Scleral Contact Lenses

EYES and ears and mouth and nose

Posted 8 June 2024 by saralynn143

June 2 marked sixteen years since microvascular decompression surgery for hemifacial spasm left me with left-sided facial paralysis. I intended to post a 15-year update, but sadly my mother passed away last year and I did not feel up to writing one. Although it’s a little late, changes over the past year make this an opportune time for an update.

At the time of my surgery, I was still in my 40s. Now that I am a wee bit older, I find it helpful to leave myself reminders, such as sticky notes on the bathroom mirror or alarms on my phone, so that I don’t forget appointments. And both morning and evening, I run through the line “Eyes and ears and mouth and nose” from the children’s song, Head, Shoulders, Knees and Toes, to make sure I’ve completed all of the daily routines necessitated by chronic facial paresis.

This post will focus on eye care, by far my biggest challenge. I have posted extensively about my eleven years of experience with scleral contact lenses, the mainstay of my visual health. I alternate between two pairs of SynergEyes VS lenses. I also have several pairs of LaserFit lenses that I keep as backups. I wear prescription progressive readers with prism correction over the scleral lenses.

I had hoped to use this year’s vision benefit on an updated pair of distance glasses for when I’m not wearing contacts (in conjunction with ointment to keep my left eye moist). But — and this is a big, fat, unfortunate but — I learned that even my right cornea is too irregular to correct vision with glasses. This hit me hard. Before I thought of myself as having complicated vision, now I feel visually impaired. This might change someday after cataract surgery, but I have no idea when that will happen or even how it can happen on my left eye that does not blink or produce tears. For now, I will have to rely on wearing scleral contacts any time that I want to see clearly. This cloud does have its silver lining: my optometrist says that I am the epitome of medical necessity for scleral lenses as vision insurance companies scramble to tighten the definition.

A combination of factors has recently caused me to make changes to my nightly routine. Over a long period of trial and error, I learned that my left eye does best with an ointment with a high ratio of mineral oil to petrolatum. With the ongoing RefreshPM shortage and the recall of comparable store brands, I have found it difficult to make do with alternatives. Either I would wake up during the night in discomfort and needing to reapply this product or my optometrist would caution me against using that product long term. After a series of ointment failures, I tried Celluvisc gel drops with a pair of dry eye goggles prescribed after my surgery. The first night went well, and I was cautiously optimistic. The second night I woke up in the wee hours needing additional drops. The next morning, I noticed that the foam lining was separating from the goggles (not surprising after 16 years). Following a little research at the Dry Eye Shop and Amazon, I ordered iVIZIA gel drops, eye bandages and a new pair of goggles. The night after they were delivered I tried the drops with an eye bandage. That combination was fantastic — the thick gel drops kept my eye moist all night and the bandage was much more comfortable than goggles.

Best of all, my vision was crystal clear from the moment I inserted my scleral lenses, which eliminated a huge longstanding challenge. I have a photography trip to Peru scheduled for this summer, and since it’s not really a viable option to ask an entire group of people to wait for me several times each morning while I try to clear up my vision, this new regimen is a huge improvement. I have yet to decide if I am comfortable wearing an eye bandage on an overnight plane trip, but maybe the goggles will work for that.

This is my packing list — I’ve added links where possible. Most items are available from either the Dry Eye Shop or Amazon, and many are available from Walmart, Target, grocery stores and pharmacies.

