The History of Contact Lenses

Introduction

* Updated for the 6th edition by Timothy J Bowden and Jacqueline Lamb from previous work by Anthony Sabell

The development of contact lenses is long and complex, starting mainly in Germany and then moving across Europe to the USA before going international. The authors have tried to keep things chronological; however, these developments do not fall into a nice convenient timeline. As you read the chapter, remember that the original ‘contact lens pioneers’ had limited equipment and materials available. They were truly working in the dark, and advancements happened only as new materials and new technologies became available. There were no antibiotics, so contact lenses were fitted by ophthalmologists only when clinically necessary, for conical cornea (keratoconus), symblepharon and other corneal diseases. Due to the working relationships between ophthalmologists and other eye care professionals, fitting soon devolved to dispensing opticians (around 1912) and later extended to optometrists (around 1935). As knowledge of the physiology of the cornea developed and materials and designs improved, so too did their success – not always as straightforward as it might appear, as some developments have solved one problem simply to replace it with another! At the time of writing, end-of-day comfort is still an issue, with some practitioners limiting wearing time to little more than it used to be in the 1930s.

† Sadly during the writing of this book, Tim Bowden passed away

Early Theorists

1508 : Leonardo da Vinci (Italy) It had previously been assumed that, in his Codex D, folio 3, famously illustrating a man with his head lowered into a large bowl of water, da Vinci showed the invention of a contact lens ( , , ). However, in the retranslation by Robert Heitz, it is clear that this was not a prototype contact lens but the beginning of understanding corneal neutralisation ( ).

1637: (France, Holland, Sweden) described in his seventh Discourse of La Dioptrique a fluid-filled tube used to enlarge the size of the retinal image ( ).

1685: Philippe de la Hire (Paris, France), a mathematician, presented his dissertations on the neutralisation of the cornea in 1685 and 1694 and speculated that myopia was axial or refractive. Sadly, his theories about accommodation and entoptic phenomenon were considered so controversial that his views on optics were largely ignored ( ).

1801: Thomas Young (Somerset, England) studied medicine in London and Edinburgh and physics at Gottingen. He conducted research into the eye, identifying the cause of astigmatism, and published a three-colour theory of perception. As a fellow at Cambridge University, he carried out his classic experiment on accommodation using a water-filled lens which he placed on the eye to neutralise the refractive effect of the cornea ( ).

1827: George Biddell Airy (England), inspired by Thomas Young and cooperating with John Herschel at Cambridge University, experimented with his own astigmatism. He described not only the optical theory of astigmatism but also its correction with a theoretical back surface toric lens ( , ).

1845: Sir John F. W. Herschel (Slough, England) was the son of Sir William Herschel, discoverer of Uranus. In his dissertation Light, he described the optical correction of malformed and distorted corneas using convex lenses applied to the eye. He suggested correcting ‘very bad cases of irregular cornea’ by using ‘some transparent animal jelly contained in a spherical capsule of glass’ and then went on to suggest whether ‘an actual mould of the cornea might be taken and impressed on some transparent medium’ ( ).

1846: Carl Zeiss (Jena, Germany), a mechanic who was 30 years of age at the time, opened a small workshop and store in Jena's Neugasse No. 7 to make scientific tools and instruments, telescopes and microscopes. This was the foundation of the company Zeiss ( www.zeiss.com ).

1851: Johann Nepomuk Czermak (Prague, Austro-German) developed a water-filled goggle strapped to the front of the eye to correct keratoconus, a device which he called the orthoscope. In 1896 Theodor Lohnstein developed a similar device, which he called the Hydrodiascope.

1854: Keratoconus . The first adequate description of keratoconus was published (John Nottingham, Great Britain).

1859: William White Cooper (London, England) was Queen Victoria's oculist. He had glass masks made by artificial-eye makers Gray and Holford of Goswell Road, London, to protect the eye in cases of symblepharon ( Fig. 1.1 ). These were clear glass shells very like scleral lenses but with no optic zone over the cornea.

