Review

Contact Lens Materials: A Materials Science

Perspective
Christopher Stephen Andrew Musgrave 1 and Fengzhou Fang 1,2,*
1 Centre of MicroNano Manufacturing Technology (MNMT-Dublin), University College Dublin, Dublin D14
YH57, Ireland; christopher.musgrave@ucd.ie
2 State Key Laboratory of Precision Measuring Technology and Instruments, Centre of MicroNano

Manufacturing Technology (MNMT), Tianjin University, Tianjin 300072, China

* Correspondence: fengzhou.fang@ucd.ie; Tel.: +353-1-716-1810

Received: 20 December 2018; Accepted: 7 January 2019; Published: 14 January 2019

Abstract: More is demanded from ophthalmic treatments using contact lenses, which are currently
used by over 125 million people around the world. Improving the material of contact lenses (CLs) is
a now rapidly evolving discipline. These materials are developing alongside the advances made in
related biomaterials for applications such as drug delivery. Contact lens materials are typically
based on polymer- or silicone-hydrogel, with additional manufacturing technologies employed to
produce the final lens. These processes are simply not enough to meet the increasing demands
from CLs and the ever-increasing number of contact lens (CL) users. This review provides an
advanced perspective on contact lens materials, with an emphasis on materials science employed
in developing new CLs. The future trends for CL materials are to graft, incapsulate, or modify the
classic CL material structure to provide new or improved functionality. In this paper, we discuss
some of the fundamental material properties, present an outlook from related emerging
biomaterials, and provide viewpoints of precision manufacturing in CL development.

Keywords: contact lens; materials; biomedical implant

1. Introduction
The market for contact lenses (CLs) is ever-growing, with over 125 million consumers as of 2004
[1], and an estimated global market size worth $7.1 billion in 2015 [2]. A quick search of patent
literature shows that over 100 patents have been filed since 2000, representing the growing
popularity of CLs. The applications of CLs range from corrective vision and therapeutics to cosmetic
appearance [3,4]. Within these applications comes the demands from the end user of the lenses,
including length of wear, comfort, durability, practically of handling, stability of vision, etc. This
also means that within the applications of contact lenses comes the demands from manufacturers,
such as material costs, ease of production, and reliability of the CLs, etc. Finally, the demands from
manufacturers determine the parameters of the material which scientists must focus their research
on for developing CL materials. This premise has guided materials scientists, from the creation of
glass scleral lenses in the 1930s to rigid, non-gas-permeable polymethyl methacrylate (PMMA) in the
1940s. The 1960s and 70s ushered in hydrogel (polymer and silicone) lenses, with silicone hydrogel
proving to be the most dominant kind of CL material today.
Commonly, the labels of “hard” or “soft” are used as blanket definitions of CLs [3,4]. Hard CLs
are rigid (durable), gas-permeable lenses, whereas soft contact lenses are made of flexible,
high-water-content material. Hard lenses are often interchangeably referred to as rigid
gas-permeable lenses (RGPs); however, this is not strictly true. The first PMMA lenses could be
classified as hard, whereas modern RGP lenses are, in fact, more flexible, due to the incorporation of

Materials 2019, 12, 261; doi:10.3390/ma12020261 www.mdpi.com/journal/materials

Materials 2019, 12, 261 2 of 36

low-modulus components—hence, they are more rigid, rather than hard. Another defining
characteristic is that PMMA hard lenses have no oxygen permeability, whereas RGP lenses are
permeable. On the other hand, a soft contact lens (SCL) is a highly flexible, oxygen-permeable
material with often high water-content. This flexibility means that SCLs fit the shape of a user’s eye
much faster than a rigid lens. SCLs can be disposed daily, weekly, or monthly. These blanket
definitions of CLs can hint at its material properties, though not for certain. There is often an overlap
in materials used between hard and soft lenses, such as silicone hydrogels and RGPs. Although both
use silicone materials, the difference lies in factors such as the gel network and water content.
Derivatives therein can further diversify the range of possible CLs and their properties. The
requirements for CLs are quite extensive, and there are a huge number of existing CLs on the market
to reflect this; daily-disposable lenses, weekly/monthly lenses, special fitting lenses, and even lenses
that can be worn overnight. Users’ demands can be described by several general parameters, such as
comfort, wear time, handling (cleaning, ease of use), cost, and vision specifications (Figure 1) [3,4].

