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Cleaning scleral lens implements (8/2023)Updated 10 months ago

SURVEY CONDUCTED: August 2023

PARTICIPANTS: 283

Sincere thanks to all who participated and shared their experiences and/or questions! 

I found these survey results very thought-provoking. 

Many people had questions or expressed interest in more information. I would encourage all scleral lens users who had any uncertainty about their answers, or who find any of the results here surprising, to do the following:

  1. Read the instructions on your contact lens solution's insert. Most of them discuss care of the contact lens case, and you can usually follow the some guidelines for plungers. The thing about manufacturer instructions is that at least those from the larger manufacturers are generally based on data that prove what works (or doesn't). I've provided links here to some of the most popular scleral lens solution inserts - easier to read online than the tiny print. If you don't see yours here, request it from the manufacturer. Clear Care insert  Boston Simplus insert  Unique pH insert
  2. Talk with your lens care provider. Your doctor may be able to give you better, more conservative, more current, more relevant instructions than what the manufacturer's label states. Don't be shy about asking questions. Have a conversation with your doctor to understand the reasons if their recommendations differ from those of the manufacturer.

Plungers

1. What do you use to clean your plunger(s)?


Clearly most people know WHAT to use to clean their plungers! 

My only comments here are: (a) For those using soap & water, check in with your doctor to get their most recent guidance - in general there's been a shift away from water even on implements, not just lenses. (b) For those just rinsing with water or saline, please consider using your contact lens solution to rinse them instead. It's easy and reasonably cheap. But if you do use water, make sure it's completely dried.


2. How often do you normally clean your plunger(s)?

Eek. About a quarter of participants don't seem to be in the habit of cleaning their little bacteria magnets, otherwise knows as plungers. I can definitely confess to sometimes being a guilty party when it comes to regularity. Feels like a great education topic! Then I can re-run this survey in a couple of years! 

We strongly encourage daily cleaning. Alcohol wipes are a simple, popular approach.


Cases

1. What do you use to clean your contact lens case? 

Lots of people on the right track here! But there are also lots of people with questions. And the answers aren't 100% straightforward. Manufacturer recommendations vary; your doctor's advice may vary as well. The big bottom line is that our lens cases should be cleaned *and dried* daily. So here is my attempt at some clarification.

Potentially acceptable ways to clean contact lens cases:

  • Alcohol
  • Hydrogen peroxide
  • Multi-purpose solution (e.g. Boston Simplus, Unique pH, Tangible Clean, etc)
  • Nothing IF you're using Clear Care or similar hydrogen peroxide solution in the case each time
  • Soap & water IF you're thoroughly drying it (not capping it while wet). HOWEVER, the most current guidance amongst solution manufacturers and industry thought leaders seems to be to avoid all exposure of all your lens care implements, including cases, to water.

Not so great (as in, ineffective):

  • Nothing, IF you use multi-purpose solution in your case. (Some participants mentioned just leaving the case open to air dry. Some manufacturers specifically recommend against this.)
  • Water rinse only (whether hot or cold)
  • Saline rinse only

2. How often do you normally clean your lens case?

Yikes. This isn't looking great. However, the data on this question are going to be a bit confusing - particularly for the "before every use" versus "N/A". If I run a survey like this again I'll make it a lot more sophisticated and create a separate pathway for those who use Clear Care versus those who use multi-purpose solutions, because separate cleaning is not required for cases used for hydrogen peroxide solutions. Here, I don't have any way of knowing for sure who's just not bothering to clean their case versus who truly doesn't need to.

Without counting the 24% N/A responses, clearly more than a third of users are not consistently cleaning their case, meaning, they believe they should but don't do so after each use. That's a pretty high number, and if we have to add some unknown proportion of the 24% who also should but don't ever, it gets even bigger.

So once again, great education topic and we'll survey again in a couple years.


Questions from participants

Here are the main questions received, and my (Rebecca's) responses:

