ROADMAP: THE PROCESS
Getting trained
I am here: I am learning how to handle, apply, remove and care for my sclerals while my provider is refining the fit.
Download training checklist
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Prep, setup & handling
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Your basic workspace supplies for scleral handling are:
Plungers for application and removal
Lint free towel to cover your work space
Preservative-free saline
Hand held mirror (suggest 3x magnification)
Alcohol prep pads
(If handling near sink) Rubber sinks trainer
We’ll talk more about these, as well as many additional items like cleaning and disinfection solution in the Supply Management section (further down this page).
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You need a flat surface to spread a towel and all the items you’re using. This may be a countertop or a table. Some people are most comfortable handling sclerals while sitting, others while standing.
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If you use moisturizing handsoap. oils from the soap can be transferred to the lenses. This makes them a magnet for gunk and may interfere with vision and comfort.
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Completely drying your hands is important because water carries the risk of acanthamoeba keratitis. Acanthamoeba causes a rare but devastating type of infection, and the risk is heightened when lenses are exposed to water.Item description
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RIGHT FIRST: If you are going to be using sclerals for both eyes, always handle the right lens first. This will help ensure that your two lenses do not get mixed up or both end up in the same side of the case.
CHECK YOUR EYES: It sounds very simple, but it’s surprisingly easy to do, especially when you’re tired: you try to put a lens in an eye that already has a lens, or you try to remove a lens that isn’t there.
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Scleral lens application
Resources
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Learning scleral lens application is NOT simply about “practice makes perfect”.
Obviously, the more you do it the better you’ll get, but until you achieve your basic competence in scleral lens application, you need expert eyes on your technique to identify anything wrong that needs to be corrected and, where necessary, to find alternative tools or techniques for you.
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A majority of scleral lens users become competent in lens application within 4 weeks if given sufficient training.
Many people need 4 to 8 weeks, and some continue to struggle quite a bit after that.
Wherever you are on the spectrum, you’re in good company! Don’t be discouraged, you’ll get there. If you are not receiving sufficient supervised training time, don’t hesitate to advocate for more assistance. Needing more time is no reflection on you.
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You get the lens onto the eye
The lens is centered
The lens is full of solution with no air bubbles
If the lens has alignment dots, the dots are aligned correctly. (Note: Not all dots are for alignment purposes.)
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I might have a hard time keeping my eyelids open wide enough, or I might let them go too soon. The larger the lens diameter, the more challenging this aspect may be.
I might have a hard time keeping the lens full of saline until it is correctly placed on the eye.
I might have a very strong “flinch” response.
If I use a plunger with suction, I might tend to release it too early or too late.
I might discover bubbles under the lens afterwards and not know why.
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Filling solutions: Whatever solution you put in your scleral lens at the beginning of the day stays there, for the most part, for hours. Your choice of solution is important both for safety reasons, and for your comfort and vision experience. Things like the pH and the viscosity (thickness) can make a difference.
Most people will use preservative-free saline solutions to rinse and fill their sclerals prior to lens application. There are several brands on the market, which you can read about in the Product Guide.
Filling solutions should always be preservative-free. Do not use preserved saline solutions to fill your sclerals, even if they are labeled “sensitive eyes”. Remember, the solution is held against your eyes all day.
Some scleral users add a preservative-free artificial tear, such as Refresh Celluvisc, to the “bowl” of their scleral.
Rinsing solutions: The most important thing you need to know about rinsing sclerals - whether before you put them in, or after you take them out - is to always use saline and never, ever use water. Water brings the risk of acanthamoeba keratitis, a rare but devastating infection.
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There are some simple, basic guidelines for applying a scleral lens with a standard “insertion plunger” (DMV Scleral Cup or DMV Vented Scleral Cup”). Most people are taught this method.
However, it is not a “one size fits all” process.
There are many people for whom this method simply does not work, and for a variety of reasons.
Maybe they have low vision, and can’t see the lens well enough to center it. Maybe they have hand tremors, and all the saline spills from the lens before they can get it in. Maybe they have a really strong blink reflex and need both hands to hold their lids open. Maybe they can only use one hand.
Unfortunately, not all scleral lens users have access to skilled trainers who are familiar with all the available tools and who have experience troubleshooting the types of challenges that can arise.
Our Scleral Lens Application Guide offers information on a variety of tools and methods to meet various special needs.
Please add your comments to share your experiences, tips and tricks!
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You can do this. You really can.
It may mean using a special method or a special tool, it may mean lots of extra supervised training time, it may mean practice and self-talk, it may mean getting some support from a group.
Don’t give up. Join a group for some encouragement. See Support menu for more information.
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The word “saline” can get really confusing for new scleral lens users who have a history of using contact lenses.
