Survey: Bubbles and scleral lenses

Survey period: February 9-14, 2023

Participants: 277

Tips, suggestions and comments: LOTS.

Which of the following best describes your experience with getting bubbles in your scleral lenses?

Choices presented in survey were:

This has never been an issue for me, not even when I was first learning. (2.5%)
I got bubbles when I first started learning, but now I don't (or only rarely). (29.2%)
I sometimes get bubbles under a lens the first time I put it in, and have to start over. (52%)
I often get bubbles under the lens. (7.6%)
Bubbles under the lens are a constant challenge for me. (7.6%)
None of these describes my experience. (1%)

So - a little over 15% of participants are frequently experiencing bubbles, which was a little concerning!

WHEN do you know that you have a bubble?

HOW do you know that you have a bubble?

This was a "check all that apply" question.

73% - It affects my vision.

43% - I can feel it (pain or other sensation)

40% - I can see the bubble in the mirror.

27% - I use a high magnification mirror to check for bubbles.

5% - Other

What strategies have been most helpful to you in preventing bubbles?

WOW. I think this set a record for the number of people providing their tips.

careful following procedure but still sometimes I get bubbles
Reentering lens
Putting Purilens into the lens slowly, making sure there are no bubbles in the liquid. Looking straight down. Moving my eyelids out of the way.
taking time to insert
None =(
Overfilling the lens with saline and holding the lens very still while inserting.
Make sure the scleral lens is overflowing with solution
Refresh drops are a lifesaver. But I also make sure that I'm looking down and try to line myself up perfectly as best as I can.
Tapping the plunger before putting it in my eye
Making sure I use a lot of solution before insertion
Over fill lens with solution and use a stand to insert lens.
My bubble issues have started since my last annual appointment. Plan to speak to the doctor about it at my next visit because it seems worse and I don't know how to prevent them.
Proper insertion, holding my head at the proper angle
Fill lens really full.
I haven’t been able to prevent them. When I notice one I just have to take the lens out, clean it and put it back in.
Fill the lens to the top with saline solution
Make sure I get it in right the first time 🤷‍♀️
Taking out the lens and reinserting. Also, making sure my head is tilted parallel with the floor when inserting lens and my eyelid is open very wide so the edge of the lens doesn’t scrape against my upper lid.
I haven't found a way to prevent them other than not touching my eyes.
Make sure to fully open eye before insertion and avoid blinking
Making sure nothing is on the lens when put them in and not over filling the lens with nutrifil.
Making sure I don't put the lens in on angle.
bracing my elbow for stability and consistently overfilling the lens. focusing on inserting the lens in one fluid motion
Not rushing insertion
Only way I know is to look closely at the lens with saline covering the lens to make sure no bubbles are visible before insertion.
Care during application
Reinsert the scleral lens
Stay focused on a spot in the mirror, start with my contact closer to my eye, move steady when I insert.
Look straight down ( don’t tuck chin ) when inserting
Switching from holding the tool in the same hand to switching tool hand (was right for both now right for left eye and vice versa)
Watch when adding liquids especially from small drop size bottle (like Celluvisc) or at the end of a bottle. I feel like air in bottles create the air bubbles.
over fill bowl with saline, maintain eye looking down
Overfilling the lens with artificial tears before inserting.
Nothing really, it just happens sometimes
Fill out the scleral more than the top with the saline solution now I also use a stand so I dont move the lens avoid spilling the solution
Go Slow with Insertion
make sure my head is level and lens is totally full
Overfilling the lens
I have to keep my eye from looking at the lens as it comes toward my eye. I do best when I start inserting within a couple inches of my eye. The longer I watch it advancing toward my eye the more chance of losing focus and having my eye wander.r
I use the tripod method & overfill sclerals and that prevents ne from getting air bubbles at all anymore :-)
Holding my eyes open very wide and keeping the pupil in the center of my eye opening.
Very full bowl
1.) Shake the vial to force bubbles air to top or out of solution. 2.) Make sure to fill lens to overflow. 3.) My slight shakiness helps them to disipate if I do not try to put them in quickly.
eye straight down on to solution/lenses. no placing off balance to eyeball.
