Question 1

What Are Scleral Lenses

Accepted Answer

Scleral lenses are a type of specialized contact lens that are larger than traditional contact lenses and designed to rest on the sclera (the white part of the eye), rather than directly on the cornea. These lenses are primarily used for people with irregular corneas, severe dry eye, and other complex visual or eye health issues that cannot be managed with standard contact lenses or glasses.
Key Characteristics of Scleral Lenses:
1. Large Diameter:
    • Scleral lenses have a larger diameter than traditional soft contact lenses. While standard contact lenses typically measure 9-15 millimeters in diameter, scleral lenses usually range from 14 to 24 millimeters.
    • They are large enough to vault over the cornea and rest on the sclera, creating a fluid reservoir between the lens and the eye.

1. Gas Permeable Material:
    • Scleral lenses are made of a rigid gas permeable (GP) material, meaning they allow oxygen to pass through the lens to the cornea, ensuring healthy oxygenation of the eye.
    • This is in contrast to traditional soft contact lenses, which do not always allow as much oxygen to reach the eye.

1. Comfort and Stability:
    • The lenses are designed to be highly stable and comfortable, offering consistent vision correction. The larger size helps to keep the lens in place, and the rigid nature provides sharp, clear vision, especially for individuals with irregular corneas.

1. Tear Reservoir:
    • One of the key benefits of scleral lenses is that they create a tear reservoir between the lens and the cornea. The fluid beneath the lens can provide lubrication and hydration, which is especially beneficial for those with dry eye disease, meibomian gland dysfunction (MGD), or keratoconus.

How Scleral Lenses Work:
1. Vaulting Over the Cornea:
    • Scleral lenses are designed to vault or "sit over" the cornea, creating a sealed chamber that is filled with a special saline solution (or sometimes lubricating drops). This reservoir of liquid helps to hydrate the cornea, providing relief from dry eye symptoms by keeping the eye moist and protected from environmental irritants.

1. Providing Stable Vision:
    • The rigid nature of scleral lenses helps to correct irregular corneas by creating a smooth optical surface. For people with conditions like keratoconus or corneal scars, these lenses improve vision clarity by compensating for the irregular shape of the cornea.

1. Protecting the Ocular Surface:
    • The lens acts as a shield over the cornea, which helps protect it from exposure to allergens, dust, wind, and other environmental factors that can exacerbate dry eye symptoms. It also minimizes irritation caused by blinking or excessive tear evaporation.

