Scleral Lens User Guide: Troubleshooting
- Difficulty with lens insertion (including buggles)
- Lenses are uncomfortable
- Difficulty with lens removal
- Lens loss
1. Difficulty with lens insertion (including bubbles)
Please see Lens Application page.
Fogging is one of the most frequent questions that comes up in our Facebook group.
It would be nice if there was a simple answer, but the fact is, there are a lot of different things that are referred to as fogging, and there are even more things that can cause it. So here are some possibilities:
- Lens fit: A lens that is not fitting quite right will be more prone to fog up.
- Hand washing and choice of soap: Any oils on your hands can transfer them to your lenses. Failing to wash your hands is not the only issue. A commonly overlooked problem is washing your hands with soap that contains moisturizers. Choose a moisturizer-free soap. Ocusoft is an excellent and very popular one, and Leader optical soap is good low-cost one. Free & Clear and many others are commonly used as well.
- The filling solution. We really don't know exactly why. Is it the pH, the viscosity, something else? All I know is what people are reporting fixes it for them - and that varies all over the place. Unbuffered saline (LacriPure, Modudose, Addipak) is acidic, with a pH typically around 5.5. Buffered saline (Purilens Plus, ScleralFil) is probably around 7. More information here about salines. Many people in the Facebook group report fogging being resolved simply by switching to buffered saline, while for some, it can make comfort worse. Another very common approach is to add Refresh Celluvisc or another preservative-free artificial tear to the saline (buffered or unbuffered), or even to fill the lenses entirely with PF artificial tears. Check this survey about lens filling preferences.
- The disinfection solution. Again, the whys aren't always available, but many people in our facebook group report a distinct improvement in fogging after switching from a multipurpose solutions (e.g. Boston Simplus) to Clear Care.
- The "rub" cleaning solution. For some, cleaning with Lobob ESC or Miraflow instead of a multipurpose solution makes the difference. But make sure the cleaning solution is suitable for your lenses - neither of these can be used with the Hydra PEG coating.
3. Mucous and deposits
This is one of the hardest problems to deal with. All I can offer right now are some random suggestions for things to explore.
The bottom line is, the more diseased the eye, the mucous it will produce, especially with a big foreign object sitting on it all day. So you have to do everything you can to reduce the reasons your eyes are producing mucous, then do everything you can to make the lenses and your eyes more willing to repel mucous for longer. It goes without saying that you should be consulting your lens provider before following any suggestions here!
- Optimize EVERYTHING first - the best possible filling solution for you, ClearCare for disinfection, and Lobob ESC for cleaning, if at all possible.
- Use Refresh Celluvisc in the lens - start with a drop or two in the saline, then increase if needed. Some people fill the entire lens with Celluvisc. The viscosity seems to sometimes help prevent mucous from getting under the lens.
- Use enzyme cleaners: Boston One Step and ProGent.
- Max out your dry eye treatments with a really good cornea specialist. Also, mucolytic eye drops if nothing else is working.
Random tip: I don't have a big problem with mucous, but when it's a problem it's actually always first thing in the morning. What helps me most is to do a warm compress and thoroughly rinse my eyes with saline a little while before putting in my lenses.
4. Lenses are uncomfortable
Is it the fit?
Lens discomfort may be a result of a lens not fitting quite right - too loose, too tight, edge riding up. If you suspect a fit issue, then the question becomes whether to continue wearing the lens till your next follow-up appointment.
Pay close attention to what your eyes look like after lens removal, and whether removal is difficult, and call your lens provider with any concerns.
Sometimes a lens that is actually too tight may be quite comfortable... till removal. Pay particular attention to new difficulties with removal.
Sometimes a lens that appears to fit perfectly in the doctor's office... feels tighter or uncomfortable later. Contact them if this happens.
Tip for doctor appointments: If you have issues with your lens after several hours; wear, make sure to schedule your appointment late in the day and wear your lens for several hours first (unless of course you've been advised not to) so that the doctor can see your eyes exactly as you are experiencing them. (Don't let the tech make you remove the lenses before you've seen the doctor.)
Is it the solution?
