All about Clear Care (hydrogen peroxide 3%)
What it is and what’s included
Clear Care brand kits include:
Bottle(s) of solution: Available in 12oz; 16oz twinpack (CostCo); or, for Clear Care Plus only, 3oz travel size. The solution consists of water, hydrogen peroxide 3%, a cleaning agent, salt, and additives to stabilize and balance the pH after neutralization. Clear Care Plus also contains “Hydraglyde Moisture Matrix”, which is formulated for silicone hydrogel soft contacts.
Special case with lens “baskets”: The case is like a simple tube. The lens baskets are attached to the lid of the case. These are not designed to accommodate larger sclerals. Scroll down for more information.
“Platinum” catalyst disc: This is a small grey wheel attached to the basket portion of the case via a plastic stem. A common off-label use among scleral lens users is to detach it for use with a larger case (“PROSE Case”).
How it works
After rubbing and rinsing your lenses, you place one lens in each “basket” of the case. You fill the case with the hydrogen peroxide solution and screw the top with the baskets into place. The catalyst reacts with the peroxide and converts it into buffered saline over a 6-hour period. You will see the solution bubbling while this happens. The case is vented (tiny holes in the top of the cap) to accommodate this process.
The solution disinfects your lenses. When the cycle is complete, the liquid left in the case is basically saline. The neutralization process is a safety feature to help ensure you don’t get peroxide in your eyes.
Clear Care vs Clear Care Plus
There are two versions of Clear Care:
Clear Care Triple Action - the original version
Clear Care Plus with Hydraglyde - the original version enhance with HydraGlyde (polyoxyethylenepolyoxybutylene), formulated for silicone hydrogel soft contact lenses.
There seems to be a strong informal community consensus in favor of Clear Care Triple Action, but it must be noted that there are also many people who prefer Clear Care Plus.
Lens size compatibility
Clear Care cases are too small for larger scleral lenses. Either the diameter or the depth of your lenses - or both - may prove to be a constraint on using Clear Care cases safely.
Unfortunately, no specifications are provided in the Clear Care product labeling. Many people report using the Clear Care case with larger lenses by placing their lenses on the outside of the baskets rather than inside. Please be mindful of the potential for lens breakage with alternative approaches, and ask you provider for their recommendation.
PROSE case for larger sclerals
PROSE cases are popular for use with larger sclerals. This represents an off-label product use, so please only do this with your provider’s recommendation or permission.
To use a PROSE case, you must purchase a Clear Care (or Clear Care Plus) kit, remove the catalyst disc, and place it in the PROSE case.
PROSE cases require nearly 3x as much solution as Clear Care cases.
Lens safety in basket cases
While we are not aware of any research on this point, anecdotal evidence suggests that scleral lenses may be at greater risk of loss or breakage when a basket style case (Clear Care or PROSE) is used. Make sure to open ane close the baskets slowly and carefully.
Too much bubbling? Half empty case?
Scleral lens users who utilize Clear Care products often report a mysterious effect where some of the solution seems to either “leak” onto the counter or simply disappear.
The explanation for this is almost always that there is residual cleaning solution (or multi-purpose solution) on the lenses when they are placed into the Clear Care solution. This solution reacts with the Clear Care and causes excessive bubbling, resulting in solution escaping through the vents at the top.
The alternative explanation is actual leakage due to a cracked container. This is usually caused by over-tightening the lid with the baskets.
Clear Care and PROSE cases vs Progent cases
Clear Care and PROSE cases are vented to accommodate the peroxide neutralization process. Venting is an essential safety feature of cases used with hydrogen peroxide solutiosn.
Progent cases, which look similar, are NOT vented. They are sealed, and must be so due to the nature of the Progent chemicals.
Progent cases are NOT interchangeable with Clear Care or PROSE cases. If you were to use a Progent case with a peroxide solution and catalyst, it could explode due to the lack of vents.
Alternative: Generics
Generics can be important options, whether for cost savings or due to brand name product shortages. The main criticism of generics that we have observed in the patient community over the years is that the catalyst discs may not last as long, which means that the solution left in the morning may not be completely neutralized and may require more thorough rinsing.
Alternative: “Brown bottle” hydrogen peroxide 3%
In the US, ordinary drug store hydrogen peroxide 3% solution has been a popular budget alternative for scleral lens users for decades. Only use this with your provider’s permission. While hydrogen peroxide 3% solution can provide adequate disinfection, it is not microfiltered and does not contain any cleaning agents.
Neutralizing discs are not sold separately from Clear Care, so in order to use “brown bottle” hydrogen peroxide, you would still need to procure Clear Care in order to get the disc.
Alternatively, disinfection in full strength hydrogen peroxide 3% followed by aggressive rinsing and brief soaking in preservative-free saline may be acceptable. Please consult your provider.
Today’s and tomorrow’s H2O2 options
As of this writing (January 2024), the hydrogen peroxide product options in the USA are:
Clear Care (Alcon)
Clear Care Plus (Alcon)
Miscellaneous Clear Care generics
Meantime, we have just come through a year-long Clear Care shortage lasting over a year. Product shortages are a chronic problem in specialty contact lens solutions.
However, the future looks brighter. We are aware of a couple manufacturers actively pursuing bringing more hydrogen peroxide products to market within the next two years.