Go beyond correcting refractive errors


Released in April 2021, the British Contact Lens Association’s evidence-based academic contact lens reports provide a global consensus on contact lens practice and research. The final report focuses on the contact lens technologies of the future,1 and, as underlined Optometry Times® ” recent conversation with report chairman Prof Lyndon Jones, PhD, FCAHS, FCOptom, FAAO, in many cases these developments will displace the function of a contact lens beyond simply correcting refractive error .

Given this knowledge, what new contact lens technologies can eye practitioners expect to see become available? When can this happen and, most importantly, what can ophthalmologists do to prepare?

The here and now

It may be surprising to find that the profession is already at the forefront of the innovation “iceberg”. FDA approval in November 2019 of the first soft contact lens design to slow the progression of myopia in children (MiSight 1 day; CooperVision) opened the door to wider access to technologies that do more than simply correct eyesight. This is an example of a contact lens with an optical design intended for use to affect the rate of growth of axial length in young myopic, and there is growing evidence for such technologies both for the soft2-4 and orthokeratology5.6 drawings.

Innovation drives changes in practice Managing myopia is also a good indication of how innovation in contact lenses will change aspects of clinical practice. Anyone involved in providing this treatment to patients will enjoy the various conversations required to advise patients and their caregivers on the technology.

It also creates a need for eyecare professionals to increase their own knowledge and continue to stay current in an ever-changing field. The management of myopia can also entail changes in clinic appointments, an investment in additional instruments and the introduction of professional fees to adequately cover the service offered. All of these are examples of changes eye practitioners can expect as new lens technologies become available.

Diagnosis and surveillance of eye disease continues to be a priority for contact lens development, with an example already commercially available in some markets. The addition of a strain gauge in combination with the on-board microelectronics provides the ability to continuously monitor intraocular pressure readings over a 24 hour period to provide information to optimize glaucoma treatment (Sensimed Triggerfish) .7

The recent regulatory approval in Japan8 and Canada’s first drug delivery contact lens (Acuvue Theravision, Johnson & Johnson Vision) demonstrates just how close this technology could be to commercialization. New technology releasing ketotifen has been shown to significantly reduce eye allergy symptoms for up to 12 hours.9

In the next 10 years

Manufacturers must move from proof of principle in the early stages of development to demonstrating efficacy and safety in clinical trials, obtaining regulatory approvals and finally launching a commercially viable product. This means that eyecare professionals can expect access to a suite of new devices to increase gradually, rather than suddenly, in the future. These technologies, when available, will be valuable additions to patient-centered healthcare. Tears are a rich source of data for the detection and monitoring of systemic and eye diseases. These data include blood sugar levels in diabetes, the detection of cancer biomarkers, as well as the diagnosis and monitoring of dry eye via measurements of osmolarity and inflammatory cytokines.1

The management of eye disease will be another welcome addition to clinical practice, especially for conditions now treated primarily with topical medications. The limitations of self-application of the drops, the poor adherence of patients instilling the drops, the short residence time of the drops on the ocular surface, and the requirement of acute 24-hour administration conditions are well understood. which leads to an understandable interest in drugs. release technology.

Beyond eye allergy, expect to see innovations in the treatment of dry eye through the sustained release of lubricants and anti-inflammatory and immunomodulatory agents as well as in the treatment of acute eye infections such as bacterial keratitis via anti-antibiotic contact lenses.

Look further

The separate technologies described above could ultimately lead to a new discipline for contact lenses: theranostics. Be prepared to learn more about this over time, as you become familiar with a medical field that brings together diagnosis and therapy. There are possibilities for a smart contact lens capable of detecting and monitoring the levels of inflammatory biomarkers, such as matrix metallopeptidase 9 or MMP-9, in dry eye, and then delivering an appropriate amount of drug to the ocular surface. to deal with this problem. problem when these levels are high enough.

Smart contact lenses as a broad category are attracting great interest among consumers. The integration of electronics into the contact lens leads to the attractive non-medical application of augmented vision, with futuristic descriptions of viewing social media and email through a contact lens. A well-publicized scleral lens (Mojo Vision) demonstrated the early potential of this head-up display option, although no lens is yet commercially available.

Many applications of augmented vision exist beyond non-medical use, and some of the first lenses available will likely be aimed at improving low vision or even auto-focusing lenses for presbyopia. Adding electronics to a contact lens comes with a lot of challenges, including how to make these additions small enough and how to power them up, which means these technologies are potentially even further down the timeline.

It’s time to act

While some innovations remain for several years, as shown, others are already with us or imminent. Ophthalmologists who keep pace with the possibilities generated by each new technology will be in the best position to embrace the changes as they arise, providing their patients with the latest advances in diagnosis, therapy and improvement. optical contact lenses.

For now, the advice is to stay vigilant and up to date. Be prepared to make the necessary changes to your practice, clinical services and at your own cost. Also, consider starting to counsel your patients on what might happen, educating them about the relevant technology and making sure they’re ready to try them as soon as they land in the real world.

Reference

1. Jones L, Hui A, Phan CM et al. CLEAR – the contact lens technologies of the future. Front Eye Cont lens. 2021; 44 (2): 398- 430. doi: 10.1016 / j.clae.2021.02.007

2. Cooper J, O’Connor B, Watanabe R, et al. Case series analysis of myopic progression control with a single extended depth of field multifocal contact lens. Eye contact lens. 2018; 44 (5): e16-e24. doi: 10.1097 / ICL.0000000000000440

3. Chamberlain P, Peixoto-de-Matos SC, Logan NS, Ngo C, Jones D, Young G. A 3-year randomized clinical trial of MiSight lenses for the control of myopia. Optom Vis Sci. 2019; 96 (8): 556-567. doi: 10.1097 / OPX.0000000000001410

4. Walline JJ, Walker MK, Mutti DO, et al; BLINK Study Group. Effect of High Adding Power, Medium Adding Power, or Unifocal Contact Lenses on Myopia Progression in Children: The BLINK Randomized Clinical Trial. JAMA. 2020; 324 (6): 571-580. doi: 10.1001 / jama.200.10834

5. Si JK, Tang K, Bi HS, Guo DB, Guo JH, Wang XR. Orthokeratology for the control of myopia: a meta-analysis. Optom Vis Sci. 2015; 92 (3): 252-257. doi: 10.1097 / OPX.00000000000000505

6. Sun Y, Xu F, Zhang T, et al. Orthokeratology for monitoring the progression of myopia: a meta-analysis. PLoS One. 2015; 10 (4): e0124535. doi: 10.1371 / journal.pone.0124535

7. Chen X, Wu X, Lin X, Wang J, Xu W. Outcome, influencing factor and development of CLS measurement in continuous monitoring of IOP: a narrative review. Front Eye Cont lens. Posted on October 19, 2020. doi: 10.1016 / j.clae.2020.10.006

8. Johnson & Johnson Vision receives approval of the world’s first and only drug-release combination contact lens for vision correction and allergic itchy eyes: Acuvue Theravision with Ketotifen. Press release. Johnson & Johnson Vision. March 24, 2021. Accessed June 11, 2021. https://www.prnewswire.com/news-releases/johnson–johnson-vision-receives-approval-of-worlds-first-and-onlydrug-release-combination- lens -contact-for-vision-correction-and-allergic-eyes-acuvue-theravision-with-ketotifen-301254442. html

9. Pall B, Gomes P, Yi F, Torkildsen G. Management of allergic itchy eyes with an antihistamine-releasing contact lens. Cornea. 2019; 38 (6): 713-717. doi: 10.1097 / ICO.0000000000001911


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