Ahead of speaking at the International Cornea and Contact Lens Congress, Professor Lyndon Jones – deemed the ‘Top Contact Lens Expert of the Decade’ by independent site Expertscape – discusses the cutting edge of care in anterior ocular pathology.
Q. In your Contact Lens and Anterior Eye Review article, you wrote “Contact lenses are medical devices which are prescribed and fitted; they should never be substituted for another lens type in the absence of a new prescription further to a full finalised fitting, for the simple reason that all soft contact lenses are not created equal. A substituted lens may have properties that result in undesirable consequences in respect of vision, ocular health, comfort, and cosmetic appearance, and may be incompatible with the lifestyle of the patient”.1 With more patients being prescribed soft disposable contact lenses, do you feel the public has become increasingly laissez faire, and that this message is now more important than ever?
I think a major issue is that the pandemic made a lot of people far more comfortable with online shopping, including shopping online for spectacles and contact lenses. There are several websites that are quite comfortable with providing a different lens to that which the patient is currently wearing, and substitution of products is common place. Our article uses evidence to show that all lenses are not equivalent, and that substitution could result in discomfort, physiological issues and potential dropout. So yes, I think this message – of the fact that lenses need to be appropriately fit and followed up, and that practitioner involvement is a critical part of this – is more important now than ever.
We will see more drug delivering contacts on the market in three to five years…
Dr Margaret Lam
Q. Your lecture, delivered at Aston University on Future Application of Contact Lenses, discussed the incredible diversity of new technologies under development that will shape the future for contact lenses, including nanotechnology and drug eluting contact lenses. Do you see these as areas of practitioner growth and expansion… and within what timeframe?
Yes, I certainly do see these areas becoming important to clinical practice over the next decade or so. In terms of when, this varies depending on the products being discussed. We have already seen incredible innovations over the past five years, with photochromic contacts, lenses that can monitor intraocular pressure and drug-eluting lenses already commercially available in many markets. When I graduated, these seemed like impossible products, but then again so did a cost-effective daily disposable lens! So, companies keep innovating.
Professor Lyndon Jones
My predictions? We will see more drug delivering contacts on the market in three to five years, biosensing contacts to detect ocular and systemic disease within the next 10 years and augmented reality lenses for things like head-up displays within a similar time frame. There are many exciting developments ahead for us contact lens practitioners for sure.
Q. At Aston University, you also discussed the “rapid growth in novel biomaterials and the development of powered contact lenses through advancements in nanotechnology, which will enable the commercialisation of lenses that can both detect and treat ocular and systemic disease”. Which biomaterials do you feel are particularly interesting?
Materials being developed to push the boundaries of comfort. We know that when we measure comfort with no lens in place, it is always (or almost always) higher than when we wear a contact lens for 10 hours or more. Why is that? Is it due to changes to the lens that upset the eye, or is it just that the biology of the eye changes over the course of the day? Companies are trying to develop lens materials that more closely resemble the ocular surface and conjunctiva to enhance comfort responses, and they are using many different concepts to achieve that.
Table 1. Percentage of COVID patients who were found to have coronavirus in their tears or on their ocular surface.2
Q. In your journal article published with Karen Walsh on COVID-19 and contact lenses,2 you shared insights (Tables 1 and 2)2 on the percentage of COVID patients who were found to have coronavirus in their tears or on their ocular surface. Now that we are learning to live with the virus, what practical advice do you think practitioners should learn from this?
Practitioners need to be assured that the eye is an unlikely route of infection for COVID-19 and we should not be concerned about fitting contact lenses to patients. The view that handling a patient’s contact lenses or touching in and around their eyes may be more likely to result in COVID-19 than handling their spectacles has not been proven. Our recent work, which looked at coronavirus binding to lenses showed there is no difference between lens materials and that the virus is easily removed from rigid and soft lens materials with a brief rub and rinse. It also showed that oxidative systems based on peroxide or povidone-iodine kill the virus almost instantaneously. So, for reusable wearers, remember to recommend that rub and rinse step.
Table 2. Percentage of COVID patients who were found to have coronavirus in their tears or on their ocular surface.2
Q. In your article with Karen Walsh and Kurt Moody in Clinical and Experimental Optometry, you addressed common myths and misconceptions in soft contact lens practice.3 Is this a topic you will discuss at ICCLC?
Yes, it is. The article addressed 10 common myths about contact lens wear and the business of contact lens practice, and it looked at how those myths can be dismissed based on peer-reviewed, contemporary evidence. It also explored the impact of oxygen on comfort, whether kids can safely wear contacts, whether astigmatism can be masked, and how good (or bad) multifocal lenses are, among other things. CORE at the University of Waterloo has a downloadable infographic to accompany this open-access publication (contactlensupdate.com/2022/01/25/top- 10-myths-of-fitting-soft-contact-lenses).
Q. What excites you about attending the ICCLC?
My view is, if you want to hear about the latest developments in contact lenses, ICCLC is a conference that you simply can’t miss. The program looks fantastic, and I am very much looking forward to catching up – in-person – on the latest research findings and clinical hints and tips to grow my practice, and to keep my patients safe and comfortable in their lenses.
The ICCLC takes place at the International Convention Centre in Sydney from 15–17 October 2022. Visit: www.cclsa.org.au.
Dr Margaret Lam is the National President of Optometry Australia and the National President of the Cornea and Contact Lens Society of Australia, Deputy President of Optometry Australia, and a Director of Optometry NSW/ACT. She teaches at the School of Optometry at UNSW as an Adjunct Senior Lecturer and works as the Head of Optometry Services for George and Matilda Eyecare.
Lyndon Jones DSc PhD FRSC FCAHS FCOptom FAAO FIACLE FBCLA, is a Professor at the School of Optometry and Vision Science, University Professor and Director of the Centre for Ocular Research & Education (CORE) at the University of Waterloo. He has authored over 450 refereed and professional papers, one text book and given over 1,000 invited lectures in over 40 countries.
References
- Efron N, Morgan PB, Nichols JJ, Walsh K, Mark D. Willcox MD, Wolffsohn JS, Jones LW. All soft contact lenses are not created equal. Contact Lens and Anterior Eye 45 (2022) doi.org/10.1016/j.clae.2021.101515
- Jones L and Walsh K, COVID-19, and contact lenses Practice re-entry considerations. Optician CET 7 August 2020.
- Walsh K, Jones L, and Moody K. Addressing common myths and misconceptions in soft contact lens practice. Clinical And Experimental Optometry https://doi.org/ 10.1080/08164622.2021.2003693
