Scleral Lens Troubleshooting: Mid-day Fogging | Conversations with Maria Walker

Contacts with Conway takes on a different format during lockdown, in which Martin discusses different topics with guests.
In this episode, Martin is joined by clinical professor, Maria Walker, who specializes in anterior segment disease and therapeutic contact lens fitting. Maria and Martin address the perpetual problem associated with scleral contact lenses: mid-day fogging. Their discussion includes potential causes of mid-day fogging and practical tips for practitioners.
Contacts with Conway is a collection of educational videos featuring Martin Conway, Contamac's Professional Services Consultant. Join Martin as he explores different contact lens fitting techniques and analysis, sharing the knowledge he has gained throughout his career.
Disclaimer: Any views or opinions expressed in this video are personal and belong to the person(s) in the video. It does not represent the opinions of people, institutions or organisations that this video may or may not be associated with, in a personal or professional capacity unless explicitly stated. Any views are not intended to malign any religion, ethnic group, club, organisation, company or individual. This is not a paid-for advertorial. All opinions are expressed voluntarily.
__________________
Contacts with Conway toman un formato diferente durante el bloqueo, en el que Martin discute diferentes temas con los invitados.
En este episodio, Martin conversa con la profesora clínica Maria Walker, que se especializa en la enfermedad del segmento anterior y la adaptación terapéutica de lentes de contacto. Maria y Martin abordan el problema perpetuo asociado con las lentes de contacto esclerales: empañamiento de mediodía. Su discusión incluye posibles causas del empañamiento de mediodía y consejos prácticos para los profesionales.
Contacts with Conway es una colección de vídeos educativos con Martin Conway, el consultor de servicios profesionales de Contamac. Únete a Martin mientras explora diferentes técnicas y análisis de ajuste de lentes de contacto, compartiendo el conocimiento que ha adquirido a lo largo de su carrera.

[@Person-mh6xq]

7 minutes in to the video and still haven’t heard an answer about fogging. For me- I have a clear eyelid hygiene regime and had no problem for 6 months. Now it’s constant fogging after the first two hours of initial clarity.

[@Dani-ICU-RN]

ANY BETTER? Humidity..here in Florida mine do like glasses

[@ThomasArnold]

Excellent!

[@contamacltd]

Thanks, Tom! Glad you like it :)

[@sandylewis8897]

My fogging is protein deposit on the surface. It actually looks like a white stripe.

[@mizazbiz]

I have been wearing Sclerals for about six weeks and I LOVE them. I have extremely dry eyes due to Sjogren’s Syndrome and KC in my left eye. I can go 10+ hrs staying clear and wonderful vision. Then I start getting the goop on an around the lens - sometime it’s a stripe of goop along the bottom and side of the lens. This happens in both eyes. It alsmost seems to “stain” the lens with a line of cloudiness. I’m pretty sure it goes away after disinfection with Clear Care. I try to just rinse away the goop, but most times need to rub. After listening to this and reading the comments, it’s not unusual I guess. Great video.

[@Dani-ICU-RN]

Goop ???!

[@couerl]

My left one gets cloudy half way through the day, but i have a cataract and cant tell if it's that or the Lense.

[@CarlsonkCarlsonk]

I am a recent sclera lens wearer and feel like my eyes get dry feeling and cloudy after about four hours. Kinda disappointing because I am so hoping to like these lenses to avoid glasses. Had RK surgery in the 80’s

[@contamacltd]

Hi Carlson, sounds very much like midday fogging - mention it to your practitioner at your next visit. - Martin

[@Dani-ICU-RN]

If I could wear glasses. It would be a blessing comma I have cared to countess in both eyes and need transplants so..,..any better? Humidity fogs up my oldenses ,like glasses would going from A/C to outside

[@antoniosantos807]

I have keratoconus. I wear scleral lenses for 10 years. I have a new lens in my right eye and it started 4 months ago; - to press and palpera in hot, temporal and nasal bottom. - becomes dull after 3 hours of use. I wash and renew the liquid inside and it becomes cloudy again. - after removing, I keep the lens mark for 1h Is it going to be dull because of being tight? Thanks

[@contamacltd]

Hi @antoniosantos807! This sounds like a fitting issue. You should consult your practitioner.