Who Benefits from Scleral Lenses?
Scleral lenses are especially helpful for individuals who suffer from complex eye conditions that cause either poor vision or discomfort. Some common conditions that benefit from scleral lenses include:
 • Dry Eye Disease: Especially those with aqueous deficient dry eye or severe meibomian gland dysfunction (MGD). The lens provides a stable tear reservoir, helping to relieve discomfort associated with dry eye.
 • Keratoconus: A condition where the cornea becomes thin and cone-shaped. Scleral lenses help provide clear vision by smoothing out the irregular surface of the cornea.
 • Post-Surgical Conditions: After eye surgeries like LASIK or cataract surgery, scleral lenses can be used to protect the cornea and improve comfort if dry eye or scarring occurs.
 • Corneal Scarring: If scarring is present due to injury or disease, scleral lenses can create a smooth surface for better vision and can help alleviate discomfort caused by the irregular corneal surface.
 • Astigmatism: Severe astigmatism or irregular corneal shapes that cannot be fully corrected with regular contact lenses can benefit from the stability and vision clarity offered by scleral lenses.
 • Sensitive Eyes: For individuals with highly sensitive eyes, scleral lenses can offer comfort by creating a cushion of moisture between the lens and the eye, protecting from dryness and irritation.
Advantages of Scleral Lenses:
1. Improved Comfort: Since they provide hydration and a stable tear film, scleral lenses can be more comfortable for people with dry eyes or other ocular surface diseases than traditional contact lenses.
2. Clearer Vision: They can provide sharp, clear vision for people with irregular corneas or those who have not had success with traditional glasses or contact lenses.
3. Protection for the Cornea: The lenses protect the cornea from exposure to irritants, environmental elements, and even physical trauma (like rubbing the eyes).
4. Longer Wear Time: Due to the tear reservoir, scleral lenses can be worn for longer periods without causing discomfort or dryness compared to standard contact lenses.
5. Customizable Fit: Scleral lenses are custom-made to fit the unique shape of the patient's eye, ensuring better comfort and effectiveness than standard lenses.
Potential Drawbacks:
1. Fitting Process: Fitting scleral lenses requires a specialized fitting process and may take longer than traditional contact lenses. Multiple visits may be needed to ensure the lens is providing the best fit and comfort.
2. Maintenance: Scleral lenses require more care and cleaning than regular contact lenses. They need to be disinfected properly and the tear reservoir must be filled with sterile saline or other recommended solutions.
3. Cost: Scleral lenses tend to be more expensive than traditional lenses, due to the custom fitting process and specialized materials used. However, many patients find the benefits to be well worth the cost.
4. Learning Curve: New users may experience a learning curve when it comes to inserting and removing scleral lenses. The process requires some practice and care, especially given the lens's large size.
Conclusion:
Scleral lenses are a highly effective treatment option for individuals with complex eye conditions like severe dry eye disease, keratoconus, and post-surgical recovery. They offer both vision correction and comfort by creating a tear reservoir between the lens and the eye, providing hydration and protection to the cornea. While they require a specialized fitting process and ongoing care, scleral lenses can significantly improve the quality of life for those with difficult-to-manage eye conditions. If you're considering scleral lenses, consult an eye care professional who specializes in contact lenses for a proper fitting and to determine if they are the right option for you.add description

Question 2

My Lenses are Fogging, What Can I Do?

Accepted Answer

Midday fogging is a common issue for scleral lens wearers and refers to a feeling of blurry or hazy vision that typically occurs in the afternoon or mid-day, even after the lens has been properly fitted and initially feels comfortable. This can be frustrating because it impacts the clarity of vision, especially since scleral lenses are designed to provide stable and clear vision throughout the day.
Causes of Midday Fogging in Scleral Lenses:
1. Lens Deposits:
    • Over time, proteins, lipids, and other debris from tears can accumulate on the surface of the lens. This can lead to a build-up that clogs the lens or makes it harder to maintain a clear, smooth surface. The foggy feeling is a result of light scattering due to these deposits on the lens.

1. Dryness or Evaporation:
    • While scleral lenses are designed to create a tear reservoir between the lens and the cornea, over the course of the day, the moisture in the reservoir can evaporate. As the tear film evaporates, the lens may start to dry out, leading to discomfort and visual blurring. This is particularly common in dry environments or for people with aqueous deficient dry eye.

1. Incomplete Tear Reservoir:
    • Sometimes the tear reservoir doesn’t fully fill due to improper lens fit, lens misalignment, or insufficient tear production. This can cause the lens to interact directly with the cornea, which results in blurry or foggy vision.

1. Increased Tear Viscosity:
    • As the day progresses, the tear film may become thicker or more viscous, especially if you're not blinking as frequently or are in a dry environment. This can lead to fogging and reduced clarity of vision.

1. Contact Lens Movement:
    • If your scleral lenses move or shift slightly throughout the day, the reservoir between the lens and the cornea may disturb the tear film, causing fogging. This is often more noticeable if the lenses are not perfectly centered or are slightly too large or small.

1. Lens or Eye Surface Contamination:
    • Small particles, dust, or even allergens can get trapped between the scleral lens and the cornea, causing a foggy sensation. This can occur especially in windy or dusty environments.

What You Can Do to Prevent or Resolve Midday Fogging:
1. Proper Lens Cleaning:
    • Ensure that your scleral lenses are thoroughly cleaned and disinfected after each use to prevent the buildup of deposits on the lens surface. Use the recommended cleaning solutions, such as Boston Simplus (for gas permeable lenses) or other solutions that help remove protein deposits.
    • Soaking the lenses overnight in a cleaning solution can help maintain the smooth surface of the lens and minimize fogging.

