Chitosan surface modified hydrogel as a therapeutic contact lens

Therapeutic contact lenses have attracted significant attention during the last decades. In this study, we used chitosan‐conjugated poly(2‐hydroxyethyl methacrylate) (PHEMA) for contact lens application. We aimed to increase affinity of anionic drugs, which are used in treatment of eye diseases. In this regard, we evaluated delivery of the small molecule anionic drug, ascorbic acid from the chitosan‐conjugated PHEMA. Chitosan immobilization improves drug loading efficiency and induces sustained release of ascorbic acid. The chitosan modified hydrogel also reduces the biofouling of tear fluid components. Our results showed that surface modification by chitosan inhibits protein and bacterial deposition on the contact lens. Protein absorption analysis revealed that neat PHEMA adsorbed tear proteins at a density of 28.4 ± 4.4 μg/cm², whereas the chitosan‐conjugated hydrogel adsorbed tear proteins at a density of 18.5 ± 1.8 μg/cm². Moreover, the neat PHEMA bacterial adhesion had a mean CFU value of 273 ± 27. However, a significant decrease in the number of bacterial colonies was observed in the chitosan group with a CFU value of 9 ± 6.     

Settling and deformation of a thin elastic shell on a thin fluid layer lying on a solid surface

placement of a soft contact lens onto the cornea, the upper eyelid deforms and settles the lens by squeezing fluid out of the post-lens tear film or POLTF (i.e., the tear fluid layer sandwiched between the lens and the cornea). This paper studies the physical mechanisms that control the dynamic state of the contact lens during blinking, i.e., its shape and its distance from the cornea, especially a long time after insertion. We model the lens as a deformable elastic shell and the cornea as a flat nondeformable body. The tear fluid is assumed to be Newtonian, and the lens is characterized by an elastic modulus and a Poisson ratio. Lubrication equations under creeping flow are used to solve the fluid problem, while the thin-shell approximation is applied to the solid lens. The solid and fluid mechanics problems are coupled by maintaining continuity of stress and velocity at the solid/liquid interface. Lid applied pressure causes the lens to approach the cornea by squeezing tear fluid out and also leads to the deformation of the lens. Subsequently, in the interblink period, since there is no applied force, the elastic energy stored in the lens due to its deformation is released causing it to move away from the cornea by imbibing tear fluid into the POLTF. If the POLTF thickness is large, the inward motion of the lens in the blink is more than the outward motion during interblink, and this causes the lens to settle closer to the cornea. Eventually, there may be a balance of the inward motion during the blink and the outward motion during the interblink. If so, the lens subsequently exhibits periodic steady-state motion. However, it is also possible that a balance of inward and outward motion is never achieved, and the lens continues to settle endlessly. If this happens, then the thinfilm interactions between the mucin-covered corneal surface and the lens material determine whether the lens actually touches the cornea and possibly adheres. Our elastohydrodynamic analysis serves as a useful tool to elucidate the effects of various lens parameters on the final settled state of the lens. In particular, we are concerned about eventual adherence and/or mechanical abrasion to the cornea, which is very important to the ocular health of soft contact lens wearers.     

Two-dimensional analysis of tear protein patterns of diabetic patients.

In diabetic patients, dry eye and other ocular surface diseases occur more often than in healthy subjects. The aim of this study was to analyze the tear protein patterns of patients suffering from diabetes mellitus type II (dia) and to compare them to the patterns of healthy volunteers (ctrl). Tear proteins of nonstimulated tears of 20 patients (ctrl n=10, dia n=10) were separated using two-dimensional electrophoretic techniques. The protein patterns of each group were analyzed by a multivariate analysis of discriminance. Furthermore, for all spots of each gel, a 50 x 50 variables pH/Mr (molecular weight) array was generated and subsequently analyzed by a multivariate analysis of discriminance. Additionally, an artificial neural network was trained using the matrix data as input and a sensitivity analysis was performed to figure out, which spots were the most important to differentiate between the tear protein patterns. In both groups a complex staining pattern could be obtained. In diabetic patients significantly more spots were detected compared to the control group (P<0.02). The analysis of discriminance found a highly significant difference between dia and ctrl (P<0.00001). Using the matrix data, the analysis of discriminance showed a significant difference between the two groups, too (P<0.0001). The sensitivity analysis by means of the artificial neural network revealed several spots that were more expressed or more frequently present in the diabetic group. Our findings reveal that the composition of tear proteins of diabetic patients is different from that of healthy subjects. The use of the two-dimensional electrophoretic technique could give more insight into the diabetic-related changes in the tear film composition.     

