Preservative Free Saline for Sclerals Part 1: Buffered vs unbuffered
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- Опубліковано 18 сер 2018
- This is part 1 of a series on preservative free saline solutions used with scleral lenses and PROSE devices. In this session we discuss the differences between buffered and unbuffered salines, whether and when it matters, and how to tell them apart.
PART 2: • Preservative Free Sali...
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I want to post some supplemental notes to this for clarification:
1) This is just an informal thing meant to highlight the pH question which I believe is being overlooked at patients' expense.
2) The numbers given in the video are NOT based on any documentary evidence of the pH of any specifically mentioned BRAND of saline mentioned. The quote of 5.5 is based on medical literature describing normal saline as having a pH of about 5.5, and the quote of 7 is based on manufacturer claims of the saline being pH balanced for the eye.
3) Unisol 4 (which was discontinued in 2015 but was the longtime favorite for PROSE and scleral lens users for many years), Purilens Plus (its successor) and ScleralFil are all borate buffered salines with the same ingredients.
4) My biggest personal concern with the buffered vs nonbuffered issue right now is actually the stability of the pH. Patients are using Addipak and Lacripure vials and stretching them out for hours or even days, sometimes at the specific recommendation of their doctor. I have been told that testing shows that unbuffered salines will experience a drop in pH after opening, and this is a serious concern when we're talking about a solution that is already acidic even before opening. If it's true that salines kept open for 24h end up even more acidic, then patients fill their lenses with it, what is the effect of the acidity of the saline on their corneas?
5) My next concern is that anecdotally, it has been my consistent experience for many years that for many patients, especially those with diseased corneas, there is a direct relationship between lens comfort and vision, and the presence of buffers in the saline (and here note that I can only speak to borate buffers simply because that's all we've ever had available on the market). For many patients the difference between these types makes the difference between lens success and lens failure, and many of these people have advanced corneal disease with few treatment options, so the difference becomes quite important.
6) On the other hand, I am also told that toxicity of borate buffers can be a significant threat to the cornea. This is something I want to understand more about and will be studying closely in coming months. I have not seen any published evidence for, specifically, toxic effects of borate buffers in a scleral lens context, so I want to come to understand what verified data exist and what they may mean for patients.
Rebecca, I learned something by watching this! I did not know that sometimes the fogging issue is made better by buffered saline! All this time in My Big Fat Scleral Lenses and I missed this. Thank you for making the videos ☺.
Kathi Y.
Rebecca, Thank you so much for posting this video.
This kind of informations are so hard to find Online.
My eye doctor didn't explaned to me either the difference between buffered and unbuffered. So I really appreciate what you did as well as other videos you made for scleral lenses users.
This kind of information is only available from the eye doctor. Thank you.
Thanks for this! Been using addipaks for years, and I'm only now realizing I was giving very little information on how to care for these, and what to use.
Very helpful information - did not quite understand until now, thanks so much!
Thank you so much for you video!! Much appreciated. I would not have gotten this information from the doctor's office most probably because I did not know enough to ask about the difference between buffered and unbuffered saline solutions, having just gotten scleral lenses a day ago.
Thanks so much for this video. You're an awesome resource and teacher!
excellent information, I didn't get this info from my dr. Thanks so much!
This information is awesome thank you so much!
Thanks for your thoroughness! There’s hope for better, comfortable eyesight. 😊
Timestamps:
0:01 Who we are!
0:16 PF Salines
0:43 Types of PF salines
0:54 What does buffered mean?
1:49 Human eye pH and saline pH
2:36 Common buffers
3:00 What brands are buffered and unbuffered
4:17 Why should I care?
4:54 Comfort
5:27 Fogging
6:13 My advice
Thank you for your commitment to better vision💞
THANKS FOR EDUCATING US. MUCH APPRECIATED!!! 😀
very informative - thank you
Great Job!!!!💪🏾💯
Hi Rebecca. So my optometrist prescribed me BioTrue multi purpose bug cause my eyes ti severely irritate and burn to the point where I couldn't open my eyes. It was so bad at another point in that time the pain was so great that I got cold sweats and started to feel like throwing up. I saw your video and got the right solution and now I'm wearing my scleral lenses for my keratoconus now flawlessly. Thank you! I found out I couldn't do unbuffered because of how much I would use them and how long I'd used them a day.
Hi there! So glad your lenses are working well for you now! It's the proverbial "devil in the details" sometimes with all these solutions, isn't it? Who would have thought it would make such a big difference in terms of comfort. I wasn't quite sure from your post whether you meant that you were using BioTrue to fill the lenses, not just rinsing and cleaning? (I have heard of this. Also some doctors seem to be recommending PureMoist. But the standard of care for filling solutions really is preservative free only.) You might just ask your optometrist if they are on the Scleral Lens Practitioners facebook group - it's a great resource for doctors who are fitting sclerals. They talk a lot more about fit than anything else but questions do come up about solutions as well.