1. Lubricating Drops:
    • Use preservative-free lubricating drops designed for scleral lenses throughout the day.  These drops can help replenish the tear reservoir under the lens and improve clarity.
    • Add moisture to the tear film by applying drops directly to the lens surface or the eye during the day to prevent drying and fogging.

1. Check for Proper Fit:
    • Ensure that your scleral lenses fit properly. If they are too tight or too loose, they may not create an adequate tear reservoir, leading to fogging. Your optometrist or ophthalmologist should monitor the fit to ensure the lens sits comfortably and appropriately on your eye.
    • Proper alignment of the lens is also important—if the lens isn’t centered, the tear reservoir might not fill evenly, contributing to fogging.

1. Use of a Cleaning or Rewetting Solution:
    • Rewetting solutions specifically for scleral lenses can be used to refresh the tear film and help reduce fogging. Some solutions are designed to help with moisture retention throughout the day.

1. Blinking More Often:
    • Frequent blinking can help ensure the lens moves slightly and that the tear film beneath the lens remains distributed evenly. Blinking also helps keep the eyes hydrated, so consider consciously increasing your blink rate, especially if you're concentrating on a screen or have been in a dry environment.

1. Avoid Dry or Irritating Environments:
    • Try to avoid or minimize time spent in dry environments, such as air-conditioned rooms or windy conditions, as this can increase evaporation and exacerbate dryness.
    • If you're in a dry environment, consider using a humidifier to help maintain moisture in the air, or wear protective eyewear to reduce exposure to wind or air drafts.

1. Ensure Adequate Tear Film Production:
    • If you have aqueous deficient dry eye, talk to your eye care professional about other treatments, such as punctal plugs, anti-inflammatory medications, or preservative-free artificial tears that can help improve tear production. You might need additional treatment to support adequate tear production throughout the day.

1. Avoid Touching the Lenses:
    • Avoid touching your lenses during the day if you can. Fingerprints or dirt on the lenses can cause fogging. If necessary, use a clean tissue to gently clean the lens.

1. Monitor Your Diet and Hydration:
    • Staying well-hydrated can help maintain a stable tear film. Dehydration can contribute to dry eyes, leading to lens fogging. Additionally, consider foods rich in omega-3 fatty acids, such as fish or flaxseed, as they may help improve tear production.

When to See an Eye Care Professional:
If midday fogging persists despite trying the above strategies, it's important to consult with your optometrist. They may recommend:
 • Reevaluating the fit of your scleral lenses.
 • Checking for underlying conditions like dry eye disease or meibomian gland dysfunction (MGD) that might be contributing to the fogging.
 • Adjusting your prescribed lens materials or the lens design (e.g., a different curvature or diameter).

Persistent fogging could also indicate that there is a more complex issue with your scleral lenses or your ocular health, requiring professional evaluation and care.

Conclusion:
Midday fogging in scleral lens wearers can be caused by factors like lens deposits, dryness, evaporation, or an improper fit. To address this issue, maintaining proper lens hygiene, using lubricating drops, ensuring a proper fit, and minimizing environmental factors can help prevent and alleviate the problem. If these measures don’t resolve the issue, seeking guidance from your eye care professional is important for finding a tailored solution.

Question 3

How do I travel with scleral lenses?

Accepted Answer

Dr. McConkey provides all scleral lens patients with a TSA Letter of Medical Necessity. To prepare for your trip, follow the tips below:

Traveling with scleral lenses through TSA (Transportation Security Administration) can be a smooth process if you're well-prepared. Here are some tips to help ensure that you travel with your lenses safely and without any issues:
1. Carry Your Scleral Lenses and Solutions in the Correct Containers
 • Lens Case: Always bring a clean, empty lens case to store your lenses while traveling. It’s a good idea to bring extra lens cases in case of any issues.
 • Saline Solution: When carrying ScleralFil saline or any other solutions (such as disinfecting or storing solution like Boston Simplus), make sure the containers are 3.4 ounces (100 milliliters) or smaller. This is the TSA regulation for liquids in carry-on bags. All liquids must be placed in a quart-sized bag and be easily accessible during screening.
 • Keep Solution and Lenses in Original Packaging: If possible, keep your saline solution and cleaning solutions in their original packaging to make them more easily identifiable during security screening.
2. TSA’s 3-1-1 Rule for Liquids
 • 3-1-1 Rule: TSA’s liquid rule allows only 3.4 ounces (100 ml) per container of liquid, gel, or aerosol. All containers must fit into a single 1 quart-sized clear plastic bag. Each passenger is allowed one quart-sized bag.
 • Medically Necessary Items: Scleral lenses and their associated solutions are considered medically necessary items. You are allowed to carry larger quantities of saline or cleaning solutions beyond the 3.4-ounce limit, as long as they are medically necessary. However, you will need to inform the TSA officer about this before you go through security.
3. Declare Your Items at Security
 • When you reach the security checkpoint, inform the TSA officer that you are carrying scleral lenses and their solutions. It's best to declare it upfront to avoid any confusion or delays.
 • You may be asked to remove the saline bottles and any other liquid items from your bag and place them separately for inspection, especially if they exceed the standard 3.4-ounce limit.
 • TSA officers are usually familiar with medical supplies like scleral lenses, but it can help to be prepared with any documentation or a doctor's note, just in case.
4. Consider Using a Travel Lens Kit
 • If you need to carry more solution, consider using a travel lens kit designed for convenience and to hold extra solutions and accessories in a compact manner. Some kits come with mini bottles that are TSA-friendly or include a cleaning system specifically for travel.
 • Make sure all liquids are properly labeled and meet TSA’s liquid restrictions.
5. Bring Extra Lenses
 • Always bring extra scleral lenses (at least one pair) in case of any issues during travel. Keep them in their own sealed case to prevent contamination.
 • It’s a good idea to keep the spare lenses in your carry-on bag, as checked luggage can sometimes experience delays or mishandling.
6. Keep Your Lenses Comfortable While Traveling
 • Lubricating Drops: Consider bringing preservative-free lubricating drops or artificial tears in your carry-on bag, especially if your eyes tend to get dry during travel. Again, these drops should comply with the TSA 3-1-1 liquid rules.
 • Hydration: Air travel can dry out your eyes, so staying hydrated with water during the flight will help maintain comfort when wearing your lenses.
7. Screening Process
 • Security Screening: When going through the security scanner, you can leave your scleral lenses and solutions in your carry-on bag, but be prepared for additional screening if required. X-ray machines are generally safe for lenses and solutions.
 • Pat-Down or Additional Screening: In rare cases, TSA officers may request a pat-down or additional inspection of your items. This is typically because of medical devices or liquids that exceed the usual limit.
8. Use Your Scleral Lenses During Travel (Optional)
 • Some travelers prefer to wear their scleral lenses throughout the flight instead of carrying a backup pair. Just make sure you have your lens care products with you for the trip, and take your lenses out as needed for cleaning or if they become uncomfortable.
9. Be Prepared for Any TSA Questions
 • TSA agents may ask about your lenses and solutions, so it’s helpful to know the details of your lens care regimen (e.g., the saline solution and cleaning system you use).
 • You don’t need a doctor’s note unless you’re carrying larger-than-usual amounts of solution or if you're traveling internationally. However, if you're concerned, you can always request one from your eye care provider as an extra precaution.
10. Traveling Internationally
 • If you’re flying internationally, check the regulations of the country you’re traveling to, as some countries may have different restrictions for medical supplies and liquids.
In Summary:
To travel smoothly with scleral lenses through TSA:
 • Keep your saline solution and lens care products within the 3.4-ounce (100 ml) rule for liquids.
 • Inform the TSA officer that you're carrying medically necessary items.
 • Store the lenses in their lens case and keep them accessible.
 • Consider carrying extra lenses and lens care supplies for peace of mind.
 • Use lubricating eye drops to keep your eyes comfortable during the flight.
Being prepared and understanding TSA’s regulations will make your travel experience with scleral lenses easier and more convenient.