Re insert the lens refilled wi the solution
The best solution for me is the greed led guide light. That and making sure the lens is filled with solution
Hold eye wide open, don't blink/squint when inserting lens.
Use plenty of Nutrifill to fill the lens and take my time inserting the lens. I find I’ll get a bubble when I rush the lens insertion.
Take lens out and retry to place..remain at 90 degree angle and ensure contact is completely full of solution to avoid air bubble
Trying to not let it touch my eyelash and just putting it right into my eye quickly
Make sure lens is level on the lens holder and that you don’t tilt it to insert. I immediately for bubbles with magnifying mirror and shine pen flashlight in my eye.
Celluvisc
Stand and green light inserter
Starting over
Re-inserting several times a day
Have had fewer bubbles since switching to Nutrifil
Careful insertion, mirror check with flashlight
Using 10-12 drops of solution even if some run off (mt doctor told me this).
Remove the lens and reinsert. I have Boston Prose lens.
1) use a plunger, and during insertion, look straight down with wide eyes "through" the hollow black hole in the center of the plunger; 2) prior to insertion, look to see if there are any visible bubbles in the liquid, even tiny ones. If there are, wait about 20 seconds for them to disappear on their own, then insert.
Bring eye to filled lens, which should remain upright and stationary. Eye to lens, not lens to eye.
Rinse well and fill lense slowly with solution
1. Take my time, don't rush. 2. Rinse my eyes with preservative free saline to wash out any eye gunk so the lens fits correctly.
Making sure I have over filled the lens, so basically I let the solution bubble pull it to my eye.
Take my time as well making sure i have enough drop inside my lense
I rinse lens one more time, then squeeze vial slowly
Using a DMV inserter and lightly tapping the fingers holding it to shake the bubbles up.
Going real slow
Careful insertion of lens
Smooth insertion and making sure there is enough liquid in the lens.
The best one for me is to overfill the bowl to an almost overflowing point
Inserting lenses with an o-ring, making sure the lens cup is overfilled
Making sure the lens is positioned correctly on the holder
Direct and careful insertion
Usually bubbles re a result of not centering the contact during insertion. My dr instructed me on what to do differently and the frequency of bubbles have been greatly reduced.
Over filling lenses
Rinse eyes with saline first to remove debris, reinsert lenses right after insertion two times, following a 5x zoom camera photo to detect small bubbles.
If I overfill the lens…and make sure my head is tilted down (same angle as the lens on the inserter) it doesn’t happen.
Fill the lens with saline.
Overfill the lens, by a lot, with saline. If saline spills, i hit eyelid, or hit finger during insert, i will start over and refill lens instead of proceeding to insert the lens. Still there are occasional days when bubbles occur during several attempts. I find that taking a short break before trying again helps. I also give myself ample time to insert the lens. The bubbles often occur when I am rushing.
Start over and repeat. Often by taking breaks to wait for the eye's irritation to subside.
Fill the lens adequately and insert using as little pressure on the lens as possible
Using the application ring allows me to insert the contact quicker which reduces the air bubbles. When I used the plunger I always had bubbles now very rarely do I get them with the ring.
Keeping’. My head horizontal during insertion, sometimes it helps to bend my neck slightly forward
Looking straight down the hole of the insertion tool.
nothing
Extra careful during insertion process
Pay attention to what i am doing
Overfill the lens
over filing the lens
I fill the contact really full and try not to hit my eyelids when inserting
One or two drops of Celluvisc along with Purilens saline is helpful in minimizing bubbles.
Overfilling lense bowl when inserting
Just start over; it shouldn't happen. ALSO: For a while, I was using Refresh to add tears, and that vial needs to be tapped so that there are no bubbles when squeezed - like a syringe before an injection.
Concentrating on NOT moving my eye during the insertion process. This only happens with my left eye and I'm right handed, so I believe that's a factor of some sort too.
Haven’t found any
Reinsert
Overfill the bowl. Do not squeeze insertion tool too forcefully (if you use one that holds lens with suction)
Make sure the saline is very full in the lens and that it’s free of bubbles. Sometimes I have to blow the bubbles off and top off with more saline.
