On Christmas Eve, 1961, in a small house in Prague, Otto Wichterle created the first prototype of a wearable hydrogen contact lens using only a hot plate, a centrifuge, and a contraption built from a gramophone, old bicycle parts, and his son’s Erector set.
Meanwhile, on the east coast of the United States, an Army veteran from World War II, named Robert Morrison, became an optometrist during a time when optometry schools didn’t require a college degree. He went on to establish thriving practices in Harrisburg, Pennsylvania and New York City.
After hearing about Dr. Wichterle’s paper on hydrophilic gels in 1961, Dr. Morrison traveled to Czechoslovakia and brought some of the material home with him. Continuing to trade ideas with Dr. Wichterle, Dr. Morrison became the first American optometrist to fit soft contact lenses in practice. While some of Dr. Wichterle’s patents were transferred to Dr. Morrison for a ridiculously low amount of money (about $300,000), Dr. Morrison sold them to the National Patent Development Corporation, who then licensed them to Bausch & Lomb for about $3 million in 1966.
By 1971, the first soft hydrogel contact lens—Soflens—was on the market, initiating Bausch & Lomb’s early monopoly on soft contact lenses in the U.S.
Setting the stage for daily disposables
In 1981, the FDA cleared the use of hydrogel contact lenses for extended wear, and by the mid 1980’s there were about 4 million users in the country. At the same time, research like the Gothenburg Study1 demonstrated the potentially harmful effects of extended and continuous wear.2
The major findings of the Gothenburg Study formed the blueprint for the development of disposable contact lenses over the next 35 years, by demonstrating that the long-term adverse effects of contact lens wear on the ocular surface could be minimized by fitting lenses that were more frequently replaced and manufactured from materials that had higher oxygen permeability.
Another landmark study by Holden and Mertz3 established that contact lenses must have an oxygen transmissibility (Dk/t) of at least 87 and specified the minimum oxygen transmissibility (24) to avoid excessive corneal edema during daily wear.
How did silicone hydrogels make wearers more comfortable?
While the first silicone elastomer lenses were manufactured in the late 1970’s, it wasn’t until the late 1990’s that engineers found a way to combine the comfort and wettability of hydrogel with the high oxygen permeability of silicone. The early pioneers making it possible to transmit greater amounts of oxygen through the lens to the corneal surface included the Bausch & Lomb PureVision lenses and the CIBA Vision Night & Day lenses. These two lenses were made with balafilcon A, which was a low-water, ionic material with a Dk of 99.
Next-generation technologies continued the comfort trend. ACUVUE OASYS, made with senofilcon A (Dk of 103), CIBA Vision O2 Optix (lotrafilcon B), and CooperVision Biofinity (comfilcon A) all surpassed hydrogel lenses by the first quarter of 2007. These new silicone materials were made with various monomers and macromers as well as wetting agents, like polyvinyl pyrrolidone (PVP).
Around the same time, The ACUVUE Brand adapted UV protection across the portfolio, ushering in a new standard of care. Today, all ACUVUE contact lenses offer Class I protection, which blocks 99.9% of UVA rays and 100% of UVB rays.
† Johnson & Johnson Vision represents the products and services of Johnson & Johnson Surgical Vision, Inc., Johnson & Johnson Vision Care, Inc., and the affiliates of both.
‡ Helps protect against transmission of harmful UV radiation to the cornea & into the eye.
How daily disposables changed the industry
In 1994, Johnson & Johnson Vision began manufacturing 1-Day ACUVUE Brand Contact Lenses. This first daily disposable opened the door to patients who were sensitive to the preservatives in contact lens solutions of the time—especially chlorhexidine and thermerosal—or whose eyes weren’t able to tolerate lenses designed for extended use. Additionally, calcium deposits and mucus-protein aggregations on extended-wear lenses were common, and the disinfecting solutions of the time weren’t always up to the task of killing harmful bacteria.