Daytime:
• Nutrifill preservative free solution
• iVIZIA Sterile Lubricant Eye Drops
• Peeps glasses cleaner

Nighttime:
• ClearCare Triple Action (travel size x2)
• Saline for Sensitive Eyes (Target or Walmart store brand)
• Boston Advance Cleaner*
• iVIZIA Lubricant Eye Gel
• Adhesive Eye Patches

Other Supplies:
• 0.9% Sodium Chloride 5 mL (Addipak, Modudose, etc.)
• Antihistamine eye drops
• Steroid eye drops (from pharmacy)
• Cotton swabs
• Eyelid cleaner
• Drain cover
• DMV vented inserter
• DMV removal plunger
• Cleaning sponges (cut into quarters and pretreated with cleaner*)
• Anti-fog goggles

Just to complicate matters, this has been a terrible year for allergies in the midwest. I had allergy symptoms in my eyes for the first time in my life, with redness, itching and absolutely disgusting stringy discharge. It is much improved and I am weaning off antihistamine eye drops that I have been using for over a month. I was on steroid eye drops for five days during the worst of it. I have an appointment for allergy testing scheduled in August.

Over the next few weeks I will post updates about ears and mouth and nose. And who knows … head, shoulders, knees and toes might make appearances as well.

Scleral Lens Emergency Kits

Posted 19 September 2022 by saralynn143

I maintain two scleral lens emergency kits — one in my handbag and one in my car. I check them every couple of months and swap out solutions as necessary.

*Scleral care kits for handbag and car.*

I use an old cell phone dry box for my handbag kit. I like that it will keep any potential spills contained as well as its thin profile. It’s easy to move from pocketbook to daypack or airline personal item, even a pocket if need be.

Handbag kit contents:

Flat contact case
Sterile saline vials
Remover and inserter tools
Cotton swabs
Alcohol wipes
Ointment tube
Small mirror

I don’t often have occasion to use the kit, but it is invaluable when needed. Since this kit is indoors most of the time, I don’t worry about the solutions overheating. None of the solutions have expired so there are no changes needed at this time.

My car kit is housed in another waterproof box. This one is from Coleman and I believe it originally contained a first aid kit. I have only used the car kit once, during a weekend trip when I inadvertently left my scleral supplies at home. Because I did not have a large case for H2O2 disinfection, I bought Boston Advance cleaning and disinfecting solutions to use with a flat contact case, augmented with sterile saline and nighttime ointment from the kit.

I’ve recently discovered new products and figured out a way to use a small ClearCare case for disinfecting scleral lenses in emergency situations, enabling me to modify the contents of my car kit.

Updated car kit contents:

Modified ClearCare case
Aplicare H2O2 packet
Sterile saline vials
Flat contact case
Remover and inserter tools
Cotton swabs
Alcohol wipes
Ointment tube
Small mirror

One Aplicare packet contains enough H2O2 to fill a ClearCare container three times. I included a tiny binder clip to fold and seal the packet if opened.

With a little bit of stacking and manipulation, it all fit, although I had to jettison an eye patch that was getting old and discolored and had never been needed anyway. I am at the point in my scleral journey that I don’t really need the mirror, but it still fits so I left it in, although if it’s lost or broken I probably won’t replace it. Since it has been a couple of months since I last checked the kit, I did replace the sterile saline vials.

The small dry boxes that I use are ideal for tucking into my bag and glove box, but emergency scleral supplies can be kept in any type of container. A TSA 3-1-1 plastic bag would work very well—and hold additional supplies—but also requires more room to store it.

Prefilled scleral emergency and travel kits are available from the Dry Eye Shop.

In Case of Scleral Emergency…

Posted 12 September 2022 by saralynn143

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…

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.

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.

New Scleral Travel Finds

Posted 29 August 2022 by saralynn143

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.

*Scleral Lens case for H2O2 disinfection* *and DMV Versa Remover/Inserter*.

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.

*PROSE case, Scleral Lens Case for H2O2 Disinfection, ClearCare Case*

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!

Sara’s Top 10 Scleral Lens Travel Tips and Tricks

Posted 15 August 2022 by saralynn143

Last week I posted about what I pack for my scleral lenses while traveling. This week I’d like to offer my favorite trips, tricks, hacks, and strategies from the past couple of years. I hope at least some are helpful to other scleral users out there.

