Scleral Lens User Guide: Cleaning & disinfection
There are three steps in cleaning and disinfecting lenses, but not all of them are required for all users:
- MUST: Daily disinfection.
- SHOULD: Daily cleaning.
- MAYBE: Special cleaners - weekly, bi-weekly, etc. to remove unusually heavy deposits.
Items you may need
It's non negotiable.
If you don't think this is part of your instructions from your doctor, you have misunderstood the instructions and should as for a clarification. It's imperative that lenses be disinfected thoroughly according to manufacturer's instructions between uses. Every now and then I come across people who are storing their lenses in saline overnight - evidence of how easy it is to get confused amongst all the solutions and tools needed for scleral lenses.
Hydrogen peroxide is best.
Experts are pretty generally agreed about the fact that the best way to disinfect scleral lenses is with hydrogen peroxide. In the US, there’s just one brand left - Alcon’s Clear Care, though there are generics available from time to time. It’s preservative free and does a great job.
Clear Care comes with a special case that has a ‘catalyst disc’ attached. This disc neutralizes the peroxide over a six-hour period so that when the disinfection process is done, you don’t have to worry about having peroxide on the lenses that needs to be rinsed off. What’s left in the case is saline. The disc lasts a couple of months. You can’t tell by looking at it whether it’s used up.
Using ClearCare with large lenses?
The case that comes with ClearCare does not say what size lens you can use in it, but it’s easy to determine in practice that it can only safely accommodate lenses up to 15.5 or perhaps 16mm. Many people have successfully used this case for larger lenses by not closing the baskets, but many have also broken costly lenses this way. If you use the case for large lenses, just know that you’re doing so at your own risk - no one is going to cover the lens replacement cost for you.
Most of those of us with very large lenses use the PROSE Disinfection Case for hydrogen peroxide disinfection. It’s an unwieldy solultion, requiring the catalyst disc to be transferred from the Clear Care case, and you have to be careful not to dump that disc down your drain when you’re discarding the solution in the morning. But it works, and it’s the only thing on the market for this purpose.
Clear Care, or Clear Care Plus with Hydraglide?
Clear Care has been the 'gold standard' for a long time. Don't assume that the "Plus" version is better, but do find out and follow your doctor's recommendations.
We've heard lots of anecdotal reports over the years that Clear Care Plus leaves a film or for some users or is less comfortable. Anecdotes aren't science, but they do matter. If you are using Clear Care Plus and have any issues, just talk with your doctor about switching to Clear Care.
Hydrogen peroxide is not necessarily the most convenient or the cheapest, so not everyone uses it.
Other options are multi-purpose solutions such as Unique pH and Boston Simplus (both of which are compatible with Hydra PEG coating). There is also Lobob CDS, however, you can't follow the instructions on it to the letter because they are outdated, recommending them to be rinsed with tap water. For all others, you can follow manufacturer instructions, discard all the solution every day and replace your case monthly. If you are experiencing lens fogging or other issues, it might be time to talk to your provider about trying Clear Care instead.
I've talked to quite a few people who use a multi-purpose solution most of the time but disinfect with ClearCare once a week, which seems like a reasonable thing to do.
Do I have to?
Not necessarily, but... you probably should.
This is not the greatest of analogies, but think about the difference between hand sanitizer and thoroughly washing your hands with soap. If there is grime on the surface of your palms, sanitizing them won't remove it. There's just no substitute for "digital" cleaning of a lens if you really want to get it clean, not just disinfect it.
What cleaner should I use?
It's very important to ask your provider, or at least to know whether your lenses are coated with Hydra PEG, because if you use the wrong cleaner, it will strip that coating right off the lens. It's important to note that this does not damage the lens. Nothing wrong with an uncoated lens! But if you need the coating, be careful about cleaners.
For all other lenses, you get to use the good ones: Lobob ESC is the "gold standard" for thorough, quality rub cleaning. Miraflow or its generics are very good as well.
How do I do it?
Follow manufacturer's instructions. What I do is put a couple of drops of the cleaner in my palm with the lens, cup it and rub it for 10-20 seconds, then rinse off the cleaner and put it in the case for disinfection.
Some people use the little green contact lens cleaning pads instead of their palm. I haven't added those to the shop (yet) because I've been told they will strip the Hydra PEG coating and I'm concerned about people doing that by accident, but you can ask your provider if that's something you can use. But fingers work well.
Don't rinse it off with water!
You can rinse off cleaner with saline, or with hydrogen peroxide or multi-purpose solution, but don't use tap water, for rinsing off cleaner or at any other step in cleaning your lenses. Here's why.
Optional extra cleaners
None of these can be used on Hydra PEG coated lenses without stripping the coating. If you need extra cleaning steps, you may need to weigh the benefits of the coating against the benefits of an extra-clean lens.
Weekly enzyme cleaner
Unfortunately there's really one one of these left on the US market at this point so far as I know - Boston One Step, but it's good and it's convenient. It's a little vial of liquid that you dump into the disinfection solution. It's made for use with Boston products, but it's commonly used with Clear Care as well. Check with your doctor to see if you need it and if it's compatible with your lens.
Menicon makes this awesome cleaner, which we don't sell here largely because it's complicated to use and eyecare providers should be involved if you're using it.
Many doctors use ProGent on their patients' lenses every once in awhile during a visit to get them extra clean. Many patients use ProGent at home with their doctor's instructions, every week, or two weeks, or monthly.
Are my lenses getting clean enough?
This is a great question to ask your doctor at every visit.
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.