DISPOSABLE LENSES

A History of Contact Lens Innovation

It's been 20 years since Vistakon launched the first disposable contact lens. Here's a look back — and ahead.

By Lee Rigel, OD, FAAO

Many practitioners will remember the days when soft contact lenses were sold in glass vials. Each lens had to be fit and inspected on the eye because no two were exactly the same. Contact lens orders could take weeks to reach a new patient.

Today, of course, consumers take for granted that they can walk out of an eyecare practitioner's office with a year's supply of lenses. Foil blister packs have replaced the glass vials of old, and numerous improvements in contact lens material and design have given lens wearers better, healthier vision and improved comfort.

Many of the improvements in modern contact lenses have built on a revolutionary concept introduced in 1987. That year, the Vistakon Division of Johnson & Johnson launched the first seven-day extended wear disposable contact lenses. In the 20 years since, Vistakon has continued to be a leader in the soft contact lens market. In the fastest-growing market segment today, silicone hydrogel lenses, more than half the lenses sold carry the Acuvue name. And many practitioners believe that the newest products in the Acuvue line, along with new-generation lenses from other manufacturers, may attract new wearers or help retain patients who would otherwise drop out of contact lenses.

Modest Beginnings

Acuvue lenses got their start at Frontier Contact Lens Company, a small firm that began making hard contact lenses in Buffalo, N.Y., in the 1950s. As the company grew, it opened a branch in Jacksonville, Fla., headed by Seymour Marco, an optometrist with a great deal of lens fitting experience. After a few years, Marco bought out the New York owners and grew the business significantly.

Seymour Marco loved promoting the success of contact lenses, according to his son David Marco, who followed his father into the eyecare business and is now CEO of the diagnostic device company Marco Ophthalmic, also based in Jacksonville.

During the 1970s, Seymour Marco developed a new hydrogel material, etafilcon A, and began making soft lenses at Frontier. By 1981, in failing health, he decided to sell the company to Johnson & Johnson.

"I think my dad recognized the soft contact lens market was about to explode and that our little company — as successful as it was — would never be able to handle what was rapidly developing into a consumer market the way Johnson & Johnson could," David Marco says.

Launching the First Disposable Lens

When Johnson & Johnson bought Frontier (which it renamed Vistakon), it acquired a very manual manufacturing process. Every employee on the production line, whether they were lathing, polishing or inspecting, handled the lenses.

Betty Neal, a longtime employee who was a lathe operator during the acquisition and is now director of manufacturing for Vistakon, remembers being shocked when management told the operations staff in 1983 that they were going to go from making 100,000 lenses a day to 1 million lenses a day. That level of production was unfathomable at the time, she says.

A new manufacturing process acquired from a Danish engineer, Stabilized Soft Molding (SSM), would soon make the unthinkable a reality. Vistakon undertook a major overhaul in its production lines, facilities and staff that culminated in the United States launch of Acuvue in 1987. The lens was originally indicated for seven-day extended wear, then became a daily wear lens.

Other manufacturers quickly followed suit. Within a matter of months, CIBA Vision and Bausch & Lomb were test-marketing their own disposable lens products. They brought the SeeQuence (polymacon, B&L) and NewVue (vifilcon A, CIBA) lenses to market shortly thereafter, and these three companies dominated the market while others scrambled to develop disposable lenses.

Today Vistakon manufactures millions of Acuvue lenses each day. The production process has been miniaturized and almost fully automated with advanced robotic technologies to produce more lenses, faster. No human hand ever touches the lenses during the manufacturing process.

The result is a process that is extremely consistent and repeatable, according to Ms. Neal. "Putting the technology, people and infrastructure in place to accomplish that vision of a million lenses a day was so exciting," she says. "I think even today, we still retain that driven, entrepreneurial spirit."

Practitioner Perspective

For eyecare practitioners, the move to disposables required a huge paradigm shift. Before Acuvue, the whole emphasis was on extending the life of a contact lens, according to James Boucher, OD, MS, FAAO, of Laramie, Wyo. At the time, it was difficult for practitioners and patients to come around to the idea of throwing away a contact lens.

Figure 1. Employees at lab in San Marco (1969-70) performed all the tasks required to manufacture contact lenses, which included trimming buttons, cutting the base curves, cutting the front edge curve, polishing the front curve, and the final edge treatment.

