SPECIAL ANNIVERSARY SECTION - 20th anniversary perspective
Contact Lenses: The Good, the Bad and the Sad and Wasteful

The 1980s were an epoch-making period for contact lenses: The first big U.S. push for extended wear (EW); the goal-setting for hypoxia-free contact lenses; the investment in mass production that would eventually underpin daily disposables; GP lenses that set a new standard for safety and efficacy; multipurpose care systems that made heat, but not peroxide, redundant.

Unfortunately the EW push was premature and it was another decade before manufacturers developed hypoxia-free soft lenses to give the modality a real chance. But the specter of infections continues to shadow the field.

Manufacturing Improvements

The late '80s and early '90s saw the development of consistent, well-made, molded and physically comfortable soft contact lenses.

Nowhere was this more noticeable than in soft toric lenses. No longer would we hand down the dreadful judgement to a distraught patient that "we can't fit you with contact lenses because you're an astigmat." It was a triumph for design and engineering.

Except engineering often cannot overcome one lingering physical challenge — a beautifully round, hospitable edge, an edge for all lenses for all tissues. Few if any manufacturers have mastered this critical parameter. Other challenges remaining for the industry include mastery of wettability and creating an inhospitable surface to invaders.

Infections and Lawsuits

But one challenge overrides them all — eliminating infections. Infections dog our industry, and we can't but wonder what might have happened if our industry had taken the money spent on lawsuits and applied it to achieving a 100-fold reduction in the risk of MK. Instead we hear: "Stop talking about MK, it will harm the business."

Fair enough, patent disputes on billion dollar products are part of the system, but advertising disputes costing millions — apparently often used as an obstacle strategy — what a waste! The fact (a la Holden) is that it's the level of oxygen behind the contact lens that counts. If you have air-levels of oxygen behind the lens, you're ready for lens wear challenges.

But back to infections — we have to decimate them. They occur five times more frequently if you sleep in lenses, maybe slightly less and less severe with high-Dk soft lenses and even less with GPs, but still too many. They occur with overnight ortho-k, but probably no more frequently than with any other overnight lens.

Manufacturers and practitioners need to work together. Give patients explicit, colorful, concise, memorable warnings of what to do and not to do. Develop anti-bacterial surfaces, cases and solutions. Bring back rubbing and rinsing. Research the causes with a really serious investment and a dogged determination to win.

Advice for the Future

We have a great industry with some really great people. We have triumphs like hypoxia-free silicone hydrogels (the ones with 125+ Dk/t) and GPs, daily disposables, torics that work, emerging comfort technologies, the hope of silicone–like pediatric lenses, good keratoconus lenses and 120 million wearers.

Round the edges, make everything anti-bacterial, provide tear film simulated wettability, develop a really good bifocal (they are getting better), stop wasting our time with the 'yes-it-is-no-it-isn't' lawsuits, put a brake on myopia and stop milking the lens care business, and invest together in solving the microbial challenges — and we could have a billion wearers. Was that a pig I saw fly past the window?

Dr. Holden, is Scientia Professor of Optometry, founder and director of the Cornea and Contact Lens Research Unit, Deputy CEO of the Vision Cooperative Research Centre and CEO of the Institute for Eye Research in Sydney, Australia, at the University of New South Wales.