My husband and I are headed to Las Vegas to visit our middle daughter over the upcoming Labor Day weekend, and we’re trying out a discount airline for the first time. Given that I am allowed a personal item only for a five-day trip, I need to minimize what I pack in all areas, including scleral supplies.

I had originally intended to take a PROSE case and five Aplicare 1-oz. hydrogen peroxide packets for disinfection. But after booking, I happened to notice a Facebook post on the Scleral Lens Education Society page about what appeared to be a smaller scleral lens case. When I was unable to find a place to purchase it, I Googled the original poster and contacted him through his clinic. He sent me this link.

I also ordered a DMV Versa combination inserter/remover, because that’s one less thing, right? It is available from the Dry Eye Shop or Amazon.

I have performed a trial run of both products. The only downside to the Versa device is that it is solid rather than hollow like the Vented Scleral Cup inserter I am used to. The suction cup side is exactly like the DMV Ultra Hard Contact Lens Remover that I generally use. The Versa doesn’t save that much space, though, so I don’t know that I would buy it again.

I am cautiously optimistic about the new scleral case. As you can see in the photo below, it falls in size between the PROSE case and the ClearCare case. Some time ago I measured the amount of ClearCare that it takes to fill a PROSE case (1 ounce) compared to a ClearCare case (⅓ ounce). The new scleral case takes ½ ounce. The jar is shorter than the PROSE case and designed with slots that the lens baskets slide into, so the diameter can be smaller and require less fluid. The lens baskets are large enough to accommodate my 19mm LaserFit lenses. However the baskets (particularly the clips that keep them closed) seem fragile and I don’t know how well they will stand up to repeated use. I may reserve it solely for travel.

Since the new scleral case requires half as much fluid as the PROSE case, a single travel size ClearCare bottle will last the duration of my upcoming trip. I will also take a backup pair of lenses in a flat case. I have just enough Nutrifill vials to last through this trip. I am also packing a few normal saline IV flush syringes for rinsing, the Versa inserter/remover, a few alcohol prep pads, nighttime ointments, a cleaning sponge saturated with cleaning solution, and a drain cover. This all fits nicely in a 3-1-1 size bag. I think I’m ready!

It’s been a minute or two since my last post about traveling with scleral lenses, so it’s probably time for an update with new products, insights, tips, tricks and strategies.

I’ve done a bit of traveling in the past year, by plane to Seattle, Las Vegas and Scotland/Ireland, and by car to Minnesota, the northeastern states for fall foliage, California to visit Joshua Tree National Park, Indianapolis and Valparaiso, Indiana, a cargo van road trip to Las Vegas, and a hiking trip in the Arcadia, Missouri area. No matter where I go or how I get there, I have to plan supplies for my scleral contact lenses. I need to wear these specialized lenses because I have left-sided facial weakness due to a surgery for hemifacial spasm that resulted in seventh cranial nerve damage (click here for more information). While I have experienced a good bit of recovery, my left eye still does not completely blink or produce tears. Without intervention I am in continual pain (think sand in your eye). I can deal with the pain by applying ointment to that eye, resulting in blurry vision. But add a scleral lens—plus a pair of progressive reading glasses with no distance correction—and my vision is nearly normal with no pain. I cannot overstate the improvement this treatment approach has made to my quality of life.

The trip to Scotland and Ireland was the most extensive and required the highest level of preparation, so most of this post relates to that trip. These are the supplies I packed (in addition to a pair of prescription progressive readers worn in conjunction with scleral lenses and a second pair of prescription glasses with distance correction for use without the contacts):

Solutions:

