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Options expand for ocular surface bandages
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I have long been fascinated by the technologies we use and the dramatic impact they have on patients’ lives. How, for instance, a tiny intraocular lens can profoundly improve the visual function of an individual blinded by cataracts. Or the instantaneous pain relief provided by a single drop of topical anesthetic in a patient with a corneal foreign body. While my list of “fascinations” is quite long, one of my favorites is the bandage contact lens – and the role it plays in corneal wound healing.
Undoubtedly, some of this bias relates to my early research years, during which time I was fortunate to co-author articles that ran the gamut from studying the impact of collagen bandage lenses on corneal wound healing (Aquavella et al.) to the clinical applications of disposable contact lenses as therapeutic bandages (Lindahl et al.). While our research was an epiphany of sorts for me, we were anything but pioneers in this arena. In fact, the concept of bandage lenses can be traced to the first century A.D., when Celsus applied honey-soaked linens to the ocular surface in an effort to enhance wound healing and prevent symblepharon formation.
Since then, clinicians have used a variety of bandage lenses, ranging from glass scleral shells (Ridley) to the hydrophilic soft contact lenses (Kaufman and Gasset). While designs and materials have evolved over the years, the fundamental principle has remained the same: restore ocular surface integrity by creating a nurturing and protected environment.
I think part of my fascination with bandage lenses is that they fit so nicely within the realm of optometry. Our contact lens training and experience certainly qualifies us to prescribe, modify and monitor bandage contact lenses. In addition, our understanding of corneal physiology – as well as the pathophysiology associated with various corneal diseases, traumas and surgical sequelae – provides us with a comfort level in employing ancillary treatments associated with bandage contact lens wear. Add the fact that most optometrists take a conservative, thorough and attentive approach in implementing bandage contact lenses and one has the perfect formula for achieving exceptional outcomes while mitigating risk.
The challenge in prescribing bandage contact lenses across a wide spectrum of clinical applications lies in staying abreast of emerging technologies. While it is safe to say that silicone hydrogels are the bandage lens of choice for most applications today, this may not always be the case. The future certainly holds promise for molecularly imprinted drug-eluting contact lenses, and other nontraditional platforms are providing alternative strategies for managing certain patients.
In this month’s Primary Care Optometry News, we take a closer look at two emerging “alternative” ocular surface bandages: the Prokera amniotic membrane lens and the Nexis Vision ocular lens. While these two technologies differ in material, design and application, they, like their predecessors, share a commonality: the ability to restore ocular surface integrity by creating a nurturing and protected environment. Fascinating, for sure.