Contact Lenses in 2020 and Beyond: What Does the Future for Contacts Look Like?

Transcription

1 Lyndon Jones PhD, FCOptom, FAAO Financial Disclosures: Contact Lenses in 2020 and Beyond: What Does the Future for Contacts Look Like? Lyndon Jones PhD FCOptom FAAO Professor and University Research Chair School of Optometry & Vision Science, Depts of Physics, Biology, Chemical Engineering & Chemistry Over the past three years members of the CCLR have received research funding and/or honoraria from the following companies: Advanced Vision Research Alcon AlgiPharma Allergan Contamac USA CooperVision Essilor J&J Vision Care Ocular Dynamics Oculus TearScience Director,, University of Waterloo, Ontario, Canada CL Developments Over Next 30 Years? Future of Contact Lenses Myopia control Detection of disease Management of disease Entertainment industry 1

2 Myopia Prevalence Myopia Prevalence USA 42% Finland 22% Sweden 50% UK 19%^ Ireland (N) 18% Germany 41% South Korea 97% Morocco 9% Israel 28% Japan 66% China 95% Iran 8% India 19% Taiwan 96% + Alarming increase in # of myopes 23% in % in billion Ghana 2% Malaysia 33% Singapore 79% Brazil 26% Indonesia 62% South Africa 10% Australia 12% Age group years; myopia definition: at least -0.50D *6year-olds; ^12-13year-olds; + criteria Fonn: Concerned parents and patients. Eye Contact Lens 2010; 36;2: Holden et al.: Global Prevalence of Myopia and High Myopia and Temporal Trends from 2000 through Ophthalmology 2016; 123;5: Change Over Time The onset of myopia is shifting to a younger age in Taiwanese school children 1 n~10,000 each year 11 year-olds in year-olds in year-olds in year-olds in % of Singaporean children at the age of 7 are at least -6.00D myopic 2 1. Lin et al.: Prevalence of myopia in Taiwanese schoolchildren: 1983 to Ann Acad Med Singapore 2004; 33;1: Saw et al.: Incidence and progression of myopia in Singaporean school children. Invest Ophthalmol Vis Sci 2005; 46;1: 51-7 Pathological Complications Peripheral Defocus Ocular pathological complications are typically seen with higher levels of myopia at least -6.00D - Also known as pathological myopia, degenerative myopia and malignant myopia Choroidal neovascularisation Maculopathy Retinal detachment Peripheral retinal complications Glaucoma Cataract Myopic retinopathy Optic disc abnormalities Posterior staphyloma Eye stretches to match peripheral retina to image shell 1. Jones & Luensmann: The prevalence and impact of high myopia. Eye Contact Lens 2012; 38;3: Verkicharla et al: Current and predicted demographics of high myopia and an update of its associated pathological changes. OPO 2015; 35;5: Figure modified from Smith, E.: Visual Experience & Myopia (ppt available at: day3/session%209%20- %20Research%20and%20Collaborations/Earl%20Smith%20-%20Myopia%20Research.ppt) 2

3 Peripheral Defocus Animal Models New strategies Development of new spectacle and contact lens designs that correct ametropia at BOTH fovea and periphery Image shell and ocular shape closely match Woods et al.: Inhibition of defocus-induced myopia in chickens. Invest Ophthalmol Vis Sci 2013; 54;4: Myopia & SCL with Peripheral Focus Control 1. Anstice et al. Effect of dual-focus soft contact lens wear on axial myopia progression in children. Ophthalmology 2011; 118;6: Sankaridurg et al. Decrease in rate of myopia progression with a contact lens designed to reduce relative peripheral hyperopia: one-year results. Invest Ophthalmol Vis Sci 2011; 52;13: Daily disposable Proclear material (omafilcon A) Multizone, dual-focus design Very limited availability Reviews on Myopia Control Ortho-K vs Atropine/SCL MF for Myopia Control 1. Walline et al: Interventions to slow progression of myopia in children. Cochrane Database Syst Rev 2011;12: CD Smith & Walline: Controlling myopia progression in children and adolescents. Adolesc Health Med Ther 2015; Gifford & Gifford: The Future of Myopia Control Contact Lenses. Optom Vis Sci 2016; 93;4: Walline: Myopia Control: A Review. Eye Contact Lens 2016; 42;1: 3-8. Smith & Walline: Controlling myopia progression in children and adolescents. Adolesc Health Med Ther 2015; 6:

4 Optics & Pharmaceuticals OK & MF Combination Kids: When Start Wearing? Wearable Sensor Market Smart CL System Market for wearable technology is expected to reach $US Billion by 2020, at annual growth rate of 17.8% smartwatches wristbands Major players Adidas; Apple; Fitbit; Garmin; Google; Nike; Samsung; Sony 4