Single eye analysis and contralateral eye comparison of tear proteins in normal and dry eye model rabbits by MALDI-ToF mass spectrometry using wax-coated target plates

A study of rabbit tear protein expression in a dry eye rabbit model was performed to determine if a pattern in expressed proteins could be identified. The uniqueness of the model allows the comparison of normal (control) eye tear protein expression with surgically induced dry eye tear protein expression in individual animals. The sensitivity of the method allows for single eye analysis. One-dimensional mini-gel electrophoresis of the tear proteins did not show substantial differences between band patterns of the normal versus the dry eye, but was used to assess the molecular weight ranges of the major proteins. Specific assignments of some of the predominant proteins were obtained by tandem mass spectrometry (MS) which showed that the lower molecular weight lipid-binding proteins (approximately 10 kDa to 36 kDa) constitute a considerable amount of the observed protein, followed in lesser quantities by the transferrins which have higher molecular weights ranging from 70 kDa to 85 kDa. Enhancement of matrix-assisted laser desorption/ionization time-of-flight (MALDI-ToF) MS linear mode analysis of intact proteins in tear fluid was demonstrated through the use of wax-coated MALDI plates and spot washing. MALDI-ToF MS analysis of the expressed tear proteins illustrates that differences between normal eye tear and dry eye tear protein content are manifested in changes in the lower molecular weight lipid-binding proteins such as lipophilin which exhibits an increase in concentration in the dry eye, and β-2 microglobulin which undergoes a decrease.     

Ophthalmic glucose sensing: a novel monosaccharide sensing disposable and colorless contact lens

We have developed a technology for continuous tear glucose monitoring, and therefore potentially blood glucose monitoring, using a daily use, disposable contact lens embedded with sugar-sensing boronic acid containing fluorophores. The novelty of our approach is two fold. Firstly, the notion of sensing extremely low glucose concentrations in tears by our approach, and secondly, the unique compatibility of our new probes with the internal environment of the disposable, off-the-shelf, contact lenses, chosen because the physiological compatibility of disposable plastic contact lenses has already been assessed and optimized with regard to vision correction, size and oxygen/analyte permeability. Our findings show that our approach is indeed suitable for the continuous monitoring of tear glucose levels in the concentration range (50-500 microM), which track blood glucose levels which are approximately 5-10 fold higher. We believe our approach offers unique opportunities for non-invasive continuous glucose monitoring for diabetics, especially since many have eye disorders and require vision correction by either contact lenses or glasses, which is thought to be due to glycation of protein in blood vessels.     

Analysis of human tear proteins by two-dimensional electrophoresis.

Human tear proteins in the conjunctival sac were separated on the basis of the differences in their isoelectric points and molecular weights using micro two-dimensional electrophoresis combined with immunoblotting. The two-dimensional electrophoretic patterns of tear proteins from patients with conjunctivitis were compared with those from normal individuals. We also measured integrated intensities of seven protein spots, lactoferrin (LF), albumin and five specific tear proteins (STP), to examine differences in the amounts of these proteins in tears from normal individuals of different sexes. In the tears from patients with conjunctivitis, secretory immunoglobulin A (IgA), LF and STP spots were stained more weakly, whereas the albumin spot was stained more strongly as compared with those from normal individuals. Furthermore, haptoglobin and IgG spots appeared in the tears from patients with conjunctivitis. These were more prominent in the tears from patients with severe conjunctivitis. There were significant differences in the amounts of LF and two kinds of STPs in the different sexes. The amounts of these proteins were larger in females.     

