Each month, Contact Lens Spectrum broadcasts a livestream series called “CLS Live!” during which host Jason Jedlicka, OD, sits down with leaders in the world of contact lenses to pinpoint key trends, critical insights, and intelligent takeaways. Dr. Jedlicka is a clinical associate professor at Indiana University School of Optometry and chief of the school’s Cornea and Contact Lens Service.

During each episode, Dr. Jedlicka and his monthly guest(s) discuss new and future products, the latest research, and worldwide trends in prescribing—and even bring viewers up to date live from the floor of CLS conferences such as the Global Specialty Lens Symposium.

>> Each CLS Live! episode airs on CLS’ Facebook and LinkedIn pages plus the CLS YouTube channel.

This episode, which originally aired on May 10, is part of a past-present-future look at the industry, this time focusing on the history of soft contact lenses. In this livestream, Dr. Jedlicka spoke with Nathan Efron, AC, DSc, PhD, an emeritus professor in the School of Optometry and Vision Science at the Queensland University of Technology in Brisbane, Australia. He lectures extensively worldwide, particularly in the field ocular response to contact lens wear. Professor Efron has won numerous international awards, including being made a companion of the Order of Australia, which is Australia’s highest civilian honor, for contributions to optometry and vision science.

Q: Jason Jedlicka, OD: When it comes to contact lenses, you have to be in the running [for the “GOAT,” aka “greatest of all time”]. It’s humbling to get to speak to you.

You have something that you’re well-known for among those of us who follow the history of contact lenses, and that is a quote you came up with some years ago about the death of GP lenses…and for some reason, that seems to follow you everywhere now.

A: Nathan Efron: I [wrote that] around 1990. I predicted by 2000 or 2010 that we wouldn’t have many rigid lenses being prescribed anymore. I used to mention it at conferences at various points, but I actually published a paper that was called “Obituary—Rigid Contact Lenses” that was published in Contact Lens & Anterior Eye. That paper pointed out why it is that rigid lenses are being prescribed less now than they have been in the past.

My thinking on this really evolved from our observation of prescribing trends that I have been working on with Philip Morgan [PhD, MCOptom] in Manchester for 25 years now, plotting the extent of prescribing of all different types of lenses in many countries around the world. It became pretty clear from the start of our survey that rigid lens prescribing was starting to drop very considerably. In the United Kingdom, it was dropping from about maybe 20% of all lenses when I started, down to about 4%.

I think I’ve been misquoted, to some extent, in respect to that “famous quote,” as you say. I’ve always said that there’ll always be a need for rigid lenses for specialist fits—if you’ve got a distorted cornea or keratoconus or post-surgery. That will always be the case.

But many practitioners back in the ’70s and ’80s would prefer rigid lenses to soft lenses. And I didn’t quite understand that, because soft lenses are more comfortable generally. For your general patient, I thought, well, rigid lenses are not going to survive. And they basically haven’t; they have survived, though, as a specialty product.

Q: Dr. Jedlicka: I couldn’t agree more. When I think about the last time I prescribed a corneal GP lens for standard refractive error—it’s been a while. Multifocals…sure, there are merits to some GP multifocals. The translation is certainly something that’s hard to get with a soft lens. And again, sclerals and orthokeratology have opened up new avenues for GP materials to grow in utilization. But, I agree, the refractive error patient, it’s just that soft lenses have come so much farther—soft torics in particular. Between that and the potential of soft lenses with aberration correction…I do think that soft lenses continue to work their way in.

When you think about those first few years when soft lenses were new—what are some of the things you saw that make you scratch your head now?

A: Professor Efron: I suppose there are a lot of things I could look back to, but one of the biggest problems we were dealing with in the 1980s were deposits on lenses. People would use the same pair of soft lenses for literally three, four, or five years. Today, we often use them for one day—that’s it, and they’re gone. So, a lot of our chair time was taken up solving problems related to deposits. There’s a whole science behind deposits, and that used to trouble me, trying to work out what these deposits were, working out strategies to get rid of them.

People didn’t want to throw their lenses out; they cost $200 each in those days—hugely expensive. We had these rigorous cleaning solutions, ultrastrong cleaning solutions, protein removal systems—I don’t know, do they still sell protein removal systems?

Dr. Jedlicka: I think you can find them if you look hard enough, but they’re hard to come by.

Professor Efron: One other example that really used to trouble me: when toric lenses became available, trying to fit toric lenses. You needed a PhD in trigonometry to work out where the axis was going to be, what the rotation was going to be, and where to put a truncation. We used to do truncations.

We used to cut the bottom off a toric lens so it would try to rest on the lower lid. It’s crazy stuff. Because, of course, if the truncation is resting on the lid margin, it’s irritating it.

Q: Dr. Jedlicka: Why was that necessary? Was it because there was such a simplistic ballasting method for the lenses? Was it just prism, and so the lower lid would move it around? Why were they so complicated to get stable?

A: Professor Efron: Lenses were thicker in those days, so if you truncated the bottom off, there was a really thick ledge that would physically locate on that lower lid. It was uncomfortable, but people put up with it because they wanted their astigmatism corrected.

In those days, when that was the choice, it was understandable that practitioners would fit GP lenses. Because once proper modern toric lenses came around, you know, with magnificent stabilization characteristics and so on, you didn’t need that sort of rigid lenses anymore.

Q: Dr. Jedlicka: Other than disposability, what other game changers have happened over the last 40 or 50 years with soft lenses?

A: Professor Efron: The three biggest innovations in soft lenses were their invention in the first place in the late 1960s. Then, the next big innovation was daily disposable lenses, which came along in the mid-1990s, and that was mainly due to manufacturing innovations—being able to do cast molding effectively on a mass scale.

Then, the next big innovation in terms of material science were silicone hydrogel materials. That was a game changer.

Q: Dr. Jedlicka: Did you imagine we were going to be using soft lenses for things like drug delivery? Are there things that you expected to see that haven’t come to fruition?

A: Professor Efron: Most things, I guess, eventually have come to fruition. We do have a lens for measuring glaucoma, but they’re talking about lenses now that can assess level of glucose in tears for diabetic patients, maybe assess the levels of metabolites in tears, which reflect the systemic level of those metabolites as well, and working out those correlations, of course, is important.

But on top of that, apart from whether you like the biosensing role of contact lenses, there’s augmented reality. Maybe they could be filled with a camera-type system or a system that could project an image into the retina or that sort of thing. There are some groups that are actively working on that.

It would not surprise me in the next 10 years if we get that sort of lens, and that would then change how we practice as optometrists. We will have to be aware of electronics, augmented reality principals, and those sort of things—the way we prescribe and the things we do. CLS

CATCH CLS LIVE! Watch this livestream’s full interview—and catch past and future episodes in the series—via the online version of Contact Lens Spectrum at clspectrum.com or our Facebook or LinkedIn pages. Additionally, you can subscribe to Contact Lens Spectrum’s YouTube channel (bit.ly/clsyoutube22 ) to view this and other past interviews and to receive notifications for upcoming ones.