The Future of Silicone Hydrogels

Silicone hydrogel versus hydrogel soft contact lenses for differences in patient-reported eye comfort and safety

BACKGROUND

Ocular discomfort is the leading cause of permanent discontinuation of soft contact lens (SCL) wear. Silicone hydrogel and hydrogel materials are the two major categories of SCLs, with silicone hydrogel materials being newer and more breathable than hydrogel materials. Whether comfort is associated with SCL material is controversial despite numerous studies. Similarly, the difference between these materials in terms of safety outcomes (e.g. frequency of microbial keratitis) is unclear.

OBJECTIVES

To evaluate the comparative effectiveness and safety of silicone hydrogel compared with hydrogel SCLs on self-reported comfort, dry eye test results, and adverse events in SCL-wearing adults 18 years of age or older.

SEARCH METHODS

The Cochrane Eyes and Vision Information Specialist searched the electronic databases for randomized controlled trials (RCTs). There were no restrictions on language or date of publication. We searched the Cochrane Central Register of Controlled Trials (CENTRAL, including the Cochrane Eyes and Vision Trials Register; 2022, Issue 6), MEDLINE Ovid, Embase.com, PubMed, LILACS (Latin American and Caribbean Health Science Information database), ClinicalTrials.gov, and World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP). We also searched the reference lists of identified studies, review articles, and guidelines for information about relevant studies that may not have been identified by our search strategy. Furthermore, we contacted investigators regarding ongoing trials. The most recent database search was conducted on 24 June 2022.

SELECTION CRITERIA

Our search selection criteria included RCTs, quasi-RCTs, and cross-over RCTs.

DATA COLLECTION AND ANALYSIS

We applied standard Cochrane methodology.

MAIN RESULTS

We included seven parallel-group RCTs conducted in the USA, the UK, Australia, Germany, India, and Turkey. A total of 1371 participants were randomized. The duration of SCL wear ranged from one to 52 weeks. Study characteristics and risk of bias The median number of participants per trial was 120 (interquartile range: 51 to 314), and the average age ranged from 20.7 to 33.0 years. Women represented the majority of participants (range 55% to 74.9%; 5 RCTs). Collectively, the included trials compared eight different silicone hydrogel SCLs with three different hydrogel SCLs. Five trials compared daily disposable SCLs, and two compared extended wear SCLs (worn for seven days and six nights). New SCL wearers were enrolled in three trials. Two trials included both new and established SCL wearers, and two trials did not report participants' history of SCL use. Five trials were sponsored by industry. We judged the overall risk of bias to be 'high' or 'some concerns' for the safety and efficacy outcomes. Findings One trial reported Ocular Surface Disease Index (OSDI) results, with the evidence being very uncertain about the effects of SCL material on OSDI scores (mean difference -1.20, 95% confidence interval [CI] -10.49 to 8.09; 1 RCT, 47 participants; very low certainty evidence). Three trials reported visual analog scale comfort score results, with no clear difference in comfort between materials, but the evidence was of very low certainty; trial results could not be combined because the three trials reported results at different time points. The evidence is very uncertain about the effect of SCL material on discontinuation of contact lens wear (risk ratio [RR] 0.64, 95% CI 0.11 to 3.74; 1 RCT, 248 participants). None of the included trials reported Contact Lens Dry Eye Questionnaire (CLDEQ-8) or Standard Patient Evaluation of Eye Dryness (SPEED) scores. There was no evidence of a clinically meaningful difference (> 0.5 unit) between daily disposable silicone hydrogel and hydrogel SCLs in corneal staining, conjunctival staining, or conjunctival redness (very low certainty evidence). Adverse events Very low certainty evidence from two trials comparing daily disposable SCLs suggested no evidence of a difference between lens materials in the risk of vision-threatening adverse events at one to four weeks (RR 0.68, 95% CI 0.08 to 5.51; 2 RCTs, 368 participants). Two trials comparing extended wear SCLs indicated that hydrogel SCLs may have a 2.03 times lower risk of adverse events at 52 weeks compared with silicone hydrogel SCLs (RR 2.03, 95% CI 1.38 to 2.99; 815 participants), but the certainty of evidence was very low.