Lysozyme transport in p-HEMA hydrogel contact lenses

Protein binding in hydrogels adversely affects their performance and can interfere with their usage in several biomedical applications including contact lenses. In this study we focus on understanding and modeling the mechanisms of protein transport in hydrogels, specifically focusing on the effect of protein concentration and gel crosslinking on transport. Specifically, we focus on lysozyme, the most abundant protein in tear fluid, and hydrogels of poly-hydroxyethyl methacrylate (p-HEMA), a common contact lens material. Protein uptake experiments with gels of different thicknesses showed a time scale increase as the square of the thickness suggesting diffusion controlled transport. Partition coefficient was found to be dependent on the equilibrium concentration of lysozyme, and also on the degree of crosslinking. Since transport is related to mesh size, gel modulus was obtained for various crosslinkings and utilized to estimate the mesh size. The transport data were fitted to a diffusion model and the fitted diffusivity was compared to diffusivity predicted from a model based on hydrogel mesh size. Both protein absorption and desorption data fitted the diffusion model with the same value of diffusivity, but the experimentally measured diffusivities were significantly smaller than those estimated on the basis of the gel mesh size. Models were modified to take into account protein binding to the polymer but the modified predictions were still larger than the measured values. The results of this study could assist in the development of contact lens materials that exhibit minimal protein binding, in designing cleaning regimens for protein removal from contact lenses, and in applications related to protein binding in several other biomaterials.     

Electrochemical Sensing in Contact Lenses

Electrochemical sensors embedded in hydrogel-based contact lenses provide valuable health-related information, enabling non-invasive and real-time continuous monitoring. Recently, considerable progress has been made in tear based electrochemical sensors. The scope of reported analytes is continuously expanding. This review identifies key chemical biomarkers (including metabolites, ions, proteins) that can be electrochemically detected in tears. The working principles of i) amperometric enzymatic biosensors, ii) ion-selective sensors for pH and ions, iii) voltammetric sensors and iv) affinity sensors are summarized. This review provides guidelines for the future development of contact lens based electrochemical sensors.     

Presence of phthalates in contact lens and cleaning solutions

A fast and simple method using liquid chromatography-tandem mass spectrometry (LC-MS/MS) has been applied to identify and quantify four phthalic acid esters (PAEs) in different contact lens cleaning solutions. A migration study of these compounds from contact lenses has also been performed. The PAEs studied were dimethyl phthalate, diethyl phthalate, butyl benzyl phthalate and dibutyl phthalate. The migration of PAEs from contact lenses was performed by suspending each contact lens in an artificial tear solution at 37 °C and shaking it at 130 rpm for 24 h. The purpose of this study was to determine a possible migration of these compounds to the eyes as a result of the use of contact lenses and their cleaning solutions. The method was precise (with relative standard deviation (RSD) from 2.2 to 11.9%). It was also sensitive, with LODs of 0.03, 0.19, 0.31 and 2.62 μg L^− 1 for DMP, DEP, BBP and DBP respectively. The results obtained confirm the presence of these substances in some types of contact lens cleaning solutions. Furthermore, DBP and BBP were liberated from the contact lenses during the migration study.     

Biocompatibility of nanofilm-encapsulated silicone and silicone-hydrogel contact lenses

A material placed in or in contact with a biological system, that causes the minimum perturbation that can be tolerated by the host biological system, can be considered to be biocompatible. The major effects caused by a contact lens can be considered to be 1) the blocking of the natural supply of oxygen to the epithelium cells of the cornea, 2) interference with the normal evaporation of water from the tear fluid layer, and 3) hindrance of the normal functions of blinking for replenishing oxygen-saturated tear fluid and removing dead epithelium cells, which result from apoptosis. The encapsulation of a highly oxygen-permeable contact lens by a nanofilm with an imperturbable surface state minimizes all these terms. The encapsulated contact lens can be worn safely in extended wear.     