The introduction of daily disposable contact lenses is still heralded as one of the greatest developments in the field of contact lenses4—aside from the addition of oxygen permeable silicone hydrogel lenses that entered the market about five years later.
What do today’s patients demand from their contacts?
What I’ve noticed in my practice is not so much that patients demand more today but that there are more demands on their eyes—including the increased use of digital devices. Additionally, as patients age, the use of screens means that there is frequent switching from near to far work, which can make it challenging for presbyopes to see optimally with multifocals.
Today’s patients care about blue light and UV protection
Whether we like it or not, we are living in a world where nearly all patients look at screens. Data tells us the average US adult spends in excess of 13 hours in front of digital devices. As optometrists, we know that digital device use results in a 60% reduction in the blink rate. When we blink less, this can lead to a compromised tear film due to the reduction of our lipid layer. Additionally many of these patients may also be dealing with glare from computers, windows and phones.
Some lenses I’ve been really happy with lately include the ACUVUE® OASYS MAX 1-Days and ACUVUE OASYS MAX 1-Day Multifocals for their comfort and visual clarity, even for those who use digital devices for an extended period. By combining two technologies into the lens: TearStable™ Technology and OptiBlue™ light filter5— Johnson & Johnson Vision aims to provide both protection and comfort to today’s contact lens wearers.
TearStable™ Technology is designed to maximize tear-film stability and lock in moisture6,8 while the OptiBlue™ light filter can filter 60%* of blue-violet light. Like previous ACUVUE® OASYS lenses, ACUVUE® OASYS MAX 1-Day lenses also filter UV, but due to the addition of the chromophore the Class I level is now even higher; 99.9% of UVA rays and 100% of UVB rays.†,‡,7,8
What surprised me was how excited patients were for this lens, especially the parents, who don’t want to purchase another pair of blue-light filtering glasses for their kids or themselves. It’s also been a hit with athletes who want UV protection but can’t—or don’t want to—wear sunglasses because of safety or performance reasons.
Dry eye disease and contact lenses
In the 1980’s, when contact lenses were gaining popularity, we didn’t know nearly as much about ocular surface health as we do today. Combined with less frequent blinking when using digital devices, patients have been coming to me with complaints of eye dryness. One of the things I try to stay up on in the industry is technology that allows more wetting agents like PVP into the lens or innovations that support tear film homeostasis and stability.
It’s estimated that about 20% of contact lens wearers will drop out at some point,9 with dryness and poor vision being two of the main causes. One thing I’ve noticed in my practice is that eye dryness can sometimes cause poor visual acuity because when the tear film is unhealthy, the lens tends to have more deposits on it, which can compromise the optics of the lens.
When I hear about new lens materials and technology, I’m always interested in innovations that allow more oxygen into the lens or promote tear film stability—which in turn can lead to greater comfort and clarity, which my patients crave. I also like to keep on top of materials that lower the evaporation rate of the tear film, which generally leads to a more comfortable fit.
Hey millennials, welcome to presbyopia
With so many multifocal lenses available today, it’s hard to believe that multifocals didn’t really come on the scene until the late 1990s when Bausch & Lomb’s SofLens MultiFocal and PureVision Multifocals entered the market as some of the first silicone hydrogel options for presbyopes.
I’m seeing a lot of demand for more comfortable multifocal lenses in my practice. Some of that is due to demographics, like the first wave of millennials (those born between 1981 and 199610) who are turning 40. While younger presbyopes might not want to talk about aging eyes, they still want sharp vision and a comfortable experience—and they are a generation used to asking for the latest tech.
To meet the demands of the next generation of contact lens wearers, CooperVision introduced the Biofinity lens in 2016, which was designed for the use of digital devices. Bausch & Lomb followed up with the INFUSE® daily wear lenses with ProBalance Technology™, which was engineered with the goal to minimize symptoms of contact lens dryness and provide protection against UVA and UVB rays.
