Contact Lens Case Reports

Our Years on the Back Page of Contact Lens Spectrum

By Patrick J. Caroline, FAAO, & Mark P. André, FAAO

For the past 22 years, publishing on the back page of contact lens journals has been our editorial specialty. Our faithful relationship with Contact Lens Spectrum's back page actually began in December 1989 when my friend and colleague Robert Campbell, MD, and myself were invited to write a monthly column for Contact Lens Forum (you old timers will remember that journal). When CL Forum and Contact Lens Spectrum merged in May 1991, Bob and I were asked to continue our column, but now it would occupy the back page of CL Spectrum. Joe Barr, OD, MS, FAAO, editor at that time, assured us that eye-care journals are always read from back-to-front, so he convinced us that indeed we had the premier spot in the journal!

Case Reports Through the Years

Bob and I continued the Between-the-Lines column until October 1993, when the format changed to its current Contact Lens Case Reports. When Bob left the Spectrum family in December 1998, none other than Mark André, FAAO, took his place, and for the past 12 years Mark and I have carried on our monthly tradition of the “Back-Page” Case Histories.

Over the past two decades we have witnessed dramatic changes in the contact lens field. In retrospect, you can trace the evolution of our industry through the changing topics of our case histories. For example, in 1989 we discussed strategies to extend the life of conventional soft lenses beyond a year. Today, in complete contrast, we expound on the health benefits of daily disposable contact lenses.

An Unanswered Question

However, despite the major advances in our field, we continue to be plagued by some unanswered questions. Among the most perplexing is, “Why are there so few long-term successful soft contact lens wearers?” It's a simple question…but without a simple answer.

Every week we hear countless testimonials from satisfied patients who have successfully worn rigid contact lenses for 20, 30, or even 40 years. Remember that soft contact lenses were introduced to the U.S. market 40 years ago, in 1971, and multipurpose solutions 22 years ago, in 1988. Therefore, we should have tens of thousands of individuals with 20 years of successful soft contact lens wear. But where are these elusive patients? For Mark and I, the only long-term soft contact lens wearers we've found in our practice use hydrogen peroxide disinfection or have switched to daily disposable or extended wear lenses. In other words, where are the tens of thousands of soft contact lens patients who have successfully used multipurpose disinfection for 20 years? Our search for such patients has left us confused and a bit concerned.

Is the lack of long-term patient success with soft contact lenses related to prolonged solution exposure? Or perhaps due to a yet unidentified stem cell anomaly from a lens modality that crosses the limbus? Do soft contact lenses cause long-term papillary and/or inflammatory tarsal plate changes that adversely affect meibomian gland anatomy and function? Or have we simply lost these millions of patients to refractive surgery, or to age-related complications such as ocular dryness and/or presbyopia?

Ultimately, the future of the contact lens industry depends on the long-term success of our patients with all rigid, soft, and hybrid modalities. While we can be proud of our impressive achievements in the contact lens field, we remain forever humbled by the many challenges that still lay ahead. CLS

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Patrick Caroline is an associate professor of optometry at Pacific University. He is also a consultant to Paragon Vision Sciences. Mark André is an associate professor of optometry at Pacific University. He is also a consultant for CooperVision.