• For filling: I am one of the fortunate individuals for whom it makes no difference whether or not the preservative-free sterile saline I use for filling my lenses is buffered. Generally I use the more economical 5ml nebulizer saline vials, such as Addipak or Modudose. However for a two-week trip abroad, I decided to take Nutrifill solution because I had read that many scleral wearers find it more comfortable and that it helps with fogging. I also liked the 10ml size — twice that of the nebulizer saline vials. I took sixteen Nutrifill vials in my carry-on and sixteen more in my checked bag. (I always overpack filling solution because preservative-free saline is not readily available in most areas.)
• For cleaning: Who doesn’t love a good sudsy cleaner for their scleral lenses? I used Lobob ESC for many years until is was discontinued. Currently I am using Naturalens GP Cleaner, but it also appears to have been discontinued. I packed my last bottle in my carry-on. I’m not sure what I will use once this bottle is depleted, but I am open to suggestions.
• For rinsing: At home I rinse my lenses with neutralized ClearCare solution from the PROSE case, supplemented by any leftover saline. If my lenses occasionally need additional rinsing, I keep a supply of Target brand saline for sensitive eyes on hand. When I travel, I throw a large bottle in my checked bag. Recently, however, our mail order pharmacy mistakenly sent a 90-day supply (360 syringes) of IV flush saline rather than nebulizer saline. It was just before changing insurance plans, and in order to avoid a potential ordeal trying to return the order, I opted to keep them. The website indicated that the flush saline is preservative free, but erring on the side of caution, I decided to use them for rinsing. I packed 16 syringes in my carry-on and a bunch more in my checked bag.
• For disinfecting: My preferred method of disinfection is ClearCare Triple Action (or equivalent Target generic) in a large PROSE case. Shortly before I began preparing for the trip, I started seeing posts about the discontinuation of travel-size ClearCare, and decided to see if I could find any. Walgreens #1 — out of stock. Target — out of stock. Walmart — out of stock. Panic starts to set in. Walgreens #2 — out of stock. HyVee (a grocery store where I seldom shop) — one lonely bottle on clearance! Score! My local pharmacy — never stocks. Gerbes West (my usual grocery store) — out of stock. A second local pharmacy — out of stock. Well, at least I have one bottle for my carry-on bag. Schnuck’s (a grocery store where I occasionally shop, usually on “Wednesday Wine-day”) — six, count ’em, SIX, bottles. Not on clearance, but I buy them out. And decide that I have enough not to head to the east side of town in search for more. I packed two travel-size ClearCare in my carry-on plus a large bottle of Target brand hydrogen peroxide cleaner in my checked bag.
• For nighttime lubrication: As I first began recovering from my microvascular decompression surgery and needed round the clock eye protection, I tried every type of eye lubricating drop, gel or ointment that I could find. The one that worked best for me was RefreshPM ointment. Even after I began wearing scleral lenses, I used it on my left eye at night. During a prolonged shortage of RefreshPM, my optometrist had me switch to Muro 128 ointment. After RefreshPM was available again, I discovered that a combination of the two ointments worked best for nighttime eye comfort. I took a tube of each in my carry-on bag. I also packed a few vials of TheraTears nighttime eye drops in case my right eye was feeling dry at night. Fortunately this seldom happens.

Additional Supplies: All of these were packed in the carry-on scleral care bag pictured above.

• DMV vented inserter and suction cup remover.
• PROSE scleral lens case for hydrogen peroxide cleaners with a neutralizing disc.
• Jar from Almay 120-count eye makeup remover pads. A perfect fit for the PROSE case, it minimizes solution spills while traveling.
• Contact Lens Accessory Pads, small green sponges used in conjunction with cleaning solution. I cut them into quarters because I find it easier to clean the interior of my lenses. Plus they last longer. I packed eight quarters (two sponges).
• Two spare pairs of lenses in small cases filled with Bio-True solution. I also carried a travel-size bottle of Bio-True in my carry-on.
• Silicon drain cover. More than once this has saved one of my lenses from going down a drain with no stopper. (In the future I will also include a small suction hook so that I can hang the drain cover on the bathroom mirror to dry.)
• Travel size fragrance-free and lotion-free hand soap.
• Lens cleaner and microfiber cloth for cleaning my glasses. Also handy for camera lenses.
• Travel size package of cotton swabs.
• Alcohol wipes.

Most of the products noted are available online from Amazon or the Dry Eye Shop. Many may be available locally from Target, Walmart or Walgreens — the exceptions being the large PROSE case, DMV inserters and removers, and preservative-free saline solution. The latter may be available from a local pharmacy with a prescription, but I have always resorted to Internet purchases.

Whenever I fly, I also carry a letter from my optometrist explaining that I need to take medically necessary fluids for scleral lenses in excess of the 3-1-1 TSA limits. I keep this with my COVID vaccine record and passport.

