Contact

What are scleral lenses?

Scleral lenses are large  gas permeable lenses that rest on the sclera and by bridging the cornea , create a cushion of thick tear layer that can treat eye surface disease and correct the corneal irregularities .

Scleral lens candidates:

• Corneal irregularities: All patients with corneal irregularities such as KCN, trauma, corneal surgery complications are candidates for scleral lenses.  
• Ocular surface disease: Another common reason for prescribing scleral lenses is to manage ocular surface disease. Patients with systemic conditions such as Sjögren’s syndrome, Graft-versus-host disease and Stevens-Johnson syndrome often present with comorbid ocular surface disease that can further decrease their quality of life and inhibit daily activities (Figure 2). For these patients, the rigid, curved shape of a scleral lens creates a liquid “cushion” that not only masks irregularity but also acts as liquid bandage that continuously bathes the anterior ocular surface. Scleral lenses also provide a barrier that protects the compromised anterior ocular surface from exposure. Additionally, many patients with OSD may also present with corneal irregularity. With scleral lens use, patients with OSD typically experience quick, dramatic improvement in comfort and vision, allowing them to return to their normal routines and activities.
• Astigmatism : Patients with moderate to severe astigmatism, especially those who have failed in other traditional lens modalities, are good candidates for scleral lenses
• Place the lens on the inserter OR stabilize the lens on three fingers (see photo) by pinching together your thumb, index and middle fingers to support the lens.
• Fill the bowl of the lens with preservative free saline.
•  Patients with sever to modern corneal irregularities, who have previously failed with RGPs can have improved health, centration and superior optics with scleral lenses.

Solutions for scleral lenses:

As with any other type of contact lens, solutions play an important role in the success of scleral contact lens wear. Scleral lenses can be cared for using approved GP lens cleaning and disinfecting products or off-label use of multipurpose soft lens solutions. Using preserved solutions with scleral lenses puts the patient at a greater risk for toxic reactions because residual solution can become trapped underneath the lens, which increases exposure time to the anterior ocular surface. Prescribing a hydrogen peroxide-based care system eliminates exposure to any potential toxins or antigens.

Scleral contact lenses have to be filled with saline before application to prevent trapped air bubbles that compromise both fit and vision. Unfortunately bottled saline solutions contain preservatives that could induce a toxic reaction.

Bottled, non-preserved solutions are available but pose two potential risks. First, there is the possibility of contamination if the bottle is used over several days. Secondly, although non-preserved, most of these solutions still contain a buffering agent that can be toxic to the patient.

Alternatively you can prescribe off-label use of 0.9% sodium chloride solution that comes in 3ml single-use vials. The sodium chloride vials do not contain any buffers and eliminate the risk of contamination because they are single use.

To apply the lens:

Place the lens either on a bulbed plunger or on a “tripod” formed with your thumb and first two fingers.

Fill the bowl of the lens with fluid, if advised to do so by your eye care provider.

Holding eyelids open widely; apply the lens to the surface of the eye.

To remove the lens:

If using a plunger, attach the plunger to the edge of the lens and tilt the lens off the eye.

If not using a plunger, look down. Manipulate the upper lid to “break the seal” at the upper edge of the lens, and “fold” the lens off the surface of the eye.

Troubleshooting tips and tricks:

If you’re using a solid lens (without holes or fenestrations) and are unable to maintain fluid in the bowl of the lens as you bring it towards your eye, make sure that your face is fully parallel to the floor. It may seem like you are nearly standing on your head when you’re in the correct position to apply the lens.

Lid control is essential; use one hand to hold lids completely out of the way, and don’t release the lids until the lens is actually fully in place and the plunger (or your finger tripod) has been removed.

If you are unable to successfully apply a solid lens with saline, you could practice applying the lens after filling the bowl of the lens with non-preserved viscous lubricant. These viscous lubricants will blur your vision compared to saline, however, so you may simply want to use them to practice lens application. Once you’ve mastered this step, you may want to switch to saline to give you better vision.

If you are using a bulbed plunger, and can see the opening in the center of the suction cup, look directly at the hole as you bring the lens into position. This will help you to position the lens correctly.

Try to keep both eyes open as you apply your lenses. This may also help you to position the lenses correctly.

What are hybrid contact lenses?

Hybrid contacts are large-diameter lenses that have a rigid gas permeable central zone, surrounded by a peripheral zone made of soft or silicone hydrogel material. The purpose of this design is to provide the visual clarity of GP lenses, combined with wearing comfort that is comparable to soft lenses.

Who are the  candidates for hybrid contact lenses?

 All patients with irregular cornea, astigmatism and presbyopia are good candidates for contact lenses.

 Moderate to advanced presbyopic patients can benefit from the excellent optics of the new generation of hybrid contact lenses called Duette Progressive .

Inserting UltraHealth Lenses

There is more than one way to insert your lenses. We recommend you pick the method that works best for you.

Always wash your hands with mild soap and dry them well before handling lenses. So you don’t get your lenses mixed up, it’s a good idea to handle them in the same order each time.

Syner

gEyes recommends using preservative-free solutions with your UltraHealth lenses.

How to Insert Your Lenses

1. Lean forward and look down at the floor. Sometimes it’s helpful to place a mirror flat on the counter to look into as you insert the lens.
2. Pull up on your upper lid with one hand by placing the fingers at the base of the lashes.
3. With palm facing up put inserter between thumb and pointer finger. Pull down on lower lid using a finger on the hand holding inserter. Gently place lens on eye. It is very important not to push lens too forcefully onto eye.
4. Using one hand, pull your upper lid back.
5. Using your finger on the opposite hand, pull down your lower lid gently.
6. With dry fingers, pinch bottom of soft skirt at the 5 & 7 o’clock position – similar to removing a piece of lint. Apply firm enough pinch to cause bottom edge of lens to buckle thus allowing air to get beneath soft skirt to release lens from surface of eye.

TOP INSERTION TIPS

Tip 1. To avoid bubbles, fill lens bowl up completely with saline. Bubbles may make lens uncomfortable and produce irregular vision.

Tip 2. Gently place lens on eye. As you insert the lens, the cornea will displace the saline and the lens will gently settle on the surface of the eye. If the lens is pushed too hard onto the eye, you may experience discomfort and lens fogging.

How to Remove Your Lenses

TOP REMOVAL TIPS

• Dry fingers
• Hold eye open
• Narrow pinch
• If lenses are uncomfortable during the day, remove, re-wet and re-insert.
• If eyes feel dry during the day, some eye care professionals recommend a lubricating drop.
• If eyes continue to feel dry even after applying lubricating drops, remove lenses and place in preservative-free saline solution to re-hydrate for a few hours.
• Try not to rub eyes during the day.
• Use a daily cleaner at the end of the day. Place the lens bowl side up in the palm of your hand and apply the cleaner. With the pad of your index finger gently rub the lens back-and forth. Be sure to clean both sides of the lens. Then rinse the lens with a preservative-free saline solution such.
• For disinfections

TOP COMFORT TIPS

How to Clean Your Lenses

Be sure to clean your UltraHealth lenses each day prior to overnight storage.