Wettability is a critical aspect of maintaining vision clarity in scleral lens wear, yet data show that 90.8% of eye care practitioners have noted poor scleral lens wettability in their patients. Signs of poor wettability include foggy and cloudy vision.²

 Below are five tips to help improve patients’ wettability:

→ Address anterior surface disease
Blepharitis, meibomian gland dysfunction, and giant papillary conjunctivitis are common conditions that cause lipid and gland variability that results in tear film instability, thus reducing wettability. Aggressive treatment is recommended in the forms of lid hygiene, hot compresses, nutritional supplements, oral tetracyclines, topical medications, such as cyclosporine and artificial tears, and in-office procedures.

→ Decrease the wetting angle
Lens materials are optimized to increase oxygen and improve wettability. A high Dk is usually desired, but if this decreases lens wettability and causes lens deposits, the wetting angle can be decreased by choosing a different lens material.

→ Try different lens treatments
Lens coatings can be used to help with lubricity and tear/lens film interaction. Before leaving the lab, most lenses are plasma-treated, which increases the hydrophilicity of the lens, thus improving tear film interaction. If this proves insufficient for a patient, another option is to consider a surface coating that can increase wettability and improve comfort.

→ Suggest specific cleaning regimens
Recommend the patient use a set routine for cleaning, disinfecting, and storing lenses. Daily, manual rubbing with preferred solutions is recommended to remove lens deposits. Extra strength cleaners can also be used for heavy lipid or protein deposits. Prior to lens insertion, the lens should be rinsed with saline solution. If patients continue to have poor lens’ wettability after other causative factors have been ruled out, switching cleaning solutions is usually recommended.³

→ Consider external contaminants 
Advise the patient on how to cleanly store, insert, and remove their lenses, as it is possible external contaminants are interfering with wettability. Cases and plungers should be regularly replaced and cleaned to prevent contamination from bacteria and inflammatory responses from debris transferred to the lens.

Eye makeup application is recommended before scleral lens insertion to avoid contamination of the lens. For the same reason, an oil-free moisturizer should be used for makeup removal after lens removal. Eye makeup replacement is recommended every three months, as makeup older than this can decrease lens wettability and lead to foggy vision. Oil-based makeup or skin products should be avoided, as well as hand creams, lotions, and cream-based foundation to avoid film build-up on lenses.³ Hairspray is another culprit that should be applied before lens insertion and while lenses are away from the area of use.⁴

Preparing patients
With wettability being a crucial part of scleral lens use, it’s important to give patients all the tools they need to make their lenses as comfortable and effective as possible.   

References

1. Pucker AD, Bickle KM, Jones-Jordan LA, et al. Assessment of a Practitioner’s Perception of Scleral Contact Lens. Cont Lens and Anterior Eye. 2019;42(1):15-19. doi: 10.1016/j.clae.2018.11.003.

2. Satjawatcharaphong P. The Scleral Lens Vault. Contact Lens Spectrum. March 1, 2020. bit.ly/sclerallensCLS0320. Accessed April 14, 2024.

3. Barnett M, Toabe M. Scleral Lens Handling. In: Barnett M, Johns LK. Ophthalmology: Current and Future Developments. Bentham Science Publisher;2017.

4. American Optometric Association. Contact Lens Care. https://bit.ly/AOAcontactlenscare. Accessed July 30, 2023.

AIMEE GRIMM, OD received her doctorate from the Pennsylvania College of Optometry and completed a residency in Ocular Disease and Refractive Surgery at Newsom Eye in Tampa, Fla. Dr. Grimm is a fellow of the Scleral Lens Society and currently practices at Advanced Eyecare Specialists in the Poconos of Pennsylvania.