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Why Do Scleral Lenses Sometimes Get Foggy?

Scleral lenses provide a successful contact lens option for people with corneal conditions such as keratoconus, severe dry eye, and those needing vision correction following eye surgery. Unfortunately, about 30% of patients with scleral lenses may experience lens fogging. This requires them to remove their lenses and refresh the saline solution, that keeps their lenses lubricated, multiple times a day. Here are some reasons why scleral lenses fog up and tips on how to keep your lenses clear.

What is Midday Fogging?

Midday fogging is when scleral lenses fog up after a few hours of wear. The most likely causes appear to be an accumulation of debris from the tears between the lens and the cornea or an inflammatory reaction of the eye or eyelids to the contact lenses.

Fogging Caused by Debris

Blinking can sometimes cause the debris to dissipate, but it doesn’t always help. There are three types of tear debris that may lodge between the eye and the lens and cause fogging.

Mucin Debris

Mucin is an opaque, white, fluffy, oil-like layer of the tears. If the fit of the scleral lens isn’t perfect, mucin debris can move from the tears into the tear reservoir behind the scleral lens. If this is the case, your eye doctor will evaluate how the scleral lens fits and make the required adjustments to its design, most likely changing the peripheral edge lift.

The peripheral edge lift, the very edge of the scleral lens, allows a refreshing flow of tears to get under the lens and into the tear reservoir behind the scleral lens. However, if there is too much lift, excessive tears will flow, allowing debris to accumulate in the tear reservoir.

If the peripheral edge lift is the problem, the lens edge may be irritating your eyelid. Your eye doctor may ask you to reduce the amount of time you wear the lens, or have you remove and reapply the lens during the day. Another option is following a lens cleaning regimen using an enzymatic cleaner or a sodium hypochlorite-potassium bromide-based system.

Meibomian Debris

Meibomian glands are tiny glands in your eyelids that produce the essential oils for our eyes. Meibomian debris can be caused by Meibomian Gland Dysfunction (MGD) or blepharitis. The debris occurs when the oils of your tears find their way under the lens and appear as semi-transparent droplets of oil floating on water. It can disperse light, like an oil slick, or appear yellowish in color.

To reduce this form of debris your eye doctor will treat the underlying cause in the eyelids as well as review the lens design. If issues with meibomian debris persist, removing and reapplying the lens can help as well.

These types of debris can occur in combination, resulting in multiple management strategies.

Front Surface Debris

Front surface debris is any debris found on the outside of the scleral lens, from the buildup of protein to the debris mentioned above. External sources such as oil-based lotions, makeup, and face and hand soaps can also cause foggy vision. Knowing where the debris is coming from can help you and your eye doctor eliminate the problem.

To remove foggy vision, make sure to wash your hands with mild hand soaps, and then rinse before handling your lenses. Also, make sure to apply face cream or makeup after inserting your lenses. Avoiding oil-based moisturizers on the eyelids, and not applying makeup to the inside area of the eyelid margin or over the meibomian glands can decrease the risk of MGD or obstruction.

Fogging Due to Inflammation

Giant Papillary Conjunctivitis (GPC)

GPC is an inflammatory reaction caused by the contact lenses. It occurs in up to 15% of all hard lens wearers and is likely due to the edge of the lens rubbing up against the conjunctiva, the protective layer on the eyelids and the outside part of the eyes. The signs of GPC are red, swollen and irritated eyelids.

If you have GPC your eye doctor may alter the design of your lens, most commonly the peripheral edge lift, and prescribe mast cell stabilizer antihistamine drops or reduced lens wearing time. The doctor may also do a deep clean of the lens with a sodium hypochlorite-potassium bromide-based system with enzymatic cleaners.

Atopic Disease and Keratoconus

Another type of debris that someone might experience with scleral lenses is due to an association between atopic disease (typically associated with the immune response to common allergens). This type of debris appears as a diluted milk-like fog in the scleral lens fluid reservoir under the lens.

Your eye doctor may recommend the following treatment options, including: reducing excessive edge lift, reducing base curves, taking an antihistamine to reduce inflammation, lens removal and reapplication, or in extreme cases, topical steroids.

Scleral lenses can be a great option for many patients, even if fogging occurs. These management strategies, along with proper lens care, can go a long way to ensure healthy life-long scleral lens wear. Contact Antoine Eye Care Scleral Lens Center to determine what may be causing your foggy vision and how to treat it today!

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Call 314-207-7355

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Cleaning & Caring for Scleral Contact Lenses

Scleral lenses offer an effective contact lens solution for those with various ocular conditions, such as dry eye syndrome, keratoconus, keratoglobus, pellucid marginal degeneration, post-LASIK ectasia, post corneal transplant, and irregular astigmatism.

Their unique design provides unparalleled comfort and visual acuity. Custom-fit to the contour of your eyes, these large lenses comfortably vault over the cornea and gently rest on the sclera. A fluid reservoir between the lens and the cornea optically neutralizes any corneal irregularities and hydrates the ocular surface, providing a moist and comfortable environment between the eye and the lens.

