Unlike Knozxy saline on amazon, which has a sachet for vials for 100% seal from microbes from manufacturer to customer, this has vials in a box that is exposed to air, so you get all microbes from Taiwan and transport to here. This is not good, as you need to wash every vial with 70% alcohol around the neck, and also boric acid is irritating a little.
They need to create more transparent labeling, i.e. to make every box indicate what is the boric concentration. Plain saline without buffer is more comfortable.
Shocking that Bausch and Lomb can make such a lousy packing for its saline. But hey, Bausch makes Minims saline too, though that one is not on amazon. Haven't tried that one, but i hope it's sealed in sachets like many French or Refresh drops are. :)
Also, boric acid is an issue as a buffer agent. The EPA 2004 PDF on toxicity lists 1 mg boron/day as good for health; anything above 10 can bring unwanted effects. “Normal levels of boron in soft tissues, urine, and blood generally range from less than 0.05 ppm to no more than 10 ppm” ► EHP 1994;102(7):113-7. MW boron is 11, boric acid 62, so since boric acid is usually the form in human body, its ppm values would be about 5 times higher. What is in blood is in tears often, so tear boric acid levels may be 0.1-1 ppm, which is very low vs 3000-5000 ppm in artificial tears; here is where toxicity comes from, not boric itself, but concentration. Oddly, boric can have some beneficial effects too on ocular tissue. CDC says in kids serum boron level is 1.25 ppm max. Drinking water boron was found to vary 1000 fold from 0.03mg/L to 29 mg/L and this seemingly influenced reproductive outcomes in humans. Also the pregnant rat studies showed severe birth defects, stillbirth, etc at doses 900+ times higher above we would get from 10 eye drops/day. However some ointments and gels that stay in eyes at night increase exposure and absorption beyond what eyes can find healthy, even if sperm may not be affected. Borate buffer is often a mix of 0.3% boric (3g/L or 48.4 mM) and 0.3% borate (NaH2BO3); pKa1=9.24; 7.4=9.2+log[H2BO3-]/ [H3BO3], but pH is influenced by other components too, or max 0.6% or 97 mM total boric acid (free or salt) in many solutions or higher, which is about 0.15 mg of boron ingested (tear electrolytes go to nose and then we swallow them) if you place 1 drop/eye 5 times a day, and 1 mg if you use tears with more boron (perborate as preservative etc). Refresh Relieva PF bottle (multi-dose) uses borate, while Refresh Relieva PF 30 vials uses lactate buffer; the reason is that borate is antimicrobial preservative in reality, so a bottle used over 30-100 days needs stronger defense than a vial used 3 hours. This may be toxic since most people only ingest 0.87-1.35 mg/day per NIH from food (on average). NIH established upper intake levels of 3 mg for toddlers and 20 mg for adults based on reproductive and development defects in animals; however, unless one uses tears with high boron 10 times daily in both eyes, one cannot really eat more than 5 mg/day, but it may damage the nose, eyes or lungs: the preservatives section explains more on borate eye toxicity. That’s why it’s safer to not place all money into one basket, and use other buffers too. Borate is more effective at wiping bacteria ► Antimic Ag Chem 1986;29(5):803-6, having been used as antibacterial for decades. J Occup Med Tox 2009;4:27 has many references to toxicity of boron compounds, when it accumulates in the body, so it is best to not use drops with borate buffer only, but have different brands if using a lot of drops. Boric acid and borate are on the EU ‘Substances of Very High Concern' List, for their reproductive toxicity, so if you had your kids it may not do much collateral damage, though that is unclear even for the eye. Odd thing is borate drops go into the nose and stomach, as we swallow the nasal tears and then get inhaled partially, and may damage our lungs even. Since our eyes have individual osmolarity, pH (6.5-7.8), properties, generating tears is way better. Recall how all so called sterile (un)preserved tears are loaded with bacteria? Then would borate come on top due to its antibacterial properties? Well, to be safe, you can take 20-100x pictures of eye redness (easy way to monitor dryness) with a phone camera and lens, to see which one is better; if equal, rotate among several brands using 5 buffers (citrate, borate, Tris-HCl, bicarbonate, low phosphate – if company tells you level of phosphate is ≤ physiological 1.45 mmol/L) and different ingredients, since it may take 400 years before they know which brand is safest for your genome, requiring way more complex tests of all ocular tissues daily (over 200 days = $5 million) to see what is best even today. The pictures (or you looking at 20x mirror) before and after repeated after each brand (1 brand/day max) can tell if one is very irritating or not at least, if confounding factors are accounted for and the redness if not caused by something else.
Cornea 2017;36(6): 712-8 Fig 1 makes it clear that PO4 at 10 mM (common in many brands), 7 times above physiological level, is highly toxic in vitro to cornea HCLE cells, just as 10 mM of borate, 10 mM is 10 milimoles/L, 10 mM Tris and 10 mM citrate are, with Tris and citrate being a tiny bit better. No wonder companies hide the concentration of boric and borate on labels. Scary charts, in fig 1, anyone can see on pubmed, google it, this means most tears damage the eyes, unless they use much lower levels of these compounds! We can only hope in vivo it’s much better as cells get help against the buffers. That’s why I like drops without buffers . Try knoxzy from amazon, made in France, i liked it a lot more.
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ScleralFil Preservative Free Saline Solution
From Bausch + Lomb Specialty Vision Products lens care products, ScleralFil—indicated as a scleral insertion solution—is an alternative for rinsing and inserting scleral lenses. It is a sterile, buffered isotonic saline solution that can be used to rinse soft and gas permeable lenses.
ScleralFil features:
- Buffered to maintain pH
- Travel-friendly, single-use, 10 mL vials stand upright
- Each carton contains a 30-day supply
- Indicated for soft and gas permeable lenses
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