Online shopping pitfalls for scleral lens patients

Rebecca Petris, Aidan Moore, Sandra Brown MD. Dry Eye Foundation, Poulsbo, WA, USA.

PURPOSE: To identify potential risks to scleral lens users from purchasing incorrect contact lens solutions online due to misleading marketing.

METHODS: We searched Amazon, Walmart and Google shopping in an incognito Chrome window on three search terms: “scleral lens filling solution”, “scleral lens storage solution” and “scleral lens cleaning solution” and we analyzed the first 25 products in each search result. We identified three popular saline solution products and reviewed listing language, descriptions, images, and marketing emails associated with these products on two general retail e-commerce platforms (Amazon, Walmart) and two specialty eye care product websites (DryEyeRescue, Oculus Curae).

RESULTS:

1. In e-commerce search results for solutions by indication on three platforms, 54% of solutions in the top 25 results for “scleral lens filling solution” were not preservative-free salines (Amazon 65%; Google 41%; Walmart 55%). 82% of solutions in search results for “scleral lens storage solutions” were salines or other solutions not indicated for storage (Amazon 73%, Google 83%, Walmart 90%). 48% of lens solutions in search results for “scleral lens cleaning solutions” were not formulated for cleaning or disinfection of RGP lenses (Amazon 28%, Google 52%, Walmart 59%).

2. Certain competitively priced lens solutions were marketed for indications incompatible with their formulation: A preservative-free saline solution (Aqua Naina, Chemtex) was marketed as a replacement for Unisol 4 and also marketed for cleaning, disinfection and/or storage on three platforms (Amazon, Walmart, Oculus Curae). The product description for a preserved saline solution (Equate Saline Solution for Sensitive Eyes, Walmart) stated that it “rinses and stores your contact lenses so that they are fresh and sanitary when you put them on again the next morning”. A testimonial-based marketing email received from an eye care products distributor (Dry Eye Rescue) appeared to promote a preservative-free saline solution (Scleralfil, Bausch & Lomb) as a cleaning solution.

DISCUSSION: Scleral lenses require the use of at least two solutions: a preservative-free saline solution indicated for scleral lens insertion, and a solution formulated for cleaning and disinfection of RGP lenses. Obtaining these solutions and using them correctly without brand-specific guidance from a provider is complicated by several factors, including: lack of availability of preservative-free solutions in local pharmacies; the need for low-cost solution options; and overlapping product indications amongst saline solutions, multi-purpose solutions, and cleaning and disinfection solutions (for example, “rinsing” and “storage” indications are each common to more than one category of solution). Most scleral lens users must purchase some or all of their solutions online and must be able to readily identify the correct use of each product they are purchasing online. However, e-commerce platforms and search engines permit sellers to list and describe products for unapproved indications and to optimize product search settings based on incompatible product indications. At the same time they do not provide any list filtering options which would allow consumers to distinguish between preservative-free and preserved solutions, or to distinguish between saline solutions and cleaning and disinfection solutions, including multi-purpose solutions. Further research is needed to identify the extent to which misleading marketing descriptions and search result optimizations contribute to the incorrect use of contact lens solutions by scleral lens patients.

CONCLUSIONS: Searching for scleral lens filling, cleaning and storage solutions on major online shopping platforms returns a high proportion of unsuitable products. In particular, searching for “filling” solutions returns preserved products, and searching for “storage” solutions returns preservative-free saline solutions, even when the precise intended use is clearly specified. Patients may require extra guidance to ensure that the solutions they purchase online have the correct indication. Scleral lens providers should review contact lens solution compliance with their patients at every follow-up visit.

Commercial interests: Rebecca Petris is the owner of Dry Eye Company, a retail business with eye and lens care products.