#1 — Get TSA Pre-Check! It’s a game changer. My bags sailed through security without being opened, despite containing more than double the allowable liquids. By the time of our return flight, which involved three different screenings in a foreign (therefore non-TSA) airport, I had depleted my supplies to fit in a single 3-1-1 bag.

#2 — Whenever I fly, I take a letter from my eye doctor that explains that I need to travel with medically necessary fluids over the 3-1-1 TSA limits. I keep this letter with my COVID vaccine record and passport.

#3 — Before TSA Pre-Check, I learned the hard way to put regular 3-1-1 liquids and my scleral care bag in separate bins. Fortunately everything turned out all right, but the situation could have been averted by simply placing one bag with my personal item and the other with my carry-on bag or shoes. The security line is so busy that TSA agents won’t know what belongs to which passenger, unless they are together in the same bin.

#4 — Another tried and true travel tip is to use flight and layover schedules to come up with a strategy for adjusting wear time for the destination time zone. On the way to Scotland, I wore my lenses from Kansas City to Newark and for most of the layover. I removed them just before boarding a flight to Edinburgh, and took a Benadryl to help me sleep. We landed first thing in the morning and took a cab to our hotel where I inserted my lenses and started the day with a photo walk. For a more detailed explanation, see my post Sclerals on Safari.

#5 — One of my past scleral travel tips is to keep the PROSE case in a 120-count Almay eye makeup remover pad jar. It fits exactly and keeps any spillage contained. But here’s a fresh hack: for a single overnight stay, remove the neutralizing disk from the PROSE case, fill it with fresh hydrogen peroxide disinfecting solution, screw on the lid and insert the case in the jar. Put the neutralizing disk on top of the PROSE case and close the lid. When it’s time to disinfect your lenses, drop the neutralizing disk into the pre-filled case. Easy peasy! Pop an inserter and remover into the jar as well for a self-contained disinfection kit.

*Tip #5 — one-night self-contained disinfection kit*

#6 — This tip is for Nutrifill users who also use DMV removal plungers. The lid from the plunger storage tube exactly fits a Nutrifill container! It even makes a satisfying pop when putting it on. This is excellent for keeping the contents from spilling out in a pocket or purse while traveling. Important disclaimer. I do NOT in any way advocate saving preservative free saline for next day use. I use remaining saline to squeegee lens surfaces with cotton swabs during the course of a day, or to refill a lens during the morning. But by afternoon or evening, I will open a new vial. Leftover saline is used to rinse my lenses at the end of the day before disinfecting, and anything remaining after that goes down the drain. I follow the same rule for lubricating drops. One use, just as the manufacturers intend. Yes, scleral supplies are expensive, and Nutrifill is one of the pricier salines. But our vision is priceless, and given that we are wearing scleral lenses, odds are that we already face increased risk factors.

By the way, I also discovered a use for the longer section of the removal plunger storage tube. Keep it with your other scleral supplies in case you need an emergency inserter. Yes, I’ve tried it, and yes, it works. Bear in mind that it’s a little harder to hold onto because it is more slippery than the DMV inserter.

#7 — Keep the tiny storage vial lid clean by dropping it in the PROSE case just before putting the lens basket in to sterilize. This might also work for DMV inserters and removers as there is plenty of room in the PROSE case, but I have not yet tried it. The smaller ClearCare cases that we otherwise discard could also be used for this purpose — I would break off the lens baskets first though.

*Tip #7 — disinfect small scleral care items in PROSE case*

#8 — Saturate cleaning sponges with a cleaning solution. That’s one fewer bottle to pack, and TSA doesn’t consider the sponges to be a liquid. Rehydrate the solution with a squirt of saline. Each sponge can be used for several days.

#9 — In a past post I suggested packing checked solutions in an absorbent JetBag (designed for wine bottles). The same can be accomplished using a wet bag or a gallon size baggie (though I don’t trust baggies as much not to leak if a bottle breaks). In carry-on bags, a bit of plastic wrap under the lids of opened bottles provides insurance against leaks.

