Contact Lenses Yesterday, Today, and the Best Yet to Come
By Joseph T. Barr, OD, MS, FAAO, & Carla J. Mack, OD, MBA, FAAO
When you consider the field of contact lenses, starting with a look back at some of the first contact lens pioneers who worked with blown glass sclerals that had little to no optics and moving forward to the innovative designs, materials, and optics that have evolved in just the last 25 years, we surely have come a long way.
Contact Lenses Over Time
Polymethylmethacrylate (PMMA) scleral designs dominated from the 1930s to the 1970s until Kevin Toughey invented the corneal design. PMMA had many advantages including that it was difficult to break or crack, it was easy to manufacture, it could be molded or lathe cut, and it was easy to clean. Of course, it had one major disadvantage, and that was lack of oxygen permeation. In fact, contact lenses were not much of a business until the 1950s when Newton Wesley, George Jessen, and a few others first marketed and sold them throughout the world.
True transformation to the contact lens field didn't occur until 1971. It was in that year, 40 years ago, that Otto Wichterle's invention, the soft lens, entered the market and was first commercialized by Bausch + Lomb as the Soflens. It proved to be a disruptive innovation that dramatically changed the landscape to come. With improved comfort over PMMA designs, especially upon application, soft lenses opened the door for many new wearers. The advent of the soft lens led to the proliferation of materials, designs, and modalities as well as to the multinational corporation involvement that we see today.
Over the next 15 years, we saw the development of soft toric lenses, extended wear approvals, and the first silicone lens for adult and pediatric aphakia. Multifocals were first available in the form of high-eccentricity PMMA lenses and alternating lens designs, followed by bifocal soft lens designs. The popularity of low-Dk GP lenses was low in the late 1970s, but increased as many new GP lens materials and designs entered the market during the 1980s.
As lens materials were evolving, so too were lens care systems. Lens care in the early 1970s was quite crude and consisted of homemade saline made of distilled water and salt tablets. Thimerosal-preserved saline was thought to be a big improvement until high sensitivity rates and numerous cases of infiltrative keratitis were reported. Heat systems and enzyme tablets were the norm in the late 1970s and 1980s. Sorbic acid replaced thimerosal as a saline preservative, but with the side effect of lens discoloration.
Hydrogen peroxide gained popularity as one of the first chemical systems, followed by the broadly commercialized multipurpose solutions that have led the market ever since.
The Impact of Contact Lenses
We have also been blessed with many firsts in innovation such as the already mentioned soft lens, the GP lens, and the silicone hydrogel lens in 1999. But innovation means nothing without positive impact for our patients. Consider the impact that these small devices have had on our patients' lives. From the little things, such as being able to exercise without spectacles, to teenagers who are thrilled to be fitted in a daily disposable, to the joy on a presbyopic patient's face when you apply multifocal contact lenses the first time, the effect is priceless.
We shouldn't forget about the opportunity that exists even now to improve our patients' lives. Many astigmatic and presbyopic spectacle wearers would like to wear contact lenses but don't know that options are available to them. Cosmetic and prosthetic lenses have transformed the lives of patients of all ages in a way that is simply not measurable. GP lens designs have allowed us to fit the most irregular of corneas and to provide sight to those who simply would not be able to see without these medical devices. Providing the best vision possible to meet the daily demands of each patient is no small task and is the reason why most of us entered the eyecare field.
Along the way we've learned things about the cornea and ocular surface related to contact lens wear that were totally unpredictable a half century ago, such as the mechanism of orthokeratology, contact lens papillary conjunctivitis, endothelial changes, inflammatory and infectious keratitis, and the importance of the tear film and meibomian glands. Researchers and manufacturers strive each day to create even better and more safe and effective lenses and lens care products that fill the unmet needs of our patients. Lens and lens care compliance is something that can and should be improved, and we all need to work harder at educating patients and providing the right tools to make this easier.
Contact Lens Spectrum Through the Years and to Come
Starting in 1976, one of the most referenced publications and leading sources of exchange of information in the field was Contact Lens Forum, which later became incorporated into Contact Lens Spectrum in May 1991. Neal Bailey, OD, PhD, was the original editor of Contact Lens Spectrum and a former editor of Contact Lens Forum.
In his first edition of Contact Lens Spectrum 25 years ago in January 1986, he wrote about the numerous reports of infection in soft lens extended wear as well as about the 14 million to 19 million U.S. lens wearers. He estimated that 60 percent of these wearers wore soft lenses and that half of the remainder wore PMMA lenses while the rest wore GP lenses. In those days, U.S. sales matched the rest of the globe whereas today they account for about one-third of global sales.
The market has grown a log unit in numbers of wearers, expanding to a nearly $6 billion market while the lens care industry has expanded to about $1.5 billion. In the October 17, 2010 issue of the Contact Lenses Today weekly e-mail newsletter, current Contact Lens Spectrum Editor Jason Nichols, OD, MPH, PhD, FAAO, wrote in his commentary that there are approximately 100 million to 120 million contact lens wearers worldwide, which could grow to an estimated $11.7 billion industry by 2015. Remarkably, the contact lens industry remained strong through one of the worst economic downturns in the last several years.
Let's hope the future holds the best yet to come and pushes the envelope on optics, great ocular health, and global access to lens wear. And, you can bet that along the way and hopefully for at least another 25 years, Contact Lens Spectrum will be providing the forum for all to exchange and share clinical, research, and practice management perspectives.
Celebrating 25 Years
We've been fortunate to work with the best of the best as former editors of Contact Lens Spectrum, and we will hear from many of them as we celebrate this remarkable anniversary. Jeff Walline, OD, PhD, an expert in children and contact lens wear, and Nathan Efron, PhD, DSc, FBCLA, FCCLSA, FIACLE, FAAO (DipCCLRT), one of the leading clinician researchers for last half century, will discuss the life cycle of the contact lens wearer. Brien Holden, PhD, DSc, OAM, FAAO, and Desmond Fonn, MOptom, FAAO, who actually knew Otto Wichterle, will address soft contact lenses. Ed Bennett, OD, MSEd, FAAO, who has dedicated his professional life to GP lenses, will provide an overview of the past 25 years of GP lenses. Bill Gleason, OD, has studied the field for nearly 40 years and will review the vast improvements and challenges of lens care products. Finally, Lyndon Jones, PhD, FCOptom, and Eric Papas, PhD, MCOptom, DipCL, will predict the future course of the contact lens field.
We hope that you enjoy the overview of the last 25 years in contact lenses and the peek into the future. CLS
Dr. Barr is vice president, Global Clinical & Medical Affairs and Professionals Services, Vision Care, Bausch + Lomb. He has served as associate dean for Professional Program and Clinical Services and EF Wildermuth Professor of Optometry at The Ohio State University College of Optometry and as editor of Contact Lens Spectrum and Contact Lenses Today. Dr. Mack is director, Global Medical Affairs – Vision Care at Bausch + Lomb. She has served as director of Clinical Services and as an associate professor of clinical optometry at The Ohio State University College of Optometry as well as editor of Contact Lens Spectrum and Contact Lenses Today.