AUTHORS' CONCLUSIONS

The overall evidence for a difference between all included silicone hydrogel and hydrogel SCLs was of very low certainty, with most trials at high overall risk of bias. The majority of studies did not assess comfort using a validated instrument. There was insufficient evidence to support recommending one SCL material over the other. For extended wear, hydrogel SCL may have a lower risk of adverse events at 52 weeks compared to silicon hydrogel. Future well-designed trials are needed to generate high certainty evidence to further clarify differences in SCL material comfort and safety.

Corneal hysteresis and intraocular pressure are altered in silicone-hydrogel soft contact lenses wearers

PURPOSE

The aim of this work is to determinate the effects in the physical parameters in terms of intraocular pressure (IOP) and central corneal thickness (CCT) and corneal biomechanics in terms of corneal resistance factor (CRF) and corneal hysteresis (CH) of wearing silicone-hydrogel soft contact lenses (SiH-CLs) in young adult subjects during a short-term follow-up.

METHODS

40 eyes of 20 healthy patients with a mean age of 22.87 ± 4.14 were involved in this study. Subjects with corneal diseases, dry eye, irregular astigmatism or who have been previous contact lens wearers were excluded. The ocular response analyzer (Reichert Ophthalmic Instruments) was used to measure CH, CRF and IOP and Scheimpflug imaging (the GALILEI™ Dual Scheimpflug camera analyzer, Ziemer) was used to measure CCT before and 10 days (Group 1) and 20 days (Group 2) after wearing the SiH-CLs.

RESULTS

IOP was significantly decreased 10 days after using the SiH-CLs (p = 0.009). Within the 20 days' period, Group 2 revealed an even more pronounced decrease in IOP (p = 0.003) while CH increased significantly (p = 0.04). CCT and CRF did not show a significant change during the period of SiH-CLs use. Our finding allowed obtaining an empirical expression that relates IOP, CCT, CRF and CH within a biomechanical compensation experimental model.

CONCLUSIONS

Corneal biomechanical parameters and physical properties of the cornea may be altered due to SiH-CLs use. Our findings could have an impact on the management of glaucoma progression and ocular hypertension.

CLEAR - Medical use of contact lenses

The medical use of contact lenses is a solution for many complex ocular conditions, including high refractive error, irregular astigmatism, primary and secondary corneal ectasia, disfiguring disease, and ocular surface disease. The development of highly oxygen permeable soft and rigid materials has extended the suitability of contact lenses for such applications. There is consistent evidence that bandage soft contact lenses, particularly silicone hydrogel lenses, improve epithelial healing and reduce pain in persistent epithelial defects, after trauma or surgery, and in corneal dystrophies. Drug delivery applications of contact lens hold promise for improving topical therapy. Modern scleral lens practice has achieved great success for both visual rehabilitation and therapeutic applications, including those requiring retention of a tear reservoir or protection from an adverse environment. This report offers a practical and relevant summary of the current evidence for the medical use of contact lenses for all eye care professionals including optometrists, ophthalmologists, opticians, and orthoptists. Topics covered include indications for use in both acute and chronic conditions, lens selection, patient selection, wear and care regimens, and recommended aftercare schedules. Prevention, presentation, and management of complications of medical use are reviewed.

