Continuous Wear of Hydrogel Contact Lenses for Therapeutic Use

doi:10.4236/ojoph.2012.24023

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Open Journal of Ophthalmology, 2012, 2, 110-113

http://dx.doi.org/10.4236/ojoph.2012.24023 Published Online November 2012 (http://www.SciRP.org/journal/ojoph)

Continuous Wear of Hydrogel Contact Lenses for

Therapeutic Use*

Daisuke Kudo1, Hiroshi Toshida2#, Toshihiko Ohta2, Akira Murakami1

1Department of Ophthalmology, Juntendo University School of Medicine, Tokyo, Japan; 2Department of Ophthalmology, Juntendo

University Shizuoka Hospital, Shizuoka, Japan.

Email: #[email protected]

Received September 10th, 2012; revised October 15th, 2012; accepted October 30th, 2012

ABSTRACT

Purpose: To investigate the efficacy and complications of continuous wear of etafilcon A for therapeutic use. Materi-

als and Methods: The subjects were 228 eyes of 219 outpatients prescribed Contact Lens (CL) for one week of con-

tinuous therapeutic wear during 10 years. The reason for prescription of CLs, the primary disease, the duration of CL

wear and the complications were assessed retrospectively. Results: The predominant reason for prescription of CLs was

relief of pain or a foreign-body sensation (62.3%) and protection of the corneal epithelium (20.6%). The primary dis-

ease was post-penetrating keratoplasty (36.8%), followed by corneal epithelial erosion (14.5%), post-lamellar kerato-

plasty (14.0%) and bullous keratopathy (12.2%). The average duration of wearing single lens was 6.5 ± 3.2 days. The

average duration of wearing CLs in total was 9.2 ± 10.7 months. The most frequent problem associated with continuous

wear of CLs was their dropping out of CLs (12.3%). The complications associated with CLs included conjunctivitis

with papillary hyperplasia, corneal erosion and superficial punctate keratitis, but corneal ulcer and corneal infiltrates

were not found. Conclusion: Serious complications were not shown changing the lenses every week to keep to the pre-

scribed time limit for continuous therapeutic wear, even if corneal epithelial barrier function is impaired.

Keywords: Therapeutic Use; Bandage; Soft Contact Lens; Continuous Wear; Complication

1. Introduction

Contact Lenses (CLs) are originally developed for the

correction of refractive errors. CLs are used not only as

an optical device but as a therapeutic device for ocular

surface disorders. Recently, Soft Contact Lenses (SCLs)

are occasionally used for treating corneal and conjunctival

diseases, being used to prevent the exfoliation of corneal

epithelial cells and to protect from mechanical damage

and to hold wettability of the ocular surface preventing

evaporation of the tear fluid [1-13].

In most patients who are prescribed SCLs for thera-

peutic use, corneal epithelial damage is present and barrier

function may be impaired. The corneal epithelium is al-

ways in contact with the external environment and is likely

to come into contact with foreign bodies and pathogens.

Nevertheless, corneal infection usually does not occur in

healthy eyes. This may be because of effective corneal

epithelial barrier function and protective substances in

the tear film. Thus, it is possible that there may be a high

rate of complications associated with continuous use of

CLs.

We investigated the efficacy and complications of

continuously wearing therapeutic SCLs in patients treated

at our hospital over a period of 10 years.

2. Materials & Methods

The subjects were 228 eyes of 219 outpatients who were

prescribed etafilcon A hydrogel SCL, Acuvue® (Johnson

& Johnson, New Brunswick, NJ, USA) for one week of

continuous wear at the Department of Ophthalmology of

Juntendo University Hospital during the 10 years be-

tween March 1995 and March 2005. They included 111

men (116 eyes) and 108 women (112 eyes). All patients

provided informed consent, and this study was conducted

in accordance with the Declaration of Helsinki. The first

trial lens data for eyes with myopia was following; base

curve: 8.8 mm; diameter: 14.0 mm, irrespective of ave-

rage corneal radius. If fitting pattern was too loose, the

base curve was changed to 8.4 mm. Eyes with hyperopia

were worn plus power lenses, which diameter was 9.1

mm. After checking lens fit, CL wear was started.

