In Contact Lenses Today, Susan Gromacki describes a case of a 16-year-old high school student who was fitted with scleral gas permeable contact lenses. She was very successful, but at her one-month follow-up visit, she had developed a diffuse 1-2+ superficial punctate keratitis throughout her right cornea. When asked about her lens care regimen, it was clear that while the cleaning and disinfection were performed properly, she had resorted to filling the lenses with conditioning and disinfecting solution prior to application. What can be learned from this, according to the author, is: no matter how intelligent a patient, there is always the potential for noncompliance with the prescribed treatment regimen. Also, although there are many good options to disinfect scleral lens overnight, what a patient fills them in the morning upon application is critical - it needs to be a non-preserved solution. This topic is also covered in a case report as part of the fellowship of the scleral lens education society (SLS), presented in its newsletter. The case, described by Pam Satjawatcharaphong, emphasizes the fact that educating patients on correct cleaning of lenses and control of the contents of the fluid reservoir is critical in avoiding a toxic reaction on the cornea. This is particularly important in patients using scleral lenses for therapeutic purposes, as these corneas are already unhealthy and may be more susceptible to insult. Michael Ward's contribution to Contact Lens Spectrum is another reminder to be aware of Acanthamoeba infection and the risk involved when allowing tap water in our care regimen - also true in (R)GP lens wear, whether corneal, corneal reshaping or scleral.