@@TheDryEyeShop so my Optometrist was making me use the BioTrue solution inside the scleral lense and was really really irritating my eyes.
@@mike40281 I'm sorry to hear that. I hope you can discuss this with your doctor. Did they give you written instructions about which solutions to use for which steps?
@@TheDryEyeShop they didnt give me a subscription. They just told me to buy that solution and I'm good to go. The specialist is relatively young though so maybe he doesnt know about the the unbuffered/buffered issue
@@mike40281 Lots of doctors aren't familiar with the buffered/unbuffered issue (though more of them are learning about it now than a few years ago). But the bigger issue here is preserved (Biotrue) versus unpreserved. Doctors should not be telling patient to use a preserved solution in their lenses. Did they never give you for example any of the pink vials to use?
Hi there, I'm obviously going on a deep dive of a lot of your videos. I do have a quick question though... The video mentioned the eye and tears should have a ph of 7... I happen to have litmus strips so out of curiosity I touched it to my eye and my ph is only 4.5-5... is this common with advanced dry eye disease? At the time of doing this I hadn't had my sclerals in for over 12 hours and hadn't recently used any drops. I produce very little natural tears even with xiidra and my meibomian glands are not producing any oil at this point in my disease. I currently use addipak vials and for the most part have little issues with comfort (however I do have corneal nerve damage that waxes and wanes) and no fogging. I should probably at least try the buffered salines to see if there is any improvement on comfort. I have one eye I have issues with more than the other so I'm curious to see if this would help. Thanks again or all you do!
Thank you very much for this information. I am a new scleral lens wearer who is struggling with fogging after a couple hours of wear. At the moment, I am using Addipak -- I will try SleralFil to see if that makes a difference. Greatly appreciated! Out of curiosity, what cleaning solutions to you recommend to prevent fogging (you mentioned this in your video). At the moment, I am using Lobob CDS and Clear Care.
Hi there! Wish you the best with your new lenses! Fogging takes a bit of troubleshooting. Saline is a good place to start. Switching to buffered saline is enough for many people, but for others they do best when they also supplement with a few drops of Refresh Celluvisc in the lens. There are also lens coatings that can make all the difference to fogging so that would be something to discuss with your lens provider. Your cleaning solutions are all good choices :) although with the Lobob CDS it depends on the lens type and whether it's coated. If you happen to be a Facebook user, you would probably find our group helpful, we have lots of discussions there about fogging. The group is called My Big Fat Scleral Lens.
Thank you for your quick response. I'm actually not a Facebook user; however, I may create an account just to participate in the group. I just ordered a package of ScleralFil from your site. As for the Refresh Celluvisc (which I have on hand) -- are you suggesting to place a couple of drops of Celluvisc in to the saline prior to inserting my lens? Or, placing a couple of Celluvisc drops directly on to my eye, prior to inserting my scleral lens? Again, thank you SOOOOO MUCH for your help -- there isn't a lot of information on this subject out there...
I think there are a lot of people who use Facebook exclusively for the medical groups... it's just so helpful to have a way to reach out and get quick responses on a lot of really obscure topics :) If you don't want to do Facebook there's also DryEyeTalk.com - you can participate as a guest or create an anonymous login. We have a forum there specifically for sclerals. Just not as many people and not such rapid responses. - Regarding Celluvisc - yes I meant adding it to the saline in the lens 'bowl' prior to insertion. You'll find in the groups that there is a huge range of "cocktails" people are putting in their lenses to optimize comfort and vision. Cellluvisc is an oldie but a goodie. I remember people using it 15 years ago for this purpose. Some people add just a couple of drops to the saline, some people much more. It's something they work out in practice. It seems to help with mucous and fogging particularly. I don't use it personally. Buffered saline on its own works best for me and I don't like methylcellulose drops particularly. - Plasma treatment or hydra peg coating are important parts of de-fogging too fyi.
Very interesting! I thought the si called "isotonic" 0.9% NaCl would already be rather neutral and may be just getting acidic when exposed to the atmoshere?
I know - that's the natural assumption! But it's acidic to start, unless buffering agents are added, and it gets more acidic when opened. - Interestingly though I saw on a scientific poster at a meeting - a year or two after the video - that Lacripure (which is also unbuffered 0.9%) seems to have a considerably higher pH than the nebulizer salines, like 6.5 rather than 5.5. Possibly attributable to different processing temps during packaging, so I'm told.
Watched this video and just cried. Please respond with help. What is the best buffered solution. Sclerefil is good but hard to find. Was prescribed the pink viles but insurance doesn’t cover!!!
Hi there, Scleralfil won't be available for at least another week--it's out on our site and on Amazon. The pink vials aren't buffered. The best saline is really up to your preference and your doctor's recommendation. Supplies for scleral lens products aren't typically covered by insurance, but some people can get a prescription for the pink vials. If you're having trouble affording your supplies, please contact us as we do have some cosmetically damaged products available for free.