SILICONE HYDROGEL CONTACT LENS

Mohamad Arief Herdiawan

Introduction
Oxygen
Attached
to the
Cornea
Initially used
for correcting
refractive
errors
More than 30
millions
Americans use
contact lenses
and 128 millions
worldwide.
Contact
Lens
Introduction

Hard
Rigid gas
permeabl
e
Hydrogel
Hybrid
Material
Daily wear
Continuous or
extended
Flexible
Conventional
Disposable
Occasional
Wear and
Replaceme
nt
Optical
Therapeut
ic
Cosmetic
Purpose
Spherical
Aspheric
Toric
Bifocal
Progressi
ve
Multicurv
e
Reverse
curve
Design
History of Contact Lens



(1827) : a
spherical glass
jelly over the
corneal surface

1888, Eugene
Kalt : contact
Lens for
keratoconus
Sir John
Herschel
1936 :
polymethylmethac
rylate (PMMA)

1948 : Kevin
Tuohy, whole
plastic Contact
Lens.
William
Feinbloom



1950 :
hydroxyethyl
methacrylate
(HEMA)

1970 : silicon
rubber material
Otto
Wichterle
History of Contact Lens


(+)
Hydrofilic
Less mechanical
effect, much
comfort

Hydrogel


(+) :
High oxygen
transmissibility
Silicon
( - ) :
Hydrophobic
mechanical
effects
( - )
Oxygen
permeability
depends on
water content
Silicone Hydrogel
Oxygen is primarily
transmitted through
the silicone
component of the
lens material
increasing the
oxygen permeability
silicone rubber
is combined
with
conventional
hydrogel
monomers
Introduced
in 1999
high oxygen
transmissibility
Resistance to
dehydration
Good fluid
transport
AAO
Types of Silicone Hydrogel CL
Advantages
1. Very high Dks
A term describing the oxygen permeability of a
lens material
D : diffusion coefficient for oxygen movement
in the material
k : solubility constant of oxygen in the material
Significantly reduce the incidence of hypoxic
complications
2. Suitable for extended wear
High-Dk, low-water-content silicone hydrogels
are used for extended wear.
Study : the annual incidence of severe keratitis
among those who wear conventional hydrogel
lenses overnight is 100/10,000 wearers.
Silicone hydrogel lenses : 20/10,000 wearers
3. Minimal Dry Eye Symptoms
Sensation of dryness is related to a variety of factors,
lens material dehydration include.
Silicone hydrogel contacts generally are low-water
lenses and may help reduce dry eye symptoms
high-water lenses draw tears away to stay properly
hydrated
Highly oxygen permeable SiH materials support a
connection between improved comfort and dryness
and the level of available oxygen.
4. High durability
SiH materials have a higher modulus of elasticity
than the majority of conventional hydrogel
materials easier to handle and potentially more
durable
Disadvantages
1. Mucin Balls
Spherical and translucent or opalescent
bodies sandwiched between a CL and the
cornea
20 and 200 mm in diameter
2. Not available in Complex
Designs
Astigmatism is not easily corrected
The lens contours to the eye and corneal
astigmatism frequently remains uncorrected.
Special designs of toric lenses available to
correct astigmatism of dioptric powers up to
4D

Types of contact lenses
Contact lenses can be classified by the nature of the
material from which they are made, by their
wearing schedule, by their purpose, or by their
design.
Nature of the Material
1. Hard
2. Rigid gas permeable
3. Hydrogel
4. Hybrid
Indications for contact lens
1. Optical Indications Most contact lens wearers fall into this group. The great majority are myopic with or
without astigmatism.

2. Medical Indications
Keratoconus
Irregular Astigmatism and/or Corneal Opacification
Anisometropia
Unilateral Aphakia
Nystagmus
After Refractive Surgery
After Penetrating Keratoplasty

