George K. Smelser (1908-1973): Atmospheric oxygen and the corneal response to contact lens wear.

Professor George Smelser was a scientist who played a crucial role in advancing the understanding of the anatomical and physiological changes within the cornea during contact lens wear. In a series of unique experiments conducted in the early 1950s, using both humans and animal models, his research team provided the first conclusive evidence that contact lenses impaired the delivery of atmospheric oxygen to the cornea, resulting in an excess of lactate within the cornea and a subsequent ingress of water, leading to corneal oedema and disturbed vision (Sattler's veil). This historical note reviews the career of George Smelser, with particular emphasis on his contributions to understanding the importance of atmospheric oxygen in maintaining corneal homeostasis.

The Charles F. Prentice Award Lecture 2014: A 50-Year Research Journey: Giants and Great Collaborators.

This article, an edited version of the 2014 Charles F. Prentice Medal presentation, recounts my 50-year journey in research, from graduation in 1965 to PhD to 2015. The most important lessons I have learned are that great people, "Giants" as I call them, are generous of spirit, creative, insightful, sharing, and caring, and second, that collaboration is really the only way to do what I want to get done. I have been very fortunate to have worked with many outstanding people. As someone said to me at the Prentice Medal presentation, "I don't like you very much but the people you work with are wonderful."My journey started with a PhD investigation into seeing if orthokeratology could control myopia at the City University London in 1966. It then moved to Australia where all aspects of contact lenses were researched to try to make contact lenses safer and more effective by understanding the cornea and anterior eye systems. That journey has now turned to making contact lenses the best they can be to slow the progress of myopia. An extremely high proportion of people who are involved with global eye care initiatives and ambitious projects to develop treatments and interventions for the major vision problems impacting the world are a joy to work with. Evidence-based systems for delivering vision to the more than 600 million people globally that are blind or vision impaired because of uncorrected refractive error have involved amazing people and collaborations. This article pays tribute to the generosity and humanity of my family and the Giants in and outside the field, and many more not so well known, and the people I work with, who have punctuated and greatly enriched this journey and made many of the scientific advances documented here possible.

The Sämisch case and the Müllers of Wiesbaden.

PURPOSE: There are significant inconsistencies in accounts in textbooks of the fitting in 1887 of a device resembling a scleral contact lens. The aim of this study was to establish the facts of this case and to provide an overview of the subsequent clinical performance of blown scleral shells and lenses. METHODS: A literature search was conducted that included the original report published in 1910 of the fitting of the patient. The dimensions and back vertex power of a blown scleral shell were measured. RESULTS: In 1887, the right eye of a patient with lagophthalmic keratitis as a sequel to cancerous destruction of the lower eyelid was fitted with a protective blown scleral shell. His left eye was effectively blind. The referring ophthalmologist was Professor Theodor Sämisch of Bonn and the fitting was undertaken by the firm of F Ad Müller & Söhne of Wiesbaden, Germany. With periodical replacement, a shell was worn for at least 21 years. Müller scleral shells were principally fitted in keratoconus providing markedly improved visual acuities and wearing times of up to 14 h a day. There were instances of continuous wear. CONCLUSIONS: Failure to consult original sources is responsible for errors in descriptions of the Sämisch case that is of historical importance because it represents both the first use of a therapeutic contact shell and the first instance of continuous wear. Blown scleral shells and lenses played an important part in the optical correction of keratoconus and the management of other ocular conditions during the first quarter of the 20th century.

Robert Mandell: a pioneer and giant in the art and science of contact lenses.

Robert B. Mandell is the quintessential modern clinical scientist. Over his long academic career, he has pioneered many advances in contact lens practice, ranging from a more complete understanding of corneal shape to the effects of contact lenses on corneal health. His classic text, Contact Lens Practice, first published in 1965, was reprinted 14 times in four editions up to 1988. Mandell's contributions to the advancement of the profession of optometry have always been characterized by a genuine concern for the patient and a steadfast belief that his research must have relevance to the practice of optometry.

Karl Otto Himmler, manufacturer of the first contact lens.

In 1889 August Müller (1864-1949) reported the correction of his own high myopia with a ground scleral contact lens that had been manufactured in Berlin two years earlier. This paper provides the first conclusive identification, based upon primary sources, of the manufacturer of these lenses. They were made by an optical engineer, Karl Otto Himmler (1841-1903), whose firm enjoyed, until the outbreak of World War II, an international reputation for the manufacture of microscopes and their accessories.