Recent progress and strategies to develop antimicrobial contact lenses and lens cases for different types of microbial keratitis

Although contact lenses are widely used for vision correction, they are also the primary cause of a number of ocular diseases such as microbial keratitis (MK), etc. and inflammatory events such as infiltrative keratitis (IK), contact lens acute red eye (CLARE), contact lens-induced peripheral ulcer (CLPU), etc. These diseases and infiltrative events often result from microbial contamination of lens care solutions and lens cases that can be exacerbated by unsanitary lens care and extended lens wear. The treatment of microbial biofilms (MBs) on lens cases and contact lenses are complicated and challenging due to their resistance to conventional antimicrobial lens care solutions. More importantly, MK caused by MBs can lead to acute visual damage or even vision impairment. Therefore, the development of lens cases, lens care solutions, and contact lenses with effective antimicrobial performance against MK will contribute to the safe use of contact lenses. This review article summarizes and discusses different chemical approaches for the development of antimicrobial contact lenses and lens cases employing passive surface modifications, antimicrobial peptides, free-radical fabricating agents, quorum sensing quenchers, antibiotics, antifungal drugs and various metals and coatings with antimicrobial nanomaterials. The benefits and shortcomings of these approaches are assessed, and alternative solutions for future developments are discussed.

Antifouling silicone hydrogel contact lenses via densely grafted phosphorylcholine polymers

Silicone hydrogel contact lenses (CLs) permit increased oxygen permeability through their incorporation of siloxane functional groups. However, contact lens biofouling can be problematic with these materials; surface modification to increase lens compatibility is necessary for acceptable properties. This work focuses on the creation of an antifouling CL surface through a novel grafting method. A polymer incorporating 2-methacryloyloxyethyl phosphorylcholine (MPC), well known for its antifouling and biomimetic properties, was grafted to the model lens surfaces using surface-initiated atom transfer radical polymerization (SI-ATRP). The SI-ATRP modification generated a unique double-grafted polymeric architecture designed to resist protein adsorption through the presence of a surrounding hydration layer due to the PC groups and steric repulsion due to the density of the grafted chains. The polymer was grafted from model silicone hydrogel CL using a four-step SI-ATRP process. Attenuated total reflectance-Fourier transform infrared spectroscopy and XPS were used to confirm the surface chemical composition at each step of the synthesis. Both the surface wettability and equilibrium water content of the materials increased significantly upon polyMPC modification. The surface water contact angle was as low as 16.04 ± 2.37° for polyMPC-50 surfaces; complete wetting (∼0°) was observed for polyMPC-100 surfaces. A decrease in the protein adsorption by as much as 83% (p < 0.000 36) for lysozyme and 73% (p < 0.0076) for bovine serum albumin was observed, with no significant difference between different polyMPC chain lengths. The data demonstrate the potential of this novel modification process for the creation of extremely wettable and superior antifouling surfaces, useful for silicone hydrogel CL surfaces.

Biofilm modelling on the contact lenses and comparison of the in vitro activities of multipurpose lens solutions and antibiotics

During the contact lens (CL) usage, microbial adhesion and biofilm formation are crucial threats for eye health due to the development of mature biofilms on CL surfaces associated with serious eye infections such as keratitis. For CL related eye infections, multi drug resistant Pseudomonas aeruginosa or Staphylococcus aureus (especially MRSA) and Candida albicans are the most common infectious bacteria and yeast, respectively. In this study, CL biofilm models were created by comparing them to reveal the differences on specific conditions. Then the anti-biofilm activities of some commercially available multipurpose CL solutions (MPSs) and antibiotic eye drops against mature biofilms of S. aureus, P. aeruginosa, and C. albicans standard and clinical strains were determined by the time killing curve (TKC) method at 6, 24 and 48 h. According to the biofilm formation models, the optimal biofilms occurred in a mixture of bovine serum albumin (20% v/v) and lysozyme (2 g/L) diluted in PBS at 37 °C for 24 h, without shaking. When we compared the CL types under the same conditions, the strongest biofilms according to their cell density, were formed on Pure Vision ≥ Softens 38 > Acuve 2 ∼ Softens Toric CLs. When we compared the used CLs with the new ones, a significant increase at the density of biofilms on the used CLs was observed. The most active MPS against P. aeruginosa and S. aureus biofilms at 24 h was Opti-Free followed by Bio-True and Renu according to the TKC analyses. In addition, the most active MPS against C. albicans was Renu followed by Opti-Free and Bio-True at 48 h. None of the MPSs showed 3 Log bactericidal/fungicidal activity, except for Opti-Free against S. aureus and P. aeruginosa biofilms during 6 h contact time. Moreover, all studied antibiotic eye drops were active against S. aureus and P. aeruginosa biofilms on CLs at 6 h and 24 h either directly or as 1/10 concentration, respectively. According to the results of the study, anti-biofilm activities of MPSs have changed depending on the chemical ingredients and contact times of MPSs, the type of infectious agent, and especially the CL type and usage time.