Question 4

How do I care for my scleral lenses?

Accepted Answer

Materials Needed:
 • Scleral contact lenses
 • Boston Simplus Solution (for cleaning, disinfecting, and storing)
 • Scleralfil Saline Solution (for rinsing and filling lenses)
 • Lens case
 • Clean towel or paper towel (for drying)
Daily Care and Cleaning Routine
1. Wash Your Hands:
    • Before touching your contact lenses, thoroughly wash your hands with lotion free soap and water. Dry them with a clean, lint-free towel.

1. Remove the Scleral Lenses:
    • Carefully remove your scleral lenses from your eyes using the recommended technique provided by your eye care professional.
    • Always make sure your fingers are clean and dry to prevent contamination of the lenses.

1. Clean the Lenses with Boston Simplus:
    • Place the lens in the palm of your hand.
    • Add 2-3 drops of Boston Simplus solution onto the lens.
    • Gently rub the lens with your fingertip for about 10-15 seconds on each side to help remove any debris or buildup.
    • After rubbing the lenses, rinse both sides of the lens with Boston Simplus to remove any residual solution or contaminants.

1. Disinfect the Lenses:
    • After cleaning, place the lenses in your clean lens case.
    • Fill the case with fresh Boston Simplus solution, ensuring that the lenses are fully submerged.
    • Leave the lenses in the solution for a minimum of 4 hours to allow for proper disinfection.
    • Do not use tap water to clean or store your lenses. Always use the recommended solutions to prevent infection.

1. Store the Lenses:
    • Keep the lens case tightly closed when not in use.
    • Store the case in a cool, dry place, and avoid exposure to heat or direct sunlight.

Before Inserting Lenses (Rinsing and Filling)
1. Wash Your Hands:
    • Wash and dry your hands thoroughly before handling your lenses.

1. Rinse the Lenses with Scleralfil Saline:
    • Take the cleaned and disinfected scleral lens from the storage case.
    • Rinse the lens with Scleralfil saline solution to remove any cleaning solution or debris.
    • Use Scleralfil saline to fill the lens reservoir: 
       • Fill the lens with Scleralfil saline (the saline is designed for the large reservoir in scleral lenses). Hold the lens upright and slowly fill it until the reservoir is full.
       • You can also place the saline directly into the lens as you prepare to insert it.

1. Insert the Lenses:
    • With the saline inside, gently insert the lens into your eye.
    • Blink a few times to ensure the lens is comfortable and properly centered.

Additional Tips:
 • Always use fresh solution: Never reuse the solutions (either Boston Simplus or Scleralfil saline). Always discard any remaining solution after use.
 • Keep the lens case clean: Clean your lens case daily by rinsing it with fresh Boston Simplus and allowing it to air dry.
 • Never touch the lens surface: When handling the lenses, avoid touching the surface that will come into contact with your eye to prevent contamination.
By following these instructions, you can ensure that your scleral lenses stay clean, comfortable, and safe to use. Always follow your eye care professional’s guidance for your specific needs.