Check back next week for my top 10 scleral lens travel tips and tricks. Meanwhile, remember that there is no reason to let scleral contact lenses keep you at home. Happy travels!

Those who know and love me, along with those who have read my series on scleral lenses, have some idea of how much they improve the quality of my life. To go from putting up with ointment-smeared blurry vision to avoid dry-eye pain to clear and usually comfortable vision was nothing short of miraculous. Sclerals rock!

I first heard about LaserFit lenses when Dr. Greg Gemoules commented on one of my web posts. The best way to learn about LaserFit is to poke around his website, but in short, rather than relying on hit-and-miss trial lenses, Dr. G uses computers to precisely measure the surface of each eye to design customized non-rotational lenses. I was intrigued by the concept of computer-designed customized lenses, but at the time I could not justify the trip. It remained in the back of my mind as a possibility, however, and late last year a number of variables fell into alignment, allowing me to schedule an appointment.

The most difficult part of the process was not wearing my prior set of scleral lenses for a week leading up to my initial appointment with Dr. Gemoules. Because the surface of the eye is malleable, this period of rest is essential to the best fit. Despite the discomfort at work and on the flight, I made it through. Coppell Family Eye Care has a medical rate arrangement with a local motel that supplies a shuttle service to the airport, eye clinic, and other attractions within a three-mile radius, including nearby Grapevine, Texas.

The Monday appointment is the longest at about two hours, during which Dr. G does a comprehensive eye exam and takes the digital measurements to design a first set of lenses. The staff carefully schedules LaserFit patients so that each one is allotted sufficient time for a successful outcome. Patients come from all over the United States and worldwide – there was a young man from China visiting the same week that I did. Custom made lenses arrive from the lab by about 2:00 p.m. the next afternoon. For the remainder of the week, Dr. G checks visual acuity and the fit of the lenses during follow-up visits that last about half an hour. In my case, the fit of the first lenses was excellent, but needed some adjustment for sharper vision.

Each subsequent set of lenses improved my distance vision. By mid-week, Dr. G experimented on designing multifocal LaserFit lenses since that was what I was used to with my prior scleral lenses. Unfortunately the multifocal aspect came at the expense of distance acuity, so we reluctantly gave up on the idea. Dr. G had warned me from the outset that I would lose near vision, but I had not expected the change to be so dramatic. He suggested trying monovision (one lens designed for distance and one for near vision) but just as when I had LASIK surgery, I prefer to have both eyes corrected for distance. After trying and rejecting various types of over-the-counter readers, I eventually bought a pair of glasses with progressive lenses that have no distance correction for wearing at work. Edited 9/22/20 to add: I buy plano to +2.0 progressive reading glasses from Zenni Optical. They usually run sales on Black Friday and a few other major holidays. 

Dr. G recommends a different care routine than I was using for my previous scleral lenses. He prefers Clear Care® hydrogen peroxide solution (although not Clear Care Plus®). LaserFit lenses are larger than the maximum recommended for the Clear Care® case, but carefully centering the lens in the basket enables its use. Do be very careful, though, not to let the lens basket snap shut as this can cause the lens to snap as well. Edited 9/22/20 to add: Sure enough, despite taking prodigious care, one of my lenses broke in the Clear Care case. I now use a larger Prose disinfection case. Note that it requires three times the amount of solution, but definitely worth the extra expense to keep these premium lenses sparking clean!

Other noteworthy tidbits:

• Because LaserFit lenses are designed to exactly follow the contour of the eye, they do not rely on suction and are therefore much easier to remove.
• It’s very very important to check with your vision insurance before booking an appointment. VSP, for example, pays hardly anything toward the lenses or the exam.
• Updated lenses may be over-refracted by another eye care professional (I am less than a year out and have not done this yet). Edited 9/22/20 to add: I have now had two over-refractions and am scheduled for a third this month. Because my optometrist is a VSP provider, replacement lenses are fully covered.

Despite the time and expense, and even though I was relatively successful with rotational scleral lenses, I would do LaserFit again in a heartbeat. Sclerals rock, and Dr. G is a rock star!