The short-term physiological impact of switching reusable silicone hydrogel wearers into a hydrogel daily disposable multifocal

Purpose: To evaluate ocular physiological responses to etafilcon A multifocal (etMF) daily disposable (DD) lenses after 4 weeks of wear, when switching from habitual silicone hydrogel (SiHy) daily wear.

Method: A single-arm, open-label, bilateral dispensing study was conducted in 39 habitual spherical SiHy wearers (14 hyperopes; 25 myopes). Clinical visits occurred with habitual SiHy (control) at baseline and after 4 weeks of etMF DD open-eye lens wear at exit. Objective limbal/bulbar hyperemia using the Oculus K5M (0–4) and subjective grading of lid wiper epitheliopathy (LWE) (0–4) were tested for non-inferiority (NI), using a margin of 1 grade. Corneal thickness along a 10 mm cord was measured using the Visante OCT and tested for NI using a 30 μm margin. Corneal staining area was graded (0–100%).

Results: The least-square mean differences (LSMD) and 95% confidence interval (95% CI) between etMF DD and habitual SiHy in central and peripheral corneal thickness (μm) were 3.64 (−2.0, 9.29) and 3.0 (−7.72, 13.72) in hyperopic, and 3.56 (−0.66, 7.78) and 6.40 (−1.62, 14.42) in myopic subjects. The LSMD (95% CI) for bulbar and limbal hyperemia were −0.08 (−0.19, 0.02) and −0.01 (−0.12, 0.09) in hyperopes, and 0.04 (−0.03, 0.12) and 0.04 (−0.04, 0.11) in myopes. The LSMD (95% CI) for LWE were 0.11 (−0.39, 0.60) and 0.30 (−0.07, 0.67) for hyperopes and myopes, respectively.

Conclusions: No clinically significant differences in a variety of physiological responses were found when habitual reusable SiHy daily wear subjects were refitted into hydrogel etMF, when the subjects were followed for 4 weeks.

Impact of Air Exposure Time on the Water Contact Angles of Daily Disposable Silicone Hydrogels

The wettability of silicone hydrogel (SiHy) contact lens (CLs) is crucial for the pre-lens tear film stability throughout the day. Therefore, sessile drop and captive bubble setups were used to study the advancing and receding water contact angles (CA) of four SiHy materials: narafilcon A (TE), senofilcon A (AOD), stenfilcon A (MD), and delefilcon A (DT). TE and AOD have 48% and 38% water content, respectively, and no surface coating. MD (54% water) implements "smart chemistry" with just 4.4% bulk silicone content, while DT has >80% water at its surface. These SiHy were subjected to continuous blink-like air exposure (10 s)/rehydration (1s) cycles for 0, 1, 2, 3, 4, 6, 8, 10, 12, 14, and 16 h. The advancing CA, which measures the rehydration propensity of the CL surface, proved to be the most sensitive parameter to discriminate between the samples. The order of performance for the entire time scale was DT > MD >> AOD ≥ TE. The extended desiccation/rehydration cycling increased the differences between the CA of DT and MD compared to AOD and TE. This suggests that the low Si surface content and the high surface hydration are major determinants of SiHy wettability.

Does Long-term Soft Contact Lens Wear Affect Corneal and Anterior Chamber Parameters?

Objectives

To assess the long-term effects of soft contact lenses (SCL) on the cornea and anterior chamber by topography.

