CONTACT LENSES

Types and uses

Presentation by Dr ANUMEHA

Contact lenses are now commonly used for correction of refractive errors.
Different type of contact lens are as follows:

Hard lenses PMMA Soft lenses

Silicone hydrogels Disposables Toric lenses Ortho-k lenses Special lenses tinted lens, presbiopic lenses, cosmetic and prosthetic lenses

HARD LENSES
These are now given the suffix focon and are classified acc to the chemical groups These are available in wide range of materials and Dk values. (Dk is the oxygen permeability of the material, D is diffusion constant and k is the solubility coefficient. The higher is the temp the higher is the Dk)

The factors taken into account for the selection of the hard lenses are:
Surface wetting properties. Lens design. Fitting method. Manufacturing technique. Mechanical stability. Optical quality

barrier effect and the avg lens thickness are also considered. The minimal central thickness is 0.14mm even for high minus powers)

Types of hard lens :

1) cellulose acetate butyrate (CAB)

2) silicon acrylates (siloxanes)

3) fluorosilicon acrylates

4) Fluoropolymers 5) Hydrophilic gas-permeable hard lenses 6) Carbosilfocon

Cellulose acetate butyrate (CAB)

One of the first modern hard lens material to be introduced. But Its Dk value is low so its use has been decreased.

Advantages of CAB:
Good wettability. Relatively inert. Does not attract protein. Low breakage rate. Very low incidence of PC.

Disadvantages of CAB
Low Dk.

Moulding necessary for dimensional stability. Limited range of lens designs. Scratches easily. Attracts lipids from the tears. Corneal adhesion in some cases. Lens flexure and distortion on toric corneas with tight lids

) Silicon acrylates (siloxanes)

These are copolymers in varying proportions of acrylate (PMMA), which provides lens rigidity, and silicon which controls the degree of oxygen permeability.

Advantages of silicon acrylates

Wide range of materials available. Wide range of designs with practitioner control. Low to medium Dks available. Good dimensional stability. Good vision

scratch resistance.

Disadvantages of silicon acrylates Attract protein from the tears. Some materials are brittle with a breakage problem.

Fluorosilicon acrylates
These are composed of fluoromonomers and siloxy acrylate monomers . The addition of fluorine atoms improves surface wettability, tear film stability and deposit resistance as well as increasing oxygen permeability

Advantages of fluorosilicon acrylates

Very high Dks possible. Suitable for flexible extended wear. Better wettability. Fewer deposit problems. Lower incidence of CLIPC. Modification possible.

Disadvantages of fluorosilicon acrylates

Brittle if too thin. Require careful manufacture. Dimensional stability depends on material and manufacture. Corneal adhesion in some cases.

Fluoropolymers:
Fluoropolymers contain no silicon and have a fluorine content of up to 50% by weight, several times that incorporated into fluorosilicon acrylates. They have so far found limited application despite their high Dk, good surface wettability, good deposit resistance and lack of brittleness. These advantages have been outweighed by problems associated with lens flexure, high specific gravity and cost

Hydrophilic gas-permeable hard lenses

Advantages Excellent visual acuity Correct corneal astigmatism. Variety of complex designs available. Ease of maintenance. Few solutions allergies. Minimal deposits with proper cleaning. High oxygen permeabilities (Dks). Do not cover the entire cornea. Tear pump on blinking. Good long-term ocular response. Easy to check. Modifications possible. Lenses available in a range of tints.

Disadvantages:
Initial discomfort. Precise fitting required. Stringent regulations concerning the use and disinfection of diagnostic lenses. Foreign bodies. Risk of loss. Flare. Lens adhesion. Breakage and scratching. Greasing with some patients. Instability of some materials.

Carbosilfocon
Used to manufacture the EpiCon lens for keratoconus The material has a Dk of 52 The material is flexible and the large diameter lenses are produced by Gelflow moulding technology

PMMA (polymethyl methacrylate

has been in use since the 1940s firstly as a replacement for the earlier glass scleral lenses, and subsequently as the material of choice with the development of corneal lenses. Advantages:

Inertness of material. Stability of material. Reproducibility. Surface wettability. Quality of vision. Myopia control. Ease of manufacture. Ease of modification. Wide range of tints.

Inexpensive.

Disadvantages
Slow adaptation. High incidence of oedema. Corneal distortion. Spectacle blur. Risk of overwear syndrome. Descemets mem folds Severely reduced corneal sensitivity

These changes are due to chronic lack of oxygen, drying of the corneal tissue and the mechanical action of the lens. The combination of these long-term effects produces the
loss of tolerance known as 'corneal exhaustion syndrome'.

There are very occasional uses for PMMA :

When flexure problems with modern hard lenses give unsatisfactory acuity, especially where a very thin lens is necessary. PMMA may occasionally be used where a trial lens - which will subsequently be disposed of - is required to check the fluorescein pattern of a complicated fitting (e.g.keratoconus or opaque cosmetic)

PMMA might also be considered for clumsy patients who may break modern hard lenses too easily; when there are deposit problems with all modern materials; or where an inert material is required because of allergies (e.g. with CLIPC).

Modified PMMA
The improved wettability gave moderately better comfort, And the increased tear flow beneath the lens proved beneficial in reducing some of the oedema problems almost inevitable with an impermeable material like PMMA.

