CURRENT CONTACT LENS CHALLENGES

Contact lens designs must adapt to increasing visual challenges by providing technological advancements that meet patients’ needs. While contemporary contact lenses represent significant advancements compared with their historical counterparts, the scope remains for improving contact lens performance. End-of-day comfort is a key consideration among eye care practitioners, with 74% viewing it as the number one performance gap for contact lenses.15 Another important challenge is vision under various lighting conditions, especially dim light. Contact lens wearers can experience fluctuating vision throughout the day, and many patients have difficulties with the visual requirements of driving at night.16 Lastly, the near vision provided by multifocal contact lenses could also be improved – as some wearers resort to using reading glasses over their contact lenses for particular tasks.17

TECHNOLOGIES FOR COMFORT AND CLARITY

To enhance both comfort and clarity, Acuvue Oasys Max 1-Day (AOM1D) employs an unprecedented combination of two innovative technologies: TearStable technology and the OptiBlue Light Filter.3 A third novel technology – Pupil Optimised Design – is included in the multifocal lens. The performance benefits demonstrated by these technologies shed light on factors that are essential for crisp, clear vision at all distances and in all lighting conditions, plus all-day comfort.18

Technology #1: TearStable

The tear film works in concert with the ocular surface to continuously lubricate, moisturise, smooth, oxygenate, clean, and protect the ocular surfaces.19 TearStable technology supports a stable tear film by mimicking the lubrication and moisturising properties of the tear film.3–5,20 To do this, AOM1D has a next-generation manufacturing technology, which optimises the senofilcon A distribution of the wetting agent throughout the lens and at the surface.3–5,20

Table 1. Key Points

*Compared to Acuvue Oasys 1-Day. †Versus Dailies Total1, My Day, and Ultra One Day, also significantly lower versus Acuvue Oasys 1-Day. §Versus publicly available information for standard daily use contact lenses as of December 2023. **Compared to competitors' designs, technology optimised for both the parameters of refractive error and add power. #Filtering of HEV light by contact lenses may reduce some unwanted visual artifacts (such as light scatter, halos and starbursts), speed photostress recovery time, as well as reduce glare discomfort. It has not been demonstrated to confer any systemic and/or ocular health benefit to the user.

Table 2. The Comfort of Max.

The lens’ wetting agent – high molecular weight polyvinylpyrrolidone (PVP) – has long been used in medicine, including ophthalmics.21 PVP is considered to have mucin-like properties; crucially, both have amphiphilic properties (i.e., both hydrophilic and lipophilic properties) that allow both water and lipid components of the tear film to spread over a surface, enabling moisture retention and lubrication.22-24 This is designed to lock in moisture throughout the lens and across the surface.3

A second key feature of this TearStable technology is, like other Acuvue Oasys lenses, the combination of PVP with a self-hydrating silicone monomer (SiMMA).25 The silicone monomer interacts with PVP and water to create a hydrated and biocompatible material.25

Pervaporation describes the combination of permeation of fluid through a substance and its subsequent evaporation from the surface of the substance. Pervaporation rate can be determined gravimetrically (Figure 1). In most cases, evaporation is the rate-limiting step compared to properties, and clinical performance indicates benefits relating to reduced tear evaporation†3,4 and enhanced tear-film stability.‡5 With AOM1D, tear evaporation is almost halved when compared to competitor lenses (Figure 2).†3,4

Tear film stability is also improved, with wearers of AOM1D being 1.6 times more likely to have a long (>10 s) visual tear film break-up time (VBUT).‡5 VBUT is a quantitative measure of the effect of tear film stability on optical quality and is determined by changes in objective scattering index
(OSI) over time. VBUT is the time elapsed from a complete blink to the point at which the subject’s vision quality drops below a predefined threshold.

Figure 1. Schematic representation of the pervaporation cell used to measure the pervaporation rates.

Figure 2. Least square mean pervaporation rate at 40% relative humidity for Acuvue Oasys Max 1-Day, Dailies Total 1, MyDay, and Ultra One Day. P≤0.0001 when all lenses are compared to Acuvue Oasys Max 1- Day.3,4

Clinical observations suggest that a break-up time of less than 10 seconds is clinically significant.26 Compared with a leading contact lens, AOM1D increased the proportion of patients with a VBUT 10 seconds, reflecting a superior tear-film stability and optical quality.‡*5 Given the complexity of the ocular system, in vivo experiments such as this are the gold standard for evaluating the effect of contact lenses on tear-film parameters. In contrast, in vitro experiments that use model eyes struggle to accurately replicate the ocular surface, the tear film, and blinking.27

The prolonged tear film stability provided by TearStable technology improves the subjective contact lens experience of wearers with respect to comfort and visual quality.‡‡1

