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
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.
Received September 10th, 2012; revised October 15th, 2012; accepted October 30th, 2012
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
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
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
#Corresponding author. The predominant reason for prescription of CLs, the
Copyright © 2012 SciRes. OJOph
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.
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
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.
Copyright © 2012 SciRes. OJOph
Continuous Wear of Hydrogel Contact Lenses for Therapeutic Use
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.
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 . 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 . 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-
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