[@nsuinteger-au]

thanks for the video. I have been wearing RGP lenses for about 2 months. I have noticed that my left lens always fog up after extended period of wearing (10+ hours). Has not happened on right anytime so far. Just on left side and happens every single day. What can I do to improve this? I have tried giving it a clean when that happens, it works for a short time but returns back quickly. Eye drops do not work either.

[@contamacltd]

Hi Mevan, As you are a relatively new wearer, then I presume your practitioner will have asked you to return for a routine follow-up visit after a month or two to resolve any issues such as the one you describe. It may be that a slight adjustment to the fit or edge profile could alleviate your problem, although your practitioner is best placed to make that judgement. - Martin

[@nsuinteger-au]

​@@contamacltd Thanks Martin for the response. Yes we've done 3 rounds of replacements within the warranty period each with a different fit or edge profile. Sadly after all of that trouble it's still existing. Was told to wait for about 6 more months for a follow up. I thought of may be asking from others who might have experience in the to see if anything comes up. The vision is 20/20 with both of them. Just the left one fogging up towards the end of the day is the problem I'm trying to solve :)

[@contamacltd]

Hi Mevan, It could be that the lid was irritated initially and, despite adjustments to the original fit, the lid needs a break to recover. As you can appreciate, it is difficult to diagnose without seeing the eye. Sometimes these minor irritations are more difficult to treat than a more significant problem. Ultimately it may need a rethink of the lens type or cleaning regimen if you cannot resolve the issue. - Martin

[@RamiAq]

This is my second day wearing scleral lenses. I have a question that might sound really dumb. Does going from a place with cold temperature to a worm one cause lenses to fog? It is too hot outside and when I step outside they get really foggy for a minute

[@contamacltd]

Hi Rami, this is probably due to your tears evaporating and leaving the lipids found naturally in tears on the surface of the lens. When you blink, you clear the grease and re-establish a normal tear film. Ensure that you clean any residue off your lenses at the end of each day’s wear in order that it does not set on the lens to give you issues in the future.

[@andrewmercer1888]

Is Saline the best thing to use to fill the lens or are there other gels or artificial tears etc??? that can be used instead.

[@contamacltd]

Hi Andrew, traditionally, non-preserved saline has been used as a fill solution for scleral lenses, some practitioners do recommend adding a few drops of lubricant, normally containing Sodium Hyaluronate, to the bowl before insertion. More recently in the United States, a new solution specifically designed for Scleral Lens Insertion purpose has been introduced - Nutrifill is formulated to contain natural electrolytes: sodium, phosphate, potassium, calcium and magnesium. All ions found naturally in the tears. Currently Nutrifill is only available in the USA. Hope that helps! - Martin

[@andrewmercer6556]

@@contamacltd Thanks for this... I am in the UK but wil keep an eye out in case they come over here...

[@Blahmanwhysoserious]

What happened to the large diameter RGP lenses? I had some so2clear lenses that were amazing… the company is no longer around and now I have sclerals and they are a huge step down. My last lenses lasted 13 years, till one broke- thanks son I could just put em in like a soft contact and plunger to take em out. I can only assume the industry didnt see money in lenses that last a decade or more and killed it off

[@contamacltd]

Hi @rm2525! SoClear lenses are still available and are supplied by No7 Contact Lenses in the UK. Many other manufacturers also supply larger-diameter RGP lenses.