However, to benefit from the lens’s unique features, you need to follow basic hygiene guidelines explained below.

How To Clean and Care for Your Scleral Lenses

First and foremost, never ever use tap water in any area of lens care, whether to rinse or fill your lens case. Tap water contains acanthamoeba, a microorganism that can cause a severe, painful and sight-threatening infection. Make sure that your hands are fully dry using a lint-free towel prior to handling your lenses.

Remove Your Scleral Lenses Before Going to Sleep

Most people can comfortably wear scleral contact lenses for up to 12 to 14 hours at a time. The best time to remove the lenses is approximately an hour before going to sleep. If your lenses fog up in the middle of the day, it’s best to remove them at that time.

The fogginess might be due to a poor fit. If the lens is poorly aligned with the eye it causes fogginess, which, in turn, causes mucus to form and get trapped in the saline layer of the lens, leading to blurred vision. At Antoine Eye Care Scleral Lens Center, we ensure the best fit for our patients, thanks to our professionally custom-designed lenses fit each eye. This prevents misalignment and fogging. If you experience any fogginess, please get in touch with our optometric team.

Remove Debris Using Multi-Purpose Lens Solution

Once you’ve thoroughly washed your hands and dried them, remove your lenses and rub them for 1-2 minutes in the contact lens case filled with saline solution to remove any debris. Doing so effectively removes any deposits and microorganisms, and lowers the risk of infection. Though scleral lenses are strong, too much force or incorrect technique can cause them to break. After rubbing, thoroughly rinse the lenses using the solution for 5-10 seconds, and place them in the case once you fill it with fresh solution. Leave it there to disinfect for at least 4 hours.

Use a Peroxide Cleaner

This solution sterilizes your lenses by immersing them in 3% hydrogen peroxide. Over a period of 6 hours, the catalyst in the case transforms the hydrogen peroxide into water and oxygen gas. This deeply cleans your lenses and removes the need to rub them, thus decreasing the risk of accidental breakage. Make sure not to use the lenses before the 6 hours are up, as the un-[neutralized] peroxide will painfully sting your eyes. Leave the lens case to dry when not in use.

Use a Filling Solution That Is Preservative-Free

Use unpreserved sterile saline solution when inserting scleral lenses by filling the bowl of the lens upon insertion. Don’t use tap water or a preserved solution as these can lead to an eye infection.

Routinely Clean and Replace Your Lens Case

Using a case without regularly cleaning and replacing it can cause ocular infection due to bacterial contamination. We advise you to clean the storage case on a daily basis and to replace it monthly or as advised by your [eye doctor].

At Antoine Eye Care Scleral Lens Center, you will receive the first-rate eye care you deserve. No matter your questions or concerns, Dr. Michael Antoine, O.D. will be happy to explain how to best care for your lenses to ensure the highest level of comfort and vision acuity.

Cleaning your scleral contact lenses is vital for your eye health, and so are follow-up appointments with your [eye doctor], who will provide you with specific lens cleaning instructions and ensure that your vision remains clear, safe & secure.

Request An Appointment
Call 314-207-7355

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Frequently Asked Question

How Much Do Scleral Contacts Cost?

Unlike regular contact lenses, scleral lenses are custom fit to the eye. This requires significantly more training on the part of the optometrist, expensive equipment and multiple visits to achieve the optimal fit. In addition to the fitting process, the patient must also be trained on how to properly care, insert and remove scleral lenses. This is why professional fees associated with fitting scleral lenses are higher than traditional contact lenses.

Our optometric team at Antoine Eye Care Scleral Lens Center will be happy to discuss your specific costs and payment options based on your individual needs.

Does Insurance Cover The Costs Of Scleral Lenses?

Scleral lenses are not automatically covered by vision or medical insurance. Though most insurances will reimburse the costs for scleral lenses when medically necessary, the rates and restrictions tend to vary greatly from one vision insurance provider to the next.

We will be happy to provide assistance in helping you apply insurance benefits to your scleral lenses. However, given that insurance policies vary widely, we cannot guarantee how much coverage you will receive from your provider.

It’s important to note that scleral lenses, which are hard lenses, last far longer than soft contact lenses. While their costs may be higher, their many benefits and lifespan make it a worthwhile investment.

What Happens During a Scleral Lens Fitting?

  • Consultation and testing (Digital Imaging)
  • Measurement and fitting
  • Dispensing of the lens
  • Training on how to care, insert and remove the lenses.
  • Follow up(s) for micro-adjustments

Are Scleral Lenses Custom Fit?

Designed by Dr. Michael Antoine, O.D., all scleral lenses are custom-made to match the exact contours of your eyes. A topographer digitally maps out the exact dimensions and shape of your eyes resulting in custom-designed scleral lenses that ensure maximum comfort and acuity. Thanks to our latest technology, we can provide microscopic precision when developing each scleral lens.

Our patients experience enormous relief when they see that they can manage their keratoconus and other corneal conditions successfully without surgery.

Request An Appointment
Call 314-207-7355
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