SOFT LENSES

They are grouped acc to the property of water content, Dk and material type Materials are given the suffix -filcon

Classification of Soft contact lenses :

1) low water content, non ionic polymer eg crofilcon Materials generally show lower levels of protein deposit. 2) low water content, ionic polymer eg Bufilcon-A 3) high water content, non ionic polymer eg Lidofilco-A 4) high water content, ionic polymer eg Etafilcon-A These polymers show the highest level of protein deposition

Soft lens water content: Hydrophilic lenses have been produced with water contents from18% to 85%. However, many of the lenses currently being used are still HEMA (Hydroxyethyl methacrylate)based in the region of 38% to 46%.

Advantages of low water content lenses

Greater tensile strength. Less breakage. Longer life span. Smaller swell factor during manufacture. Better reproducibility. Easier to manufacture. Can be made thinner. Less dehydration on the eye. Less discoloration with age. Fewer solutions problems.

Disadvantages of low water content lenses

The disadvantages of low water content lenses relate mainly to their relatively low Dk values. A greater tendency to cause corneal oedema. A long-term tendency with thicker lenses (e.g. with high powers) to cause vascularization

Advantages of high water content lenses

Most high water content materials have Dks between three and five times that of HEMA. Apart from their obvious application in oedema cases, they have several other advantages: Better comfort because of material softness. Faster adaptation. Longer wearing time. Extended wear. Easier to handle because of greater thickness. Better vision because of greater thickness. Better for intermittent wear.

Disadvantages of high water content lenses

Shorter life span.
Greater fragility. More deposits, especially white spots. More discolouration. Reproducibility less reliable. More difficult to manufacture by lathing. Greater variation with environment. Fitting requires longer settling time. Greater variability in vision. More solutions problems. Lens dehydration. Corneal desiccation

Lens thickness
The typical centre thickness for a 'standard' corneal diameter HEMA lens of power -3.00D is in the region of 0.10-0.14mm. < 0.10 mm - thin lens < 0.o7 mm - ultra thin < 0.05 mm super thin or hyper thin

Advantages of thin lenses

Lower incidence of oedema.

Reduced lid sensation because of thinner edges. Reduced limbal irritation because of thinner edges and larger total diameter. Different fitting characteristic may provide better centration than standard lenses. Easier to fit because fewer fitting steps are necessary. Safer if patients accidentally fall asleep.

Disadvantages of thin lenses

Higher breakage rate than standard thickness lenses. Life span is shorter, especially with heat disinfection. Visual acuity may be less good with toric corneas. Greater tendency to dehydrate on the eye and disturb precorneal tear film. Handling is more difficult, especially in low minus powers below about -2.00D.

Silicone hydrogels
Advantages of silicone hydrogels Very high Dks available. Suitable for extended wear. Rapid adaptation. Suitable for patients with vascularization. Good dehydration characteristics. Easier handling because of lens rigidity. Low rate of deposits. Good tensile strength with low breakage rate. Low uptake of fluorescein during aftercare.

Disadvantages of silicone hydrogels

Not available in complex designs (torics, bifocals). Available only as disposables. More likely to create arcuate staining Frequently exhibit mucin balls Expensive.

Types: 1) Silicone rubber lenses (elastomers) 2) Silicone resin lenses

Silicon lenses

Silicone rubber lenses (elastomers): They can be flexed,

stretched and turned inside out. They have excellent elastic properties, partly conform to the shape of the cornea in wear, and have extremely high Dks

Advantages of silicone lenses

Very high Dk. Better and more stable vision than many soft lenses. Little variation in comfort or fitting with environmental factors. Low risk of loss or damage.

Disadvantages of silicone lenses

Difficult to fit, requiring as much precision as hard lenses. A negative pressure effect producing lens adhesion, particularly if not correctly fitted. Breakdown in surface coating and difficulties with wetting. Build-up of deposits. Foreign bodies, especially with loose fittings.

Silicone resin lenses

Resin lenses differ from silicone elastomers
because they are not flexible, having many of the physical properties of hard lenses.

Dk values, however, are significantly lower than the elastomers and they have so far found only limited application

USESES OF CONTACT LENS

Visual:
Anisometropia. High myopia. Aphakia. Irregular corneas, scarring, keratoconus, grafts. Failures with refractive surgery

Occupational

Theatre, film and other stage performers. Armed forces. Professional sports.

Cosmetic

To avoid spectacles. Change eye colour. Prosthetic lenses or shells.

Medical
Therapeutic. Bandage.

Therapeutic fitting
Contact lenses are used for therapeutic reasons to: Correct vision in eyes with existing pathology. Correct irregular corneal astigmatism by providing a smooth optical surface. Promote healing by protecting denuded cornea and new epithelium from the lids. Prevent epithelial breakdown. Relieve pain or foreign body sensation. Protect the cornea and, when used in conjunction with lubricating solutions, provide a moist environment.

Additional therapeutic uses

Drug-release lenses : Soft lenses or shields of
a collagen material are used as a drug release mechanism

Psychological

Where the patient cannot accept wearing spectacles.

Sports. Physical inability to wear spectacles (e.g. allergy to frame materials, nasal problems).

Other