*Funding support: None

All authors have no proprietary interest in the materials discussed in

this manuscript.

#Corresponding author. The predominant reason for prescription of CLs, the

Continuous Wear of Hydrogel Contact Lenses for Therapeutic Use 111

predominant primary disease, the duration of wearing

therapeutic CLs and the complications associated with

CLs were assessed retrospectively. Data were shown as

the mean ± standard deviation.

3. Results

Patients included 111 men (116 eyes) and 108 women

(112 eyes) and the proportions of male and female pa-

tients were comparable. The age of starting to wear CLs

was between 8 and 89 years, and their average age was

55.0 ± 17.2 years. Base curve of the most frequent pre-

scribed lens was 8.8 mm (204 eyes), and 8.4 mm (12 eyes)

and 9.1 mm for hyperopia (12 eyes) were followed.

The predominant reason for prescription of CLs was

relief of pain or a foreign-body sensation (142 eyes,

62.3%), followed by protection of the corneal epithelium

(47 eyes, 20.6%), both of the above (38 eyes, 16.7%) and

protection of the conjunctiva (1 eye, 0.4%).

The predominant primary disease was post-penetrating

keratoplasty (84 eyes, 36.8%), followed by corneal epi-

thelial erosion (33 eyes, 14.5%), post-lamellar kerato-

plasty (32 eyes, 14.0%), bullous keratopathy (28 eyes,

12.3%), corneal ulcer (18 eyes, 7.9%), superficial punc-

tate keratitis (8 eyes, 3.5%) and filamentosa (6 eyes, 2.6%)

(Table 1).The average duration of wearing each single

lens was 6.5 ± 3.2 days. With regard to the total duration

of wearing CLs, the average was 9.2 ± 10.7 months. The

longest duration was for bullous keratopathy (14.8 ± 13.9

months), followed by penetrating keratoplasty (12.0 ±

12.0 months) and filamentary keratitis (10.0 ± 9.2 mon-

ths) (Table 2).

The most frequent problem associated with continuous

Table 1. The predominant primary diseases for prescription of therapeutic contact lenses (CLs) and major complications.

Major complications (stopped wearing CLs)

Predominant primary diseases Number of eyes (%)CLPC Corneal erosion SPK Total

Post-penetrating keratoplasty 84 (36.8%) 3/84 (3.6%) 1/84 (1.2%) 1/84 (1.2%) 5/84 (6.0%)

Corneal erosion 33 (14.5%) - - - -

Post-lamellar keratoplasty 32 (14.0%) - - - -

Bullous keratopathy 28 (12.3%) 7/28 (25.0%) 3/28 (10.7%) 1/28 (3.6%) 11/28 (39.3%)

Corneal ulcer 18 (7.9%) - - - -

Superficial punctuate keratitis 8 (3.5%) - - - -

Filamentosa 6 (2.6%) - - - -

Others 19 (8.3%) - - - -

Total 228 (100.0%) 10/228 (4.4%)4/228 (1.8%) 2/228 (0.9%) 16/228 (7.0%)

Data were collected at the Department of Ophthalmology, Juntendo University Hospital, Japan, between March 1995 and March 2005. CLPC = contact lens

induced papillary conjunctivitis; SPK = Superficial Punctuate Keratitis.

Table 2. Average duration of continuous CL w ear and problems associated with the CL wear.

Problems associated with contact lens

Predominant primary diseases Average duration of

wearing (months) Dropping out

of lenses Lens fitting

failure Lens

breakage Total

Bullous keratopathy (n = 28) 14.8 ± 13.9 6/28 (21.4%) - 1/28 (3.6%) 7/28 (25.0%)

Post-penetrating keratoplasty (n = 84) 12.0 ± 12.0 13/84 (15.5%) 2/84 (2.4%) 1/84 (1.2%) 16/84 (19.0%)

Filamentosa (n = 6) 10.0 ± 9.2 4/6 (66.7%) - - 4/6 (66.7%)

Post-lamellar keratoplasty (n=32) 8.4 ± 7.4 - - - -

Corneal ulcer (n = 18) 5.3 ± 5.3 - 1/18 (5.6%) - 1/18 (5.6%)

Superficial punctate keratitis (n = 8) 2.7 ± 3.1 - - - -

Corneal erosion (n = 33) 1.5 ± 1.8 2/33 (6.1%) - - 2/33 (6 .1%)

Total (n = 228) 9.2 ± 10.7 25/228 (11. 0 %)3/228 (1.3%)2/228 (0.9%) 30/228 (13.2%)

ata collected at the Department of Ophthalmology, Juntendo University Hospital, Japan, between March 1995 and March 2005.