I discovered Dry Eye Talk forums when I was researching scleral lenses as a result of conversations at the ANA Eye Issues Forum. It’s part of the very helpful site Dry Eye Zone, which also hosts news items pertaining to dry eye, an encyclopedia of dry eye topics, a computer blink reminder, and a Dry Eye Shop.

I never knew there were so many causes of dry eye, or that LASIK was one of them. As a extremely nearsighted, middle-aged woman with large pupils, I am fortunate to be a LASIK success story. However, thanks to post-surgical facial paresis, I became all too familiar with the pain and misery of dry eye. Early on I got a platinum eyelid implant. It aided nighttime closure but still left an incomplete blink.

One of the forum categories at Dry Eye Talk is Our Dry Eye Triumphs. After more than five years, I feel that I have finally arrived at that point. The remainder of this post is a before and after comparison of my dry eye care routine.

Before

I tried every type of eye drop, gel and ointment I could find. Eye drops and gels, no matter how thick, gave only a fleeting moment of relief. Standard eye ointments containing about 15% mineral oil and 85% white petrolatum offered 15-20 minutes of relief before I needed to reapply. Refresh PM, with a higher proportion of mineral oil (42.5%), gave me much longer relief. I always applied it before bedtime and first thing in the morning. During the summer that might be all I needed; during the winter I usually required a mid-afternoon application as well. Although some less expensive store brands, such as Walmart and Walgreens, contain the same proportion of ingredients, they did not work as well for me.

My eyes felt pretty good, but the vision on the left side was blurry, like looking through a lens smeared with vaseline. My brain learned to compensate, relying more on the clear vision in my right eye while utilizing the images from the left eye for depth perception. My overall vision was similar to this image, courtesy of Visionsimulations.com:

My method of applying ointment was a bit unconventional. Instead of squeezing it onto my eye from the tube, I put a small amount on my ring finger and applied it to the sclera below the iris, then closed my eye to distribute it over the cornea. I’m sure ointment manufacturers and eye care professionals alike would be appalled, but it worked for me. For nearly five years, 24/7 application of Refresh PM ointment comprised my eye care routine.

For a while, the absence of dry eye pain compensated for the loss of crystal clear vision. But over time I began to experience mental fatigue from the continuous effort of concentrating on my right-side vision. That, with the nearly constant nuisance of extra ointment under my eye – which also made wearing eye makeup an impossibility – led me to begin researching scleral lenses in earnest.

After

A scleral lens is much larger than a standard gas permeable contact and vaults the cornea, allowing a pool of saline to remain between the lens and the surface of the eye to combat dryness. Scleral lenses are more expensive because they require a precision fitting process. In my case, the first lens turned out to be too loose, but the second one is just right.

Here is the rest of my new eye care routine. Yes, it costs more and takes more time.

Solutions:

• Scleral lenses must be filled with preservative-free saline prior to insertion. Large bottles of saline contain preservatives, which leaves the more expensive option of individual vials. There are many brands with varying levels of lubricating agents added. Individual vials contain 2-3ml of fluid, which is just enough to fill a scleral lens. I found a much more cost-effective option to be sterile saline vials manufactured for nebulizer use. They are available in 3ml, 5ml and 15ml sizes. They contain no lubricating ingredients, and the lid can’t be snapped back on once opened. I prefer the 5ml size because it contains enough to both rinse and fill the lens. Beginners often need more than one attempt at insertion, so there is extra to allow for that. Any extra saline can either be discarded or used at the end of the day to rinse the lens after removal, but should not be kept for use the next day. I’m fairly sure 5ml would still be sufficient for two scleral lenses. Amazon.com has the lowest prices I’ve found for nebulizer saline. I usually buy 100 vials for around $15, but they are also available in quantities of 1000 for about $125.
• At the end of the day when I remove my lens. I use a daily cleaner called Lobob ESC to remove surface dirt and oils.
• I prefer UniquePH multipurpose solution for soaking and disinfecting. It is not available locally (at least here) and is sometimes hard to find online, in which case I use Lobob CDS but I don’t like it as well.