A major factor in practitioner acceptance was the convenience, says Boston-based Lawrence Phillips, OD. He recalls that when he started fitting contact lenses in 1972, he had to keep a huge stock of vials and sterilize and re-store all the trial lenses every time he fit a patient. The ability to dispense Acuvue lenses immediately and to be confident that each lens was manufactured to be exactly the same as the next represented a huge practice shift for contact lens specialists.

Clinicians saw marked decreases in ulcerative keratitis and GPC with disposable lenses. They also noticed that consumers' attitudes about contact lenses began to change. According to Dr. Phillips, Acuvue helped usher in an era in which contact lens wear became widely accepted by the general public. Prior to that, contact lenses were seen as too expensive, too risky, too complicated, he says.

A Series of "Firsts"

Throughout the next 20 years, Vistakon brought to market a number of innovations that contact lens practitioners embraced. For example, in 1995 the company took the concept of frequent replacement one step further with the first daily disposable lens, 1-Day Acuvue.

Since then, a number of other manufacturers have introduced lenses in this modality, which is very popular in Europe and Japan. CIBA Vision (Focus Dailies) even offers bifocal and toric daily disposables.

Daily disposable lenses rapidly became the modality of choice for Brad Ripps, OD, a private practitioner in Lake Hopatcong, N.J., who feels the compliance, comfort and safety benefits of a fresh lens every day just can't be beat. Even with the advent of other new materials and wearing modalities, he finds that single-use contact lenses afford the best success with the fewest unscheduled office visits. He prescribes them for all of his patients ages 18 and younger and for about 40 percent of his adult patients, especially those who have allergies.

Another first for Vistakon was the first disposable presbyopic lens, Acuvue Bifocal, introduced in 1998. Acuvue Bifocal created a new category for the contact lens market. Today, millions of presbyopes wear multifocal contact lenses, although challenges remain in successfully meeting near and distance vision needs with contact lenses, especially in dryer eyes. Many other manufacturers have introduced good multifocal lenses, including B&L's SofLens Multi-Focal and PureVision Multi-Focal, which is the first silicone hydrogel presbyopia lens; and CooperVision's Proclear Multifocal, which is approved for dry eye and available in toric powers.

Figure 2. Two employees put the finishing on the lens edges and then inspect the lenses with a 10X magnifier.

In 1998, as part of the company's commitment to overall eye health, Vistakon began incorporating ultraviolet (UV) protection in its contact lenses. Today, all Acuvue brand contact lenses offer Class I or Class II UV-blocking, a rarity in soft contact lenses.

In Wyoming's high altitudes, UV radiation is something Dr. Boucher takes seriously. He considers UV-blocking lenses a major advancement, even though they should still be worn in conjunction with sunglasses and hats. "Vistakon has been a real leader with this development," he says.

In fact, the Acuvue Advance, Acuvue Advance for Astigmatism and Acuvue Oasys lenses are the first and only lenses so far to receive the American Optometric Association's Commission on Ophthalmic Standards Seal of Acceptance for Ultraviolet Absorbing Contact Lenses (2006) and the World Council of Optometry's Global Seal of Acceptance for Ultraviolet Absorbing Contact Lenses (2007).

Silicone Hydrogel Lenses

Throughout the 1990s, contact lens manufacturers were looking for ways to combine the comfort and wettability of hydrogel with the high oxygen permeability of silicone. The first silicone hydrogel lenses on the market, the Bausch & Lomb PureVision and CIBA Vision Night & Day lenses, were surfacetreated to make them more comfortable. For the first time, they made it possible to transmit significantly greater amounts of oxygen through the lens to the corneal surface.

Dr. Phillips, who started fitting these lenses as soon as they came on the market, quickly found that lens-related dryness was a problem for patients wearing silicone hydrogels, despite the surface treatments intended to make the materials more hydrophilic. By 2003, when Vistakon introduced Acuvue Advance with Hydraclear, a new silicone hydrogel material (galyfilcon A) that incorporated a moisture-rich wetting agent without surface treatments, Dr. Phillips was ready to try again. He says the difference in comfort of Acuvue Advance compared to earlier silicone hydrogel efforts was quite noticeable to his patients.

Within just four months, Acuvue Advance became the leading silicone hydrogel contact lens in the United States and the second most prescribed contact lens overall. Market innovations have continued with new, second-generation materials like senofilcon A (Acuvue Oasys), lotrafilcon B (CIBA Vision O₂Optix) and comfilcon A (CooperVision Biofinity), providing patients with even greater comfort. Today, about 50 percent of contact lens patients are wearing lenses made from silicone hydrogel materials, and the silicone hydrogel category is the fastest growing contact lens market segment. In fact, in the first quarter of 2007, silicone hydrogel lenses surpassed hydrogel lenses in new fits and refits of spherical lenses for the first time. Toric and multifocal silicone hydrogel lenses have made impressive market gains as well since they were introduced.

