Cleaning of scleral lenses.

[Dolphin]

To all you scleral lens wearers out there!

I would just like to know the different ways that you clean your scleral lenses. I was told to clean them with contact lens cleaner, dry them and store them dry untill I next need them. Cleaning them again before I insert them of course. I recently read that I should also be soaking them in a disinfecting solution because the cleaner does not get rid of the bacteria. Does anyone know if this is correct? If I should be doing this then does anyone know where i can get a case big enough to soak them in?

Thanks
Dolphin

[rosemary johnson]

Right.......
When I first got sclerals, they were PMMA ("Perspex"). I was told when I took them out to dry them on a tissue or clean dry cloth and put them in their case, then when I next wanted them, get them out, apply wetting solution all over, tinse off the excess and put them in.
This worked fine with PMMA - every so often, they said, sok them in a bowl of water with a bit of the wetting solution in (Contactasolm in those days).
Never had a problem with this.........
Actually, there was a middle stage - I moved to the other end of the country, got a new hospital and new hospital's info sheet whisch just said to clean them periodically in "household cleaner" and dry and put away in case.
That was PMMA.
Then came RGP lenses. Scleral ones, I mean. ANd those rigid gas permeable polymers need to be cleaned every time, or they won't wet properly.
WHen I got first rGP scleral, the hospital instructions were to clean them as soon as I took them out, then dry and put away in case, then I could get them out and put them straight in next time.
In fact I don't and never did - too fond of reading in bed and hoiking the things out just before I drop off.
SO in fact I take them out, dry them and put them away, and clean them just before I'm going to put them in. Unless I know I@m going to be wanting to put one in somewhere without good cleaning facilities (eg. on a plane or cross-channel ferry) in which case I do clean them and put them away, and hope I don't get so many fingerprints on them they won't wet.
As reagrds soaking them - haven't done that for years, and current hospital have never once suggested it to me as being at all necessary.
In the early days, with the periodic soaking in wetting ssolution in water, I used a (clean, obviously!) cereal bowl, IIRR, and later a small glass (whicky tumbler type, or sherry glass).
Delighted not to have had to bother ewith this for years.
As regards what cleaners don't clean off - well, that probably depends on a0 what cleaner you use and b) your own metabolism, and how thick and sticky your tears, or what sticky fingerprints you put on the lenses.
I've never had any problems with Stuff BUILDING OUP ON MY LENSES AND NOT GETTING CLEANED OFF. pRACTITIONER HAS EVEN COMMENTED ON HOW NICE AND CLEAN )p[[[s! keyboard gone mad) they are!
DUnno if any of that helps, but that's my experience, anyway.
Rosemary

[rosemary johnson]

PS to the above:
There are 2 sorts of bacteria: aerobic and anaerobic.
The aerobic sort live on oxygen in the air and need to be in the air to live. If the lens is well wetted in your eye, on both surfaces, the aerobic ones will drown.
The anaerobic ones need to be in water (or underground) and will "drown" in fresh air when you dry the lens and store it dry.
SO storing sclerals dry will automatically be keeping the bacteria levels down.
You'd be more vulnerable to a build-up of anaerobic bacteria with soft lenses, that have to be kept wet permanently because the liquid os part of the structure of the lens, or with corneal-sized hard lenses stored in fluid when not in the eye.
(Whydo people store corneal lenses wet??? - wouldn't cleanliness be easier if they are kept dry?)
Rosemary

[GarethB]

Microbiologist here

Anaerobic need low or zero oxygen and aerobic need oxygen, both survive equally well in water depending on the strain. Some of the lttle devils can switch between the two processes.

There are many types of contact lens material, PMMA is one, most the others fall under the rigid gas permeable category and each has differetn surface properties so will make them more or less susceptable to bacteria or protein build up so best to be guided by the lens manufacturer, many of which are independant of the lens solution companies.

Sclerals take up a large amount of solution to store wet which is my undersanding why they often get recomended to store dry. However once the cleaner is rinsed off I have been told it should then be rinsed with the conditioning solution which is not only an antibacterial properties but neutralises the cleaner. It is really painful if any amount of cleaner however small or even if it is dried on the lens.

Corneal lenses are often stored wet because you get a thin layer of liquid between the lens and the case which helps to prevent surface scratches.

Soft lenses and Rosemary points out need to be stored wet to maintain their hydration and these solutions do have anti-bacterial properties.

I have found if simple basic hygiens principles are followed bacterial growth is kept to a minimum. We need a balance anyway for us to remain healthy even though TV adverts overdo this somewhat.

[rosemary johnson]

GarethB, how come I've know you all this time and not not know you as a microbiologist?! - which field are you working in?
I spent 7 not-very-happy years working for "Colindale", aka the HQ of the Public Health Labs, as then was. But in an IT dept not at the lab bench face.
Resulted in a strong stomach, what with all the "shop" some of my colleagues discussed over lunch, some very sick humour, and all too much experience as a union rep.
Oh, and the maxim that "Post mortems are for pathologists."

To get slightly bac on topic - might be worth pointing out that we all carry round lots of "friendly" bacteria, and being too lavish in the antibacterial stuff kills off the good friendly ones as well as the not-so-nice variety.
Ever met anyone who seems to have nasty skin rashes most of the time, and can't understand why, because they are very thorough in getting all the latest antibacterial hand washes and kitchen, etc, cleaners and using them regularly and always getting the latest? - they are killing off the friendly bacteria that live on the skin and normally keep the bad ones at bay. Without the good ones there and healthy, the bad ones can stroll in unchallenged.
As regards wet/dry storage : OK, I can see that keeping a little corneal lens in a pot of liquid may be one way to protect it from bumps and cracks, etc. I can't see the slightest benefit of tryng to store a scleral wet - they are much bigger and tougher and harder to lose - and a lot of scope for flooded handbags/briefcases.
OK, keeping them in their case, not joiking them out while out and about, rolling them in a tissue and sticking them in your purse, has to be the preferred option.
None of my practitiouners ahve ever suggested trying to store the things wet - and have always provided cases that are very clearly for dry storage only.
Rosemary