Materials and Methods

Thirty-nine eyes of 22 healthy patients were included in this prospective study. Changes in corneal and anterior chamber parameters before and after 12 months of daily SCL use (Air Optix Aqua, Air Optix Aqua for Astigmatism, Acuvue Oasys and Acuvue Oasys for Astigmatism) were evaluated with Pentacam (Oculus, Germany).

Results

Best corrected visual acuity with toric SCL was significantly better compared to spectacles in the toric SCL group (0.98±0.34 vs 0.94±0.72, p=0.004). None of the corneal (horizontal and vertical keratometry, corneal volume, anterior and posterior corneal astigmatism, corneal pachymetry of apex and thinnest location) and anterior chamber (anterior chamber depth, volume and angle) parameters showed a statistically significant change after long-term daily wear of SCLs.

Conclusion

The results of this study revealed that long-term wear of current high oxygen permeable and relatively low modulus silicone hydrogel SCLs does not impact cornea and anterior chamber morphology or volumetric parameters. Furthermore, toric silicone hydrogel SCLs can provide better visual performance than spectacles.

Strategies to design antimicrobial contact lenses and contact lens cases

Contact lens wear is a primary risk factor for developing ocular complications, such as contact lens acute red eye (CLARE), contact lens-induced peripheral ulcer (CLPU) and microbial keratitis (MK). Infections occur due to microbial contamination of contact lenses, lens cases and lens care solution, which are exacerbated by extended lens wear and unsanitary lens care practices. The development of microbial biofilms inside lens cases is an additional complication, as the developed biofilms are resistant to conventional lens cleaning solutions. Ocular infections, particularly in the case of MK, can lead to visual impairment or even blindness, so there is a pressing need for the development of antimicrobial contact lenses and cases. Additionally, with the increasing use of bandage contact lenses and contact lenses as drug depots and with the development of smart contact lenses, contact lens hygiene becomes a therapeutically important issue. In this review, we attempt to compile and summarize various chemical strategies for developing antimicrobial contact lenses and lens cases by using silver, free-radical producing agents, antimicrobial peptides or by employing passive surface modification approaches. We also evaluated the advantages and disadvantages of each system and tried to provide input to future directions. Finally, we summarize the developing technologies of therapeutic contact lenses to shed light on the future of contact lens applications.

Adhesion of Acanthamoeba on Cosmetic Contact Lenses

BACKGROUND

This study aimed to evaluate the adhesion of Acanthamoeba trophozoites on cosmetic contact lenses (CLs) with and without CL care multipurpose solution (MPS) treatment.

METHODS

Acanthamoeba lugdunensis L3a trophozoites were inoculated onto disks trimmed from CLs: 1-day Acuvue moist, 1-day Acuvue define, Acuvue 2, and Acuvue 2 define. After 18-hour inoculation, the number of adherent trophozoites was counted under phase contrast microscopy. The effects of MPS, Opti-Free Express, soaking CLs for 6 hours, on Acanthamoeba adhesion were analyzed. Scanning electron microscopic examination was performed for assessment of Acanthamoeba attached on the lens surface.

RESULTS

Acanthamoeba trophozoites showed greater adhesion to cosmetic CL (P = 0.017 for 1-day CL and P = 0.009 for 2-week CL) although there was no significant difference between the types of cosmetic CL. On all lenses, the number of adherent Acanthamoeba was significantly reduced after treatment with MPS (P < 0.001 for 1-day Acuvue moist, P = 0.046 for 1-day Acuvue define, P < 0.001 for Acuvue 2, and P = 0.015 for Acuvue 2 define), but there was still significant difference between conventional and cosmetic CLs (P = 0.003 for 1-day CL and P < 0.001 for 2-week CL, respectively). More attachment of Acanthamoeba was observed on colored area and the acanthopodia of Acanthamoeba was placed on the rough surface of colored area.

