Shortly after the first glass contact lenses were fitted, it became evident that wear time would be limited due to the depletion of oxygen underneath the lenses. The resulting cornea edema, described by Adolf Eugen Fick in 1888 (Heitz, 2003), became known as “Fick’s Phenomena.” From then until present day, contact lens-related corneal edema has been a major challenge to overcome.

At that time, there was little that could be done to clinically manage this edema, and it wasn’t until almost six decades later that a single manufacturing advancement took place that dramatically diminished its appearance. In the late 1930s, a German-born student named Norman Bier arrived in London enrolling in the College of Optometry at the Northampton Polytechnic (now City University.)

In his early 20s, Bier traveled the U.S., and while in New York City, spent time with optician Theodore Obrig and optometrist William Feinbloom to expand his contact lens knowledge.

After returning to London, Bier began working with Keith Clifford Hall in his Park Lane specialty practice. From the outset of his career, Bier dedicated himself to the contact lens field. And, in the early 1940s, he was only one of six contact lens practitioners in the United Kingdom.

By accident, in the early 1940s, Bier realized that a scleral lens without a bubble trapped beneath it exhibited corneal edema before a lens that had a trapped bubble. Building on this, he developed the idea of placing a fenestration (vent) into the contact lens to enable oxygenated tears to flow into and out of the hole. It also had the advantage of reducing the pressure forces beneath the scleral lens. Bier found that a hole placed at the corneoscleral junction was adequate to provide the exchange of oxygen and carbon dioxide.

In the late 1940s, he was granted a patent for the ventilation of contact lenses (Obrig and Salvatori, 1957). However, Bier never enforced this patent and the fenestration of glass and polymethyl methacrylate (PMMA) scleral lenses soon became widespread globally. The simple presence of a bubble that moved around the limbal region upon eye movement, in combination with minimal apical and adequate limbal clearance, made all-day wear possible for many scleral lens wearers.

Bier went on to develop a preformed PMMA diagnostic set, called the Fenestrated Lens for Optic Measurement system, designed for U.S. practitioners as they could not use anesthetics while taking eye impressions (Bowden, 2009). He also developed the idea of a transition curve between the optic and sclera portions, called the Transcurve. In 1947, he founded Omega Contact Lens to fabricate his designs.

In 1956, he described his contour corneal lens that featured a tri-curve back surface intended to provide an improved corneal fitting relationship compared to mono-curve microlens designs. He also invented the Bier Spherometer, the first instrument to measure the contact lens base curve, which was acquired and marketed by the American Optical Company under their trade name Radiuscope.

Bier shared his vast knowledge by publishing his first textbook, Contact Lens Routine & Practice, followed in 1977 with Contact Lens Correction, which he co-authored with Gerald E. Lowther, OD, PhD.

Today, Bier is remembered as the first person to successfully address the complication of contact lens-induced corneal edema. CLS

REFERENCES

1. Heitz RF. The History of Contact Lenses, Volume One, Early Neutralizations of the Corneal Dioptric Power. Translated by Mailer C. Julius Hirschberg, 2003.
2. Obrig TE, Salvatori PL. Contact Lenses, third ed. Obrig Laboratories. New York. 1957:638-649.
3. Bowden TJ. The Development of Contact Lenses. In Contact Lenses: The Story. Bower House Publications. 2009:119-121.