3. Cosmesis
Prosthetic, tinted lenses are often used in patients with a disfiguring corneal scar or an iris coloboma to
improve the aesthetics of a nonseeing eye or to occlude an iris coloboma. Cosmetic lenses may also
simply be used to alter the color of the eye.
4.Therapeutic Lenses
treatment of a corneal disease
Contraindications
Evaluate the patients motivation, ocular needs, and ocular and medical
history. Unmotivated patients tend not to adhere to the prescribed methods
and care regimens for the contact lens, putting them at greater risk of
complications.
1. Any acute or subacute inflammation of the anterior segment of the eye
2. Acute and chronic ocular infections
3. Any eye disease affecting the cornea, conjunctiva, and lids (e.g., epithelial
fragility, endothelial failure, dry eye, allergy, pinguecula, pterygium)
4. Corneal hypesthesia
5. Uncontrolled glaucoma
6. Vitreocorneal touch in aphakia
7. Psychological intolerance to the placement of a foreign body in the eye
Advantages and disadvantages of contact
lenses
compared with spectacles
Advantages
Wider field of view.
Better for refractive anisometropia.
Retinal image size almost normal with
refractive ametropia (e.g. with aphakia, high
minus).
No unwanted prismatic effects with eye
movements.
Less convergence required by hyperopes for
near vision.
Avoid surface reflections.
Minimal oblique or other aberrations.
Cosmetically superior.
More practical for sports.
Avoid weather problems (rain, snow, fogging
up).
Provide good acuity for irregular corneas
(keratoconus, trauma, and subsequent to
refractive surgery).
Therapeutic uses.
Vocational uses
Disadvantages
Time required for fitting and adaptation.
Handling skills required by patient.
Hygienic procedures and lens disinfection necessary.
Wearing time may be limited.
Range of useful tints limited, especially with complex lenses.
For binocular problems, only limited vertical prism possible.
Greater convergence required by myopes for near vision.
Lenses can be lost or broken.
Problems with foreign bodies.
Peripheral flare (especially at night).
Deteriorate with use and age.
Retinal image size disparity in axial anisometropia
Maintenance costs.
Greater overall expense.
Administrative procedures for disposable lens supplies
Rigid gas permeable
A rigid gas permeable lens is made of a
material with a molecular structure that permits
the passage of oxygen and carbon dioxide gas
Advantages
High oxygen
permeability
Reduced spectacle blur
More comfort
More stability, better
centration
Prevent lid impact and
blink inhibition
Ease in handling
Disadvantages
Need adaptation
Uncomfortable for
novice
Expensive cost
Poor wetting
Greater fragility
Easily scrathed
surfaces
RGP
CONT..
Advantages
Low maintenance cost
(can be clean &
polished easily)
Good visual
performance
Better masking of
astigmatism
Less glare
Resist deposits than
soft lens
More durable, last
longer
Disadvantages
Need adaptation
Uncomfortable for
novice
Expensive cost
Poor wetting
Easily scrathed
surfaces
RGP
Indication
Rigid / soft lens drop out
Keratoconus
Excessive spectacle blur
Patients susceptible to
flare
High corneal astigmat up
to 2.5D
Giant Papilary Conjuctivitis
Rigid lens discomfort
Contraindications
Sports activities
Wide pupil (> 6mm)
Acute inflammation
Uncontrolled Glaucoma
Psychologycal intolerance
RGP
water content (degree of
hydration) of a hydrophilic contact
lens
The water content represents the percent water contained in the
polymer matrix and ranges from 35% to 80% in hydrogel
contact lenses.
Hydrophilic contact lenses can be classified in two categories
based on water content:
1. Low water content (less than 50% water)
2. High water content (greater than 50% water)

The oxygen transmissibility of a hydrophilic contact lens is
directly related to its water content and inversely related to its
thickness.
Ionic Content of Hydrogel CL
Contact lenses may also be classified by their
ionic nature. Ionic materials are negatively
charged and therefore more reactive, whereas
nonionic materials are electrically neutral. The
ionic lenses are more prone to protein
deposition on the surface of the lens.
therapeutic contact lens
indications
Pain reduction caused by defects or lesions of the corneal
epithelium
More rapid restoration and preservation of corneal epithelial
integrity
Protection of the cornea in cases of corneal drying
Protection of the cornea in cases of mechanical injury
secondary to entropion and trichiasis
Restoration of the anterior chamber after shallowing caused
by small corneal perforations
Delivery of medications to the ocular surface
benefits of using a therapeutic contact lens?
Alleviation of pain
Treatment of corneal disease
Improvement of visual acuity

The following testing should be completed at the follow-up visit for
hydrophilic soft lens wearers:
1. Visual acuity measurement
2. Overrefraction
3. Assessment of the patients contact lensrelated comfort
4. Evaluation of the length of wear
5. Evaluation of lens maintenance
6. Biomicroscopy (examination for microcysts, fluorescein staining of the cornea,
infiltrates, neovascularization, edema, and erosions)
The follow-up schedule depends on the sensitivities and individual characteristics of
each eye. First-time contact lens wearers should be examined 2 weeks after the initial
dispensing visit and then at 3- to 6-month intervals during the first year, depending on
the wearing schedule and lens type. In wearers who intend to sleep with their contact
lenses, the clinician should verify that there are no contraindications to extended wear,
with immediate discontinuation of use at the first signs of any adverse effects on the
cornea. For those wearers who do not intend to sleep with their contact lenses, an
annual examination is sufficient. In follow-up examinations, the clinician should always
verify that the instructions for contact lens maintenance are being adhered to. Many
eyes are very sensitive and show signs of hypoxia and overwear. In these cases,
wearing time with a contact lens of low permeability should be reduced 4 to 6 hours per
day
The TBUT
measures the interval between the last
complete blink and the first appearance of a
dry spot or disruption of the tear film
Three TBUT scores were averaged :
> 10 seconds = normal
< 10 seconds = presence of dry eye

Schirmer Test
Test Topical
anesthesia
Time Nasal
Stimulation
Normal value
Basic tear
secretion
+ 5 min - > 10 mm
Schirmer I - 5 min - > 10 mm
Schirmer II - 5 min + > 15 mm