What you fill your lens with can directly affect lens comfort. Not that you will feel the lens more, but you might feel, for example, a little off or even a slight burning sensation. This might show up later in the day, or it might show up only after days of using the same filling solution.
What is it about the solution that might be bothering your eyes? Some of this, as you'll see, overlaps with saline differences that can result in fogging for some users:
- The pH of the solution. There are two types of preservative free saline - unbuffered, which is acidic (lower pH than the eye) and buffered, which is pH balanced for the eye. More information here. This can be changed by switching from unbuffered to buffered saline or vice versa, or by using artificial tears in addition or instead.
- Additives in the solution. Buffered salines - that is, salines with a pH adjusted to match the eye - contain simple additives to raise the pH. Some individuals are sensitive to these 'buffers' and need to avoid them. But if you switch from buffered saline to an artificial tear, check the ingredients of the artificial tear to make sure it doesn't contain the same buffers.
- Preservatives in the solution. Hopefully you know better than to use something preserved in your scleral lens, but if not, time to learn.
5. Difficulty with lens removal
Please see Lens Removal page.
6. How not to break or lose a lens
If you're in our Facebook group, My Big Fat Scleral Lens, you may have seen some of those excruciating conversations about lens loss! I have killed a couple of lenses myself and had many near misses over the years. There is nothing quite like that sinking feeling when you hear that characteristic sound and know that your very costly lens is now history.
Problem #1: Lens slips, pops or bounces.
We all learn over time the myriad ways a lens can unexpectedly move. But learning how far and in how many directions a lens can bounce is particularly fun. Ultimately, it may land...
- In a porcelain sink where it may crack and/or roll into the drain.
- On the counter, somewhere, where it can't be seen because it's transparent.
- On the bathroom floor where the patient (without their lens in!) cannot find it and may step on it while looking.
- On the carpet, where it's even harder.
Memories of my early days with PROSE lenses include my kid, many a time, on hands and knees with a flashlight, trying to recover a lens that dropped and bounced. I was lucky - it always survived.
There is no substitute for a nice large soft terry towel spread out across your work area when inserting or removing lenses, so that if a lens drops, it will get a soft landing AND stay put.
Problem #2: Down the drain.
Occasionally a lens grows wings, and even though you're working over the countertop, the lens lands in the sink and slips down the drain. Once, my husband pretty much had to take apart the sink to retrieve a PROSE lens that went down the drain... miraculously, it survived the ordeal. I eventually learned safer handling practices.
SOLUTION: Rubber catch mat.
Problem #3: Lens too big for the ClearCare case.
If you have ever used scleral lenses and ClearCare, you know exactly what I'm talking about. Even if it's a mini-scleral that seems to fit fine, you're closing the little basket thing and at the last minute the lens slips. Crunch!
Then there are the larger lenses that definitely don't fit in the baskets. Some patients leave the baskets open when they put it in the tube with peroxide. This can work okay. Until it doesn't, and your lens - worth somewhere between, say, $300 and $8,000 breaks. Who is responsible for the lens replacement cost? You will. A little prevention is your insurance policy. Exercising a little prevention is a good thing.
SOLUTION: PROSE disinfection case
This is not a perfect solution. First of all, it's a nuisance to have to transfer the catalyst disc from the ClearCare case - sometimes it actually has to be broken off with pliers. Second, the PROSE case accommodates all sizes of scleral lenses, but it's a hog for saline, so it may cost 2 to 3 times more in terms of solution (unless you use simple hydrogen peroxide 3%). For some of you, that's going to be a compelling reason to stick to an eye-friendly MPS like Unique pH rather than a hydrogen peroxide disinfection system. On the other hand, the performance of preservative-free hydrogen peroxide disinfection is so hard to match, let alone beat, especially for those of us with sensitive eyes! For spanking clean fog-free comfortable lenses, this often ends up being an important part of your lens care regimen. And when you weigh solution costs against lens replacement costs, it starts to make sense.
Note: The pictures below show my 18.5mm EyePrintPro lens in the ClearCare case and the PROSE disinfection case, respectively.
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.