It’s been recently brought to my attention that my hard contact lens wearing patients have it a lot harder than my soft contact lens wearing patients. Soft contact lens solution is readily available at pharmacies and grocery stores and big box retailers. But hard contact cleaning solutions, conditioning solutions, insertion and removal plungers, even preservative free saline is near impossible to find. God forbid one of my hard contact lens wearing patients has to travel somewhere and forgets something. They are basically screwed because the chances of them finding hard lens provisions is pretty slim. Is this why hard contact wearers are so rare now? Or is it because hard contact wearers are so rare that most stores don’t carry hard contact lens provisions? What came first the chicken or the egg?
But what about all my patients who have irregular corneas (the front part of the eye) that have to wear hard lenses to see clearly? Hard contact lenses, especially Scleral lenses that fit all the way out to the sclera (the whites of your eyes), provide the best vision for people with irregular corneas. This is because the hard lens, and the filling solution between the lens and your eye, physically smooths out the irregularities in people’s eyes, giving them a smooth refractive surface to see out of. Scleral vision is the best vision, and many of my patients can’t see in anything else. Glasses and soft contacts that don’t smooth out the irregularities in the cornea don’t provide as good vision. There’s no vision like Scleral vision, especially for patients with corneal irregularities.
Hard contact life is so hard for some of these patients that one guy, named Jeff, even started a blog about the difficulties of #Scleral.life:
Here is a link to his blog: https://jeffscleral.com/
See, Jeff has Keratoconus, a disorder that occurs when the the normally round cornea thins and bulges outward into cone shaped (see picture above). This irregular shape causes blurred vision, light sensitivity, and glare that often cannot be corrected by glasses or soft contacts. Keratoconus patients like Jeff need hard scleral lenses to smooth out the front of his cornea all the way out to his sclera. They have no other option. And it sucks that the solutions and saline and plungers they need are not readily available to them. Also their contact lenses are super expensive and they constantly live in fear of breaking or losing their lenses. So Jeff wants to make #Scleral.life better for people like him, and all hard lens wearers out there who are suffering a hard-knock hard lens life. And as an eye doctor who wears hard Ortho-K lenses and loves prescribing them to all my patients to prevent the progression of nearsightedness instead of just correcting it, I want to help him out.
So here is some information about the best hard lens provisions and where to find them:
According to Jeff, who has done a lot of research into finding the solution that makes his Scleral contacts the most comfortable, Tangible is his favorite. I have actually talked with the scientist who invented the stuff and evidently the secret sauce is that it coats the hard lenses with a mucin-like hydrophilic shell. Mucin is a component of the eye’s tear film, so I think the eye almost recognizes the hard contact lens as a part of it’s own tear film instead of as a foreign substance. Anyways, its very technologically advanced stuff that comes with patient recommendations so I am a fan.
It does everything you need a hard contact lens multi-purpose solution to do: cleans, conditions, cushions, disinfects and removes protein deposits. Despite being a hard lens solution, I have actually seen it in some pharmacies. You have the marketing power of Bausch and Lomb to thank for that. It works, but sometimes you need to rub the lenses off a little bit if they look dirty or get an extra protein remover. Or run it through a hydrogen peroxide cleaning solution for a little extra cleaning.
Paragon CRT Ortho-K Lenses are the hard lenses that I prescribe the most for nearsightedness prevention. And Paragon recommends using this solution to clean their lenses. It can be used for any hard contact lens, not just for Paragon Ortho-K lenses. I have used it, but prefer Clear Care because it’s easier for even me to get.
This is by far the easiest to find at all pharmacies, grocery stores, big box retailers etc because it can be used to clean both soft and hard contact lenses. It also helps when Alcon is owed by Novartis, who can afford to buy the prime real estate on store shelves. Any Hydrogen Peroxide Cleaner (not just the Clear Care name brand) works great at cleaning hard contact lenses. However, you may want to put a drop of conditioner or lubricant in the lens before you insert it into your eye to improve the comfort of the lens (I’ll recommend a few options in the next row).
The Boston Advance Cleaner, often sold in a 2 pack with the Boston Advance Conditioner, is a great deposit cleaner. But it also stings like crazy if you ever get it in your eye so remember to always clean off the cleaner with saline before you put the contact lens in your eye. You should also soak the contact in a conditioning solution, like the Boston Advance Conditioning Solution, before you put it in your eye.
Progent works so well as cleaning off protein deposits that you only have to use it biweekly. It is a great supplemental cleaner for your hard contacts, but you still need a daily multi-purpose solution or cleaner/conditioner combo.
This is usually packaged with the Boston Advance Cleaner, which is Step 1. This is step 2, a conditioning solution for your contact lens after you clean it with the Step 1 Cleaner.
This is my absolute favorite conditioning solution to put in my Ortho-K hard contacts before I put them in. It just makes the lens so much more comfortable. It is also the best lubricant eye gel if your eyes are super dry and you don’t mind the goopy-ness. The goopy-ness makes the soothing dry eye relief last longer because the drops don’t just evaporate immediately. However, it can blur your vision temporally right when you put it in because it is so goopy. Personally, I like to pair Clear Care cleaner with Refresh Celluvisc drops as conditioning solution. I fill my hard Ortho-K lenses up with Refresh Celluvisc before I put them in at bedtime for the optimal nighttime correction of my vision when I sleep. Refresh Celluvisc is often sold out or backordered, so I often buy a bunch of it to hoard whenever I can find it.
Daytime scleral wearers have to fill their lenses up with a preservative free saline filling solution before inserting their lenses in the morning. According to Jeff’s blog, he recommends trying all of the available preservative free filling solutions for Scleral lenses because a lot of it is personal preference. But when I asked him what his personal favorite was, he said he liked Nutrifil and Scleralfil, but Scleralfil is so hard to find that he uses Nutrifil.
Jeff’s favorite preservative free saline filling solution that is more readily available.
This is what I prescribed to all my keratoconus patients before I met Jeff and started reading his blog. Now I’m just going to point my patients to this blog post so they can experiment with all the filling solutions until they figure out which one they like the best.
Another preservative free saline filling solution option.
These smaller vented plungers are used for removing hard contact lenses. Half of my patients prefer the vented plungers and the other half prefer the non-vented ones without the hole in the middle.
These are the non-vented plungers for removing hard lenses. Some patients prefer these to the vented plungers because you don’t have to squeeze the plunger to attach it to and release it from the lens.
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