Two dimensional electrophoretic analysis of human tears: collection method in dry eye syndrome

Tear proteomics, by 2-DE, can give a fingerprint of the protein profile, which is well suited in clinical proteomics for biomarker identification and in diagnostics. The mode of tear collection can influence the representation of the proteins in the tear and therefore it is important to use the appropriate method. In this study, capillary and Schirmer mode of tear collection was done in the healthy controls and the Schirmer method was validated in dry eye syndrome conditions. 2-D PAGE of normal and dry eye tear was performed using pH 3-10 linear IPG strips followed by 13% SDS-PAGE. The spot intensity was analyzed by the PD quest software. The two methods were compared using Bland-Altman statistical tool. The 2-D map of capillary and Schirmer tear showed 147 ± 8 spots and 145 ± 7 spots respectively. Both the collection methods were in agreement with each other and were comparable. Dry eye tear protein showed differential expression of proteins as observed in 25-35 kDa region. One of the significantly reduced protein was identified as proline-rich 4 protein. Schirmer method of tear collection is reliable in patients with dry eye, which can display the differential protein expression and help in biomarker identification.     

Analysis of human tear proteins by different high-performance liquid chromatographic techniques

A comparison of the efficiencies of hydrophobic interaction chromatography, ion-exchange chromatography, reversed-phase chromatography and gel permeation chromatography in the separation of tear proteins was made using a variety of different buffers. Separation of immunoglobulins, lactoferrin, albumin, PMFA (protein migrating faster than albumin) and lysozyme was accomplished by gel permeation chromatography in less than 30 min using a TSK-type SW3000 column equilibrated with ammonium acetate buffer (pH 4.1) with a high reproducibility. When gel permeation chromatography was used as a completely automated diagnostic method, only minute volumes (1.0 microliter) of tear samples were necessary for the quantitative analysis of proteins. The other three methods proved to be more suitable for the preparation of individual tear proteins but were less suitable for their quantitation.     

Insertion of tear proteins into a meibomian lipids film

The eyelid meibomian gland secretions form the outer layer of the tear film. That layer functions as a lubricant during a blink, and as a barrier against intrusion of foreign bodies. The lipid film is also exposed to proteins present in the aqueous phase that may adsorb there, and thus form an integral part of the surface of the tear film, or possibly, cause disruption to the outermost layer. Therefore, the adsorption of tear proteins to the meibomian lipid layer was object of the present investigation. A model tear was set up coating a pendant drop of saline with a film of meibomian lipids and measuring variations of the interfacial pressure after the injection of tear proteins into the aqueous subphase at their physiological concentration. All tear proteins adsorbed at the interface causing the initial surface pressure to increase. For each protein, a limiting surface pressure at which a given protein was no longer able to insert into the lipid layer was found. Among the proteins tested, lipocalin was the most surface active one and inserted into the lipid layer in the whole range of surface pressure exerted by the meibomian lipid mixture. Lactoferrin, lysozyme and IgA also interacted with the lipids whereas albumin interacted more weakly. The timescale of the protein insertion into the lipid layer was of the order of 10(2) s. It was hypothesized that protein adsorption at the interface could be associated with structural changes. Indeed, the enzymatic activity of lysozyme was maintained in the presence of an outermost meibomian lipid layer that prevented its denaturation while exposure at the air/aqueous interface induced significant lysozime degradation. meibomian lipid composition is therefore functional to maintain tear proteins activity.     