CONCLUSION

Acanthamoeba showed a greater affinity for cosmetic CL and mostly attached on colored area. Although MPS that contained myristamidopropyl dimethylamine reduced the adhesion rate, there was a significant difference between conventional and cosmetic CLs.

Risk Factors for Contact Lens-Related Microbial Keratitis: A Case-Control Multicenter Study

PURPOSE

The most feared complication of contact lens (CL) wear is microbial keratitis (MK), even though its incidence remains low. This study aimed to identify the risk factors of CL-related MK in a large, prospective, multicenter case-control study.

METHODS

A multicenter case-control study was designed. The CL-related MK subpopulation (Case) was compared with healthy CL wearers (Control) using a 52-item anonymous questionnaire designed to determine subject demographics and lens wear history. Univariate and multivariate logistic regression analyses were performed to compare both groups.

RESULTS

The study enrolled 499 cases and 508 controls. The risk factors associated with the greatest increased odds of CL-related MK were as follows: using disinfecting solution more than 3 months (odds ratio [OR]=1.94), cosmetic CL wear and use of multipurpose disinfection solution (1.37 each), overnight wear, and soft lens use (OR=1.24 each). The protective factors associated with the greatest reduction in OR were fitting by an ophthalmologist (OR=0.73) and hyperopia versus myopia (OR=0.75).

CONCLUSIONS

The infectious determinants were linked to the type of lenses, hygiene routine, CL handling, disinfecting solution, and storage case. This study aimed to highlight the increasingly CL-related MK, which likely occurs because of lack of patient information regarding basic rules of hygiene and CL care and handling.

Atropine and Roscovitine Release from Model Silicone Hydrogels

PURPOSE

Drug delivery to the anterior eye has a low compliance and results in significant drug losses. In pediatric patients, eye diseases such as myopia and retinoblastoma can potentially be treated pharmacologically, but the risk associated with high drug concentrations coupled with the need for regular dosing limits their effectiveness. The current study examined the feasibility of atropine and roscovitine delivery from model silicone hydrogel materials which could potentially be used to treat myopia and retinoblastoma, respectively.

METHODS

Model silicone hydrogel materials that comprised TRIS and DMA were prepared with the drug incorporated during synthesis. Various materials properties, with and without incorporated drug, were investigated including water uptake, water contact angle, and light transmission. Drug release was evaluated under sink conditions into phosphate buffered saline.

RESULTS

The results demonstrate that up to 2 wt% of the drugs can be incorporated into model silicone hydrogel materials without adversely affecting critical materials properties such as water uptake, light transmission, and surface hydrophilicity. Equilibrium water content ranged from 15 to 32% and transmission exceeded 89% for materials with at least 70% DMA. Extended release exceeding 14 days was possible with both drugs, with the total amount of drug released from the materials ranging from 16% to over 76%. Although a burst effect was noted, this was thought to be due to surface-bound drug, and therefore storage in an appropriate packaging solution could be used to overcome this if desired.

CONCLUSIONS

Silicone hydrogel materials have the potential to deliver drugs for over 2 weeks without compromising lens properties. This could potentially overcome the need for regular drop instillation and allow for the maintenance of drug concentration in the tear film over the period of wear. This represents a potential option for treating a host of ophthalmic disorders in children including myopia and retinoblastoma.

Contact lenses as drug reservoirs & delivery systems: the successes & challenges

Although conventional eye drops comprise over 90% of the marketed ocular dosage forms, they do have limitations, such as poor ocular drug bioavailability and systemic side effects; contact lenses are amongst the new delivery systems and devices that could overcome some of these problems. The most common approach to load drug molecules into contact lenses includes soaking in a drug solution. This approach had some success, but failed to achieve controlled/sustained drug release to the eye. On the other hand, nanoreservoir systems comprising nanoparticles, cyclodextrins, liposomes or surfactant aggregates being incorporated into the contact lenses could offer a plausible solution. This review highlights the status quo with contact lenses as ocular drug-delivery carriers and identifies possible future directions.