for some, seem to provide better vision. The very newest saline on the market, Nutrifill, also contains added electrolytes.
Unbuffered salines are acidic and contain only sodium chloride and purified water. They are commonly used with success by many scleral lens users.
"On label" vs "off label"
Scleral lenses are specialty lenses - a relatively small niche in the contact lens world. As a result, not many products are designed, tested and labeled specifically for use with scleral lenses yet.
A solution is considered "off label" when it is being used for something other than the purpose for which it has been tested and labeled to the FDA's satisfaction. Many products are used "off label". If you are using something "off label", make sure your doctor has approved your use of it.
|Labeled for filling scleral lenses||"Off label"|
Scleral lens "cocktails"
Some scleral lens users add one or more drops of a preservative-free lubricant drop (a/k/a artificial tears) to the saline in their lens. Some even use preservative-free lubricants to completely fill the lens. That's an expensive approach, but sometimes it's just all about what works.
Why do people do this?
- To prevent debris from collecting under the lens
- To prevent midday fogging
- To improve vision
- To improve comfort.
Using artificial tears in the lens is not guaranteed to do any of these things, but this kind of use is widespread because it does seem to work for a lot of people. The most popular "supplemental" drop of this type over the years has always been Refresh Celluvisc, but these days people are using many others, including some of the brands with sodium hyaluronate such as Oasis.
If you are considering this approach, please talk to your eye doctor, and remember that this is an off-label use of lubricant drops.
When to discard your vials or bottles
Single-use vials: Discard same-day. Not only are these vials easily contaminated, but if they are the unbuffered type, they are also believed to become more acidic after opening. Refrigeration isn't a fix.
Purilens bottles: We recommend getting specific guidance from your doctor on how long you can use Purilens bottles for filling.
Preservative-free salines are available in the following sizes:
|5mL||Addipak, Modudose, LacriPure|
|10mL||Nutrifill (not pictured), Scleralfil|
|2oz||Purilens Mini (not pictured)|
Since 2016, no preservative-free contact lens salines have been sold in drugstores. However, you may purchase sodium chloride 0.9% vials in drugstores with a prescription. Also, some lens providers stock salines in their practice for their patients' convenience.
That's our specialty, of course, and we're always here to help at dryeyeshop.com. Preservative-free salines are our most popular subscription items.
About solutions for RINSING scleral lenses
When do we rinse?
Here are the three times we most commonly want to rinse our lenses:
- Rinsing off disinfection solution in the morning before filling and insertion
- Rinsing lenses while removing and re-applying during the day due to fogging or mucous in/on the lenses
- Rinsing off cleaning solution after rub cleaning, before placing the lenses in a case for overnight disinfection
Not everyone needs this much rinsing. Not everyone uses a rub cleaner, for one thing. And many people who use Clear Care overnight don't bother to rinse it off because after the neutralization process it's basically been converted to preservative free saline.
What can we safely rinse our lenses with?
1. Preservative free saline
Using preservative free saline for both rinsing and filling is a good option because it keeps things simple and safe.
However, it's expensive!
2. Preserved saline
Many scleral lens users are able to economize by using preserved saline such as Bausch & Lomb Sensitive Eyes Saline Solution. This can be used for rinsing lenses prior to disinfection or rinsing off cleaning solutions. However, prior to re-inserting your lenses, you should do a final rinse with preservative free saline to remove any preserved saline from the bowl of the lens.
3. Preserved multi-purpose solution
Similarly, multi-purpose solutions such as Unique pH can be used for most rinsing. Again, do a final rinse with preservative free saline to remove any preserved solution from the bowl of the lens.
4. DO NOT RINSE SCLERAL LENSES WITH WATER.
Due to risk of acanthamoeba infections, please don't ever use water to rinse your lenses, not even if you are going to disinfect them afterwards, because common disinfection solutions haven't actually been proven to neutralize acanthamoeba.
FOR INFORMATIONAL PURPOSES ONLY. THIS GUIDE IS COMPRISED OF PEER-TO-PEER SUGGESTIONS, NOT MEDICAL ADVICE. CONSULT YOUR EYE DOCTOR WITH ALL YOUR EYE CARE AND LENS QUESTIONS.