To contact lens users, “saline” is a solution they use for rinsing and inserting their lenses. They might even use that term (incorrectly) to refer to a “multi-purpose solution” (MPS), which is what it sounds like - designed for
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Scleral lens removal
Why supervised lens removal training matters
You need an expert’s eyes while you are learning. Contrary to what you might have read on Facebook, this is not about “practice makes perfect”. Anyone can remove a scleral lens if they try hard enough. The real goal is to learn to consistently remove it without traumatizing your eye or putting the lens at risk.
The skilled trainer you need (1) knows things you don’t and (2) sees things you can’t see. They can spot issues like the following during training:
My technique increases the risk of losing a lens.
I am doing something that seems to work but may not be good for my eyes.
My lens might be too tight.
Resources
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Cleaning & Care
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Scleral lenses should be cleaned and disinfected in between each use.
CLEANING means rubbing both sides of the lens with an approved cleaning solution and then rinsing them off.
DISINFECTION means soaking your lenses (after cleaning) in an approved disinfection solution for the time period specified in the manufacturer’s instructions. This is usually either 4 or 6 hours.
Storage
Temporary lens storage, e.g. 30 minutes, 2 hours: You have taken your lenses out in order to take a nap, or a shower, or to do a warm compress. Store them in multi-purpose solution.
Storage while not in use, e.g. spare lenses: Store hydra-peg coated lenses in multi-purpose solution. For non-coated lenses, clean and dry them and store them dry.
Depending on the regimen your provider recommends, you might be using a single solution for both steps, or you might use a different solution for each step.
You need to know if your sclerals have Hydra-PEG coating, because only a few cleaning & disinfection solutions are compatible with Hydra-PEG.
Your provider may also recommend additional “deep cleaning” steps with yet another product weekly or at some other interval, especially if your lenses get lots of deposits on them.
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Supply Management
Need-to-knows
Most scleral lens supplies can only be purchased online. Find reputable suppliers and stick with them.
Some scleral lens supplies are prone to shortages and backorders. Make sure you have acceptable alternatives.
Use our handy Scleral Lens Supply Worksheet to determine your needs and work out your routines.
Keep a reserve supply of essential solutions.
Use an auto-replenishment service. These services will often give you a heads up in advance of a regularly scheduled ship date if something is out of stock.
RESOURCES:
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Daily Lens Wear
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This is an important question to discuss with your provider. There are many possible outcomes.
Some people can wear their sclerals literally all their waking hours, every day. Others wear them much fewer hours, by choice or necessity.
Many people remove, clean, rinse and refill their sclerals at least once a day due to a buildup of deposits. Some people use lens wetting drops to help keep them clear and comfortable.
Sclerals are made of gas permeable material - yet they still limit the oxygen getting to the cornea. As a result, some corneal diseases make it necessary to limit wearing time for safety reasons.
On the other hand, your referring specialist and provider may want you to maximize your wear time, temporarily or over the long term, to improve your corneal health.
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These issues affect many scleral users. Talk with your provider about it while you are still in training, so you can start to learn some prevention techniques. Some contributing factors may simply be related to lens care, compliance and solutions. Others may be disease-specific, in which case your referring specialist is likely to contribute to the answers.
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Your provider can give you guidance on what is acceptable or normal for you, and what should prompt a phone call or email.
“Midday Fogging” et cetera
You do not need to plan for or ask about every possible what-if in advance. Even in the best of cases, after your sclerals are dispensed, you will almost certainly have questions that you need to contact your provider about.
However, it can be truly helpful to know about common questions and complaints from new users, and discuss them with your provider before your final lenses are dispensed. It can be helpful to get your provider’s take on what types of questions they absolutely want to be consulted about. Some types of questions are purely practical and floating them in a Facebook group is harmless. Others have medical implications and must be referred to your provider.
Below are common examples:
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My Scleral Lens Parameters
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Examples:
ZenLens
Custom Stable
PROSE devices
EyePrintPro
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This is important information for determining compatibility of contact lens cases and, in some cases, handling devices.
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Distance vision
Near vision
Monovision (one eye undercorrected to allow near vision without glasses)
Multifocal
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Examples:
My right lens has one dot and my left lens has two dots.
My right lens has one dot and my left lens has no dot.
My right lens has a pale blue tint and my left lens does not.
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This is essential information for determining compatibility of contact lens solutions. Even if you have a cleaning and disinfection solution recommended by your doctor, there may be times when you are unable to get it and need to know which alternatives are suitable. The wrong solution will not damage your lens, but it will probably damage or strip the coating.
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If your sclerals have orientation dots, that means you need to apply them to your eyes with the dots at a specific position. Make sure you know whether it’s supposed to be 12 o’clock or 6 o’clock.