Fill the lens to the brim. Keep it horizontal. I have steep cornea. Dont know if that makes a difference.
I make certain that I am going in a straight line
Pracrice. Took a long time to learn how to put lenses in without getting bubbles. My doctor took a lot of time, many trial pair of lenses, until found a good fit.
Taking my time and overfilling as well as tilting my head downward and level
Overfilling my lens while also keeping my eyes open wide until the lens is properly inserted
Pull my eyes wide open during insertion
Overfill the lens, head parallel to countertop, open the eye wider
Wearing sunglasses to try to prevent wind from getting into my eyes and drying them out which often leads to movement of the lens and bubbles
I believe I got bubbles more often earlier because I didn't fill the lens until it domed, and I inserted it with too much force, if you will. I now ensure there is an adequate dome, and gently touch it to the surface of my eye where it adheres immediately, leaving no bubbles behind.
I check for bubbles b 4 i insert
remove, re-clean and fill the lens - then re-insert
Inserting slowly and avoid blinking right away.
Reinsertion
I get them when putting them in. My doc has me wear and eye patch on my dominant eye when putting it in and it seems to help.
Our daughter is autistic and not coordinated enough to insert the lenses herself. We put them in for her. We have found that we carefully overfill the lens with saline, have her tip parallel to the floor and then we insert from below her. It's complicated, but we consider ourselves incredibly fortunate that she cooperates. If there's a bubble she notices right away and we start over.
I fill the bowl of the lens all the way prior to insertion, and then have to hold open my eye with the opposite hand.
Start over ir give up on wearing the kenses
I remove the lens and reinsert it.
Overfilling the lens with saline and avoiding any hesitation as cool saline initially contacts the eye; instead proceed onward with a little pressure until complete contact is made; then perform a little twist or rotation of the plunger, maybe 45 degrees, before withdrawing it away from eye.
Make sure the contact goes on parallel to the floor
Don’t rush, check in magnifying mirror
Be sure lens is filled adequately with saline - to top. About 6 drop for me from Sclerafil. Look straight down and insert straight up. Hit your mark and keep it there. Don't move lens around. Doesn't matter if excess saline runs out of the eye. Do not remove too fast (thus slipping the lens out of place) and do not look up till you are sure it is in place. Pressure is not the key so much as direction and accuracy.
Not sure really. I try to insert it more slowly and with slightly more pressure. I also try and keep my eye wide open, but still I'm not sure it's effective.
Slow, one drop at a time of solution
Inserting it correctly helped me
Running my finger around the outside of the full lens , and filling it until it spills over the edges
Keep clean af
Pay careful attention to inserting them into the eye evenly and checking with flashlight if in doubt.
Slow and steady
Steady hand and head is in a direct line to the contact. Not at a angle
I I look straight down, my hands are resting on a solid surface and I lower my eye to the lens. My plunger is see through so I have a target of light to aim at as I lower my eye for insurtion.
Honestly, I have no idea. I don't know how to prevent bubbles. I do everything the same and sometimes there are bubbles, and sometimes there aren't.
Apparently the fact that I'm making sure to overfill the lenses has helped me to avoid this issue.
By using the insertion tool with the hole in the enter I make sure i get lens in center of eye and doit slowly til i feel the saline solution on my eyey
Not bumping the lens as I am inserting it. Make sure it is full of solution.
Overfilling. Cu/ing off the bottom of the rubber inserting tool. Not pressing hard.
Other than the HUGE bubble which I feel right away, the tiny ones I don’t feel. I didn’t know these were happening until my OD commented. Now I always do two things: I figured out they happen due to dry eye. My first step is to open my sclerafil vial and put one drop in each eye before I fill and insert the lens. If I forget to do this first step that is when the tiny bubbles show up. After I’ve inserted the lenses, I also check for the big bubbles. This usually occur when the lens is off center on the inserter or when I bump it as it is inserted.
Focus on the green light
I use a stand so that I have both hands free to keep my eyelids open and insert the lens. I put in my lenses sitting down, which gives me more stability and I don't have to bend my knees and stand in an awkward position.
Addipaks use to give me the most bubble
