Hard contact lenses
Learn how long you could keep them in...
Learn how long you could keep them in...
The first proper contact lenses were large, rigid and complicated to make and insert. Many patients could only bear to wear them for a couple of hours before the irritation became too great. By 1937, however, Ida Mann at the Moorfields Eye Hospital in London could report patients able to wear carefully fitted lenses for an entire day or longer. Lens fenestration in the 1940s increased wearing time across a wider range of patients and helped avoid corneal oedema. Hard lenses grew smaller over the years and their soft alternative was often preferred from the late 1960s onwards, though even today certain patients will still benefit most from a hard lens such as a rigid gas permeable lens (RGP).
F. A. Müller
In 1887 Friedrich Anton Müller of Wiesbaden (1862-1939), an artificial eye maker, produced and fitted a blown glass contact shell (kontaktschalen) as a protective cover for a patient's eye which had been ravaged by malignant disease. This encased the front surface of the eye - the cornea - but did not touch it. It had a white scleral portion overpainted with blood vessels, and the patient was still wearing it twenty one years later.
That patient had been sent to him by a Dr Theodore Sämisch. It is possible that Sämisch had the initial idea, or that he fitted the lenses made for him by Müller. Alternatively, Müller may have told Sämisch about earlier (undocumented) experiments and asked him to look out for a suitable patient.
F. A. Müller worked alongside Albert Carl Müller (1864-1923) in the development of 'contact adhesion spectacles'. These were regarded as extended wear devices, in keeping with their origins as an extension of the field of artificial eye-making.
Our illustration of the older Müller is taken from the front of his co-authored book Das Künstliche Auge (1910) and is contemporary with it. Wider knowledge of his work was probably scant prior to its publication.
A. E. Fick
In 1888 Adolf Eugen Fick (in Zurich, pictured) and also Eugene Kalt (in Paris) independently developed optically corrective scleral contact lenses. A. E. Fick (1852-1937) noted the presence of a type of visual clouding or corneal 'veiling'. Importantly, he published about his work at a very early juncture. A book chapter of March 1888 indicates that he had been experimenting prior to September 1887 on at least 17 patients and gives details of the attempt to improve the vision of 6 of those patients.
The BOA Museum now possesses a negative found in 1988 by Mrs Barbara L. Schmidt in the possessions of her husband, the late Wilfried Schmidt, optician of Richmond (South Africa), who had apparently traced the whereabouts of a contemporary portrait of Fick during the course of his researches circa 1983. The current whereabouts of the portrait is unknown but presumably in South Africa, where Fick practised for a while 1879-1886. Our illustration of Fick is taken from that negative.
Despite this early pioneering contribution, Fick's later career did not emphasise contact lenses. His text book Diseases of the eye and ophthalmoscopy (1896, translated into English 1902) made only a single passing reference to his hope of treating a conical cornea with a contact glass.
Under the direction of Ernst Abbe (1840-1905), Carl Zeiss Ltd produced some very early glass scleral lenses in 1888, exploiting improvements in glass technology pioneered by Otto Schott. These were ground on behalf of A. E. Fick and possibly others, although whether or not they were successful is disputed. It is known that various practitioners sent blown lenses made by the Müllers to Zeiss in order that the clear optical portion be ground to a specific power. These mostly broke. Zeiss would develop its own range of entirely ground glass lenses by 1911.
Our illustration is taken from a roundel on Abbe's memorial in Jena.
Kalt's first lenses were made from segments cut off the bottom of glass test tubes. His coques de verre were trialled on two patients in Paris. It seems he hoped to use them to treat keratoconus by suppressing the cone. These were, effectively, what would later be termed corneal lenses, that exerted pressure on the corneal apex. Kalt (1861-1941) did not state the specification of such lenses, but from the start, he acknowledged Fick's claim to priority and also observed that they had used practically identical lenses.
August Müller (1865-1949), working in Kiel, fitted himself with a blown glass lens in 1889, accurate to within 0.50 D but he had to insert it under water to prevent air bubbles and even using cocaine as a local anaesthetic allowed him to tolerate the lens for only half an hour. This lens had a scleral radius of 12mm but the term he coined, Hornhautlinsen, would more commonly be used to describe corneal lenses in future. A. Müller was not to play any role in that future; perhaps because he was so myopic, he abandoned ophthalmology and became an orthopaedic specialist instead.