1882: Dr Xavier Galezowski (Franco-Polish) suggested using a gelatine disc applied to the cornea immediately after cataract extraction. The disc was impregnated with cocaine and sublimate of mercury to provide corneal anaesthesia to relieve postoperative pain and antiseptic cover to prevent infection ( ). Here we see not only the first use of a soft and hydrophilic contact appliance but also the forerunner of the hydrophilic lens as a dispenser of ophthalmic medication. Local anaesthesia in the form of cocaine drops was widely used by 1886. Initially adopted by Karl Koller in 1884, the anaesthesia's use in German ophthalmology became almost universal ( www.rsm.ac.uk ).

Scleral Lenses

1887: Friedrich A. Müller and Albert C. Müller (Wiesbaden, Germany) were from a family of artificial-eye makers; they made and supplied a protective device for a patient of Dr Theodore Saemisch. The patient had surgical damage to the right eyelids leaving the cornea exposed, whilst sight in his left eye was impaired due to myopia and cataract. By making a glass shell, which encased but did not touch the cornea, the Müllers maintained fluid around the cornea, preventing its further desiccation. The protective shell looked like an artificial eye, although the cornea was left clear ( ). The patient wrote a letter in 1908 (now lost) reporting that since 1887 he had worn the lens continuously, day and night, for 18 months to 2 years at a time ( , , ). In reality the lens needed to be replaced every 18 months to 2 years due to corrosion of the glass surface by the tears ( ). The Müller brothers continued to produce thin, lightweight blown glass lenses with clear corneal regions and white scleral portions ( Fig. 1.2 ), which were well tolerated. The optic portions were variable, and years later it was proposed that the excellent toleration of these glass lenses (and apparent avoidance of corneal oedema) was probably due to the characteristic aspheric shape of their scleral zones, producing loose channels for better tear flow and oxygen exchange.

1888: (Germany) was an ophthalmologist who, after returning from South Africa, began work in the ophthalmic clinic in Zurich under Professor Haab. He was interested in keratoconus and experimented with making corneal moulds and constructing glass shells for rabbits' eyes. He had glass scleral lenses made by Professor Abbe at Carl Zeiss in Jena for human cadaver eyes. The lenses had a back optic zone radius of 8 mm, optic zone diameter of 14 mm, a scleral band width of 3 mm, with a scleral zone radius of curvature of 15 mm. Fick described six patients on whom he had tried his lenses: One was keratoconic, and the other five had varying degrees of corneal opacity. In the keratoconic eye, he improved the vision from 2/60 to 6/36, but at the time he published, none of these patients was actually wearing the lenses for any length of time. He observed that:

• ▪

  the radius of curvature of the cornea was steeper than that of the globe of the eye

• ▪

  the conjunctiva flattened steadily away from the cornea

• ▪

  clouding in the epithelial layer (corneal oedema, later called Fick's phenomenon or Sattler's veil) reduced as lens tolerance and wearing time increased.

• ▪

  air trapped behind the contact lens on insertion retarded the onset of corneal clouding

• ▪

  using a boiled solution of 2% grape sugar on insertion gave 8–10 hours wear by his rabbits before corneal clouding developed

• ▪

  cosmetic (prosthetic) contact shells could be used when corneal scarring precluded good vision

• ▪

  an iridectomy to produce an artificial pupil followed by a contact lens upon which an opaque iris and a black pupil was painted with a clear aperture positioned adjacent to the iridectomy could be used for conical cornea as an alternative to corneal tattooing, which often resulted in severe infection

• ▪

  contact lenses could be used in aphakia where ‘the high degree of hypermetropia could be diminished by the increased curvature of the glass cornea’ thus increasing the power of the liquid lens.

Professor Ernst Karl Abbe (Jena, Germany) had joined Carl Zeiss' optical works in 1866 as a research director. He was a professor of physics and mathematics at the University of Jena and a prolific inventor and writer of scientific papers on optics. Abbe developed the first Zeiss contact lenses using glass produced by Otto Schott, the son of a family of glassmakers who refined the chemistry of glassmaking. Previously glassmaking was a cottage industry with highly variable results from one batch to the next and from one family to another ( www.zeiss.com ).