#10 — I wish I had know about this product before overseas travel — Aplicare Hydrogen Peroxide one-ounce packets. One ounce exactly fills the PROSE case. I have purchased a box of packets and tried one at home. I plan to take it on a flight to Las Vegas over Labor Day. With the discontinuation of trial-size ClearCare, these packets may be a godsend for scleral lens wearers suffering from wanderlust.

*Tip #10 — single-use hydrogen peroxide packets for PROSE case*

Traveling with Sclerals: 2022 Edition

Posted 8 August 2022 by saralynn143

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):

*Contents of my carry-on scleral care bag for Scotland and Ireland.*

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!

Sclerals on Safari

Posted 24 February 2019 by saralynn143

I recently participated in a two-week photo tour in Tanzania. This is something I have wanted to do for several years, and I had no intention of allowing high-maintenance eye care to keep me from achieving that goal.

Image courtesy of Jeff Cable www.jeffcable.com

I have traveled overseas with scleral lenses successfully in the past, most recently on a hiking trip in England, but Africa is another matter. I asked M&M Photo Tours to find out about the availability of ClearCare in Tanzania, but as I suspected, it is not readily available. I also considered buying plain hydrogen peroxide, but a Google search turned up evidence that the purity in Tanzania is not to the same standard as in the US, so I quickly discarded that plan.

Next, I thought I would carry on a travel size bottle of UniquePH and a couple of ClearCare, and alternate between the two. However an e-mail exchange with Dr. G (the developer of LaserFit lenses) along with input from the My Big Fat Scleral Lens Facebook group caused me to rethink that approach in favor of packing additional ClearCare in a checked bag.

This is my final packing list, in addition to the LaserFit lenses and progressive reading glasses (no distance correction) that I usually wear:

LaserFit contact lenses – 2 backup pairs in carry-on
Prescription glasses, in carry-on
Ziena moisture chamber glasses fitted with progressive reading lenses (no distance correction), in carry-on
Quartz silicon shield, in carry-on
ClearCare – 2x 3-oz in carry-on, 2x 12-oz in checked bag
Saline for Sensitive Eyes (Target brand) – 12-oz in checked bag
15ml Modudose sterile saline – 16 vials in carry-on, 6 in checked bag
5ml Modudose sterile saline – 16 vials in carry-on, 16 in checked bag
Theratears Nighttime Liquid Gel – 16 vials in carry-on, 8 in checked bag
UniquePH – 2-oz in carry-on
LoBob ESC cleaner – travel size, in carry-on
Muro128 – 1 tube in carry-on, 1 tube in checked bag
Refresh PM – 1 tube in carry-on
Cleaning sponges – 6 cut into 24 quarters, in carry-on
Ocusoft hand soap – 1-oz travel size, in carry-on
Sink catch mat – in carry-on
Travel size cotton swabs – 1 in carry-on, 1 in checked bag
Alcohol prep pads – some in carry-on, some in checked bag
Prose Disinfection case – 2x in carry-on
Small contact lens case – 2x in carry-on
DMV vented scleral cup – in carry=on
DMV ultra remover – in carry-on

I always carry an emergency scleral kit that contains a small contact case, a mirror, a few 5ml Modudose vials, a Theratears liquid gel vial, a tube of Muro128, a DMV vented scleral cup and ultra remover, and some cotton swabs. This was also in my carry-on.

That’s a lot of stuff, but as any photographer will tell you, it’s all in the optics – and that includes eyesight, my friends, And thus, I overpacked.

I have flown several times, including overseas, with scleral lenses. I pack two quart bags, one with my regular fluids and one marked “Medical Fluids,” and previously was never questioned. This time, a TSA agent at Kansas City International Airport stopped me to say that I was over my allocation. I explained that one of the bags was for medical purposes, but she remained steadfast. I then offered to show her a letter from my doctor, but before I was able to get it out, a supervisor came over and waved me through, explaining that the excess fluids were clearly medically necessary and all under 3.4 ounces. Disaster averted! In retrospect, I could probably have avoided the situation by putting each bag in a separate bin. It’s always a good idea to have a letter from your doctor listing medications and the need for extra fluids.