  • What is the best way to clean implements? Alcohol, hydrogen peroxide, or multi-purpose solution. Anything is better than water, saline, or failing to clean them at all. And anything that involves water (such as soap & water), it's very important to dry them thoroughly before they get sealed up.
  • How often should plungers be replaced? No simple answer here. Some replace monthly, some keep them till they stop working. The big picture is that a plunger needs to (a) BE CLEAN and (b) work. To keep it clean, clean it daily in the most convenient way for you that involves an actual cleaning agent, and replace it when it doesn't work anymore or at whatever frequency your doctor recommends.
  • How often should cases be replaced? You really shouldn't have to make a choice about this. Most solutions generally come with a new case so you use that one and throw the old one away. If yours doesn't, ask your doctor. For PROSE cases, ask your doctor.
  • How long can you keep the lenses in the clear care solution? According to the manufacturer, one week. See insert.
  • What is the safest way to transfer clear care to a smaller bottle? There isn't one, so don't. Shame on Alcon for its longstanding supply problems and discontinuation of the travel size. Call their customer service and tell them so! 1 (800) 862-5266. Meantime, when traveling, use a multi-purpose solution instead.
  • What should I use to "rub" clean lenses? Ask your doctor what they recommend. But for context, any disinfection solution can be used as a rub cleaner; however, for heavy deposits, an alcohol based dedicated cleaning solution such as Sereine ESC or Miraflow may be indicated - please discuss with your doctor. There's also Menicon's Progent, a super duper cleaner to be used weekly or less frequently and it will take off anything that can come off.
  • If the rubber plunger is disinfected too often, do you worry about the silicone breaking down? DMV plungers are made from powder latex, not silicone, though silicone ones are available under See Green brand. But to answer the question, I'm not sure what breaking down means? I know sometimes the DMV ones can get "sticky" after a time, and sometimes can just stop seeming to work, but I don't know of any reason to be worried about the material itself.
  • When you say lens case, are we talking about the PROSE case? I was talking about any lens case. If I'd had more time I would definitely have made a better survey with a lot of steps where you could choose :) PROSE cases, thankfully, don't need separate cleaning. But I've heard of an awful lot of weird cleaning regimens for PROSE cases that seemed to me to be introducing issues rather than solutions, so I thought the survey would be a good prompter for people to talk to their lens provider. :) 
  • I use Miraflow for lenses cleaning. Clear Care Plus for overnight in the basket container. Sodium Chloride 0.9% for fill the lens to put in the eyes. Am doing correct? Any suggestions would be appreciated. These are all perfectly good solution choices in terms of safety. My only comment is on your filling solution. Sodium Chloride 0.9% is highly acidic (pH about 5.5) and is sold as inhalation solution, not for ocular use. In practice, it seems to work for many people, and it's the cheapest preservative-free saline on the market, so if you have no issues, there is probably no reason to fix 'what ain't broken'. However, having a scleral lens hold acidic solution against the eye all day is most definitely less than ideal. If you are noticing any comfort issues, deposits, etc, I would certainly recommend looking into a pH buffered saline.
  • Why would the case need any more cleaning that wiping out the multipurpose cleaner? Cases that are used with hydrogen peroxide solutions don't. However, cases for use with multi-purpose solutions are absolutely notorious for bacteria build-up and good case hygiene is an important safety practice. Check the instructions for your particular solution. These are based on scientific studies of how to keep a contact lens case safe. I've seen an awful lot of scary contact lens case data at every contact lens related conference I've ever attended.

Comments people shared about the survey topic

(or, well, anything else they felt like commenting on)