Continuous Wear of Hydrogel Contact Lenses for Therapeutic Use

112

wear of CLs was their dropping out of the lenses from

their eyes (25 eyes, 11.0%), followed by lens fitting fail-

ure (3 eyes, 1.3%) and lens breakage (2 eyes, 0.9%) (Ta-

ble 2). All of these problems were reported in patients

with bullous keratopathy or penetrating keratoplasty.

Major complications associated with CLs, resulted in-

stop wearing CLs were shown in 16 eyes of 228 eyes

(7.0%), included conjunctivitis with papillary hyperplasia

(CLPC) (10 eyes, 4.4%), corneal erosion (4 eyes, 1.8%)

and superficial punctate keratitis (2 eyes, 0.9%) (Table 1),

but corneal ulcer and corneal infiltrates were not found.

4. Discussion

Usually, the use of conventional SCLs for therapeutic

wearis reported that it causes few problems.In contrast,

there are many evidences of the advantage for therapeutic

use of disposable Acuvue® lens clinically [1-6]. Although

Acuvue® is a disposable SCL for continuous wear until 1

week, therapeutic use is not permitted by FDA. In ge-

neral, lens care is not required for continuous wear CLs

including therapeutic use of CLs. So the risks of conta-

mination of CLs can be decreased by poor lens cleaning,

ineffective lens care agents and contamination of the lens

case. It seems to be a favorable situation, but there are

actually complications caused by continuous wear of CLs

[14-16]. This is because infectious keratit can develop

after bacterial infection is established after damage to the

corneal epithelium barrier function. Especially corneal epi-

thelium barrier function was usually disturbed in patients

who need CLs for therapeutic use. Therefore, it seems

that the risk factor is higher than common CL wearers.

However, in the present study, even if corneal epithelial

barrier function was impaired, serious complications such

as infectious keratitis might be avoided if proper care of

CLs and the eyes is taken, including changing the lenses

every week to keep to the prescribed time limit for con-

tinuous wear, periodical eye examinations. Further, the

patients understood and agreed attending the eye clinic as

soon as an abnormality is noted. However, these can re-

sults in health care more expensive depending on the

health system of each country. These require spending

time and effort. These are drawback.

In the present study, the most frequent problem asso-

ciated with continuous wear of CLs was their dropping

out of the lens mainly shown in patients with bullous

keratopathy, post-penetrating keratoplasty and filamentosa

(Table 2). These patients were needed a long duration of

continuous CL wear. Long period might be a reason of

higher frequency of dropping out of their lenses.

The number of the patients who stopped wearing CLs

was the highest in that with bullous keratopathy (Table

1). These patients wore CLs temporary until receiving

penetrating keratoplasty. That seemed to be the reason.

On the other hand, the patients with bullous keratopathy

needed the longest duration of CL wearing. This would

be based on the Japanese specific condition, because of

lack of donor. Recently, precut donor can be imported

from foreign countries for Descemet Stripping Auto-

mated Endothelial Keratoplasty (DSAEK), and waiting

time for those patients will become shorter, gradually. It

may dissolve this problem in Japan.

Recently, it is reported the benefit of silicone hydrogel

lenses for therapeutic use [7-13]. On the other hand, the

same bacteria were detected from the lens, eyelids and

conjunctiva during periodical examination of patients who

were continuously wearing silicone hydrogel lenses, sug-

gesting that lens contamination during continuous wear

was derived from the eyelids or conjunctiva [17]. Some

recent studies have shown that the incidence of infectious

keratitis associated with continuous wearing of silicone

hydrogel lenses is lower than or similar to that associated

with use of daily SCLs or rigid gas permeable contact

lenses [18,19]. There is a report that, even with silicone

hydrogel lenses, continuous wear of CLs is a risk factor

for bacterial infection [20]. This problem seemed to have

been solved after silicone hydrogel lenses became avail-

able, but there may be other reasons why infectious ke-

ratitis has not yet been eliminated.