D. E. Sulzer
In 1892 Sulzer of Geneva fitted ground Zeiss lenses to patients with high myopic astigmatism and keratoconus.
Trial and error fitting
Müller blown glass lenses went into regular production in 1909.
In 1914 Siegrist pioneered fitting lenses from stock.
For the next two decades the Müllers produced large numbers of blown lenses. They had to, as there was no way to produce a precise optical specification, so the only way to fit a patient was to get them to try multiple examples until they found one that worked. Some patients were made to try as many as sixty lenses! Thus, despite the scale of production, it cannot be said that contact lens use was common. The white haptic portions had the advantage of masking any conjunctival hyperaemia that might be caused by wearing the lenses, but the disadvantage of making it impossible to make any reasonable inspection of scleral fit.
After the First World War contact shells were also used in conjunction with ophthalmic X-Ray investigations and in the management of mustard gas injuries. Therapeutic and diagnostic applications for contact shells were still foremost in the minds of medical staff into the 1920s.
In 1927 ground glass contact lenses were fitted by R. S. ('Dick') Smellie, working for Theodore Hamblin Ltd under Gerald Wingate in Wigmore Street, London. The lenses were ordered from Zeiss in Germany and took about six weeks to arrive. Smellie is pictured here demonstrating a new apparatus for inserting lenses.
In this era contact lenses were still very rare and, in the UK, were generally supplied by dispensing opticians at the request of medically-qualified ophthalmologists. In the USA it would appear that optometrists became involved at a slightly earlier date. Certainly William Feinbloom was writing on the subject by 1930.
The firm of Müller-Welt moved from Wiesbaden to Stuttgart in 1920. Already, in 1900, it had attempted to make a sceral lens, but it proved uneconomic. In 1928 Adolf Müller-Welt (1904-1972) applied for a patent for the fluidless lens made from moulded Schott glass. In 1929 he blended the transition curve and changed from moulded to blown lenses. Müller-Welt began annealing the glass to reduce stress from 1933 and our image is of a Müller-Welt lens and its case from circa that date. Note the internal retaining ring. The firm perfected the first thickness control in 1939 and their lenses proved popular with German military officers during the Second World War.
In 1929 Josef Dallos of Budapest moulded scleral lenses for individual patients from the living subject using 'Negocoll' - a derivative of seaweed. To take an impression of the patient's eye required an impression tray...Müller blown glass lenses proved to be useful for this purpose.
Dallos lenses developed differently from their Zeiss predecessors or American contemporaries. The emphasis was on a close corneal fit, and a looser scleral fit, allowing fresh tears to be channelled towards the corneal surface.
Heine and the introduction of preformed fitting
Also in 1929, Professor Leopold Heine of Kiel developed afocal lenses, causing their increased popularity. These were preformed ground glass lenses with corneal radii ranging from 5-13mm and scleral curves of 11, 12 or 13 mm. The visual correction was supplied by the liquid 'lens' - a solution of Holocaine 2% saline in warm water. Dallos subsequently refined the design with a third curve to reduce the water volume.
Early preformed fitting sets were issued by Zeiss and marketed as 'Haftglaser', meaning glass that is affixed or fastened. The name was adopted by Zeiss before 1920.
Andrew Rugg-Gunn (1884-1972) wrote the first UK paper on contact lenses which appeared in the medical journal The Lancet in 1930. He showed an awareness of the then limitations on grinding glass to the right shape. He felt that success with blown lenses was superior but often a lucky accident.
'In the last analysis it is comfort that determines whether a glass shall or shall not be worn'
In 1931 The Western Ophthalmic Hospital in Marylebone started using Zeiss 'haftglaser' trial sets of afocal spherical lenses with varying corneal and scleral curves after Rugg-Gunn brought a set back with him from Hamburg. Soon the butt of criticism from Ida Mann (1893-1983), they were only partly successful in England where many contact lens-prescribing ophthalmologists preferred to leave the fitting to dispensing opticians.
Also in 1931 Professor C. H. Sattler described corneal 'veiling'. Corneal oedema due to contact lens wearing has eversince been known as Sattler's Veil. Where there was a close scleral fit, thereby sealing the cornea from the air, there was a greater risk of Sattler's Veil developing, which outweighed the improved comfort experienced in the short-term. A lot of research was carried out into contact lens solutions, in the hope that these would delay the onset of Sattler's Veil.
