Removing a scleral contact lens

1. Place a re-wetting drop into your eye and a drop of saline on to the removal plunger

2. Using your free hand pull down on your lower eyelid. If you have a tendency to close or blink then go ahead and grab both top and bottom lids!

3. Place plunger on the lower 1/3 of the lens, as seen in the illustration, and then gently push lens in and then pull. The goal here is to rock the lens in order to break the suction, which allows it to come out easily. NEVER PLACE PLUNGER ON THE CENTER ON THE LENS!

   
   
   

4. Once removed from your eye, gently slide the plunger off of the edge of the lens. Clean and store using the steps on your other checklist!

Extra Tips for removal!

• Don’t panic or get frustrated. Staying calm makes everything easier!

• Using a mirror to make sure the plunger is the correct place is always helpful!

• Never place the plunger on the center on the lens (where your pupil is).  Try to place the plunger very close to the edge of lens.

• You don’t need to push hard to remove. A gentle push and a pull usually does the trick.

• If nothing happens on your first attempt, just try again! Try adding a few more drops of saline if it still seems difficult to remove.

Inserting a scleral contact lens

 

1. After following instructions on your other checklist (rinsing the lens), place the lens on the center of your insertion plunger.

   
   
   

2. Fill the lens with your Sterile Saline, making sure to fill all of the way. It will look like the lens is about to overflow when it is full.

   
   
   

3. Bend at the waist, as close to a 90 degree as possible, keeping your gaze straight. At this point you will be looking straight at the ground.  Make sure your nose is pointed straight down as well.

   
   
   

4. While holding both your top and bottom lids wide open, place the lens on the center of your eye. Make sure to keep your gaze focused straight down. You can fixate on the hole on the plunger and use it as a guide to ensure you are lined up appropriately.

5. After placing the lens on the eye, close your eye and then pull the plunger away. Your lids will hold the lens in place while removing the plunger.

6. Open your eyes and look straight ahead again to make sure the lens is in the correct place. Looking around or away may cause air bubbles or prevent the lens from going in.

Extra Tips for Insertion!

• Use the hole in the plunger to help line yourself up. Holding it over a light surface will make it easier to see through the hole.

• Once leaned over and ready to insert, tuck your chin into your chest, this will help open your eye a bit more.

• Air bubbles can happen for several reasons.  The most common - not filling the lens enough before insertion, bumping into lids or lashes, and looking around or away from lens during insertion. Air bubbles will not fix themselves, just remove and try again!

  
  
  

• If you get the lens in and for some reason things just don’t feel right simply remove and try again!

 

Preparing to insert your scleral contact lenses

1. Remove lenses from case and cleaning solution (Boston Simplus/Tangible Clean)

2. Gently rub lens to loosen up the cleaning solution that remains after removing it from the case. TIP: This makes rinsing the lens easier!

3. Thoroughly rinse lens with Sensitive Eyes Saline, making sure to rinse off any of the solution the lens has been sitting in overnight.

4. Place lens on the DMV Vented Scleral Cup/EZI Scleral Ring face up so it is shaped like a bowl (you may be using a different type of insertion device in this step).

5. Fill lens using the PuriLens/Airlife Sterile Saline (the small pink vials). TIP: be sure to fill lens all of the way, it will look like it is about to overflow when it is full. Getting the lens in without enough saline may result in an air bubble.

What to do after removing lenses

1. Remove lens using the DMV Ultra Remover, the smaller, colorful plunger. TIP: Adding a drop of saline to the plunger and a couple re-wetting drops into the eye helps get things moving!

2. Gently remove lens from plunger by sliding the plunger off of the edge of lens. Do not pop it off like a suction cup.

3. Add a few drops of the Boston Simplus/Tangible Clean (cleaning solution) to the lens. Gently rub the surface of the lens (without applying too much pressure, no squeezing or mashing the lens) the cleaning solution will start to work up a lather or bubbles, kind or like dish soap! Make sure to rub both sides for at least 30 seconds per side. TIP: If you notice more fogging than usual or the lenses do not feel as comfortable as they typically do, try rubbing the lens surface a little longer during this step!

4. Using the Sensitive Eyes Saline, thoroughly rinse the lens making sure not to leave any suds from the cleaner on the surface of the lens (this is all the debris you have cleaned off you don’t want to leave any behind).

5. Put lenses into contact lens case and fill with Boston Simplus/Tangible Clean (this is used for cleaning and for storing your lenses overnight).

Cataract surgery implant lens options

Different intraocular lenses (IOLs) can be implanted to achieve customized results based on your visual goals.

Monofocal for distance. The standard IOL is a one focus lens. This option is typically covered by medical insurance. The most common visual goal is best distance, and this requires glasses for clear vision at intermediate and near.

Monofocal for near. The standard IOL can be calibrated for near, and this requires glasses for clear distance vision.  Patients who have been naturally myopic, or nearsighted, may prefer this option because they have always seen well at near without glasses.

Astigmatism correction. Astigmatism causes details to appear more ghosted or smeared. Depending on the amount, it is common that an eye that has astigmatism before surgery will still have astigmatism after surgery.  Mild amounts may not require correction.  Surgical astigmatism management is considered an elective upgrade and is not covered by insurance.  Out of pocket expenses can be $3,000 to $6,000 (total for both eyes).  If medium or full astigmatism is not addressed surgically, glasses will likely be necessary to see the most clearly for distance, intermediate and near.

Monovision or Blended vision.  One eye will be focused for distance and the other for near or intermediate vision. This allows for relatively good vision at both distance and near without much need for glasses. Depth perception at distance may be compromised, so glasses may be required for certain tasks like driving. Reading glasses when print is very small or in dim lighting may be necessary. This uses the standard IOL, and is most successful for patients who have already spent years with this approach in contact lenses.

Multifocal.  This lens splits light and is designed to allow each eye to see well for distance, intermediate, and near depending on the specific lens. There is a risk of halos and glare with these lenses, especially in artificial light. Patients that are very motivated to be free of glasses often feel some glare is acceptable.  This is considered an elective upgrade by insurance and is typically $7,000 to $8,000 out of pocket (total for both eyes).  A leading design is the Alcon PanOptix

Extended depth of focus.  This lens is designed to allow each eye to see well for distance and intermediate. These lenses bend light more than split light, so there is some risk of halos and glare with these lenses, though less than with a multifocal lens. Mild (+1.25) reading glasses will likely be required for near work and reading.  This is also an elective upgrade in the $7,000 to $8,000 out of pocket range (total for both eyes).  The Alcon Vivity is a leading IOL in this category.