Mechanical and physico-chemical characterization of cyclodextrin finished polyamide fibers

We present the study of the cyclodextrin (CDs) finishing of polyamide fibers (PA) by means of citric acid (CTR) as crosslinking agent. We observed that the mode of grafting happened by the formation of a crosslinked polymer formed between CTR and CDs. This polymer physically adhered to the fibers network and was resistant to hot water washings. Modified fibers were characterized by evaluating the contact angle with a polar liquid and by studying the hysteresis of damping of PA fibers (Cahn balance) with various grafting rates and by studying the absorptivity of grafted fabrics via the technique of the posed drop (Digidrop^® instrument). Then a mechanical characterization of the PA fabrics grafted with various proportions of CDs was accomplished, by traction and tear tests by using a tensile-test bench Lohmergy. Finally a topographic study of PA grafted surfaces was approached by atomic force microscopy (AFM and LFM; contact and non-contact mode) which permitted to evaluate the roughness and the chemical heterogeneity of the grafted surfaces.     

Study of the protein distribution in the pig lens cross section by Raman spectroscopy

The distribution of proteins in the cross section of a normal pig lens was studied by near-infrared Raman spectroscopy. The Raman spectra were measured in the visual and equatorial axes of this cross section and the protein peak intensities were determined. It was found that along each axis the protein intensities fluctuate. They have a considerable increment along the visual axis with the exception of the C-N bond peak intensities at 1087.2 cm(-1), which decrease, and along the equatorial axis the increment is slight. This increment in protein distribution along the visual axis is related with the refractive gradient of the lens. The classification of pig lens spectra in these axes was performed using principal component analysis (PCA) and linear discriminant analysis (LDA). Cross-validation shows an excellent group separation.     

Soft contact lens biosensor for in situ monitoring of tear glucose as non-invasive blood sugar assessment

A contact lens (CL) biosensor for in situ monitoring of tear glucose was fabricated and tested. Biocompatible 2-methacryloyloxyethyl phosphorylcholine (MPC) polymer and polydimethyl siloxane (PDMS) were employed as the biosensor material. The biosensor consists of a flexible Pt working electrode and a Ag/AgCl reference/counter electrode, which were formed by micro-electro-mechanical systems (MEMS) technique. The electrode at the sensing region was modified with glucose oxidase (GOD). The CL biosensor showed a good relationship between the output current and glucose concentration in a range of 0.03-5.0 mM, with a correlation coefficient of 0.999. The calibration range covered the reported tear glucose concentrations in normal and diabetic patients. Also, the CL biosensor was applied to a rabbit for the purpose of tear glucose monitoring. The basal tear glucose was estimated to 0.11 mM. Also, the change of tear glucose induced by the change of blood sugar level was assessed by the oral glucose tolerance test. As a result, tear glucose level increased with a delay of 10 min from blood sugar level. The result showed that the CL biosensor is expected to provide further detailed information about the relationship between dynamics of blood glucose and tear glucose.     

Advanced glycation endproducts induce photocrosslinking and oxidation of bovine lens proteins through type-I mechanism

Advanced glycation endproducts (AGEs) have been suggested as photosensitizers that are capable of mediating eye lens photo-damage during aging. In the present work, we investigate the photo-crosslinking and oxidation of bovine lens proteins sensitized by AGEs, with special regard to low oxygen conditions. A mechanistic study was conducted using different oxygen concentrations and specific additives with the aim either to scavenge or enhance Type-I or Type-II photoprocesses. Quantum yields for Trp decomposition were determined at 5%, 20% and 100% O₂, in the presence of ferricyanide and D₂O to elucidate the mechanism of action of AGEs. Type-I mechanism proved to be the most efficient pathway for AGE-sensitized Trp decomposition at low oxygen concentration. Photocrosslinking of lens proteins and crystallin fractions due to Type-I interaction was observed. The influence of the oxygen concentration and additives was also studied. The results show that both Type-I mechanism and oxygen-mediated reactions contribute to protein crosslinking. Carbonyl group formation due to protein photo-oxidation was detected with Oxyblot technique. The generation of high levels of hydrogen peroxide during the irradiations was detected and attributed mainly to Type-I reactions. The results support that AGEs act preferentially as Type-I sensitizers at the low oxygen concentration found in the lens and are capable of inducing protein crosslinking, oxidation and peroxide formation.     