Part of my preparation for the trip was to plan scleral wear time during travel. I made a matrix with columns for home time and time at each intermediate stop before Kilimanjaro. I knew that I had 3-4 hour layovers at Minneapolis-St. Paul and Amsterdam, that I would have two 8-hour flights, and would be arriving at Kilimanjaro at night. I prefer not to insert or remove my contacts during flight, and I hoped to get a head start on adjusting my sleep schedule to Africa time. I also don’t want to go over 16 hours of wear time. Taking all of that into consideration, I determined that the best schedule on the way there was to wear them on the flight from Kansas City to Minneapolis, take them out just before boarding the flight to Amsterdam (and try to sleep on that flight), put them in upon arrival in Amsterdam, and remove them after arrival at the lodge in Tanzania.

Sound complicated? Welcome to the new normal for scleral lens patients.

The plan worked great, although the Amsterdam airport had some interesting sinks with footlong drains offering ample opportunity to lose a lens. I solved that problem by pulling out a small quick dry towel that I keep in my camera bag and using it to cover the drain while I inserted my lenses. I was a bit self-conscious about the amount of time and space I needed for all of my lens paraphernalia, but I did what I needed to do. During transit I disinfect with UniquePH rather than ClearCare so that spillage is not an issue.

Another small glitch came when I opened my suitcase at the first lodge and the first couple of layers of clothing in my checked bag were damp. The bottles of ClearCare and saline were intact, so some must have leached out. (I think it was likely the saline since none of the clothing showed signs of bleaching.) The clothing was all quick dry and all was fine by morning. However for the rest of the trip, I stowed all of my larger bottles of solution in a JetBag that I had brought with me. These bags are designed to absorb 750ml of liquid in case a bottle of wine breaks in a checked bag. I’m not sure why I didn’t think of this to begin with, but it is my takeaway travel tip for this trip.

All of my compulsive planning and supply redundancy proved invaluable during the actual safari. Game drives are extremely dusty. The Ziena moisture chamber glasses, which I am wearing in the photo above, worked perfectly to keep as much dust as possible away from my scleral lenses. I had them fitted with progressive reading lenses (no distance correction) so that I could easily see the settings on my camera. At night I used Muro128 to lubricate my left eye, which does not blink fully or produce tears. I took along a Quartz silicon shield in case I should need it, but never wore it.

There were two days when I wore each of the three pairs of LaserFit lenses. I established a rule that I would never reinsert lenses until they had been disinfected. One particularly dusty morning, I changed lenses when we returned to camp at noon, and again when I took a shower before dinner. I make it a practice never to wear my lenses in the shower, and in Africa that is an even more important safety rule. So one evening when I forgot and took a shower with the second set in, I immediately removed them for disinfection. It would have been possible to travel with one or two sets of lenses, but I was glad to have taken three.

I ended up using one 12-oz and one 3-oz bottle of ClearCare solution, and the 12-oz bottle of saline (for rinsing) during the trip. Each day I rinsed my disinfected lenses in the neutralized ClearCare solution, then used one 15ml Modudose vial and one Theratears vial for insertion, plus a 5ml Modudose vial if I needed to squeegee my left lens. I immediately discarded any unused solution in the vials, and used a fresh quarter of a cleaning sponge every time I cleaned my lenses.

On the trip home, we left Kilimanjaro on a late evening flight, so I had already removed my lenses. I reinserted them in Amsterdam (again utilizing my quick dry towel to cover the massive drain), and removed them in Minneapolis before my final flight to Kansas City. I was fortunate enough to be a guest in a Delta lounge, so the bathroom situation was much better.