Illuminated insertion device
Overfill the lens
Rinse lenses thoroughly after cleaning so there's no soap residue
to fill completly
I put IN more solution
I use my phone flashlight at an angle to illuminate my eyes and look in the mirror. The bubble leaves a large shadow and is immediately obvious.
Overfilling the lens with solution and making direct contact when inserting into my eye (when I’m nervous or unsure-I always get a bubble) or if my eye isn’t opening wide enough
filling the lens with at least 7 drops of solution, until I note that it is brimming full
Overfill bowl, don’t press anywhere near your eye
Removing and re-cleaning the scleral lens
Inserting lenses carefully with overflow of saline.
Make sure the lens is overfilled and put in straight
Stand and green light inserter
Filling the Scleral Lens will saline solution till it makes a heap over the lens and put it in one controlled swoop with my three fingers.
I remove the lens and start over.
using the dmv inserter cup vs. just fingers
Over fill with saline
I have to take my lens out and start over.
Slowly and carefully fill bowl, check for bubbles if possible before insertion.
I haven't found one yet
Filling the lens to the point that the liquid rounds out and almost overflows
Bubbles usually happen if I blink at the wrong time while inserting lens
Adequately retracting eyelids (retracting from lid margin), overfilling lens with saline, re-inserting lens if lid or retracting fingers were bumped during insertion
Using the plunger with the hole at the bottom
Watching for bubbles when I am filling the lens and overfilling the lens until it is convex
fill lens all the way, insert horizontal
overfill lens, lean over to try and be parallel to table, make sure my fingers and eyelids are dry
Overfill the lend and use dmv inserter
You can not be in a hurry in putting in your lenses and experience
Ensure there are no bubbles in the filling solution and lightly press the lens into the eye when inserting.
Keeping eyelids spread apart as much as possible.
Be sure there are no bubbles in the liquid before you insert the lens
I usually get bubbles because I’m in a hurry! So I have to take some deep breathe and slow down. Make sure my lender is full and make sure I’m looking straight down into my lense.
overfilling lens with saline. Using stand to keep eyelids under better control with both hands
Overfilling bowl , opening eyelids wide whike bending down towards lens on plunger stand.
Keep head horizontal when inserting lenses
Fill lens bowl to overflowing before insertion. Be sure to approach the eye straight on, no tipping of the insertion plunger
trying not to shake the vials as i move them
Have experimented with various drops and number of drops added the my PFS. In addition to those drops, my dr recommended adding two drops of my autologous tears to each lens, too.
Remove and reinsert the lens
i don’t seem to have anything in particular. it just happens sometimes
Cut a hole at the bottom of the tool.
take the lense out immediately and start cleaning again!
I don’t know what I do wrong to cause them
Make sure lens is filled to overflowing and keep head level
Reinsertion
Time. Practice.
remove lens and try again
I initially make sure there are not bubbles in the drops inserted in lens before applying to eye
Straight insertion no hesitations
I try to check that I actually did overfill the lens. If I feel the fingers holding my upper eyelid touch the lens, I’ve learned this often causes a bubble so I stop and reset the lens & top off the lens.
Using my fingers rather than a large plunger to insert my lens has helped the most because I can feel how hard I'm pressing it onto my eye. If I don't press hard enough, I get a bubble.
optimum positioning when inserting; doesn't work 100% of the time though
Overfill the lenses for insertion so that the saline squishes out; no room for air bubbles.
Fill the lens FULL. To over flowing
Using as much saline as possible and a visual inspection prior to insertion.
Overfill lens, make sure to slowly drip saline in, use a small vial of saline
Being careful to not inserting lenses in too quickly
It took possibly as long as a year but eventually I learned what I needed to do to insert the lenses without bubbles and that I needed to check each eye immediately after inserting the lens with a special, high magnifyling lens to ensure there were no bubbles before going on with my day.
Celluvisc
Ensuring that no liquid spills from my lens as I insert it.
Immediately before I put in my lenses, I put a drop of Purilens in each eye. The added liquid under the lens eliminates the bubbles. It works every time and is an easy habit to get into.
Lining up perfectly and coming down on the lens just right.