1888: Manuel Straub (Amsterdam, Holland) introduced ophthalmological solutions of fluorescein for the investigation of corneal lesions. However, their fluorescent properties under blue light were not recognised for another 50 years ( , ).

1889: Eugene Kalt (Paris, France), an ophthalmologist, investigated contact lenses as ‘orthopaedic appliances’ in the treatment of keratoconus. He noticed that the contact lens changed the shape of the cornea, and thus he laid some of the groundwork that led to orthokeratology.

1889: August Müller (Kiel, Germany), a final-year medical student, presented his thesis Brillengläser und Hornhautlinsen (Spectacle Lenses and Corneal Lenses) at the University of Kiel for his doctorate in medicine. This concerned the correction of his own 14 dioptres of myopia with contact lenses and made the first reference to a ‘corneal lens’. He had three lenses, measuring 15–16 mm across, made by Otto Himmler, a Berlin optician and instrument maker, which still exist in the Germanisch Museum in Munich. Due to his poor sight, Müller did not pursue a career in ophthalmology but went into orthopaedics. However, he noted:

• ▪

  Adverse signs and symptoms of lens wear caused by ‘a disturbance of nourishment of corneal tissue’. This was validated in the 1950s, when it was demonstrated that the cornea required atmospheric oxygen, dissolved in tears, to maintain a normal respiratory status ( ).

• ▪

  Lens discomfort arose from pressure on the conjunctiva from the scleral zone of the lens.

• ▪

  To avoid trapping air bubbles, he inserted his lenses under water; however, corneal oedema would develop within about 15 minutes due to the pH of water. Due to the discomfort, Müller used cocaine eye drops before lens insertion, but the toxicity of cocaine would have further inhibited his success ( ).

1892: Henri Dor (Lyon, France) an ophthalmologist, recommended the use of physiological saline solution to insert contact lenses. This remained popular until the early 1940s ( ).

1900: Dr Louis de Wecker (France and Germany) used a contact lens as a splint to retain a corneal graft in position during healing ( ).

1911: Allvar Gullstrand (Sweden) invented the slit-lamp, facilitating more detailed examination of the cornea.

1912: Heinrich Erggelet (Freiburg, Germany) commissioned Zeiss to make made ground glass ‘experimental contact lenses’ to induce artificial ametropia to test ‘the optical quality of the corrected curve glasses’ ( ). These were actually corneal lenses but were too heavy to wear successfully ( , ). Zeiss produced their first contact lens trial set for use by ophthalmologists. By this time over 2000 contact lenses had been made, mainly by Zeiss ( ).

1916: Zeiss produced the first trial set especially for keratoconus ( ).

1918: Zeiss made lenses with small lead pellets embedded in them to assist locating ophthalmic foreign bodies in conjunction with x-ray images.

1918: Leonhard Koeppe (Halle, Germany) was an ophthalmologist who described a contact lens for specialist observation of internal features of the eye using a slit-lamp biomicroscope. This type of short-use lens was termed a gonioscope ( ).

1920: Zeiss manufactured a four-lens preformed fitting set primarily for keratoconus. It was introduced and developed by Professor W. Stock (from Jena University), who was a sufferer of the condition ( ). The first lens had a 12 mm back scleral radius, but later a full range from 10.0–14.0 mm in 0.25 mm steps became available ( ). In the early 20th century, lens choice lay between the blown glass lenses produced by the firm of Müllers of Wiesbaden and the ground glass contact lenses such as those made by Carl Zeiss of Jena. The former were inferior in consistency of optical quality, but superior in comfort and duration of wear. Zeiss lenses could correct reasonable amounts of ametropia, but their maximum wearing time was between 30 minutes and 2 hours.

1922: Zeiss were granted a US and German patent for plastic (Cellon or celluloid) contact lenses. Appearance and discolouration stopped further development. Zeiss was also granted a patent for a lens formed between two lathe-cut moulds.

1927: Adolf Wilhelm Müller-Welt (Stuttgart, Germany) , an artificial-eye maker ( ), applied for a patent for the first fluidless blown glass lens (granted in 1932). The lenses, made from glass obtained from Schott of Jena, were blown over a series of preformed toric castings, which formed the scleral portion of the lens. These included areas of differing curvature to incorporate the insertions of the recti muscles ( ). The unfinished corneal portion was later ground and polished to the desired prescription. He understood the stresses produced in the glass during lens manufacture and annealed the glass to improve durability ( Figs 1.3, 1.4 & 1.5 ).