In conclusion, the duration of continuous wear of each

Acuvue® lens for therapeutic use is only one week. Be-

cause handling of lenses and lens care are not required so

that touching the eyes and lenses with contaminated fin-

gers and hands can be avoided, with the result being that

there is few possibility of lens contamination by external

factors. Especially, most of patients might be sensitive to

ocular abnormalities since they already have eye diseases.

As mentioned above, it is possible to prevent major com-

plications including infectious keratitis by taking proper

care of therapeutic CLs and the eyes, even when con-

tinuous wearing of SCLs is done to treat corneal diseases

associated with impaired corneal epithelium barrier func-

tion. Some drawbacks are still remaining. For example, it

results in health care more expensive and requires spend-

ing time and effort.

REFERENCES

[1] P. Donshik, F. J. Weinstock, S. Wechsler, P. Asbell, J.

Atwood, H. Davis, B. Farkas, R. L. Farris, E. Gruber and

J. Hartstein, “Disposable Hydrogel Contact Lenses for

Extended Wear,” Contact Lens Association of Ophthal-

mologists Journal, Vol. 14, No. 4, 1988, pp. 191-194.

[2] J. E. Josephson, B. E. Caffery, I. Campbell and A. R.

Slomovic, “Disposable Contact Lenses vs Contact Lens

Maintenance for Extended Wear,” Contact Lens Associa-

tion of Ophthalmologists Journal, Vol. 16, No. 3, 1990,

pp. 184-188.

[3] K. J. Lindahl, M. D. DePaolis, J. V. Aquavella, G. O. Tem-

Continuous Wear of Hydrogel Contact Lenses for Therapeutic Use 113

nycky and R. A. Erdey, “Applications of Hydrophilic Dis-

posable Contact Lenses as Therapeutic Bandages,” Con-

tact Lens Association of Ophthalmologists Journal, Vol.

17, No. 4, 1991, pp. 241-243.

[4] E. Gruber, “The Acuvue Disposable Contact Lens as a

Therapeutic Bandage Lens,” Annals of Ophthalmology,

Vol. 23, No. 12, 1991, pp. 446-447.

[5] C. S. Bouchard and S. N. Trimble, “Indications and Com-

plications of Therapeutic Disposable Acuvue Contact

Lenses,” Contact Lens Association of Ophthalmologists

Journal, Vol. 22, No. 2, 1996, pp. 106-108.

[6] M. Srur and D. Dattas, “The Use of Disposable Contact

Lenses as Therapeutic Lenses,” Contact Lens Association

of Ophthalmolog ists Journal, Vol. 23, No. 1, 1997, pp. 40-

42.

[7] L. Lim, D. T. Tan and W. K. Chan, “Therapeutic Use of

Bausch & Lomb Pure Vision Contact Lenses,” Contact

Lens Association of Ophthalmologists Journal, Vol. 27,

No. 4, 2001, pp. 179-185.

[8] J. Montero, J. Sparholt and R. Mély, “Retrospective Case

Series of Therapeutic Applications of a Lotrafilcon a Sili-

cone Hydrogel Soft Contact Lens,” Eye & Contact Lens,

Vol. 29, No. 1, 2003, pp. S54-S56.

doi:10.1097/00140068-200301001-00015

[9] J. P. Szaflik, A. M. Ambroziak and J. Szaflik “Therapeutic

Use of a Lotrafilcon a Silicone Hydrogel Soft Contact

Lens as a Bandage after LASEK Surgery,” Eye & Contact

Lens, Vol. 30, No. 1, 2004, pp. 59-62.