It takes a lot of foresight and planning to travel with scleral lenses, but they needn’t keep us from pursuing our goals. I think the only thing I would have done differently – besides packing my checked fluids in a JetBag – is to forego the 12-oz bottle of saline and 15ml Modudose vials in favor of 5ml vials. They come in connected sets of four flat vials that are easy to pack, and I always ended up discarding extra fluid in the 15ml vials. I think a four-pack per day plus a few extra for insurance would have been sufficient.

So there you have it – sclerals on safari! Now to begin planning for my next big travel adventure.

More Scleral Tools and Tips

Posted 2 June 2018 by saralynn143

Today marks ten years since I awoke from microvascular decompression surgery to left-side facial paresis. Well, paralysis at that time. Single-sided deafness as well. Fortunately over time I regained most of my balance and hearing and enough facial function that most people don’t notice anything amiss. My blink and tear function have never returned, so I have spent a decade finding a remedy for painful dry eye. The solution that has worked best for me is the combination of an implanted eyelid weight and scleral contact lenses. These large-diameter specialty lenses are expensive and require quite a bit of maintenance, but in my opinion are worth every bit of cost and effort.

In past posts I outlined the care routine that works best for me. Since then I’ve discovered a couple more items that make it more manageable.

Several months ago I had to have my collarbone plated following an auto accident. Something went wrong with the nerve block and for a while my left arm did not function. My insertion technique requires both hands – one to hold the inserter and lens, the other to hold my eyelid wide open. For the first couple of weeks my husband helped with the eyelid part. We were both relieved when I regained the minimal movement and grip necessary to hold the inserter relatively steady. It was frustrating at first. My left hand did not have the strength to hold my eyelids, so I could only use it to hold the inserter and lens. Fine for my right side, but very awkward for the left. It wasn’t what I was used to and I kept bumping into my nose moving my right hand across my face to open the left eyelids. The weakness in my left hand caused me to spill the solution quite often. I also had a hard time aligning the left lens in the mirror I used on the counter. I was back to needing ten to fifteen minutes or more just to insert my contacts.

I remembered seeing a scleral insertion system that incorporated a lighted stand, but remembered it as pricey. I also didn’t want to have to wait on shipping. I thought about my craft light box but couldn’t find it, so we went to Hobby Lobby to see what they might have. A store employee directed us to this:

I snapped it up with a 40% off coupon and it worked like a charm. All I needed to do was align the inserter so that I could see a little circle of light. This lasted for a few weeks before it died. I think that even though I blotted up excess saline right away, some made its way into the box and shorted its circuits. In retrospect, I should have put a square of glass or plastic over it to keep the liquid out.

No worries though – since the concept worked so well I wondered if combining lights with a mirror I had been using wouldn’t be any better. I started searching at Amazon.com and found this lighted compact:

I highly recommend this for people who have trouble inserting their lenses. I find that it helps immensely to align lenses properly, plus it’s inexpensive and small enough for travel.

Before I regained normal strength and dexterity in my hand, I reverted to using disinfecting solution rather than ClearCare. I did not want to run the risk of snapping a lens, even having moved to PROSE cases with their larger baskets. As soon as I was able, I switched back to ClearCare, but there is a drawback. I have two pairs of lenses that I switch between every other day. Because the hydrogen peroxide system doesn’t seal, when I travel there is a risk of spilling the solution out of the second case. Before our most recent hiking trip to South Dakota, I made an exciting discovery. The PROSE case exactly fits into an empty eye makeup remover jar. (The labels peel off easily.)

Make sure it’s the extra-large 120-count jar. The 80-count is too short for the PROSE case, but might work with a ClearCare case. While a little solution may still seep into the jar, it won’t leak out into luggage.

It amazes me to look back and see how far scleral lens technology and use has come in the past decade. I’m looking forward to seeing what the next ten years bring.

A Scleral Quantum Leap

Posted 5 October 2017 by saralynn143

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!