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Survey of Bandage Lens Use in North America, October–December 2002

Karlgard, Caroline C.S. M.A.Sc.; Jones, Lyndon W. Ph.D., F.C.Optom., F.A.A.O.; Moresoli, Christine Dr.Sc.Tech.

Eye & Contact Lens: Science & Clinical Practice: January 2004 - Volume 30 - Issue 1 - pp 25-30
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Purpose. The purpose of this work was to report the findings of a survey of current modes of bandage lens (BL) use by optometrists and ophthalmologists in Canada and the United States in 2002.

Methods. Two thousand voluntary surveys were sent to ophthalmic practitioners across the United States and Canada. The survey contained a questionnaire with 15 questions about the practitioner’s background and BL-prescribing trends and views. It also contained a 10-patient list with parameters such as patient profile, BL type, and pharmaceutical use.

Results. Seventy-two percent of those opthalmic practitioners who returned surveys have prescribed soft contact lenses for therapeutic purposes. BLs are most often used for corneal wound healing and for managing postoperative complications. Pharmaceuticals are concomitantly administered in more than 81% of the patients treated with BLs. The most commonly prescribed pharmaceuticals are antibiotics (47.5% of patients) and antiinflammatory drugs (42% of patients). ACUVUE and Focus Night & Day lenses are the most popular choices for BLs. Most respondents (93%), regardless of whether they routinely prescribed BLs, would be interested in a BL that could deliver a topical pharmaceutical drug.

Conclusions. The results from the survey indicated that BL use is prevalent across North America. The BL-prescribing habits of North American practitioners indicate that there is a strong interest and need for a drug-delivering therapeutic soft contact lens.

Hydrogel bandage lenses (BLs), or therapeutic soft contact lenses, were envisioned as early as the 1960s by the father of the soft contact lens, Otto Wichterle. 1 Contact lenses were approved for therapeutic use in the 1970s in the United States. They are typically prescribed to provide mechanical protection to the cornea, relieve pain, and enhance healing of the corneal surface. However, the use of hydrogel BLs in ophthalmic practice is controversial, given that BLs may be worn on an extended-wear schedule for several weeks at a time. Traditional hydrogel materials provide insufficient corneal oxygenation during overnight wear, 2 and the risk for microbial keratitis is increased with the use of such materials. 3 Several studies have been published investigating the efficacy of BLs. Ahmed and Breslin 4 showed that BLs were unnecessary for pain relief after laser-assisted in situ keratomileusis, because the use of topical drops alone was more effective than the use of BLs. However, Brilakis and Deutsch 5 successfully used BLs in conjunction with topical pharmaceuticals for pain control after photorefractive keratectomy, with 48% of patients using only the BL and no pharmaceutical for pain control. Amos 6 found that 71% of patients had moderate or significant pain relief with the use of BLs. Saini et al. 7 recommended against the use of BLs after penetrating keratoplasty, and warned against the increased risk of the development of a corneal ulcer, whereas Majmundar et al. 8 used BLs with mitomycin-C on patients after refractive corneal surgery with positive results. Simsek et al. 9 showed that the use of BLs alone significantly improved corneal wound healing in rabbits, with BLs contributing to significantly reduced wound sizes. Smith and Doyle 10 recommended the use of oversized bandage soft contact lenses in the management of early hypotony after filtration surgery, with 9 of 10 cases being successfully treated. Hugkulstone 11 successfully used a BL with topical pharmaceuticals for perforating corneal injuries in four patients and avoided surgical intervention in all patients. Lindahl et al. 12 reported that 90% of their patients expressed improvement in symptoms, and 87% had an objective improvement in corneal appearance with the use of BLs, whereas Dohlman 13 reported only a 56% rate of full or partial therapeutic success for patients treated with BLs. Many other studies have recommended the use of BLs for various conditions, including painful bullous keratopathy, corneal epithelial defects, corneal epithelial irregularity, and corneal ulceration, and as an adjunct to surgical care. 12,14–27

The recent commercialization of new silicone hydrogel materials has provided clinicians with a potential alternative for treating patients who require BLs. The increased oxygen transmission 28 and greater stiffness 29 of the materials should provide improved mechanical protection and safer overnight wear than is afforded by conventional hydrogel lenses. Recent reports have shown that silicone hydrogels may be used as BLs with positive outcomes. Lim et al. 30 used the PureVision lens (balafilcon A) (Bausch & Lomb, Rochester, NY), whereas Montero et al. 31,32 reported on Focus Night & Day lenses (lotrafilcon A) (CIBA Vision, Duluth, GA).

Most soft contact lenses are used as BLs off label, although a few lenses are designated as therapeutic lenses. The Focus Night & Day silicone hydrogel lens, for example, received U.S. Food and Drug Administration approval for therapeutic use in February 2003. Furthermore, the silicone hydrogels (PureVision and Focus Night & Day) are currently being recommended as the optimal choice for BLs. 33 A survey on the management of corneal abrasions in the United Kingdom in 1997 indicated that BLs were infrequently used to treat corneal abrasions. 34 Apart from this, few data are available on the widespread clinical use of BLs, although anecdotal data suggest that BLs are frequently used for various conditions. Because of the conflicting data on therapeutic BL use and the recent reports of silicone hydrogel BL use, it is timely to determine the current management practices of clinicians’ use of BLs.

The purpose of this work was to conduct a survey of BL use in clinical practice across North America.

From the Department of Chemical Engineering (C.C.S.K., C.M.) and the Centre for Contact Lens Research (C.C.S.K. L.W.J.), School of Optometry, University of Waterloo, Waterloo, Ontario, Canada.

Accepted September 4, 2003.

Address correspondence and reprint requests to Dr. L.W. Jones, Centre for Contact Lens Research, School of Optometry, University of Waterloo, Waterloo, Ontario, Canada, N2L 3G1; e-mail: lwjones@uwaterloo.ca

Supported by the Canadian Optometric Education Trust Fund.

© 2004 Lippincott Williams & Wilkins, Inc.