Helping someone else with their lenses

Why a helper matters

Handling is the part of scleral lenses that people find hardest. In a study of 120 veterans fitted with scleral lenses, difficulty with insertion and removal was the most common reason for stopping, given by 53.7% of those who discontinued.^[1] A trained helper can be the difference between someone keeping the vision their lenses give them and giving up. That might be a parent helping a child, a partner covering bad-arthritis days, or a professional caregiver.

Start with training

Ask the wearer’s fitter to train you, ideally at a visit where the wearer is there too. Clinics that fit children build this in: in one 21-year review of children fitted with scleral lenses, parents were involved in learning insertion and removal, and the team didn’t apply a lens until both the clinician and the parents were confident they could hold the lids open well.^[2] In another study, children and their caretakers were trained in insertion and removal using both a plunger and a stand, over a two-day dispensing visit.^[3] The same approach works for adults who need help.

Ask the fitter to watch you do each step, not just explain it. Write down anything specific to this person’s lenses: which lens is which, the wearing schedule, and the care products to use.

Hygiene comes first

You’re handling something that sits on another person’s eye all day, so clean hands are non-negotiable.

• Wash your hands before every lens session. The FDA advises washing hands before handling contact lenses to reduce the chance of infection.^[4] Use plain soap, scrub under your nails, and dry completely with a lint-free towel.
• Rub and rinse lenses as the fitter directs, use fresh solution in the case every night, and never top off old solution.^[5]
• Keep water away from the lenses: no tap, bottled, or distilled water.^[5]
• Clean the tools too. In a report of infections in scleral lens wearers, the authors included cleaning the plunger among the care steps to emphasize.^[7]
• One person’s lenses at a time. If you care for more than one lens wearer, keep everything separate and labeled. The FDA advises never swapping lenses between people.^[6]

Positioning for insertion

A scleral lens goes in filled with saline, so the wearer’s face needs to be parallel to the floor, looking down, as the lens comes up from below. Without that, the saline spills before the lens reaches the eye. That means you’ll be working from below and slightly to the side of their face.

Every pair of people finds their own setup. Some things to try with the fitter:

• The wearer seated at a table, leaning forward with elbows braced, and you seated low beside them.
• An insertion stand on the table holding the filled lens, so the wearer lowers their eye onto it while you hold their lids.
• The wearer holding their own lower lid, if they can, so you have one hand for the upper lid and one for the lens.

Hold the lids right at the base of the lashes and keep holding until the lens has settled. Ask the wearer to look into the center of the lens as it comes up.

Removal

Removal doesn’t need the face-down position. Ask the fitter which position works best for the two of you.

1. Put a drop or two of artificial tears in the eye.
2. Hold the lids apart if needed.
3. Press the small removal plunger onto the lower third of the lens, never the center, until it grips.
4. Pull outward gently. The lens should tip out from the bottom.
5. Work over a towel in case it falls.

If it won’t release after a few gentle tries, stop and call the fitter. A scleral lens can’t get lost behind the eye: the membrane that lines the eyelids folds back over the white of the eye, so there’s no space for it to go.^[8] See stuck lens.

Watch for warning signs

Some people you help may not notice or report problems, especially young children or people with memory or communication difficulties. Ask how their eyes feel at every session, and look. The FDA lists these as symptoms of eye irritation or infection: discomfort, excess tearing or discharge, unusual sensitivity to light, itching, burning or grittiness, unusual redness, blurred vision, swelling, and pain. If you see any of them, remove the lenses, don’t put them back in, and contact the eye care professional. Keep the lenses in their case to bring along.^[5]

Look after yourself too

Helping with lenses every day is a commitment. If it’s becoming hard to keep up, tell the fitter. A different tool, a stand, a change to the routine, or training a second helper can all make it more manageable.