Experimental study of albumin and lysozyme adsorption onto acrylic acid (AA) and 2-hydroxyethyl methacrylate (HEMA) surfaces

Many commercial soft contact lenses are based on poly-2-hydroxyethyl methacrylate (HEMA) and acrylic acid (AA) hydrogels. The adsorption of proteins, albumin and lysozyme, on such contact lens surfaces may cause problems in their applications. In this work the adsorption of proteins, albumin and lysozyme, on hydrogel surfaces, AA and HEMA, was investigated as a function of concentration of protein. Also the effects of pH and ionic strength of protein solution on the adsorption of protein were examined. The obtained results indicated that the degree of adsorption of protein increased with the concentration of protein, and the adsorption of albumin on HEMA surface at the studied pHs (6.2-8.6) was higher than AA surface, whereas the adsorption of lysozyme on AA surface at the same pHs was higher than HEMA. The change in ionic strength of protein solution affected the proteins adsorption on both AA and HEMA surfaces. Also, the amount of sodium ions deposited on the AA surface was much higher than HEMA surface. This effect can be related to the negative surface charge of AA and its higher tendency for adsorption of sodium ions compared to the HEMA surface.     

Analysis of rabbit tear proteins by high-pressure liquid chromatography/electrospray ionization mass spectrometry

The aim of this study was to develop a fast and reliable analytical procedure for the display of the protein components of tears that can be used to differentiate the status of the ocular surface. Using this new procedure, we analyzed the tear protein components following a corneal wound in the rabbit. Calibrated 10-microL glass, fire-polished capillary micropipettes were used to collect tears from New Zealand White rabbits prior to and daily for 9 days following a unilateral 6-mm diameter centrally placed anterior keratectomy. Tear proteins were eluted by a reversed-phase high-performance liquid chromatography (RP-HPLC) column and the tear protein profile was monitored by electrospray ionization (ESI) mass spectrometry positive total ion current (TIC) chromatography. Tear proteins were reliably separated into 17 peaks, each of which contained one or a number of protein components. The molecular weight of each protein component was determined by on-line ESI. Major tear protein components, lactoferrin, lysozyme (minimally detectable in rabbit tears), albumin, lipocalin, lipophilin and beta2-microglobulin, were tentatively identified by this method. Based on the mass spectrometric data, beta2-microglobulin was found to be glycosylated with N-acetylhexosamine. ESI-positive TIC chromatograms and mass spectra revealed comparative differences in the tear protein spectra after corneal wounding. One day after wounding, rabbit lysozyme with a molecular weight of 14,717 Da was found to be 8-fold higher in the tears of wounded eyes when compared with tears from unwounded eyes. It dropped back to normal 3 days after wounding. The expression of an unidentified tear protein with the molecular weight of 16,060 Da was also elevated after corneal wounding and returned to normal level by day 5. In this study, LC/ESI-MS was developed as a fast, reproducible and simple method for the identification and analysis of many of the protein components of the tears. Importantly, this technique also allows quantification of each component resolved in the chromatogram. This method is very suitable for mapping peptides and proteins (<80 kDa) in tears.     

Soft Contact Lenses as Drug Delivery Systems: A Review

This review describes the role of contact lenses as an innovative drug delivery system in treating eye diseases. Current ophthalmic drug delivery systems are inadequate, particularly eye drops, which allow about 95% of the active substance to be lost through tear drainage. According to the literature, many interdisciplinary studies have been carried out on the ability of contact lenses to increase the penetration of topical therapeutic agents. Contact lenses limit drug loss by releasing the medicine into two layers of tears on either side of the contact lens, eventually extending the time of contact with the ocular surface. Thanks to weighted soft contact lenses, a continuous release of the drug over an extended period is possible. This article reviewed the various techniques to deliver medications through contact lenses, examining their advantages and disadvantages. In addition, the potential of drug delivery systems based on contact lenses has been extensively studied.