In 1932 Hans Hartinger developed various Zeiss lens designs.
Also in 1932 K. O. Dunscombe FBOA studied at Zeiss in Jena and brought the techniques learned home to the family firm in Bristol. See our separate web page about the Dunscombe Lens, the first ever 'British' contact lens.
For a while longer, most contact lenses to reach the United Kingdom originated in Germany, as with this rare dated example from December 1934, made by Müller-Söhne of Wiesbaden.
Introduction of plastic lens elements
In 1933 ICI priduced the first commercially successful synthesis of PMMA, known by various brandnames including 'Perspex' and, in Germany, ‘Plexiglass’, registered by Röhm & Haas of Darmstadt.
In 1937 William Feinbloom introduced lenses with a glass optical portion and plastic scleral rim. Plastic simply wasn't clear enough to see through at this stage.
Plastics lens materials ultimately led to better control of the production process and greater patient safety.
Theodore Obrig and the Fluorescein Test
In 1936 Theodore Obrig of New York introduced all-plastic lenses moulded from acrylic resin. These moulded lenses formed a viable alternative to the preformed lenses.
His other great innovation came the same year when he discovered that by introducing a cobalt blue filter into a slit lamp it was possible to illuminate a dye in the eye, thus revealing where the lens rested on the surface and where there was clearance. Dallos, however, did not use the technique, preferring to rely on his own close observation. In this he was unusual. Obrig estimated that the increased comfort that this test made possible would result in making contact lenses a viable option for some 85% of the spectacle-wearing public. It was one of many early predictions of the death of spectacles not borne out by events.
Dallos and the Contact Lens Centre
In 1937 Theodore Hamblin Ltd invited Dallos to work in London, founding the Contact Lens Centre in Cavendish Square. Ida Mann was instrumental in encouraging Dallos to accept the invitation and Rugg Gunn also influenced his decision. Istvan Györffy stayed behind in Hungary to continue Dallos' work and made the first PMMA scleral lens. (Dallos continued to work with glass until the late 1970s).
PMMA - i.e. 'perspex'. A hard or 'rigid' plastic, Polymethyl methacrylate was not a purpose-designed lens material and thus had had the disadvantage of negligible oxygen transmission and a relatively hydrophobic surface.
Also in 1937, the dispensing optician and ophthalmic instrument designer Charles H. Keeler (1903-1993) and the optometrist Edmund Plaice FBOA of Clement Clarke Ltd studied manufacture and fitting of contact lenses under Professor H. J. M. Weve in Utrecht. Weve also had a surgical application for Zeiss glass corneal lenses - he used them on patients to keep the cornea clear during detachment operations, by preventing drying and fogging. This helped the ophthalmic surgeon to localise the retinal tears.
Moorfields Eye Hospital opened a Contact Lens Department in 1938. Our photograph shows that department after the Second World War.
In 1939 the engineer Cyril Winter of C. W. Dixey Ltd made the first lathe for PMMA scleral lenses.
On a trip to the USA just before the Second World War broke out, Frank Dickinson FBOA met fellow optometrist Keith Clifford Hall FSMC on the Queen Mary liner. They went on to become the most distinguished optometrists to fit contact lenses. Hall, in particular, made use of the lathe-turned Dixey lenses. In the UK at least these overtook the Zeiss sets for preformed fitting.
Frank Dickinson, FBOA (1906-1978)
This internationally renowned contact lens practitioner (and wearer) from St Annes began studying contact lenses in 1935 and made two research visits to the USA (rather than Europe) before the Second World War. Here he met key figures such as Obrig and Feinbloom. One of the greatest early communicators on the subject, he combined his clinical and professional knowledge with a prodigious output of published work covering some fifty years from 1929 to a posthumous article of 1979.
He collaborated with his fellow optometrist Keith Clifford Hall on the first British textbook, An Introduction to the Prescribing and Fitting of Contact Lenses (1946), contributing the more technical aspects to the book. In the late 1940s he was accredited with introducing contact lenses to South Africa.