Tools:

• DMV Lens Insertion Tool – there is a great YouTube video that shows techniques for manual insertion and removal of scleral lenses, but I don’t like the thought of it, plus there is the possibility of getting skin oil or soap/lotion residue on the lens. I prefer to use an insertion tool, like the one pictured at left.
• DMV Removal Tool – the thought of breaking the suction between the lens and my eye using my fingers just gives me the creeps. I very very very very much prefer to use a removal plunger, pictured at right. There is also a plain suction cup without a hollow, but I prefer the way this one allows suction to be started and stopped by squeezing the bulb.
• Mirror – I place a hand mirror on the bathroom counter during lens insertion. The insertion tool is hollow all the way through, so I line up the reflection. When I can see the excess fluid spilling out, I know the lens is in the right place. I use the regular bathroom mirror during removal to find the right spot to apply the suction cup.

Tips:

• During insertion, tuck your chin toward your chest until your eye has to look slightly up toward the mirror. That keeps the lens level and the fluid in the cup through the insertion process.
• Blink hard a few times after insertion to help center the lens. You will notice your vision getting appreciably clearer with each blink.
• If you see ghosted images after insertion, too much fluid was displaced and there is an air bubble in the lens. Take it out right away to refill and reinsert, because in just a few seconds it will begin to smart like crazy.
• During removal, apply the suction cup to the outer edge of the lens. If the suction cup is in the middle of the lens, it will increase rather than break the suction. Placing a drop of saline on both the contact and the removal tool helps a lot. If the suction is still hard to break, try gently moving the edge of the lens slightly back and forth with the suction cup before trying again.
• If your vision starts to blur during the day, apply a drop of saline over the lens and blink a couple of times. If this doesn’t help, remove the lens, refill with fresh sterile and reinsert. Blink hard a few times to recenter the lens.

Nighttime care: At first, I continued using Refresh PM whenever I was not wearing the scleral lens. My optometrist recommended using lubricating eye drops with a silicon eye shield at night, but I needed the security of my old method for a few weeks. I was extremely happy once I made the switch. The lens stays cleaner and my eyes feel even better in the morning. Often I can wait two or three hours before having to put in my scleral.

• TheraTears Liquid Gel drops – I’ve tried a lot of different lubricating eye drops and this one is my favorite. It’s a thick solution and my eyes feel better in the morning than with any other drop I have tried. The top of these vials can be snapped shut, and although it is not recommended, I generally use a vial for two nights. Bonus: there is a $2 coupon good through 2013 available here and a $1 coupon good through 2014 available here.
• Quartz silicon eye shield – also available in a dark version called Onyix. It was originally developed to combat dry eye among  CPAP users, and is made by the same manufacturer as another nighttime dry eye product, TranquilEyes. I have found a couple of drawbacks with the Quartz shield. First, it tends to leave marks on my cheeks that take up to an hour to fade. Also, the adjustable fabric band tends to slip so I use hair clips or bobby pins to keep it in place. Fortunately, that way it does not have to be as tight so the morning marks aren’t quite so bad. TranquilEyes are supposedly less likely to leave marks, but they are not available in a clear version so I will probably stick with the Quartz shield.

The vision in my right eye has slightly diminished to -1.0 since my LASIK surgery thirteen years ago. I am not currently wearing a contact on that eye. I wear a pair of prescription glasses with clip-on sunglasses to drive and sometimes at the movie theater or to watch TV. Since I ended up with classic monovision, I rarely need to wear readers to read or work on the computer. I will decide by my next scleral appointment, currently scheduled for July 2014, whether I want another lens for the right side or if I am content to continue this way.

I keep a a few necessities in my purse in case of emergency – a spare set of insertion and removal tools, contact case, saline and Thera Tears Gel vials, alcohol wipes, a compact mirror and a tube of Refresh PM. My new eye routine definitely requires more money, time and stuff. But is it worth it? Well, the optometrist tells me that my eye is healthier. I am less fatigued at the end of the day. I no longer have to worry about wiping extra eye ointment off my cheek. I can wear eye makeup when I choose to. And best of all, I now see like this:

I am still waiting for the outcome of an appeal to my insurance company to cover the scleral lens as a prosthetic device for a nonfunctional eyelid. My argument is that it will decrease the possibility of corneal disease and accident. Whatever their decision, there is no question that the lens enhances my quality of life.

Read my next post on scleral lenses.