Dr. Phillips rarely considers anything other than silicone hydrogel material, except in special circumstances. He likens choosing older materials to offering someone a Pentium I computer processor, rather than the newest technology that is going to offer the best results.

Helping Grow Practices

According to Allan S. Tocker, OD, in private practice in Wilmington, Del., the latest generation lenses support three key areas of opportunity for practice growth.

Expanding the ranks of contact lens wearers. As new, more comfortable materials become available, savvy practitioners find they expand the ranks of successful contact lens wearers at both ends of the age spectrum. Dr. Tocker says, for example, that he's more comfortable prescribing silicone hydrogel lenses for pre-teen patients because of the lenses' high oxygen transmission.

And for older patients who havebeen tempted to give up on contact lenses because of discomfort, the smoothness and wettability of newer lenses such as Acuvue Oasys have been key, especially when patients are dealing with a dry environment, computer use or systemic medications. "Virtually everyone has one of those three problems that contribute to contact lens dropout. Acuvue Oasys allows more people to stay in the contact lens category," says Dr. Tocker, who prefers to start with the latest lens technology rather than saving it for problem cases.

Bringing astigmatism into the mainstream. Market data indicate that practitioners have often chosen to mask patients' astigmatism rather than correct it. Of patients with astigmatic spectacle prescriptions who wear contact lenses, fewer than half currently wear an astigmatic lens. Dr. Tocker says this is probably because first-generation toric lenses didn't fully satisfy patients' visual, comfort or ocular health needs.

But he believes the Acuvue Advance for Astigmatism, SofLens 66 Toric and other new torics are completely changing how clinicians approach astigmatism because they're easier to fit and made from healthier materials. "There's a huge opportunity now to fit more astigmatic patients and exceed their expectations for comfort and vision with these new toric designs," says Dr. Tocker.

Fitting daily disposables. The third area where he sees opportunity is in the single-use category. Single-use lenses that employ the latest in lens comfort technology are ideal, according to Dr. Tocker, for people who have allergies or solution sensitivities, kids whose parents want them to have the easiest possible care regimen and for sports enthusiasts or other occasional-use wearers.

A Look Ahead

A key challenge for Acuvue — and indeed, for the entire optometric and ophthalmic communities — will be meeting the needs of presbyopes in the years ahead. Whether they're wearing spectacles or contact lenses, seeking refractive surgery or undergoing cataract surgery, aging baby boomers and the generations to follow them have high expectations of their vision and of their eyecare providers.

Dr. Boucher predicts a growing demand for better presbyopic solutions. He said he is still waiting for multifocal contact lenses that can offer the same quality of vision that patients achieve with bifocal spectacles.

But thanks to the increased oxygen permeability and comfort of disposable soft contact lenses over the years, Dr. Boucher says he thinks contact lenses will always hold their own against refractive surgery.

At the other end of the age spectrum, as Dr. Tocker notes, practitioners are considering contact lenses for younger and younger patients, now that healthier silicone hydrogel materials are available. A recent study conducted by Jeffrey Walline, OD, PhD, assistant professor of Optometry at Ohio State University, found that children age 8 to 12 are as responsible with contact lenses as 13- to 17-year-olds. Moreover, both children and teens in the study reported a higher quality of life, greater ability to participate in sports and other activities and greater satisfaction with their vision with contact lenses.

"With the exceptional health benefits of silicone hydrogel lenses, we no longer have to be as concerned that starting young people in contact lenses early will expose them to hypoxic corneal damage over the long term," says Los Angeles optometrist Arti Shah.

Her wish list for the future includes a silicone hydrogel daily disposable lens; more custom silicone hydrogel lenses for infants, high myopes and other specialty populations; and better multifocal contact lens options.

According to Dr. Shah, the No. 1 concern from a contact lens patient's perspective is always comfort, with clarity and quality of vision being a close second. She's looking forward to future innovative lens products that will continue to offer her patients the most in ocular health and visual performance while also increasing their ability to comfortably wear their lenses all day. CLS

To obtain references for this article, please visit http://www.clspectrum.com/references.asp and click on document #142.