In 1952 he was Founder Secretary of the International Society of Contact Lens Specialists (ISCLS) established in Munich in collaboration with Wilhelm P. Söhnges and Dr John C. Neill of Philadelphia, USA. He earned the Contact Lens Diploma of the British Optical Association in 1948 and was President of the BOA in 1961. For many years he taught optometry courses at the Manchester College of Technology. On his death his collection of historic contact lenses, cases and other historic material was donated to the BOA Museum. Further associated material was transferred to this museum from the University of Manchester in 2010.
Keith Clifford Hall, FSMC (1910-1964)
'KCH' pioneered many aspects of contact lens practice. He began fitting them in 1934, three years after qualifying as an ophthalmic optician and established the first UK practice specialising in contact lenses at 139 Park Lane in 1945, later moving to larger rooms next door and attracting an international clientele. He exported his talents to Norway and Denmark on a regular basis. His technique used scleral fitting shells which were modifed with wax prior to machining.
He was technical adviser on contact lens matters and lecturer and demonstrator of the fitting and prescribing of contact lenses at the London Refraction Hospital on Newington Causeway (today the Institute of Optometry). With Frank Dickinson he wrote his student text book, contributing the more practical chapters, at the suggestion of the Secretary of the British Optical Association, George Giles, and he incorporated many suggestions and line drawings of Arthur Bennett, then of Stigmat Ltd. (Bennett later became Honorary Assistant Curator of the BOA Museum and the ophthalmic lens collection is named after him). The BOA Museum also contains a number of items associated with Hall. The collection might have been even better but for the fact that Hall lost his entire fitting set in 1941. He set about rebuilding it from scratch, incorporating several examples of the most advanced ground lenses of the 1940s. By 1948 he was predicting both soft lenses and disposable lenses.
The museum’s collection is complemented by the BOA Library’s Keith Clifford Hall Collection, a reference collection of books and other literature (including lecture notes) established to commemorate his work. The collection continues to be supported by the BCLA and books received for review in the Association's journal Contact Lens & Anterior Eye are added to the collection.
In 1942 C.W. Dixey & Son Ltd announced the perfecting of a grinding technique for plastic lenses.
Also in 1942, Obrig published the first book on contact lens fitting, simply entitled Contact Lenses.
In 1944 Josef Dallos and Norman Bier independently produced fenestrated haptic lenses to combat Sattler's Veil but Bier was awarded the patent the following year. The fenestration (a small hole) worked by trapping a small bubble of air between the lens and the cornea. Our illustration shows some early experimental fenestrated lenses made by Norman Bier, pre-1945.
Fenestrated glass lenses allowed for at least a doubling of the wearing time, and at least one patient claimed to be able to wear them for a whole day.
Bier later developed corneal measuring caps, known as fenestrated lenses for optical measurement (FLOMs).
Dallos' work on large fenestrations influenced T. Charles Trodd at Moorfields Eye Hospital, who went on to develop 'slotted' lenses.
The Contact Lens Society (CLS)
The Contact Lens Society was founded in 1947. Its first president was Ida Mann with F. Williamson-Noble and Keith Clifford Hall as vice-presidents and A. G. Cross and G. H. Giles as joint secretaries. Sir Stewart Duke Elder also played an influential role in setting it up. The CLS held its first meeting at the British Optical Association headquarters, then at 65 Brook Street, on 27 January.
Contact Lens Research Group
Also in 1947 a Contact Lens Research Group was formed at the London Refraction Hospital - early members included Lew Sasieni, Euin Steele and D. W. A. Mitchell who experimented on each other's eyes, taking impressions with the dental material 'Zelex'.
That same year Gunther Wingate (later to co-found Omega Contact Lenses) and Norman Bier went into partnership and the Wesley-Jessen company was founded when George Jessen designed corneal lenses to fit Newton K. Wesley's kerataconus.
In the late 1940s the manufacturer Newbold & Co Ltd of London would lend out three-part lens fitting sets comprising 73 lenses in all. Opticians could hire the set for a period of four days. In those days only the most specialist contact lens practitioners amassed their own fitting sets.
Introduction of Corneal Lenses - The Tuohy Lens
Corneal lenses are much smaller than scleral lenses. They cover just the front surface of the eye where the light passes through.