1929: Professor Leopold Heine (Kiel, Germany), an ophthalmologist, developed an ‘afocal’ fitting set for Zeiss ( ). This utilised the increasing range of back optic zone radii to form a liquid lens of various powers underneath the lens to correct ametropia. However, physiological requirements of the eye were sacrificed for vision.

1930s: Josef Dallos (Budapest, Hungary), an ophthalmologist at the No. 1 Eye Clinic at the Royal Hungarian Peter Pazmany University ( Fig. 1.6 ), developed an interest in the use of contact lenses and investigated various impression materials. He tried Negocoll (derived from seaweed and described by Dr Alphons Poller of Zürich) on a cadaver face and noted that the corneal surface was reproduced with a smooth, polished texture. He prepared a positive cast of this impression in the waxlike substance Hominit, and the smooth appearance of the visible corneal segment convinced him that Negocoll would be a suitable medium for ophthalmic impressions (Dallos, J., personal communication to Sabell, 1977). Dallos used Müller contact lenses as impression trays ( ) and filled the impression achieved with Hominit, making a positive cast. From this he made a negative cast with plaster of Paris which was then converted into a brass die ( ) ( Figs 1.7 and 1.8 ), i.e. a positive which he then used to thrust through a sheet of heated glass. The heated brass die was secured in the swinging arm of the press and pushed into the softened glass plate (initially using thin glass photographic plates) at a suitable temperature, as judged by its colour. The heat was then removed, and the glass solidified immediately. The central zone of these shells was then optically ground and polished. This method of manufacturing lenses, with some minor modifications, was also used for the acrylic materials introduced some 10 years later. Dallos laid down physiological principles for the fitting of scleral contact lenses. Working on the assumption that the natural body fluid offers the best chance of success, he set out to conserve the tear reservoir and to allow for its interchange by fresh tears. In 1933 Dallos suggested that if the front optic diameter were restricted to 8 mm (lenticulated), much higher powers would be achievable, whilst minimising thickness and weight.

Impression Materials

For a more detailed history of impression materials, see Section 8 , History available at: https://expertconsult.inkling.com/ .

Josef Dallos was the first to successfully take an impression of a living eye and use this mould to make a cast and from this make a contact lens. In 1935, Theodore Obrig started using Negocoll to produce corneal impressions using funnel-shaped blown glass shells that were 22 mm in diameter and 7 mm deep with a 25 mm-long hollow handle plugged with cotton wool to retain the Negocoll ( ). Negocoll was applied hot to the eye, so it was not a very pleasant experience even with corneal anaesthetics. In 1943 he introduced Ophthalmic Moldite, the first cold alginate impression material intended specifically for ophthalmic work using acrylic impression trays with hollow tubular handles and perforated bowls ( ).

In 1945 ophthalmic Zelex, another cold setting impression material, was developed by Charles Keeler in Windsor, UK ( Figs 1.9 and 1.10 ). Panasil C was developed by Kettenbach GmbH in 1987, which was withdrawn in 1993 but reintroduced in 1995 by Panasil light body.

1930+: Theodore Obrig (New York, USA), an optical technician working for Gall and Lembke, initiated the full clearance method of fitting scleral lenses by using a large optic zone, improving comfort by reducing corneal pressure. Although it was widely used in the USA and the UK, it had the following drawbacks ( ):

• ▪

  Cosmetically, the lens was ugly.

• ▪

  As the optic had to remain filled with fluid for the wearer to see, a glovelike seal was required on the scleral zone. Any bubbles trapped in the steep apex of the lens affected vision.

• ▪

  Due to this seal, corneal oedema developed after some 2 hours of wear. Initially seen as a faint blue haze resembling tobacco smoke, this developed into the classic rainbow rings resembling glaucoma haloes, which was followed by photophobia, blepharospasm and an unpleasant sensation of heat.