Comfort may be improved because the tear film moisturises and lubricates the eye. AOM1D achieves superior end-of-day comfort,*1 and nine out of 10 wearers reported all-day comfort.1 AOM1D also provides superior clarity of vision indoors and out,*1 which may be due to the human tear film creating an optically transparent, smooth, and highly refractive interface between the eye and the surrounding atmosphere.1,5

Technology #2: OptiBlue Light Filter

The electromagnetic spectrum spans a broad continuum of wavelengths; at one end of the spectrum, extremely low frequency radio waves can have wavelengths larger than planets; at the other end, the wavelengths of gamma rays are smaller than atoms.28 Only a tiny part of the spectrum (0.0035%) is visible to the human eye.29

Shorter wavelengths within the visual spectrum are of particular interest; high-energy blue-violet light (380–450 nm) is more biologically significant than other visible light. Blue-violet light can be emitted from various sources, such as the sun, indoor lighting, car headlights, and digital devices. Depending on the precise wavelength, blue-violet light can have positive or negative effects.

Longer blue wavelengths of around 460–500 nm are responsible for regulating pupillary light reflexes and circadian rhythm.30 Intrinsically photosensitive retinal ganglion cells (ipRGCs) are sensitive to these wavelengths of light,31 and exposure causes pupil constriction, irrespective of age.32 These cells also play a key role in regulating circadian rhythm (the sleep/wake cycle),33 with exposure to these wavelengths leading to reduced sleepiness,34 increased alertness,35 and increased cognitive function.36 Therefore, filtering at these longer wavelengths may reduce or delay the associated biological processes.

Some shorter blue-violet wavelengths can have negative effects because of their higher energy. Wavelengths from around 415–455 nm have been shown to be particularly phototoxic to retinal pigment epithelial cells.37 Shorter blue-violet light also has a negative effect on visual comfort and clarity. These wavelengths are more uncomfortable to view than the longer orange-red wavelengths (assuming equal luminous output),38,39 which can lead to compensating behaviours to help mitigate exposure.40-42 Shorter wavelengths are also scattered more easily than longer wavelengths – this phenomenon, known as Rayleigh scattering,43 is responsible for the blue colour of the sky during the day and the ‘blue haze’ observed when looking at distant objects. However, when light scatters within the eye, there is a reduction in retinal contrast and, in turn, reduced visual clarity.44 Therefore, filtering at these shorter wavelengths of the blue-violet range can improve both subjective and objective visual outcomes.38,39,45

Figure 3. Spectral transmittance curves for Acuvue Oasys 1-Day (teal) and Acuvue Oasys Max 1-Day (yellow) across a range of wavelengths, including ultraviolet (UV), high-energy visible (HEV) and visible light.

Figure 4. Pupil optimised design of Acuvue Oasys Multifocal (top row) compared to leading competitor’s design.**7

Not all blue-violet light filters are created equal; they can have different levels of filtering and can act on different regions of the light spectrum. The OptiBlue Filter has been developed to provide the highest level of blue-violet light filtering,§#3,4 reducing blue-violet light transmission by 60% within a range of shorter wavelengths (Figure 3).#3 This high-level, preferential filtering is designed to reduce light scatter and thereby, improve visual clarity.#3 Scientific literature suggests that filtering blue-violet light can reduce disability glare,45-48 photostress recovery time,45,48-52 halo and starburst diameters,53-55 and eyelid squinting,47-49,56,57 and improve visual comfort,38,39,56,58-60 visual contrast,48,58,59,61-67 chromatic contrast,48,59,68 and brightness perception.66,69-72 In clinical trials, AOM1D wearers experienced a significant improvement of vision indoors in bright light and outdoors,*1 and they were able to see more comfortably and clearly while using a computer or digital device.*1

AOM1D reduces light scatter by nearly 20%, starbursts by 23%, and halos by 30%.*3,5

Figure 3 also shows the UV blocking characteristics of AOM1D with the lenses absorbing 100% of UVB and 99.9% of UVA radiation.^,^^4 This is even higher than the existing AO1D family; both of which qualify as Class 1 UV blocking contact lenses.^,^^4

Technology #3: Pupil Optimised Design

As well as reduced accommodation, tear-film stability reduces,73,74 and intraocular light scattering increases with age.75,76 Of contact lens wearers over age 40, 94% expect to continue in contact lenses.§§77 Despite this, half of patients over 45 will drop out of contact lens wear.† However, nine out of 10 patients say they would try a new lens if it delivered more comfort and clarity.78

With the unprecedented combination of two innovative technologies,3 AOM1D
is well placed to meet the needs of the modern presbyopic patient. Wearers of AOM1D Multifocal reported high levels of comfort throughout the day and at the end of the day.18 Wearers also experienced crisp, clear vision at all distances and in all lighting conditions.18