Hundredth anniversary of August Müller's inaugural dissertation on contact lenses.

In celebration of the centenary of August Müller's pioneering work on contact lenses, we present, for the first time, a full translation into English of Part III of his inaugural dissertation. Müller describes his attempts to correct his own -14.00 diopters of myopia with "cornea-lenses," which were essentially glass scleral lenses. His inability to tolerate lens wear for more than half an hour was probably due to a) limbal pressure as a result of the primary optic diameter being too small, and b) the use of water to occupy the space between the lens and cornea, which would have induced severe corneal edema. Many of the observations and recommendations embodied in Müller's thesis, such as the importance of a good fit, adequate tear flow and rounded edges, are still relevant to contact lens practice today.

Twenty-five years of contact lenses: the impact on the cornea and ophthalmic practice.

PURPOSE: The history of contact lenses has occurred in the latter half of the 20th century. In particular, events in the 1970s through the 1980s related to the invention of soft, hydrogel contact lenses have revolutionized the contact lens industry and the eye care attached to it. This article recounts that history from the perspective of market forces, inventions, and discoveries about the physiologic functioning of the cornea. METHODS: The relevant literature is critically reviewed. RESULTS: Discoveries about the oxygen needs of the cornea and consumer pressure for clear, comfortable, around-the-clock vision have resulted in a history of rigid gas permeable and soft lenses that leads to today's contact lens picture. The short-term and long-term effects of chronic hypoxia and the levels of lens oxygen transmissibility necessary to avoid them have been well-described. The advent of the soft lens, followed by the "human experiment" with initial extended-wear modalities, led to the advent of the disposable soft contact lens. CONCLUSIONS: In the past 25 years, the development and wide acceptance of soft contact lenses have revolutionized the management of refractive error and corneal diseases.

The use of contact lenses by USAF aviators.

Contact lenses are an alternative method to spectacles for correcting refractive errors, but the U.S. Air Force prohibits the wearing of contact lenses by all aircrew members unless medically or optically indicated (AFR 167-3). USAFSAM has a clinical contact lens study consisting of 55 individuals wearing contact lenses for eye defects such as keratoconus, aphakia, anisometropia, and other special indications. Of these 55 individuals, 33 had medical conditions affecting their vision and were unconditionally grounded. Of these individuals, 31 (18 of 19 pilots, 8 of 9 navigators, 5 of 5 other categories) were visually rehabilitated and returned to full flight status by the use of contact lenses. Hard lenses were used in 70% of the cases and soft lenses in 30%. The large number of USAF aviators required to wear spectacles and new head-borne equipment has created compatibility problems with the standard USAF aviators' spectacle. For this spectacle compatibility problem, contact lenses appear as a viable alternative. However, for wide-spread use, concerns remain about the potential aviation hazards, such as +Gz effects, bubble formation, and corneal hypoxia.

Contact lens wear by Royal Air Force aircrew in World War II.

PURPOSE: To provide an overview of the use of contact lenses by RAF aircrew in World War II by identifying some of the fitters and wearers and appraising the clinical results that they achieved. METHODS: A wide-ranging literature search was undertaken that encompassed peer-reviewed journals, non-refereed publications, books, official publications, newspapers and archived documents. RESULTS: Thirty-one aircrew are known to have worn sealed scleral lenses in order to meet the required visual standards. Of these, only two were considered to be completely unsuccessful, one of whom was unilaterally aphakic. One additional case of undisclosed contact lens wear was found and the identity of this officer was established. Brief biographies of a few pilots establish the context of their contact lens wear. CONCLUSION: Overall, the results of scleral lens wear were variable reflecting those achieved by civilian patients of the period. While three men complained of discomfort due to heat and glare, one pilot experienced no photophobia when flying above white clouds in brilliant sunshine and another found no difficulty caused by altitude or tropical climate. Wearing time ranged from about 2h to 16, or more, hours. In about a third of the cases, wearing time was limited due to the onset of a form of contact lens induced-epithelial oedema known as Sattler's veil and effective solutions to this problem were not implemented until after the war.

1. History, evolution, and evolving standards of contact lens care.

Contact lenses and lens care regimens are an important part of eyecare practices and vital to lens-wearing patients. New contact lens materials and cleaning options continue to come to market and affect how patients wear and care for their lenses. In this section we look at how the contact lens and lens solution revolution started, how it has evolved over the last 40 years, and how standards have evolved and impacted these new offerings.