An American, Kevin Tuohy, 'invented' the corneal lens in 1948 (he patented it in 1950, so our illustrated sample must post-date then, though it is still extremely rare). Keith Clifford Hall was an early British user of the original design.
The Tuohy lens had just a single curve, so it sat flatter on the cornea than the shape of the cornea would really have liked, leading to problems. Future research would concentrate on developing multi-curve or 'contour' lenses that could give the desired clearance. Tuohy lenses were easily dislodged and could only correct low amounts of astigmatism. They were dismissed as impractical for general field use by the US Army.
Also in 1948, Heinrich Wöhlk produced moulded corneal lenses.
The development of corneal lenses had been held back due to fears they would cause ulceration. Once proven to work they were seen to have great benefits. They did not need to be used in conjunction with contact lens solutions and Sattler's Veil was avoided.
The Feincone and the Kelvin Lenses
In 1947 the proprietor of Kelvin Lenses Ltd, Raymond K. Watson, designed a lens with a conical transition (developing the 'Feincone' idea of Feinbloom in the USA), making the preformed Kelvin lens more comfortable than that of Zeiss. An elaborate manufacturing set-up using metal moulds meant that in 1947-8 the company could sell more than 120 fitting sets containing fifty lenses in each set. The tools to make them, all of which were hand polished, included some fifty main tools with fifteen inserts and over a hundred buttons.
Kelvin introduced contact lenses to Holland, Belgium and parts of Scandinavia. From its factory in Denton it was also to become the UK's largest manufacturer of corneal lenses because its moulding techniques were more consistent than those to be found in factories using lathes.
Formation of the ACLP
1949 saw the foundation of the Association of Contact Lens Practitioners (ACLP). Founder members included Euin Steele, Reg Tyler-Jones and Bernard Donner. The ACLP was incorporated as a limited company in 1955 and hosted the first congress purely devoted to contact lenses to be held in Great Britain in 1960. Its official journal was The Contact Lens Practitioner.
In 1950 Butterfield of Oregon designed a corneal lens formed to the eye’s shape.
Bifocal contact lenses
Also in 1950, Frederick Williamson-Noble (1889-1969), an ophthalmic surgeon, described a practical bifocal contact lens - with a central near zone surrounded by a distance vision annulus. Three years later he was fitted with a pair himself.
That same year Clifford Knott became the first travelling representative for a contact lens company when he began such work for C. W. Dixey Ltd.
In 1951 a collaborative effort by three optometrists produced the 'Microlens' - an improved corneal lens due to W. P. Söhnges, of Germany, John C. Neill of America and Frank Dickinson of England. The Microlens was a PMMA lens just 9.5mm in diameter with a single posterior curve and a very small edge bevel. It could thus be fitted some 0.2 to 0.3mm flatter than any other lens hitherto available. Named by Muriel Dickinson the lens was announced to the world in 1953. The sample illustrated dates from 1954. Later enhancements to the back surface design and modern gas-permeable materials have given us the hard lens of today.
'I went to the London Refraction Hospital [in 1953] where I took a week's course and was judged competent to fit moulded contact lenses. A mould was taken of the patient's corneas and sent to Obrigs laboratory for processing. After much to-ing and fro-ing the final lenses were completed and returned. It was rather a time consuming operation. I was one of the the few who completed the course first time'. K. A. Stephens, FCOptom
In 1955 John de Carle, a London Optometrist, produced a bifocal corneal lens
Corneal Lens - A lens resting only on the cornea of the eye; these days more commonly called simply a 'contact lens'
Scleral Lens - A lens resting only on the sclera or white outer portion of the eye. Also known as a 'haptic' lens
Peter Madden (d.1983)
A whole generation of British customers (i.e. the opticians who would then supply the lenses to the public) received a carnation from Peter Madden who made the flower his trademark. He was a highly successful sales manager for Sphercon from 1957 and later founded Belgravia Optical (1962) and a partnership with the optical technician Randolph Layman (1970). He was also a visiting lecturer on the London Course of Optometry through which many overseas students were introduced to contact lenses for the first time. The Museum now owns a full colour portrait photograph that used to hang in his boardroom. Note that, despite his firm's product, he himself was always pictured wearing spectacles.
Hard contact lenses remained the normal type until the mid 1960s when there was a large scale rush to prescribe and fit soft lenses instead.