Midday Fogging of Scleral Contact Lenses: Current Perspectives

Abstract

Midday fogging is a common problem in scleral lens wear, as particles accumulate in the tear reservoir between the posterior surface of the lens and the front of the ocular surface during wear. As particulate waste collects, symptoms of blurred vision and discomfort arise, typically leading patients to remove their lenses for cleaning, refilling with fresh solution, and reinsertion into the eye. The appearance of the particulate can vary, likely due to different causes for midday fogging. Studies which attempted to identify the particulate have given some insight into some of the causes, but larger studies are needed to identify this debris. Research on lens solutions used for filling the lens reservoir and of various aspects of scleral lens fits have also begun to culminate in the concept that midday fogging may ultimately be related to inflammation. Since scleral lens wearers can have varied and multiple sources of inflammation, strategies in minimizing midday fogging can differ between patients.

Patient Experiences With Therapeutic Contact Lenses and Dry Eye Disease

“…13,14 Mid-day fogging has been reported to occur in 26% to 46% of patients using SLs. [31][32][33][34][35] In this study, 75% of SL wearers reported issues with lens fogging or clouding of vision necessitating midday lens removal in 60% of those reporting the phenomena. However, mid-day fogging or clouding of vision has not been formally investigated in soft lens wearers.…”

“…35,38 Mid-day fogging and clouding of vision in both soft and SL wearers can negatively affect visual function and significantly increase the burden of care associated with lens wear. 31,34 Patients for whom mid-day removal is required may find it difficult to maintain productivity at work and may even limit activities outside of their homes because of the need to have specific lens solutions and handling supplies available.…”

Anterior Segment Optical Coherence Tomography In Scleral Lens Fitting

“…An edge lift much greater than this can lead to a lot of tear debris accumulation in long term and also cause discomfort to the patient. Mid Day Fogging can occur which is the accumulation of debris or particulate matter within the post lens tear layer, [24] occurring rapidly after the lens insertion. It can reduce visual acuity and the contrast sensitivity.…”

Lens and solution properties in patients with and without midday fogging

“…Symptoms of midday fogging include hazy or foggy vision that worsens over time and may necessitate periodic lens removal, refilling with fresh solution and reapplication, thus increasing the burden of care associated with SL wear. These symptoms have generally been attributed to increases in particulate debris or generalised loss of optical clarity within the post‐lens fluid reservoir (FR) during SL wear 2,5,6 . Up to 20%–46% of patients who wear SL may experience this phenomenon 1,3,7 .…”

“…Retrospective studies are limited to information that may be contained in patients' medical records; specific information on all factors which may contribute to midday fogging may not be collected routinely as part of a SL follow‐up evaluation. Furthermore, most published literature ignores the fact that symptoms may be caused by something other than debris in the FR, such as front surface deposits or corneal oedema 5 …”