In addition to TearStable technology and the OptiBlue Filter, the multifocal lens of the AOM1D family incorporates Pupil Optimised Design. Pupil size varies with age and refraction: older and more hyperopic eyes tend to have smaller pupils.80,79 By tailoring optical parameters to pupil-size variation across both near and distance powers, AOM1D Multifocal is designed for superior visual performance (Figure 4).‡80 The Pupil Optimised Design also enables a high rate of fitting success, with 96% of patients successfully fit using two pairs of lenses or fewer.**18

CLINICAL PERFORMANCE OF ACUVUE OASYS MAX 1-DAY

Wearers of AOM1D report excellent outcomes for all-day comfort and all-day clarity.18 These findings are based on the results from four randomised, subject-masked, two-week dispensing studies: three studies were 2x2 crossover dispensing trials, and one was a two-arm parallel study. In total, the studies enrolled 767 subjects, and 731 subjects completed the studies.

AOM1D provided comfort all day long; compared with habitual lenses, AOM1D was preferred for overall comfort and for comfort throughout the day,‡‡1 with nine out of 10 patients experiencing all-day comfort while wearing AOM1D.1

AOM1D also provided clear, comfortable vision across a wide range of lighting conditions. For example, wearers had comfortable vision while driving during the day and at night.1 More than 90% of wearers reported the ability to see comfortably when driving at night.1

Furthermore, when compared with habitual lenses, AOM1D was preferred for overall vision.‡‡1 Similarly, AOM1D was preferred over habitual lenses for clarity of vision from activity to activity.‡‡1

Likewise, the lens showed benefits for viewing digital devices. AOM1D lenses provided the ability to see comfortably while using a computer or other digital device.*1 Nearly two-thirds of heavy computer users wearing AOM1D rated the reduction in the feeling of tired eyes from using a computer as ‘very good’ or ‘excellent’. Additionally, AOM1D wearers were more likely to report excellent clarity of vision when using a computer or digital device.*1

PATIENT CHARACTERISTICS

The AOM1D family is designed to help address contact lens needs throughout a lifetime. Optometrists may consider prescribing AOM1D if patients report heavy digital device use, if the patient is having comfort issues with their current contact lenses, if the patient has a compromised tear film (as evidenced by rapid tear break-up time, mild desiccation staining, or a reduced tear meniscus height), or if the patient is interested in blue-violet light filtering. In addition, presbyopic patients may benefit from AOM1D Multifocal, particularly if they struggle with reading close up or in dim light.18

CONCLUSION

Many patients are straining to keep up with today’s visually demanding lifestyles. Acuvue Oasys Max 1-Day uses two innovative technologies to deliver the performance of Max.1 TearStable technology is Johnson and Johnson Vision Care’s first and only lens material specifically designed to
prolong tear-film stability,5 while OptiBlue is a precision light filter that provides the highest level of blue-violet light filtering.#§3,4 Additionally, Acuvue Oasys Max 1-Day Multifocal combines these two technologies with Pupil Optimised Design. Together, these technologies result in a lens family that provides clear vision throughout the day and exceptional comfort.1,18 Now is the time to
offer your patients the performance of Max.1

To earn your CPD hours from this article visit: mieducation.com/contact-lens-technologies-for-the-performance-of-max.

§Versus publicly available information for standard daily use contact lenses as of December 2023.
*Compared to Acuvue Oasys 1-Day.
§§Those between the ages of 40 and 64 years old have intention to continue wearing contact lenses based on indicating “Definitely/Probably would continue wearing contact lenses in the next 12 months”.
†JJV data on file 2021. Growth levers analysis based on IPSOS Global/Appinio Incidence Tracker, retail outlet consumption data and national census population data covering the United States, United Kingdom, Russia, Japan, South Korea, and China.
‡Compared to prior JJVC multifocal design, technology optimised for both the parameters of refractive error and add power for a multitude of viewing distances and light levels.
^Helps protect against transmission of harmful UV radiation to the cornea and into the eye.
^^WARNING: UV-absorbing contact lenses are NOT substitutes for protective UV-absorbing eyewear such as UV-absorbing goggles or sunglasses because they do not completely cover the eye and surrounding area. Patients should continue to use UV-absorbing eyewear as directed.
#Filtering of HEV light by contact lenses may reduce some unwanted visual artifacts (such as light scatter, halos and starbursts), speed photostress recovery
time, as well as reduce glare discomfort. It has not been demonstrated to confer any systemic and/or ocular health benefit to the user. Consult your Eye Care Professional for more information.
**Compared to competitors’ designs, technology optimised for both the parameters of refractive error and add power.
‡‡Among patients with a preference vs habitual lens.

References available at mivision.com.au.