In the first of two keynotes that opened the education of the 2025 Global Specialty Lens Symposium (GSLS) on Thursday, Jan. 16, Fiona Stapleton, FCOptom, PhD, MSc, BSc, looked at the last 25 years of silicone hydrogel (SiHy) materials and how they compared to hydrogel materials in several categories. 

To start, she noted that SiHy lenses are prescribed three times more than hydrogels. According to international prescribing data, prescribing for SiHy lenses has jumped from 4% to 5% in 2000 up to a plateau of ~70% to 80% starting around "the 20-teens."

Dr. Stapleton stated that SiHy lenses are a first-choice lens in the daily wear and daily disposable categories for patients who have low refractive errors. When compared to hydrogels, there did not seem to be any significant difference between SiHy and hydrogel lenses in terms of the rates of lens-associated papillary conjunctivitis. Incidence of corneal infiltrates was higher for SiHy lenses in daily and extended wear, but there was no significant difference in the daily disposable categories. Additionally, SiHy lenses showed a lower risk of metabolic diseases. “No matter how hard we look, we can’t find a difference between materials in terms of infectious keratitis,” noted Dr. Stapleton. “There is also no clear evidence for differences in SiHy and hydrogels for meibomian gland changes, ocular surface sensitivity, subclinical corneal, and lid margin inflammation and comfort.”

Dr. Stapleton continued her presentation with a more detailed look at SiHy use for pediatric patients. She explained that treating this population involves looking at various special considerations that are different from adults such as different altered skin or ocular surface microbiomes, altered immune status, different comorbidities and lifestyle and behaviors (e.g., more interaction with digital environment). There also should be an emphasis on hygiene and compliance considerations with pediatric patients.

She concluded the keynote by offering the following advice: “Do a risk/benefit analysis, get the whole medical team involved (if necessary), and manage any comorbidities,” she said. “It is important to have a detailed plan.”