25^th Anniversary Perspective

Contact Lens Spectrum's 25 Years of GP Contact Lenses

By Edward S. Bennett, OD, MSEd, FAAO

It all began in the January 1986 issue, in which Contact Lens Spectrum (CLS) announced that the Boston IV (Bausch + Lomb) lens had just received FDA approval; it has continued for the past 25 years as CLS has remained our source for timely clinical information on GP contact lens designs, materials, and applications and has been the leader in educating contact lens practitioners about this modality.

CLS and the CLMA

This support of GP lenses was due in large part to the efforts of Founding Editor Neal Bailey, OD, PhD, and his successor Editor Joe Barr, OD, MS, FAAO. In an environment that was becoming softer by the day, it was their belief that CLS should always have an emphasis on GP lenses. Joe stated in his October 1998 Editor's Perspective, “When you succeed in fitting RGPs, your patient will believe you know what you are doing. And you'll probably feel that it was a more stimulating enterprise than a simple soft contact lens design.”

Joe and Neal were also very supportive of the Contact Lens Manufacturers Association (CLMA), and for many years Neal would attend the CLMA Annual Meeting (camera in hand) and write a report on new GP designs and manufacturing technology presented at the meeting. Joe, likewise, often attended this meeting, and in his February 1990 editorial, “RGP Education Falls Short,” expressed the opinion that the consistency of manufacturing quality was not present and that more education of practitioners was necessary. As we are aware today, the manufacturing quality is very good (the CLMA has a “Seal of Excellence” program for laboratories exhibiting high quality in their lens manufacturing), and the educational division of the CLMA, the GP Lens Institute—with the assistance of CLS—has become a leading source of GP lens programs and resources.

Materials From PMMA to GP

In the April 1991 issue of CLS, Bob Grohe, OD, spelled the demise of the predecessor to GP lenses in an article titled: “The Punishing Paradox of PMMA.” He stated: “I doubt if there is a court in the country that would agree that PMMA would be a benchmark material within our industry today. It has simply become obsolete. PMMA is a triad of concern to the practitioners—the physiology, the safety, and the liability of this material should be of concern to all.” Four years later (October 1995), with soft lenses impacting the rigid lens market, I commented in Joe Barr's column that: “It's a simple axiom: the more effort you make initially to fit RGP lenses the more likely you will experience a significant growth curve in RGP use and increase patient and professional satisfaction.”

Addressing Timely GP Topics

The emphasis of CLS always has been and will continue to be addressing timely clinical topics impacting everyday contact lens practitioners. To this extent, the archived library of articles is invaluable. CLS is a living library of GP lenses, and any GP topic is only a few seconds away. Do you want to know the important pearls in patient selection, evaluation, design, fitting, and troubleshooting of GP multifocals? Then proceed to any of Dave Hansen, OD, FAAO's columns, or columns by Tom Quinn, OD, MS, FAAO, and Craig Norman, FCLSA, or any of the excellent articles by Rob Davis, OD, FAAO. Are you interested in designing a bitoric lens? Tom Quinn's columns or articles by Tim Edrington, OD, MS, FAAO, are invaluable.

If you are interested in optimizing initial comfort, you will find a large series of articles and columns that are still timely today. For a GP material guide, check out Marjorie Rah, OD, PhD's July 2007 column. To determine how to make GP lens fitting more efficient, you can read excellent articles on empirical multifocal fitting by Keith Ames, OD (October 2001), and Doug Benoit, OD, FAAO (October 2009), as well as empirical bitoric fitting (Pitts et al, October 2001). If you are interested in incorporating overnight orthokeratology into your practice, the columns by John Mountford, FAAO, FCLSA, Dip.App.Sc.; Marjorie Rah; Jeff Walline, OD, PhD; and John Mark Jackson, OD, MS, FAAO, are extremely beneficial.

In 2010, the most relevant GP topic was scleral lens designs. CLS has provided no fewer than 10 columns and articles on this important GP design in the last 18 months alone, including very informative fitting and application articles by Greg DeNaeyer, OD, FAAO (“Modern Scleral Contact Lens Fitting,” June 2010), and how to select patients and fit corneo-sclerals, mini-sclerals, and full sclerals in the October 2010 article “Scleral Contact Lens Fitting Guide” by Jason Jedlicka, OD, FAAO; Lynette Johns, OD, FAAO; and Stephen Byrnes, OD, FAAO, not to mention the columns by Ann Laurenzi-Jones, OD, FAAO, on applications for graft-versus-host disease and dry eye.

For every highly technical article such as “A Mathematical Model for Corneal Shape Changes Associated with Orthokeratology” by John Mountford and Don Noack, Dip Op (WA) (June 1998), there is a more fundamental article such as “Unmasking the RGP Fit with Fluorescein” (Joe Barr, Ed Bennett, OD, MSEd, and Jeff Johnson, OD, October 1998) to help practitioners who want to initiate GP fitting in their practice. In addition, there is a large number of archived articles that are still relevant today on spherical lens design, fitting, and troubleshooting.

GP Columns and Theme Issues

I had the privilege of authoring the first of what is now more than 200 columns on GP lenses when RGP Forum (now GP Insights) first published in the October 1993 issue. The first annual theme issue on GP lenses in CLS appeared in December 1993 on the topic of building your practice with GP lenses. The content for these issues, with the support of current Editor Jason Nichols and past Editors Carla Mack, OD, MBA, FAAO, and Joe Barr, has been under the direction of the GP Lens Institute and includes timely clinical articles by the experts from the GPLI Advisory Committee. Since 1994, the October issue has been the Annual GP issue, with the 2010 issue emphasizing scleral lenses while also introducing the first “GP Annual Report.”

Seminal Articles

CLS was often the first to report important clinical findings pertaining to GP lenses. Richard Wlodyga, OD, initiated accelerated orthokeratology (April 1989) while Stuart Grant, OD, introduced overnight lens wear for orthokeratology therapy and retention (November 1992). Tom Salmon, OD, showed us how we can use GP-induced flexure to our advantage (August 1992). Loretta Szczotka-Flynn, OD, PhD, MS, FAAO, indicated how much RGP parameter change is significant (April 2001).

More recently, Christine Sindt, OD, FAAO's article in October 2008 on “Basic Scleral Lens Fitting and Design” defined the various types of scleral lens designs. Likewise, although some important GP study results first published in peer-reviewed journals, CLS has been able to make this information “mainstream” via overview articles in which this information was provided to a much larger number of practitioners. For example, Jason Nichols' overnight orthokeratology article (January 2000) and Jeff Walline's article summarizing the impact that his Corneal Reshaping and Yearly Observation of Nearsightedness (CRAYON) study and Pauline Cho, PhD, FAAO, FBCLA's Longitudinal Orthokeratology Research in Children (LORIC) Study had on slowing axial length growth in young people via overnight orthokeratology.

The Future of GPs and CLS

Professor Nathan Efron has been relentless in the last 16 years indicating that GP lenses will become obsolete (first indicating by the year 2000, and then by 2010). I first responded to his comments in the February 2003 issue (“GPs Obsolete in 2010: It Won't Happen”). Now it is 2011 and the 25th anniversary of CLS. We don't know at this time whether CLS will have the opportunity to celebrate a 50th anniversary, but if it does, this much is certain: GP lenses—in some form—will be here in 2036, and CLS will inform you how to best utilize this modality in your practice. CLS

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Dr. Bennett is assistant dean for Student Services and Alumni Relations at the University of Missouri-St. Louis College of Optometry and is executive director of the GP Lens Institute. You can reach him at ebennett@umsl.edu.