  • I was told to use alcohol wipes to clean plungers and cases. When I store my extra lenses I add multi purpose solution to the case which I believe helps keep the case clean.
  • I use Tangible Clean and have found that is the best and easiest I have found to use. I use it to clean my lens and to leave it in overnight.
  • I use soap and water to clean plungers and cases. Please make sure to thoroughly dry before use!
  • I clean my case with soap and water but then after it dries, I swish it with a little bit of Tangible clean
  • I change out my lens cases once a month. [Great - but no substitute for daily cleaning, unless it's used with Clear Care.]
  • I clean my case with soap and water but then after it dries, I swish it with a little bit of Tangible clean
  • So glad you sell plungers and inserters. I replace any soft materials every few months.
  • I wash my plungers and case with soap and water immediately after each use. I keep a clean towel folded up on my counter that I only use for placing the plungers and case parts on to dry. This ensures that they dry out thoroughly before the next use. If I clean with anything else it leaves salt deposits
  • I use saline solution then air dry them everyday. Wash them with soap and water every couple weeks. Saline doesn't really do anything... please consider using your overnight soaking solution instead, or alcohol or peroxide.
  • I change my lens case with each new bottle of solution.
  • My doctor strongly recommends avoiding use of Addipak. This is especially important for people with complex eye issues & surgeries. Addipak is not a buffered product It is not stable nor a controlled substance, it has no quality standards. Avoid using it. Hear hear!
  • I have trouble with my lens sticking to my eyeballs. Use Nutrifill with a drop of Refresh Optive to prevent clouding. Also have used Refresh Optive Advanced which tends to be too thick and coats over.
  • When I clean my case, I clean it with soap and hot water, and then let it dry and then before I fill it to put my lenses in, I switch it out with Tangible clean solution
  • sometimes i feel they need an extra cleaning
  • Rinse, Rinse, and Rinse again. What with - that's the material point
  • I don't know what to clean the pluggers with so I brought a pack and just change them. Whatever's cheap and handy but also an effective disinfectant. Alcohol, peroxide, contact lens multi-purpose solution.
  • I rub them for 30 seconds with Simplus before Clear Care to break up any buildup. I'm guessing you're talking about the lenses rather than the implements, not sure though.
  • When I take out my lenses, I often use an alcohol prep pad to clean the plunger instead of the usual soap & water bc cleaning w/the alcohol pad is quicker & easier. And safer than water.
  • I clean my See Green stand w/soap & water after every use. I gently wipe the See Green light w/a damp paper towel after every use to gently remove the saline that gets on it from the insertion fluid.
  • Bc I need to take out and reinsert my lens once or twice during the day (to take my medicated eye drops as prescribed, to shower, swim, etc), I alternate using 3 storage vials w/insertion & removal plungers to make sure the plungers don’t have any water on them as I know that it is a Big No No to get water on my Scleral lenses. I clean the plunger storage vials with soap & water once a week. I have a routine to stagger cleaning the vials to make sure I have plungers & vials that are available to use that are dry. RESOUNDING APPLAUSE
  • When I need to temporarily remove my lenses during the day, I put them in a case w/ Tangible Clean. I only use Tangible Clean and a tissue to clean the case after every use and I rest the case face down on the towel to dry before the next use. EXCELLENT
  • I use Clear Care to clean my lenses every night. After I have inserted my lenses every morning, I rinse the Clear Care lens case with a small amount of Clear Care solution and toss out the Clear Care solution out to clean out any debris left in the case. YUP YUP
  • I also use Sereine Cleaner followed by rinsing with water and saline to clean the lens the day of use. I follow up by using Nutrifill for the lens insertion. We strongly recommend against using water to rinse off Sereine. While the product labeling may say this is okay, it is not consistent with the latest industry norms or recommendations from FDA, CDC and professional organizations.
  • I really struggle to cleanse my plunger so am anxious to hear what others do. I find that mine gets kind of yucky and often that gets transferred to my lens. Personally I have a big brown bottle of hydrogen peroxide and use it to generously rinse my implements. Dirt cheap and does the job :) As you can see from the survey, lots of options.
  • I use a new lens case every month (there is a case included with my soaking solution). I buy new plungers every 3 months. Great! As mentioned above, not a substitute for daily cleaning.
  • A drop of Castille soap (like Dr. Bronner's) works well.
  • I use Clear Care nightly so no need for regular cleaning of lens cases. Yup
  • Before and after every fitting I rinse each with warm water doesn't help, may harm if not 100% dried
  • I clean my case and plungers once a day after putting in my lens. Wonderful! 
  • After soap and water I dry then run over with an alcohol wipe
  • I cannot clean my case before each use because my lenses are in it so I clean it after each use. Poorly worded question. The option stated "Before or after every use" and it was referring to timing in relation to when the lenses go in the case. Some people clean the case immediately after putting the lenses in their eyes (ideal). Some people clean it at the end of the day just before putting their lenses back in the case.
  • Clean my Scleral lens cases daily with Boston Simplus, and once a month soak in Clorox solution( 2ounce Clorox and 18 ounce water) over night. Then rinse and clean with water, and dry and store. I have 3cases, and rotate them. Very interesting.
  • About once a month, I wash everything in blue Dawn, rinse well, then dip for 5 seconds in tap water that has been boiling for 10 minutes. We recommend against water, in general.... If you need a cheap thing, suggest alcohol or peroxide as that does not require water rinse.
  • I did not know I should b cleaning plungers but makes sense. No one told me to do do fine 2006! Totally understand this. But hey, I've been driving since 1984 and never had an accident, and I wear my seatbelt anyway, every single time I get in the car because... today could be the exception and I do not ever, ver want to be catapulted through my windshield. That's how i feel about acanthamoeba keratitis. Very rare... and very bad, so prevention is valuable.
  • I still need training in putting mine in. They are difficult to insert Good luck, let us know if we can help :) Hit up your doctor's office for maximal support and assistance.
  • Clean after every use. Yay!
  • I probably should clean more than I do but have already forgot recommended times and have not experienced problems yet. See comment above about seatbelts. Or consider the stock market. Past performance is not a predictor of the future. 

Survey suggestions from participants (thanks!)

