Scleral Lens User Guide: 5 - Lens Application (Insertion)
3. Prep and setup
4. Rinsing & filling
5. Lens application
6. Lens removal
7. Cleaning & disinfection
8. Midday fogging & debris
9. Storage & replacement
10. Traveling with sclerals
Items you might need
- Alcohol wipes (to clean plunger tips)
- Lighted magnification mirror to check for bubbles (i-Chek works for some users)
- DMV Scleral Cup
- DMV Vented Scleral Cup
- EZI Applicator ring for Mini-Sclerals or for Sclerals
- Dalsey Adaptives lighted inserter and/or plunger stand
- #8 O-Ring from a hardware store
Basic steps in lens application
- Wash hands with non-moisturizing soap and dry thoroughly.
- If you are using a plunger, make sure it's clean.
- Rinse and fill your lens (click here for more about filling solutions options).
- Hold upper and lower lids wide open.
- Apply lens. Tools and techniques vary a great deal- we have tips below, but follow the instructions from your provider for best results!
- Check for correct lens position and bubbles, and redo if needed.
Some people learn lens insertion from the get-go with no problems, especially if the lenses are relatively small or they have experience with other lens types.
For others, it can be anywhere from moderately frustrating to extremely challenging. Learning times vary from days to weeks to months. If you're having a hard time, please know that this is NOT unusual! Check out our survey about this.
- Lid spread: Getting them wide enough so that you can get the lens in.
- An "over-filled" lens, and keeping enough saline in the lens till it's on the eye. That means keeping the lens stable.
- Correct positioning: Centered on the eye and, for some lenses, ensuring it's oriented correctly (some lenses have dots intended to be at the top or bottom).
- Bubble prevention.
To accomplish all this, you will need to work out two things:
- What is the best tool for me?
- What is the best technique for me?
The answers are NOT the same for everyone - in fact, they're all over the map!
Here are all of the tools I know of. If you know another, please let us know.
- Fingers ("tripod" method)
- O-Ring: You put this on your finger to help hold the lens more stable.
- DMV Scleral Cup: This is by far the most common tool for scleral lens insertion. It is closed at one end, which allows for suction.
- DMV Vented Scleral Cup: Some prefer this, as they can see the light through the other end, which may help with centering.
- Home-made extensions for DMV scleral cups: Some people find that these are too short to conveniently use. I've heard of using anything from a plastic DMV case to a straw on the end of one to extend the length.
- EZI Lens Applicator Rings (available in two cup sizes and two ring sizes). These allow you to use a single finger to apply the lens, which provides more flexibility for use of your hands in spreading your lens.
- Silicone scleral cup, for those with severe latex allergy (it's rare for this to be a problem, but it happens)
- Dalsey Adaptives "See-Green" lighted inserter: This shines a green light through a specially sized plunger. It's very popular especially amongst low vision patients who have trouble with lens centration.
- Dalsey Adaptives "See-Green" plunger stand: There is a version of this for use on its own, and another for use with the lighted inserter. This is extremely beneficial for a variety of special needs, including those with Parkinson's patients to those with manual dexterity issues. Instead of putting the lens on your eye, you're putting your eye on the lens.
- Home-made plunger stands: I've heard of everything from a dixie cup with a hole for the plunger to a Dalsey Adaptives wannabe made from PVC piping. Whatever you rig, please be mindful of safety!
- Cliara Chio is a new member of this club, a dual insertion/removal tool which features a "quick release" mechanism.
- Under Construction -
More to come here soon. - I will be posting some new videos as well as links to some of the best of the videos about this on YouTube.
I think that the most important thing to know is that there is no single answer that will work for everyone. I use my right hand for both eyes; others switch hands for each eye. I stand up; others sit down. And so on through all the details of how it's done.
One little tip on lid spread: it's important for both your hands and your face to be quite dry. Slippery lids cannot be held reliably.
Tip from a user: WARM saline. Some have found that if they flinch too much when colder saline touches their eye, warming it slightly helps.
Does practice make perfect?
Sometimes it really is all about more practice.
But sometimes you won't make headway unless you change your technique or try a different tool.
If you find you are trying over and over and over and still can't get your lenses in, don't just keep trying. Take a break. Trying too long or too hard can result in very irritated eyelids or even corneal abrasions! Furthermore, the stress alone may be getting in your way. Your doctor's office needs to be providing plenty of support and training, and you can also reach out to fellow users on our Facebook scleral lens group.
If there is a bubble under the lens, it's going to cause problems. It's very important to ensure that before you get up and go, you check your lenses to make sure there are no bubbles, however small. Use a lighted magnification mirror for this. Sometimes a bubble can be felt or seen immediately, but they are certainly not always obvious. If your near vision isn't great, that makes it doubly hard to detect them.
Ask your doctor
Speak up if things aren't working for you. Part of the scleral lens dispensing process must involve plenty of training until you are able to safely, consistently and successfully put your lenses in. Your lens provider bears
Red or irritated eyes or lids from the insertion process? Let your doctor know.
Can't get them in without bubbles? Let your doctor know.
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.