Here’s a list of helpful tips for using scleral contact lenses to ensure comfort, safety, and longevity:
1. Always Wash Your Hands:
 • Before handling your lenses, wash your hands thoroughly with lotion free soap and water to prevent contamination and infections.
2. Use the Right Solutions:
 • Boston Simplus is typically used for cleaning, disinfecting, and storing scleral lenses.
 • Scleralfil saline should be used for rinsing the lenses before insertion and for filling the lens reservoir.
3. Clean Lenses Properly:
 • Clean your lenses daily by rubbing them with cleaning solution (like Boston Simplus) for 10-15 seconds to remove any debris.
 • Never use tap water to clean your lenses, as it can introduce harmful bacteria.
4. Store Lenses in Fresh Solution:
 • Always store your lenses in fresh solution in a clean case. Avoid reusing old solution.
 • Make sure the lenses are fully submerged in the solution to ensure proper disinfecting.
5. Inspect Lenses Before Inserting:
 • Inspect each lens for any visible damage or debris before insertion. Look for any tears, cracks, or deposits.
 • Ensure there are no air bubbles in the lens reservoir when inserting.
6. Rinse Lenses with Saline Before Insertion:
 • Before putting lenses in your eyes, rinse them with Scleralfil saline to remove any residual cleaning solution and hydrate the lens.
7. Apply Scleral Lenses with Care:
 • When inserting your lenses, use a gentle, steady hand. Hold your eyelids open and place the lens on the eye without force.
 • If the lens feels uncomfortable, remove it and recheck for debris or improper insertion.
8. Keep Your Lens Case Clean:
 • Clean your lens case every day with Boston Simplus solution and let it air dry. Replace your lens case every 1-3 months.
9. Avoid Sleeping in Lenses:
 • Unless specifically prescribed, avoid wearing your scleral lenses overnight. Sleeping in lenses can increase the risk of infections and discomfort.
10. Stay Hydrated:
 • Scleral lenses create a reservoir of saline between your eye and the lens. If your eyes feel dry or uncomfortable, ensure you are properly hydrating throughout the day.
11. Be Mindful of Lens Drying:
 • Never let your lenses dry out completely. If they do, they could become damaged, making them difficult or uncomfortable to wear.
12. Follow Replacement Schedules:
 • Scleral lenses have a recommended lifespan. Make sure to replace them according to your eye care professional's instructions.
13. Use a Lens Insertion and Removal Tool:
 • If you find it difficult to handle the lenses with your fingers, consider using a lens inserter/remover tool. This can help avoid direct contact with your lenses and reduce the risk of contamination.
14. Monitor for Discomfort or Vision Changes:
 • If you experience persistent discomfort, vision changes, or irritation, remove the lenses immediately and contact your eye care provider.
15. Do Not Share Your Lenses:
 • Never share your scleral lenses with others, as this can lead to serious eye infections.
16. Regularly Visit Your Eye Care Professional:
 • Schedule regular check-ups with your eye care professional to ensure the lenses fit properly, your eyes are healthy, and any issues are addressed promptly.
By following these tips, you can maximize the comfort and safety of wearing scleral lenses, ensuring they provide the best vision correction while maintaining eye health.

Question 5

What is Hydrapeg?

Accepted Answer

More information coming soon

Question 6

How often do I have to replace my scleral lenses?

Accepted Answer

Scleral lenses should be replaced every 1 to 2 years, to prevent warpage, and possible complications. You should have your eyes examined at least once a year if you wear scleral lenses.

Scleral Lenses

WELCOME TO OUR SCLERAL LENS CLINIC

Visual Improvement for Irregular Corneas: The lenses act like a smooth, stable surface that helps to focus light more evenly on the retina, improving vision clarity.

High Customized: Scleral lenses are custom-designed to fit the contours of each individual's eye.

Comfortable and Safe: Scleral lenses rest on the sclera (white of the eye) rather than directly on the cornea, improving comfort and safety.

Enhanced Comfort for Dry Eye: Scleral lenses create a liquid reservoir between the lens and the cornea, providing a continuous supply of moisture to the eye.

3-D Cornea and Scleral Mapping (Profilometry)

Custom Designed Lenses

One and a Half Hour Initial Consultation

Support Packet Including Instructions, Tips, Letter of Medical Necessity

Products Sold In Office so You Never Run Out

Corneal Ectasia: Conditions like Keratoconus and Pellucid Marginal degeneration are genetic conditions causing the cornea to become irregular

Post Refractive Corneas: On rare occasions, the cornea does not hold well after refractive surgeries, leading to surgical induced ectasia or irregularity.

Corneal Scarring: Whether from infection, trauma, or other causes, scleral lenses can be an excellent option for those with corneal scarring.

Dry Eye and Corneal Pain: Scleral lenses create a liquid reservoir between the lens and the cornea, providing a continuous supply of moisture to the eye.

HERE'S WHAT'S TO EXPECT

FIRST VISIT

Evaluation and Fitting

SECOND VISIT

Training and Dispense

THIRD VISIT

Follow Up

Resources

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