Response from Dr. Chiu:

This is tough, it could be related to ocular surface disease and their specific condition. I find that with some dry eye, Sjogrens, or GVHD pts, they constantly develop mucus debris that adheres to the front of the lens, not fogging under, but over.

If the lens is not brand new (because there may be an adjustment period for brand new lenses), patient may need to re-clean, do Q-tip swabs over, try Hydra-PEG coating, or treat their OSD better. May need some topical steroids or immunomodulator to help the tear film quality. May also try to change lens materials or cleaning products.

This is a problem that will require them to work with their eye doctor to find out the cause and solution.

Response from Dr. Chiu:

You can use Boston Simplus, or any of the multipurpose solutions to both clean, rub, and store. Unique pH and Tangible Clean are not as thick as Boston Simplus.

You can also try Miraflow to clean/rub if you can find it online.

Answer from Dr. Chiu: To store a scleral lens dry, first clean with appropriate cleaner and rinse off with sterile NP saline. Then wipe or dab gently with a Kimwipe or soft tissue. When completely dry (no moisture or droplets left), place gently into dry CL case (the hard screw on cap type are best). The lens should move gently in the case, not sticking to the sides. Then close the cap and label with lens details/date of storage.

Answer from Dr. Chiu:

I’d stick with alcohol swab wiping and air dry. Or, submerging in a clean container with rubbing alcohol for a few minutes, and then taking out and letting air dry. You can tap the plunger hole side down (for the larger insertion plungers) to force out any residual liquid to expedite drying. And, if your plungers look contaminated, throw away and buy some new ones.

Answer from Dr. Chiu:

All scleral lenses are different – the diameter, thickness and design. It is hard to predict whether your own lens may get damaged in the ultrasonic cleaner. Some may be fine, but if yours is thinner or scratched/chipped, it may risk getting compromised. The safest way would be to rub your lens with an approved cleaner, rinse with PF saline, and soak in approved overnight solution and case.

The ultrasonic cleaners have not been officially tested and approved for all scleral lenses.

Gloria B Chiu, OD, FAAO, FSLS

Answer from Dr. Chiu:

Make sure your fingers and lids are dry so that you can get a good grip on your eyelids, while holding the plunger/lens in the other hand. There are also application tools that can be used to stabilize the plunger/lens, which allow for 2 hands to hold your eyelids. Fixation is also important; there are lighted devices that can help with this. Many products can be found on dryeyeshop and amazon.

Some might also try using thin medical gloves; that can be helpful in the beginning.

Question continued:

My lenses are always very easy to remove after I attach the plunger I only have to very gently pull. It is rare that there is suction between my lenses and my eyes. I have LSCD and my left eye can get sore while wearing the lenses. Should ask for an evaluation or refitting of my lenses?

Response from Dr. Chiu:

Hard to say for sure without seeing your lens. But, it's good if there is no suction and the lens is easy to remove at the end of the day. If you have good comfort and vision with wear during the day, the fit is probably good. Your doctor should have evaluated your lens and eye after some period of lens wear to finalize the fit. If you have any concerns, please reach out to your eye doctor.

Response from Dr. Chiu:

Upon cataract removal, the surgeon will typically place an IOL (intraocular lens) behind the iris, matched to the ideal power for your distance vision. Vision is usually better in the eye after cataract removal. However, if you have chronic dry eyes, you will likely still need topical drops or medications. If you wear a scleral lens before the surgery for dry eye, you will likely still need the lens for dry eye relief after. But, the scleral lens power will often need to be updated. After cataract surgery, no scleral lens wear is recommend for 2-4 weeks, to allow the eye to heal before lens wear again

Response from Dr. Chiu:

Some doctors and offices recommend discarding the multi-dose Purilens bottle after 48 hrs, but I would understand your concern if you're not using it all and flushing money literally down the drain. Of utmost concern is your eye health and safety. While there is no hard concrete rule about when to discard the 4 oz bottles for scleral lens rinsing and filling, I wouldn't want to risk using contaminated saline in your scleral lens fluid reservoir, especially in compromised eyes. 48 would be safest, or you could choose to use single dose vials each time so they are new and fresh, or the 2 oz size. For my patients, I advise using the 4oz Purilens bottle no more than 7 days - honestly it is an arbitrary value, but it has worked. If you are not using the bottle up within 7 days, you are likely not rinsing your lenses or eyes enough. Most patients go through the bottle within 4-7 days, if using for 2 eyes. Be sure to wash hands before handling bottles, cap after each use, and do not touch the bottle tip on your fingers or eyelids/lashes. You might even use one bottle for rinsing eyes and one for filling, which may help prevent bottle tip contamination. If the solution does not feel or look right, throw it away! Do not leave in cars or hot areas, which may spur bacterial growth..... so much can be said for this question!