[@Lvtinstallion]

I keep having issues with fogging, but the fog appears almost immediately after insertion. I’ve take them out, cleaned them with my cleaning solution and rubbed the lens with my fingertips and refilled with clean saline and reinserted them and the fog reappears almost right away. Is very frustrating as I don’t know if it’s internally or outside the lens. I’m residing in Canada. Is there a more studied cleaning solution & filling solution to prevent these kind of issues? Also my optometrist been refitting my lenses and I’ve gone through 2 pairs, yet the issue comes and goes. I’m not talking about midday fogging, I get that too but rather like an immediate fogging as soon as I put them in. Thank you for any recommendations.

[@crazytargets]

I have same problem...l am from India.from Amritsar . please help me. In Amritsar there is only one doctor who comes once in month from delhi.what you do for this problem ...my lens start fogging in half an hour... please tell me ur saline name and solution name

[@contamacltd]

Hi Andres, if the fogging appears immediately on insertion, it is probably grease from your tears collecting on a dry lens surface. There are two issues to consider. First ensure that your tears are healthy - ask your practitioner for advice on improving tear quality such as hot compresses, lid treatments etc. Secondly ensure that your lens is wetting properly. Clean the lens thoroughly to remove grease build up and then soak the lens for as long as possible - preferably 48 hours, but at least 24 hours in your storage solution in order to recondition the lens surface. In extreme cases, lenses may be surface treated using a Hydra-PEG surface treatment.

[@lorenaduque1681]

Im having the same issue only on my rigut eye :(. Were you able to figure it out?

[@Lvtinstallion]

@@lorenaduque1681 use a lens cleaner solution that holds the lenses in a case and submerges it a peroxide solution, the recommendation is 6h before the solution losses the acidity and you should have clean lenses after that. Rinse them with any saline solution for soft contacts and then fill the lenses prior insertion with the saline solution for filling and you should have 0 to no issues on that immediate fogging. Midday fogging is caused by the fit of the lens itself and only the optometrist can really fix that by finding the very best fitting for the eye.

[@lorenaduque1681]

@@Lvtinstallion thank you so much Andrés. Do you have any brand you'd recommend?

[@Maurice419]

What is the reservoir?

[@contamacltd]

Hey Maurice419 With a scleral lens, a layer of fluid is formed between the back of the lens and the cornea. This is known as the tear reservoir, although, strictly speaking, it is formed by the saline used to fill the lens prior to insertion. This tear reservoir should be a sealed system, but if it becomes contaminated during the day’s wear, it can become cloudy and obscure vision. This is known as midday fogging as it normally occurs around that time and means that the wearer needs to remove the lens, rinse and clean it and re-insert with fresh saline. It is estimated that up to 30% of wearers suffer from this phenomenon, although new fitting techniques are beginning to reduce its occurrence. Hope this answers your question 😄 Martin C

[@hashirmohd2588]

Hello, Is it possible to use 0.9% nacl sterile saline with the scleral lens?

[@contamacltd]

Hi Hashir, it is recommended to use non-preserved normal saline for filling a scleral lens prior to insertion, as the solution in the lens at insertion will be held in contact with the cornea for the whole of the wearing time. Preserved saline, such as that used for the care of soft lenses, can be used for storage, but the preservatives, surfactants and disinfecting agents contained in these products can cause irritation when used for insertion of scleral lenses as they will be held in contact with the cornea for much longer than is the case when they are normally used with soft lenses. For patients with dry eyes, I sometimes add a drop or two of non-preserved wetting solution containing hyaluronate to the non-preserved 0.9% saline. I hope this helps. - Martin

[@hashirmohd2588]

Thanks Alot for the info, recently I have heard about Purilens filling solution. Do you actually recommend the brand?

[@contamacltd]

Hi Hashir, Purilens is widely used as a scleral lens filling solution. We have no specific information regarding its performance as we have not conducted any studies with it. - Martin

[@hashirmohd2588]

Thanks for the info, and one more info I need to ask, is it safe to use a ultrasonic rgp lens cleaner device with the scleral lens? Will it damage the lens?

[@contamacltd]

Hi Hashir, it is safe to use an ultrasonic cleaner and it will not damage the lens. - Martin