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.

Allergy Eye Drops 2023

Pataday (olopatadine) was prescription only, is now over the counter, and continues to be one of the most successful drops for eye allergies.  It is available as once daily, twice daily and extra strength.  The majority of eyes benefit the most from twice daily, and that version is the best value.  Current market rate is around $17 for a 5 ml bottle

Lastacaft is the newest over the counter allergy eye drop.  It previously was prescription only and is a once daily drop, however can be used twice a day if needed.  It is priced around $14 for a 5 ml bottle.

Alaway continues to be very effective and is a very good value.  A 10 ml bottle is around $12.

If you try these and still have symptoms, please call our office.  We are eager to help!

Tips for Contact Lens Success

 

Congratulations on successfully wearing contact lenses!  Here is some advice designed to keep you on a path of success:

Wash Your Hands!

Wash, rinse and dry your hands each time you put in or take out your lenses.  Avoid oily or heavily scented soaps.  If you need a moisturizer, use it after you handle your lenses.  The residue from lotions can stick to them.

Cleaning and Storage

Multipurpose solutions let you clean, rinse, disinfect and store your lenses.  Once you've put the lenses in your eyes, it is best to empty the case and let it sit dry through the day.  "No rub" solutions claim that rinsing alone will clean the lens, but rubbing cleans better.  Saline solutions can rinse lenses, but are not a substitute for a multipurpose solution. Hydrogen peroxide systems use a case with a basket for holding the lenses.  These solutions have a red cap to remind you not to put the solution directly in your eye.  The lenses must sit in the case for 4-6 hours before putting the lenses back in your eyes.  

Water and Lenses Don't Mix!

If you are out of lens solution, you might be tempted to use tap water.  Don't do it!  Soft contact lenses act like little sponges and can absorb microbes in the tap water, increasing your risk of infection.  Also, never put your lenses in your mouth or use saliva to wet them.

Clean Your Case

Clean your case as carefully as you clean your lenses.  Periodically wipe the case with a tissue and always let it air dry to prevent growth of bacteria.  Most packages of solution include a new case, so take advantage and replace the case every time you open a new bottle of solution.   It is best to replace the case every 1-3 months.

Properly Dispose of Your Lenses

Discard your lenses in the trash, never in the sink or toilet!  For recycling, the outer paperboard cartons are recyclable paper.  The individual plastic blisters are classified as a #5/PP plastic, a designation similar to yogurt cups.  The foil blister covers can be removed, bundled together in a ball, and recycled as aluminum.

If Your Lenses Hurt

Remove the lens immediately if it becomes uncomfortable.  Check to see if your lens is inside-out or torn.  Rinse the lens with a rewetting drop or non-peroxide solution.  Don't keep wearing the lenses if they continue to be uncomfortable.  If discomfort continues after removing the lens, please call our office.

Teens and Lenses

Mature teenagers can wear lenses as long as they learn to care for them and can be trusted to follow all of the care instructions exactly.  Single use lenses are a good choice because there are no cases or cleaning involved.  Work with your doctor to find the best lenses for you.  Never try on a friends lens.  An eye doctor needs to fit a lens perfectly to your eyes.  The doctor can provide samples to be sure the chosen lenses fit well.

Makeup Tips for Lens Wearers

Lenses first! Put your contacts in before applying makeup.  Remove the lenses before taking off your makeup.  Non-allergenic makeup is often best.  Avoid glittery or metallic eye shadows and liners, waterproof and lash-lengthening mascara.  These can irritate or stain your lenses.  Don't apply eyeliner to your inner rims, between the lashes and your eye.

Contact Lenses and Sports

You can wear your contacts for most sports and activities.  They rarely move out of place and provide better peripheral vision than glasses.  For swimming and watersports, try to avoid getting water in your eyes, and wear a single use lens that you can throw away at the end of the day to reduce the risk of infection.

Keep Your Glasses!

You will still want a good pair of up-to-date eyeglasses to wear when your eyes need a break from contacts and to have in an emergency.  Having sunglasses is good advice too.

Decorative Contact Lenses

It can be fun to have lenses that change your eye color, or to have cat's eyes for a Halloween party.  Be sure to get the lenses from your doctor.  It is illegal to buy them without a prescription, and ill fitting lenses can scratch the eyes or cause infections.

Lubricating Eye Drops 2022

Dry eye disease (DED) is a prevalent condition across the globe, affecting people of all ages and demographics. Treatment of DED starts simple and can become more complex depending upon the severity of the condition and how each patient responds to treatment. 99% of all dry eye cases require some form of lubrication, and the number of choices can definitely be overwhelming. 

Our doctors have put together a good-better-best approach to our recommendations for first-line artificial tear therapy.  They are available without a prescription online and at the major pharmacies and grocery stores.  The key to success is to use them consistently everyday!

Good - Mainstays

Better - Last longer, can temporarily blur vision

Best - Preservative free, a good choice for those who need drops more than four times per day

 

Refresh Celluvisc is preservative free and thicker - lasts longer, can temporarily blur vision

For those who wake up with symptoms, a thicker lubricant before sleep can be helpful.  

 

The oils that provide quality tears are produced in the eyelids. Applying 10 minutes of sustained heat to the eyelids daily can significantly improve the condition of the natural tears. The best results are obtained from a microwavable mask. A warm washcloth tends to lose the heat too quickly; traditional methods including rice in a sock and tea bags risk overheating. 

Other helpful ideas:

• 20/20/20 When staring at screens, every 20 min look 20 feet away for 20 seconds.
• Modify your environment. Add a humidifier. Turn fans and vents away from the face.
• Clean the eyelids. Use a warm washcloth and gently rub the eyelashes.
• Stop smoking. Smoking greatly increases symptoms.

Remember, dry eye disease is a long term battle and has many causes. No one treatment is a cure-all. Continue to stay positive and be sure to call our office if symptoms worsen. 

Why a New Pair of Scleral Lenses?

 

I already have scleral lenses, why get a new pair?

Congratulations!  You know first hand the benefits of this category of lens.  Here are some thoughts to consider:

The latest generation of scleral lenses have been even more comfortable.  We can now customize the back surface of the lenses to a higher degree.

It's important to have back-up lenses.  When your current pair is working well, they become an excellent back-up to keep for an emergency if a lens breaks or is lost.

Your co-pays with insurance are low.  Your out-of-pocket costs are minimal.

It takes fewer office visits when you are an established patient.  You can often have your updated lenses in just two trips to our office.