Confusion about scleral lens rubbing

[m4shore]

Hey guys,

I've received conflicting information from scleral lens specialists regarding using rubbing solutions on lenses.
One doc has told me not to ever rub since it can wear off the coating and potentially damage optics. The other told me to definitely to it to remove debris that the soaking doesn't remove.
Both docs are experts at the top of their field, so I find this quite bewildering.

I'd love to get some input on this issue.

Mike.

[Rebecca Petris]

Hi Mike,

Great question. There's a lot of confusion about this generally, and not a lot of consistency in advice given!

Many people get by just fine with no rub cleaning. But many of us - and probably more so, the more diseased the corneas are (eg more dry) are more successful in lenses when using a rub cleaner. If your lenses are hydra peg coated, you have to be REALLY careful about what solutions you use. Here's the coating manufacturer's page about it:

https://www.tangiblescience.com/hydra-peg-care-tips

It's confusing though because if you do NOT have hydra peg but do have plasma treated lenses, the advice may be quite different. For example, Lobob ESC has always been the gold standard for the plasma treated lenses, but you can't use it with hydra peg lenses or it will strip the coating. You also cannot use enzyme removers including Progent with hydra peg.

I know a lot of scleral lens fitters that never recommend a rub cleaner - but then, we also have an awful lot of people that wander into the scleral lens facebook group having issues with their lenses, and this is often one of things they end up doing to try to improve their comfort & clarity & wear time.

Me, I started with PROSE years ago, where we always had a really rigorous care regimen and I thought a rub cleaner was standard for everyone. I only learned in the last few years how many doctors don't have their patients bother with it.

Personally, I can go without rub cleaning for a few days, but I can feel, and see, the difference.

[m4shore]

Thanks for the response Rebecca!

What is your take on the concerns about rubbing wearing off the coating?
On the same note, I've also gotten conflicting info about whether or not Hydra-PEG can be recoated, or whether they need to be completely replaced. Do you know which of these is the case?

[Rebecca Petris]

Oh it's definitely true that a lot of rub cleaning will wear it off faster, no matter what cleaner you use, or so I've been told. Makes sense. It's a coating, if it wears off eventually by itself, it will wear off faster with extra friction.

Re re-coating: It most certainly CAN be done, and multiple times, too, I know tons of people who do that regularly. It's more a question of who's willing to or has it in their policy. For mainstream use I don't think it's done all that much. I think that the specialty practices where they treat a lot of very diseased eyes are the ones most willing to arrange to get it done.

[m4shore]

Gotcha. That's good to hear.
Do you know if there is a general guideline as to how often lenses should be recoated? Does the guideline vary between plasma and Hydra-PEG?

[Rebecca Petris]

For hydra peg I believe that the expectation was that it would last up to a year. In practice it's all over the map depending on disease and cleaning regimen and so many other factors. My understanding is that plasma doesn't last very long at all, but because re-doing plasma wears out the lens much faster, you can only re-treat it a few times before having to replace the lens, whereas you can redo plasma quite a few more times without compromising the life of the lens.

[m4shore]

"My understanding is that plasma doesn't last very long at all, but because re-doing plasma wears out the lens much faster, you can only re-treat it a few times before having to replace the lens, whereas you can redo plasma quite a few more times without compromising the life of the lens."

I'm a little confused by this. Can you clarify?

Thanks so much for all the info Rebecca!