In Case of Scleral Emergency…

Edited to add: I wrote this post when I wore LaserFit lenses, which are marked with dots to differentiate right from left. Due to insurance, I have switched to another brand of lenses, which are not marked. If I were to use this emergency hack today, I would separate the lenses into two cases and mark them for left and right lenses.

As I packed scleral supplies for a recent airline trip, my mind was preoccupied with the panicky thought, “What if my scleral supplies are confiscated?” It’s a long shot, but WHAT IF???

Most of the supplies in my scleral care kit are replaceable…with the notable exception of a large diameter lens case for use with hydrogen peroxide disinfection solution. Of course, I could substitute a different RPG cleaning solution in a flat case. However, my eyes are much happier with hydrogen peroxide disinfection.

So…I began seriously contemplating some WHAT IFs. What if I am flying and my supplies are confiscated? Or what if my scleral case breaks? Or what if I am unexpectedly caught away from home overnight? My emergency kits—purse or car—do not include disinfecting solutions.

I live in the United States, so most of the places where I might be stranded would have access to a Walmart, Target, or grocery/pharmacy/convenience store of some variety. Again, if necessary I would purchase some kind of RGP solution with a flat case, and rinse the lenses to within an inch of their lives with saline the next morning. Then again, I might be able to procure ClearCare (or equivalent generic), but not have a scleral case. What then?

I have read that some scleral users have successfully disinfected their lenses by carefully centering them within a ClearCare case. In fact, I began my scleral journey that way…until suffering my first lens break. Other users leave the baskets ajar rather than closing them over the lenses. But every time that I practiced a dry run of this technique, one or both of the baskets snapped shut upon insertion into the jar, in which case a lens might also very well snap.

So, I took another look at a ClearCare case, and came up with a emergency use solution that I feel is workable for those of us with larger lenses. I tested this using old lenses, and although I haven’t yet tried it on current lenses, I am confident that this approach would be safe for emergency use.

The case used here is from ClearCare. However the steps would be the same for generic store brand equivalents.

Step 1. Remove the lens baskets from the basket assembly.

Step 2. Snap the basket assembly off of the lid. Why? It is much easier to place the scleral lenses into the solution with the neutralizing disk and lens basket assembly inserted in the jar, but the lid removed. Note that there is a flange remaining on the underside of the lid. Leave it there. Why? Stay tuned…

Disassembled ClearCare case.

Step 3. Fill the jar with hydrogen peroxide cleaning solution up to or just a little over the line on the jar. It will need to completely cover the lenses.

Step 4. Place each lens in an opposite side of the lens basket assembly. Add more H2O2 solution if necessary, but keeping the level below the top of the lens basket assembly will help prevent it from floating.

Step 5. Center the lens basket assembly/neutralizing disk in the jar and screw on the lid. The flange left attached to the lid will keep the lens basket assembly from floating as well as centered within the jar so there is not a gap for one of the lenses to sink between the side of the jar and the neutralizing disk.

Scleral lenses during disinfection.

Step 6. After at least six hours of disinfection time, scleral lenses may be retrieved, rinsed, and inserted as usual. I used a suction cup removal tool, but the basket assembly could be carefully raised until the lenses can be taken out.

This is probably the appropriate place to insert a disclaimer: I offer this as an emergency approach to disinfecting scleral lenses. I do not recommend it as a long-term solution for using less ClearCare than a PROSE case as I have no idea what potential harm long-term contact with the neutralizing disk might have on scleral lenses.

Next week, a review of my handbag and car emergency kits.

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