One lens I’m having a lot of success with is the ACUVUE OASYS MAX 1-Day Multifocal lenses. Some patients say it feels like butter on their eyes. Others have been so excited about the comfort that on their way out, they’ve told patients in my waiting area that they have to try them. It reminded me of going to a restaurant and hearing other diners raving about their meals.
As an eyecare professional, I’m most excited about the optics of these lenses and the ease it gives my presbyopes as they switch between far and near work. I’ve always had a harder time fitting multifocal patients. Sometimes their distance vision is 20/20, and a multifocal to help them with near work can compromise the distance vision. With the ACUVUE MAX lenses, I don’t have that problem as long as I’m not too aggressive with the ADD.
According to clinical research, the ACUVUE OASYS MAX 1-Days have a 2x lower evaporation rate than other lenses,*,**,11,12 which is why I also recommend them to my presbyopes who struggle with eye dryness.
We’re living in a time now where the latest version of everything is desired, whether it’s a phone, a pair of sneakers, or contact lenses. Sometimes that puts more pressure on us as eyecare providers, but in other ways, it’s gotten easier to talk about new lens technologies, as patients are typically eager to have what’s new and what’s next.
* Versus ACUVUE® OASYS 1-Day
** Also significantly less than ACUVUE® OASYS 1-Day
Tips for introducing patients to new lenses
- DO get a sense of your patient’s lifestyle. Do they play sports outside? Then consider giving them a lens with UV protection. Are they on their screens a lot? Then you might be dealing with a lower blink rate and the need for blue light protection.
- DO ask personal questions. As professionals, we sometimes steer clear of personal questions. But I’ve found that the more I inquire about their lives, the better our doctor-patient relationship becomes. I recently had a patient who wore spectacles and was turning 50. I asked what she was doing for her birthday, and she began telling me about her plans to visit Hawaii to celebrate. This in turn led to the possibility of wearing contacts rather than glasses. This small act made her feel more attractive and improved her self-confidence just in time for her trip.
- DO express confidence. If you believe in a lens, then your patients will be more likely to try it out. If I’m having great success with a lens, I tell my patients, “Look, I’m having a 90% success rate with this lens and I think it will work for you because …” I also like to be very specific about why I think the lens will work for their individual eyes. As ODs, our job is to prescribe the best options.
- DON’T make things too complicated. As an OD, I believe it’s my job to find the best solution for my patient and tell them why. Then I wait for them to ask the questions.
- DON’T go crazy with the ADD when fitting multifocals. One thing I’ve noticed is that the ACUVUE OASYS MAX lenses have a potent ADD and I don’t need to be quite so zealous in my prescriptions or my patients will experience distance blur.
- DON’T be afraid to mix things up. I have one patient who has an executive job during the week with lots of screen time and likes to golf on the weekend. While it might be unconventional, I gave him a few boxes of lenses with a prescription optimized for distance—for weekends he plays golf—and the rest of the boxes with a prescription that is more suited to screen time as well as his distance needs.
What will the contact lens of the future look like?
Contact lenses that dose prescription therapeutics, “talk” to doctors and let you consult on ski or surf conditions? If you are a contact lens wearer of the future, you might be privy to all of these perks. Mojo Vision, an American startup, has been developing prototypes of “smart” contact lenses that contain a microLED display the size of a grain of sand, while Sony applied for a patent a few years ago for a contact lens that can record videos.13 Academic researchers are looking into lenses that can zoom in and out with a blink, while others at the University of Michigan are experimenting with contacts that offer spectacle-free night vision for the military.
While the sci-fi potential of contact lenses is exciting, the biggest application for future contact lenses is likely to occur in the healthcare arena, where scientists and tech experts are already designing prototypes of lenses that can look at the biomarkers in tear fluid to diagnose diseases, monitor eye pressure in glaucoma suspects, and even provide precise dosage of medications directly to the eye.
With so much that has happened in the past 50 years, there’s no doubt that the next 50 years will be equally as exciting. I personally can’t wait to see what’s next.