Comments from participants

A small flashlight helps a lot! There are many I would not see without that.
In some cases the bubbles are due to scleral needing to be refit since the kerataconus is progressive; if the bubbles do not go away its probably time to see the doc.
What causes bubbles? Do they ever occur later during the day or were they always there since putting the lens in?
I find that it's not necessarily bubble as much as minor leakages that effect me. This happens when I do things like rub my eyes, go some place where there is a dramatic change in pressure or have a large change in temperature. The vision in my eye (usually the left one) will be hazy and eventually it will start to hurt.
I over fill to minimize the chances of a bubble occurring.
I recommend overfilling them With whatever preservative free solution you use that way the air has no space to get in & make a bubble
Any advancement towards getting BSS solution to fill lens reservoir ???
I’m very curious to read others’ experiences with this as I would love to know how to prevent it from happening as often. Thank you for addressing this topic!
I never had bubbles until recently . It seems to happen when I’m having a bad flare up of dry eye and my eyes are swollen .
It does get easier to avoid bubbles and to recognize right away if you have one. If they are appearing long after insertion, have fit checked.
My advice is to be patient with yourself. Rinse your eyes and the lens with preservative free saline to help the lens fit properly.
I hate bubbles and having to try inserting sometimes 3 or more times, without scratching my eye. If I do that then it becomes a glasses day.
Since using Nutrifill, rarely have bubbles
My bubbles are really small, insertion with artificial tears like celluvisc will not make it any better. I have a lot of debris und proteins on my eye. Do you have the same problem?
Don’t be in a hurry..or you’ll end up having to do it over!
Is there a better solution than Puri Lens that can prevent bubbles better?
I am not really sure if I have bubbles or just inadequate lens filling when I have poor vision after insertion. How does one really tell if bubbles are the cause of the poor vision?
Whenever I hesitated to put the lenses in is when I got the most air bubbles.
I can never see the bubble, however, I immediately know if there is one because I can see light refracting in all directions from that area of the lens. There is also a sensation of discomfort in that area.
I just take them out and I insert them sgai
How long can I wear them daily?
On my last visit to Boston Sight, I was prescribed significantly larger lenses. Prior to this, bubbles were never an issue for me.
An LED flashlight in a mirror in an otherwise dark room is a great way to identify bubbles.
If the bubble is tiny it will go away on its own so you can ignore it
Wish I could prevent them from happening so often..
I would like to ask how long a pair of scleral contacts usually lasts people.
Is there anyway to eliminate the bubble without removing the lens?
our daughter seems to FREQUENTLY have protein build up that floats around in her lenses after 4-5 hours. We switch her saline 2-3 times per day. We wonder if there is a way to get her eyes to not make so much protein ("eye boogies") and how do you keep them out of the lens solution?
My lenses are foggy all the time. I have to rely on my glasses almost daily.
I have found that bubbles are a sign that I may need a new insertion plunger.
Why are bubbles so bad?
I can sense a bubble but it is not painful. It rarely happens, but did a couple times in the beginning of use till I developed my technique. You just sense it and for me that sensation was usually immediate - however it rarely occurs and has been so long, I am going by memory here.. What affects vision and can be painful is if the lens moves off the center or correct fit site on the eye, after it has been in place for awhile. Rubbing the eye can cause this. This too happens rarely, but can occur. These lenses stay in place remarkably well if you insert them correctly.
Using thicker options like celluvisc adds bubbles for me so i only use saline to fill
Why do we get the bubbles? There have been times when I have had to remove and restart 4-5 times.
When I first started using scleral lenses I cut the bottom of my applicator and used the light at bottom as my guide.
Sometimes just tapping on the side removes the bubbles
It is really important to get rid of the bubbles asap as I once got a corneal abrasion from leaving it in too long despite the discomfort as I was skiing and it was awkward to deal with. Never again!
It flies across my vision when i have bubbles.
Definitely less frequent as I became more comfortable with the lenses. I also use plenty of saline, so that prevents a bubble before insertion.
Having a magnifying mirror of sufficient strength to actually see the presence or absence of bubbles was essential when I first started using scleral lenses at age 70. Presbyopia made magnification and a good light source critical. As I got more experience with insertion I no longer needed the mirror, but keep it around when I'm not sure if I have a bubble and need to check with direct inspection.
It's not really an issue, long as you can insert lens with face down. Becomes an issue if you have to insert lens on-the-go without a desk or flat surface to work on.
Din’t give up too easily, take your time, stay calm
i use ampleye lenses (this is my second pair) and the left eye always has issues with bubbles. is it just the shape of my eye?
make sure you fill completely and have your head down and looking straight down at the tool. don’t angle your eye up at all.
I have PROSE lenses, but the same bubble now and then! Today was a nightmare!
Tips for prevention
I always check with a light
Pen light helps with seeing very small bubbles
I also use serum eye drops and have noticed less bubbles since I started using them.
It’s time consuming and can be frustrating
Why do the bubbles come after wearing the lens for 1 to 2 hours?
See your specialist to make sure the fit of your scleral is accurate.
I hate scleral lenses!
This is a very rare occurrence for me. It has only happened 3-4 times over my 3 years in sclerals.
I always wash my hands with a hand cleaner like Vista Prep just prior to inserting my lenses. Clean hands helps the process. I give myself time in the morning to put in contacts. I only try to insert 3 times. If that doesn't work, I put the lens back in the case and do something else for a few minutes. Being frustrated and continuing to put a lens in an eye only irritates the eye, reduces my chance of being successful and makes me cranky.
I do not reinsert for tiny bubbles.

Additional comment received by email - adding this one as it's the first time I've heard it and don't know how to explain it: "Using Unique pH for disinfection has repeatedly caused bubbles when filling the lens cup, while no such bubbles with Clear Care disinfection. just fyi. Otherwise, less bubbles after insertion now that I am using a stand."

Bubbles and scleral lenses (2/2023)Updated a year ago