5 Powered CL Developments Verily (Google Life Sciences) Lee et al. High-Performance, Transparent, and Stretchable Electrodes Using Graphene Metal Nanowire Hybrid Structures. Nano Letters 2013;13: J&J; Samsung CL Monitoring Devices Glaucoma Sensimed Triggerfish Smart" contact lens with tiny embedded strain gauge to monitor curvature of the eye over a period of 24 hours Looks at relative changes in IOP not absolute values Silicone-based (Dk=292) Thickness = 325µm Dk/t = 119 Single-use only >60 patents since Lorenz, et al. (2013). Tolerability of 24-hour intraocular pressure monitoring of a pressure-sensitive contact lens. J Glaucoma, 22(4), Mansouri, & Weinreb (2012). Continuous 24-hour intraocular pressure monitoring for glaucoma--time for a paradigm change. Swiss Med Wkly, 142, w Mansouri & Weinreb (2012). Meeting an unmet need in glaucoma: continuous 24-h monitoring of intraocular pressure. Expert Rev Med Devices, 9(3), , Mansouri et al (2015). Efficacy of a contact lens sensor for monitoring 24-h intraocular pressure related patterns. PLoS One, 10(5), e CL Monitoring Devices Glaucoma Lens contains a tiny dedicated processing circuit and an RF transmitter to communicate the measurements to an adhesive antenna worn around the neck, which then sends the info to a portable data recorder worn by the patient 24 hr IOP monitoring FDA Approval: March Mansouri & Weinreb: Meeting an unmet need in glaucoma: continuous 24-h monitoring of intraocular pressure. Expert Rev Med Devices 2012; 9;3: Aref: What happens to glaucoma patients during sleep? Curr Opin Ophthalmol 2013; 24;2: Lorenz et al.: Tolerability of 24-hour intraocular pressure monitoring of a pressure-sensitive contact lens. J Glaucoma 2013; 22;4:

6 Despite lack of further evidence on potentially beneficial effects of sexual activity on glaucoma, the present data suggest that sexual activity may (at the least) not cause worsening of the IOPdependent mechanism of glaucoma. Interesting Data Mansouri et al: Intraocular pressure changes during sexual activity. Acta Ophthalmol 2013; 91;4: e Contact Lenses for Diabetes? 382 million diabetics worldwide Daily monitoring of blood glucose is intrusive diabetic patient pricks their finger 1800 times a year Different body fluid such as urine, saliva or tears could be monitored The glucose monitoring devices market is expected to be more than $16 billion by the end of 2014 Tears are easily accessible but takes more than 10 mins to collect enough tears in a capillary tube to test Zhang et al. Non-invasive diagnostic devices for diabetes through measuring tear glucose. J Diabetes Sci Tech 2011;5: Blood vs Tear Glucose Nanostructure Glucose Sensors Poor correlation between blood and tears for glucose levels in non-diabetics Excellent correlation for diabetics (R 2 >0.8) Unable to develop a viable CL-based detection product at the time due to technical limitations Blood Tears Lane et al. Tear glucose dynamics in diabetes mellitus. Curr Eye Res 2006;31: Zhang et al. Non-invasive diagnostic devices for diabetes through measuring tear glucose. J Diabetes Sci Tech 2011;5: Electrical Glucose Sensors Jan 17 th 2014 Google announces its entry into the market.. Chu et al. Soft contact lens biosensor for in situ monitoring of tear glucose as non-invasive blood sugar assessment. Talanta 2011;83:

7 July 15 th 2014 CLs for Cancer Monitoring? Certain biomarkers are elevated in dogs who have cancer Lacryglobin elevated in human tears in patients with breast, colon, lung, prostate and ovarian cancer Could develop CL sensors to these biomarkers 1. de Freitas Campos et al. Proteomic analysis of dog tears for potential cancer markers. Research in Veterinary Science 2008;85: Evans et al. Lacryglobin in human tears, a potential marker for cancer. Clinical and Experimental Ophthalmology 2001;29: CL Biosensor Targets? IOP Blood pressure Heart rate Respiratory rate Kidney function Ovulation Foetal monitoring branch Corneal Abrasions Prophylactic: Deep Abrasions & RCE curling iron 7

8 Drug Delivery Treatment: Microbial Keratitis 90% of current market formulations for disease management poor insertion technique in >50% over-spill poor compliance in 50% tear flow drainage diluted by blinking corneal diffusion resistance Substantial systemic absorption <5% of drug gets to target Plenty of recent interest A Dream? Number of Peer-Reviewed Articles PubMed search: drug delivery + contact lens = L Jones. Contact Lens Spectrum 2009; 24;3: Recent Articles Drug Delivering SiHy Materials 8

9 Release Rates Ophthalmic Drug Delivery Acuvue 2 phema Soflens 66 PureVision Biofinity Hui et al. Eye Contact Lens 2008; 34;5: Molecular Imprinting: Novel CL Materials Clinically Relevant Amounts of Release up to 14 days Hui et al.: Acetic and acrylic acid molecular imprinted model silicone hydrogel materials for ciprofloxacin-hcl delivery. Materials 2012; 5;1: Hui A, Sheardown H, Jones L. Acetic and Acrylic Acid Molecular Imprinted Model Silicone Hydrogel Materials for Ciprofloxacin-HCl Delivery. Materials 2012;5: Rabbit Model of Microbial Keratitis Drugs Under Investigation 0 Hours: epithelium scratched and inoculated with 10 8 P aeruginosa 16 Hours: Intervention with hourly drops or CL (control and loaded with cipro) 24 Hours: rabbits euthanized, corneas excised and homogenised and bacterial # recovered Anti-infective Anti-inflammatory Anti-glaucoma Epidermal growth factor Anti-allergy J&J have already evaluated a ketotifenreleasing DD lens antihistamine/mast cell stabilizer 9

10 Virtual Reality Contacts? inc.com Visual Augmentation Mission Impossible: Ghost Protocol inc.com Contact lens is a key component permits focus on content close to the eye or carries the information display (Image: Institute of Physics) Sept 20 th 2015 Nov 15 th

11 Future for Contacts? Summary Contact lens industry is alive and well practitioners now have MANY excellent products to offer to patients Contacts will still be here in 2050! Development of new products with extended roles in health monitoring health treatment unique optical uses 11