ESCRS - GOOGLE OPHTHALMOLOGY

GOOGLE OPHTHALMOLOGY

When Google and Novartis announced a partnership earlier this year to develop a range of smart contact lenses to improve vision and monitor health, the widespread media coverage was predictably upbeat.
“Sweet solution for diabetics”, “Smart contact lens promises to revolutionise diabetes treatment” and “Smart lenses eyed as medical breakthrough” were just three typical headlines welcoming the announcement.
The professed aim of the collaboration is to develop contact lenses targeting two massive health markets: first diabetes, with a lens capable of monitoring glucose levels, and second presbyopia, with an autofocusing lens that will dispense with the need for reading glasses.
Jeff George, division head of Alcon, the second largest unit within Novartis that will be charged with developing the smart lenses, spoke of unlocking “a new frontier to jointly address the unmet medical needs of millions of eye care patients around the world”.
This new frontier is a place where miniaturised technology and human biology intersect, with wearable and implantable technologies giving people the opportunity to proactively take charge of their own health management.
“I believe that the product holds a lot of promise, and with Novartis collaborating on the project, there is the willpower to push through with it,” said Chloe Wu, an analyst at market research provider Euromonitor International.
Nevertheless, significant hurdles will have to be overcome if the promise of a smart contact lens is to become a commercial reality, she warned.
“With a large proportion of diabetes diagnoses coming from lower-income groups, the immediate question that comes to mind relates to the cost and practicality of the glucose-sensing contact lenses. In addition, there are reports that suggest that diabetic patients may be particularly susceptible to developing ocular complications from contact lens wear,” she said.
The biocompatibility issue is certainly one that will engage the creative energies of Alcon’s engineers in the coming months. Lens technology which incorporates non-invasive sensors, microchips and other miniaturized electronics will also need to find a way to allow vital nutrients to reach the cornea and maintain a healthy ocular surface.
“We have to remember that the cornea is an extremely unique tissue that combines the unlikely features of optical clarity, hydrophila and structural integrity, all of which are independently challenging to duplicate,” said Jeffrey Anshel OD, FAAO, an optometrist in private practice in Carlsbad, California, and President of the Ocular Nutrition Society.
The specific problem for a glucose-sensing lens is that diabetics frequently show deficient tear levels, so are contraindicated to wear “traditional” contact lenses, he added.
“Unless newer materials are developed that are more biocompatible with these reduced bio-tissues, complications may subvert the success of this technology,” he said.
While diabetes and presbyopia are the initial targets for the contact lens technology, other ocular and systemic indications are sure to follow.
Glaucoma, for instance, with an estimated 60 million patients worldwide, represents another potentially huge opportunity for smart contact lens technology.
Dr Anshel also noted that the tear layer does have the ability to express several bodily functions, so the possibilities of smart contact lenses might be expanded to tear testing.
Unlike diabetes and presbyopia, however, the contact lens technology to monitor intraocular pressure (IOP) is not wishful thinking for the future, but is already here and commercially available.
The Swiss company Sensimed AG has stolen a march on its potential rivals by developing Triggerfish®, a contact lens used to automatically record both volume change and IOP over a 24-hour period.
Kaweh Mansouri MD, MPH, a glaucoma specialist at Geneva University Hospital, Switzerland, who was involved in the clinical trials of the Triggerfish®, told EuroTimes that the contact lens technology has been largely perfected by Sensimed.
“The measurements have been shown to be extremely repeatable and reliable. Over the 24-hour measurement period the contact lens is generally well tolerated by patients. The key challenge is therefore interpretation of the resultant data to guide clinicians on ways to improve the treatment of their glaucoma patients,” he said.
Although some companies might understandably see a threat in Google’s ambitions for the healthcare industry, Dr Mansouri believes that the Google-Novartis partnership is actually a “huge positive” for everyone involved in developing contact lens sensing technology.
“It further demonstrates the pivotal role of the visual organ in the future of eMedicine. As our understanding of the molecular mechanisms of disease improves in line with advances in micro- and nano-technology, a multipurpose diagnostic and therapeutic contact lens should not be considered pure science fiction,” he said.