doi:10.1097/01.ICL.0000107181.42704.D8

[10] A. M. Ambroziak, J. P. Szaflik and J. Szaflik, “Therapeutic

Use of a Silicone Hydrogel Contact Lens in Selected

Clinical Cases,” Eye & Contact Lens, Vol. 30, No. 1, 2004,

pp. 63-67. doi:10.1097/01.ICL.0000105563.54932.44

[11] R. Arora, S. Jain, S. Monga, R. Narayanan, U. K. Raina

and D. K. Mehta, “Efficacy of Continuous Wear Pure Vi-

sion Contact Lenses for Therapeutic Use,” Contact Lens

& Anterior Eye, Vol. 27, No. 1, 2004, pp. 39-43.

doi:10.1016/j.clae.2003.09.004

[12] C. C. Karlgard, L. W. Jones and C. Moresoli, “Survey of

Bandage Lens Use in North America, October-December

2002,” Eye & Contact Lens, Vol. 30, No. 1, 2004, pp. 25-

30. doi:10.1097/01.ICL.0000105564.71700.EE

[13] Y. Ozkurt, O. Rodop, Y. Oral, A. Cömez, B. Kandemir

and O. K. Doğan, “Therapeutic Applications of Lotrafil-

con a Silicone Hydrogel Soft Contact Lenses,” Eye &

Contact Lens, Vol. 31, No. 6, 2005, pp. 268-269.

doi:10.1097/01.ICL.0000163449.92288.71

[14] J. R. Armstrong, K. L. Cohen and L. R. McCarthy, “Hae-

mophilus Influenzae Corneal Ulcer in a Therapeutic Con-

tact Lens Wearer,” British Journal of Ophthalmology,

Vol. 68, No. 3, 1984, pp. 188-191.

doi:10.1136/bjo.68.3.188

[15] S. Koh, N. Maeda, T. Soma, Y. Hori, M. Tsujikawa, H.

Watanabe and K. Nishida, “Development of Methicillin-

Resistant Staphylococcus Aureus Keratitis in a Dry Eye

Patient with a Therapeutic Contact Lens,” Eye & Contact

Lens, Vol. 38, No. 3, 2012, pp. 200-202.

doi:10.1097/ICL.0b013e31823ff1f4

[16] N. Inoue, H. Toshida, N. Mamada, N. Kogure and A.

Murakami, “Contact Lens-Induced Infectious Keratitis in

Japan,” Eye & Contact Lens, Vol. 33, No. 2, 2007, pp. 65-

69. doi:10.1097/01.icl.0000233869.21964.1b

[17] L. B. Szczotka-Flynn, S. Bajaksouzian, M. R. Jacobs and

A. Rimm, “Risk Factors for Contact Lens Bacterial Con-

tamination during Continuous Wear,” Optometry & Vision

Science, Vol. 86, No. 11, 2009, pp. 1216-1226.

doi:10.1097/OPX.0b013e3181bbca18

[18] F. R. Edmunds, L. C. Timothy and W. T. Reindel, “Cu-

mulative Clinical Results and Projected Incident Rates of

Microbial Keratitis with PureVision Silicone Hydrogel

Lenses,” International Contact Lens Clinic, Vol. 27, No.

5, 2000, pp. 182-186.

doi:10.1016/S0892-8967(02)00082-2

[19] T. Sakimoto, Y. Miyamoto, M. Fukuda, Y. Shimomura, K.

Takahashi, T. Ishikawa, A. Murakami, K. Nakayasu, S.

Takeda, Y. Kamei, M. Matsubara, T. Sakimoto, N. Ta-

kaura, N. Fushimi, M. Sawa and Y. Kashima, “Clinical-

Report on Long-Term Extended Wear of Silicone Hy-

drogel Soft Contact Lens (RD-677),” Japanese Journal of

Contact Lens Society, Vol. 47, No. 1, 2005, pp. 6-21.

[20] F. Stapleton, L. Keay, K. Edwards, T. Naduvilath, J. K.

Dart, G. Brian and B. A. Holden, “The Incidence of Con-

tact Lens-Related Microbial Keratitis in Australia,” Oph-

thalmology, Vol. 115, No. 10, 2008, pp. 1655-1662.

doi:10.1016/j.ophtha.2008.04.002