  • Coupon industry Sorry, I have no knowledge about this topic! But if you want coupons for contact lens solutions, call the manufacturer, there's usually something going.
  • Fogging and protein deposit buildup during day if not perfectly inserted. Any tips for perfect insertion? See insertion section of tutorial. Also, here's our most recent survey on insertion.
  • Contact lens moisture drops safe for scleral use. FOR SURE - planning this soon.
  • What do users do to avoid lens fogging See midday fogging part of tutorial
  • How many sets of lenses did you go through for the initial fitting process? Check out Question #1 on this survey from 2019. Promise I'll try to redo this to see if anything's changed, but meantime, lots of interesting info there!
  • Can people share their experiences with dotting their lenses and how often. What method they use. I have to do mine often. Oooh great question, will do!
  • Cleaning substitutes for use in international travel Do you mean travel-friendly solutions, or what you can purchase outside of US? We generally recommend travel-size multi-purpose solution - such as 3.5 oz Unique pH - and not anything with hydrogen peroxide due to risk of confiscation. See also Traveling with Sclerals section of tutorial.
  • Can the hydra lens coating be redone or is a new pair recommended? Depends on the lab's willingness to re-coat. Ask about Tangible Boost to maintain the coating.
  • Has anyone had difficulty getting instance to pay for lenses? For sure. Here's a survey showing how many people get insurance coverage.
  • Only slightly facetious: is using a mirror preventing you from easy insertion of lenses? Hahaha never used a mirror myself. I get the point though, more info on insertion. 
  • How long does a PROSE case last. My first one broke after 2 months. Yikes! We have a 3-month warranty - please contact us for free replacement! They are, sadly, much too delicate. As a very long time user I'm a pro and manage to nurse mine along for forever. The biggest problems with PROSE cases tend to be with over-tightening of the lid (it will crack the case) and with the basket hinges (handle with great care). If it fails anyway, ask for replacement. 
  • Travelling See Traveling with Sclerals section of tutorial. If you have additional questions you'd like us to survey on let us know!
  • What Cleaning Solution do you use, and why? (Boston, Sirene, etc) I'm gathering you mean for 'rub' cleaning? Here's a survey from 2019, and I promise to do a similar but better one soon. Thanks for the suggestion.
  • Describe your issues with fog and discomfort over a day's wear. What have you tried / are you trying / to address the issues? Oooh great one. So basically just descriptive responses. I will plan on it! Meantime, check out our Midday Fogging tutorial section.
  • Do you condition sclera lens? How frequently if any? Hmmmm please email me about this. Honestly never been quite clear on this, different people use the word differently. Wetting thing? deep cleaning? other?
  • How many people have red rings around eyes after lens removal....can you PLZZZZ ask this question... I do not know anyone else who wears scleral lenses and I'm having this issue and no doctor is able to help me so I would like to know if this is common or not? The other question that I would really really appreciate you asking in a survey is how many people who wear scleral lenses have developed even minor neovascularization? I am told by many top professionals that this is a normal finding with long-term scleral lens wear and other times say it is not normal so love to hear other people's experience on this.. thank you so much for the work you do... Jeepers. Oh boy. I'd like to talk to you about both of these if poss - please reach out, let Brenda know I said I'd like to chat so she doesn't try to gate-keep :) Can definitely think of a survey but these are just really interesting questions I'd like to talk about.
  • How to prepare for an emergency visit to a hospital. GREAT question!
  • How frequently do you get a new pair of scleral lenses Surveyed about this earlier this year. Here's a link.
  • Clear night goggles, how do you keep them from fogging Hmmm need some clarification. Are you talking about moisture chamber glasses to wear while wearing sclerals, or moisture goggles to wear while sleeping? If the latter, they are supposed to fog (that's the moisture buildup). Maybe call and ask for me so we can discuss.
  • What org./sources have given you helpful info re KC/Sclerals/dry eye? What tips/products have you found work for you re: dry eye/Sclerals Can do
  • Can a defective cornea ever "correct" i.e., have a situation where a Scleral lens is no longer needed? What kind of defects are we talking about? Vision? Disease? Dryness?
  • How many hours typically do you wear your lenses & if you have to take them out say at x amount of time—which might be 4-5 hours before you would normally take them out for the day; do you clean them and soak them or store in a dry container until you put them back in. Check out recent lens wear time survey. I'll work on the temporary storage thing. Our recommendation is always store in multi-purpose solution, not dry or saline, when temporarily removing during day.
  • You should add a question about how often your replace your scleral lens tools. Yup, great idea, will do.
  • Drops to keep conjunctiva moist? Will do
  • What are the types of drops people use over the lens while wearing them. Will do, popular question
  • What solutions do you insert into the lens prior to application? Did this just a couple months ago - here's a link.
  • How to find proper solutions Check out our tutorial on rinsing & filling and also on cleaning & disinfection. If that doesn't cover it, please reach out and let me know what you meant.
  • How to insert See insertion section of tutorial. Also, here's our most recent survey on insertion.
  • Best drops during day while wearing lenses to clean? Clean? Hm. Lubricate, yes, will do, not sure about this though
  • cloudiness after 6 hours wear or computer strain dryness Consider moisture chamber glasses for computer use.  Midday fogging tips here. Survey about removing & refilling needs here.
  • I alternates to Purilens. Recent survey here.
  • Where can you get them with insurance? Not sure what you mean by where? which provider? which insurer? Here's a survey about how many people are getting some or all of the lens cost covered by insurance.
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