continuous wear colloquy
Putting Silicone Hydrogel Lenses to Use Therapeutically
BY LORETTA B. SZCZOTKA, OD, MS, FAAO

What's been your lens of choice for bandage lens use? Was it your favorite one- to two-week disposable lens, or a conventional vial lens? Did the FDA approve it for this purpose or have you used as an off- label? As of May 2003, we now have one silicone hydrogel lens that the FDA has approved for therapeutic use: CIBA Vision's Focus Night & Day lens, approved for protection of the corneal surface and relief of pain in acute or chronic ocular pathology or post surgical lens use. The lens is now available in plano for these purposes. In fact, it's the only disposable lens that the FDA approved for therapeutic use (Table 1).

A Lens of Many Trades

Therapeutic lenses have many uses for corneal rehabilitation. They most frequently function as a mechanical barrier for corneal protection from the lids, lashes and scar tissue, enhancing corneal surface healing in conditions such as basement membrane disease with recurrent erosions or non-healing ulcers and epithelial defects. Therapeutic lenses are invaluable for managing pain associated with conditions such as corneal abrasions, bullous keratopathy and filamentary keratitis as well as postoperative pain. As a splint or sealant, the lenses also assist in sealing leaky wounds after cataract, penetrating keratoplasty or glaucoma filtering surgery.

Use Long or Short Term

We can use therapeutic lenses for as short as a few days or as long as several years. I most commonly use lenses in a 30-day continuous wear bandage approach for treating chronic conditions such as bullous keratopathy, recurrent erosions and basement membrane dystrophy. It's also my first treatment of choice in the short-term management of corneal erosions, and it has replaced patching and NSAIDs as a first line of therapy.

Healing Rates Improve

Other therapeutic lens options include high-Dk GP scleral lenses, collagen shields or low-Dk hydrogel lenses. However, my first lens of choice is a hyper-Dk silicone hydrogel lens. Since using the Focus Night & Day lens, I've noticed significantly improved healing rates over low-Dk lenses.

Dr. Anne Laurenzi reinforced the advantages of hyper-Dk lenses on the promotion of epithelial healing at the recent Contact Lens and Eyecare Symposium meeting. She reviewed studies by Drs. Ladage and Cavanagh, which have clearly shown that hyper-Dk lenses improve epithelial cell migration and proliferation and decrease lens-induced epithelial bacterial binding over traditional hydrogels.

These factors are especially important when treating patients who have ocular surface disease and who are consequently much more susceptible to complications from extended wear contact lens use than is a healthy individual. In fact, I haven't encountered a complication with bandage contact lens use while using the Focus Night & Day hyper-Dk silicone hydrogel lens.

Dr. Szczotka is an associate professor at Case Western Reserve University Dept. of Ophthalmology and is director of the Contact Lens Service at University Hospitals of Cleveland.