EACH MONTH, Contact Lens Spectrum broadcasts a livestream series called CLS Live! during which the host sits down with leaders in the world of contact lenses to discuss new and future products, the latest research, and worldwide trends in prescribing—and even brings viewers up to date live from the floor of CLS conferences such as the Global Specialty Lens Symposium.
This episode, which aired on July 21, was hosted by Jason Jedlicka, OD, a clinical professor at Indiana University School of Optometry and chief of the school’s Cornea and Contact Lens Service. He spoke with Lyndon Jones, PhD, DSc, director of the Centre for Ocular Research and Education (CORE) at the University of Waterloo. Dr. Jones was recently made a fellow of the Royal Society of Canada, making him only the second optometrist ever to be granted this distinction.
Q: Jason Jedlicka, OD: When we mention the future of contact lenses, I think of the contact lenses we prescribe now and how things will evolve. But I sometimes think about the “sci-fi” aspect: how contact lenses might do things in the future that they don’t do now or they’re just scratching the surface. With the series, we are we going to talk about both concepts. Where are we headed?
A: Lyndon Jones, PhD, DSc: When we think about the features of contact lenses, I think the sexy stuff is what we see popping up in news releases and journal articles about using contact lenses for heads-up displays and drug delivery and telling you how your diabetes is doing. Those are great things, but all of them are going to be relatively small markets, certainly for a long period of time. There are people working on them, but in terms of them being commercialized, I think that’s going to be a way off.
What we’re going to do in this upcoming series is divide up each of the three episodes into two sections, the first being the “now.” What’s the future for contact lenses now? What are the new iterations of lenses that people are working on? What are the things that we can think about to optimize comfort, vision, safety with contact lenses using the products that we have now or the ones that are soon going to come into practice? Then we’re going to look at the more futuristic things.
Q: Dr. Jedlicka: When we talk about current lens and future lens improvements, we can talk about comfort, eye health, and vision. Is there anything else?
A: Dr. Jones: Those are certainly the three major things that we’re going to [focus on]. The major reasons why patients fail with contact lenses today, in order, are failures with comfort, [poor] vision, and complications with the lenses.
Another reason why people drop out is handling, particularly with new lens wearers. So that’s something to think about if you do have a patient who’s new to lenses. It’s important that we think about not just their vision and comfort, but how they are doing with putting those lenses on and taking them off.
Some other things that we will be addressing are things like antibacterial surfaces—what we have that’s soon coming down the pipe that can reduce bacterial binding, which we know are key to infections and inflammation. Unless your ocular surface is optimal and healthy, you can have the best contact lens or solution in the world and that lens isn’t going to be successful. Those are important when you’ve got that patient in your chair because those all play into this dropout issue.
Q: Dr. Jedlicka: We think about wanting to make the lenses better, but is there room for better solutions or eye drops or other therapies that we can add to the contact lens wearing experience that might be a more cost-effective way of enhancing these rather than changing the lenses?
A: Dr. Jones: Whenever you survey practitioners about what they think about doing [when patients come in and are uncomfortable], the number one [answer] is: change the lens. The lens is actually as good as it gets. Maybe that’s not the problem. It’s the underlying ocular surface. We’ve certainly gained a better understanding of the role of the ocular surface in the success of contact lens wear. So, unless you sort that out, you can change the lens as many times as you like, but it’s not going to help very much.
Q: Dr. Jedlicka: Contact lenses always seem to be a target for this kind of sci-fi technology. There are so many movies that have been made with heads-up computerized displays. What is it about contact lenses that makes them so good for vision or comfort or drug delivery or health monitoring?
A: Dr. Jones: So many people have [smart] watches or [fitness trackers] that give them all kinds of information about heart rate and blood pressure, but they’re quite invasive. You have to wear them, and they’re quite heavy sometimes. Having a contact lens that’s on the ocular surface and can look at a variety of biological biomarkers would be fantastic. We have ways of detecting those biomarkers, but the technologies that we have at the moment are large scale and they need large amounts of fluid. That’s not the situation with tear film; tear film is only a couple of microliters. There are almost as many biomarkers in the tear film as there are in blood. So, if we could do that with low volumes, that would be fantastic.
Also, virtual reality is a big deal. All of these people are working on heads-up displays…but they are large things that you have to put on your head. If you could miniaturize that and have a contact lens that could be overlaid over the visual environment that you’re looking at, that would be huge.
Another thing that’s really interesting is technologies where, for example, you’re wearing a lens that someone’s unaware of. I’m certainly interested in facial recognition. If I could have a contact lens that could recognize someone’s face and tell me what their name is, that would be so cool, because I am terrible [at that]. And, of course, there’s all kinds of military-type applications that people are interested in as well. At the same time, we’re getting miniaturization out of things like batteries, and we’re getting much more biocompatible materials. You put all those things together, and you’ve got a great way of being able to look into the future.
But it’s hard. It took us a long time to get the world’s first drug delivery contact lens. [Now,] what if we could deliver a comfort agent? Let’s take a contact lens that could actually elute something that makes that lens more comfortable, and that’s the kind of near-term thing that I think we’re much closer to seeing.
Q: Dr. Jedlicka: Contact lenses already do that to an extent, but mainly with lubricants. So, you’re taking a lens that’s been fabricated and soaked in a lubricant, and it’s going to time release a bit as I’m wearing it to help with comfort.The idea of being able to go from this large, bulky display wearable to a contact lens—I don’t think that’s unrealistic. It’s really just the hows and whys.
A: Dr. Jones: The other interesting thing is this whole concept of individualized medicine…to say that giving this drug at this concentration for every patient is not what we need. So, when you think about that for contact lenses, how cool would it be if you could do two or three simple tests…and it’ll spit out exactly what contact lens material and frequency of replacement or solution combination would be best for you?
The final thing relates to the use of 3D printing. How cool would it be if you could take a very sophisticated image of what the ocular surface looks like and then send that to a room in your back office that could 3D print a scleral lens that is perfect for that ocular surface? I don’t think that’s actually that far away. I think we’re starting to get to that point where 3D printing now is really inexpensive. CLS
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