Figure 1. General user demands from CLs. Each parameter can be sub-divided into many categories,
which is why the CL market is so vastly populated.

PMMA is a durable, optically transparent polymer with limited hydrophilic character.

However, PMMA has negligible oxygen permeability, which may lead to several eye health issues,
such as hypoxia [5,6]. Researchers quickly discovered polymer hydrogels, which were typically
based on hydroxy ethyl methacrylate (HEMA) [7,8]. These polymer hydrogels were composed of
hydrophilic monomers, meaning they contained electrochemical polarity allowing interaction with
water. This provided much greater biocompatibility than PMMA. These hydrogels were also an
oxygen-permeable and flexible class of material that could hold a large percentage of water within
the polymer network. These factors improved the comfort, oxygen permeability, and wear time of
CLs, which resulted in many CL derivatives based on HEMA [9,10]. Progress did not stop, as the
oxygen permeability of HEMA hydrogels was not sufficient for extended CL wear (>24 h) [3,4]. The
next evolution of CLs was silicone-based rigid lenses and hydrogels. These materials have very high
gas-permeability, meaning extended-wear lenses could be fabricated. However, silicone materials
are inherently hydrophobic, meaning they are not comfortable due to factors such as poor wetting
and abrasiveness. Polymer scientists overcame this by using copolymerization of a silicone
monomer (e.g., siloxymethacrylates and fluoromethacrylates) with hydrophilic comonomers to add
the desired hydrophilic character [11–14]. This was particularly successful for silicone hydrogel
lenses, which is the most dominant CL material on the market today (64% in the US) [15]. Newer CL
materials appeared in the 1990s, such as polyvinyl alcohol (PVA), which is a low-cost and very
hydrophilic polymer [16,17]. In fact, the PVA hydrogel was the subject of investigation in the early
1990s as a potential CL material [18]. In addition, new surface coatings, such as polyethylene glycol
(PEG) have appeared in recent years to improve the hydrophilicity of silicone-based CLs [19]. These
are just two examples amongst a vast pool of relevant literature.
Materials 2019, 12, 261 3 of 36

Despite this significant progress, more is demanded from CLs today. CLs provide a route for
improving the quality of life. This could simply be for cosmetic reasons or for corrective vision in
place of traditional spectacles, which remain the two most common uses of CLs today [20]. Cosmetic
CLs can include anything from pigmented to prosthetic CLs. However, CLs are increasingly
considered a platform for more proactive ophthalmic treatments. As the number of people
developing myopia, glaucoma, and other eye conditions is increasing globally, more effective
treatments are required [21]. One review paper estimated that over 1400 million people worldwide
are currently suffering from myopia [22]. Myopia control using CLs has been a subject of debate [23];
however, there is mounting research that specialty lenses can control the progression of myopia [24].
CLs can offer one such treatment route for glaucoma; the drug-loaded lens can simply be placed
onto the eye, and the drug is released onto the eye [25–27]. This is currently a hot topic, and has been
the subject of several excellent review papers [27–29]. Therefore, it is clear that new and improved
CL materials are required to deliver more effective treatments for these growing issues.
Many sources detail the general synthesis of hydrogels or discuss their end application, such as
bioavailability, eye-fitting, CLs in practice, manufacturing, and much more [3,4,30,31]. There have
been some articles that have talked specifically about materials for contact lenses, which provided
important insights at the time [32,33]. Other sources have discussed general bioavailable materials
[34,35] and the properties of CL brands [33], with a lot of modern research being concerned about
drug delivery using CLs [27,36–38]. This review brings together research specifically about the latest
development of CL materials, and touches on details from a materials science perspective. We aim to
bring together the innovations in CL materials and explain the impact they have. We discuss general
polymerization mechanisms and monomers used to produce CL materials, which are all
considerations for designing new CLs. We then discuss new evolutions to the main classes of CL
materials, such as RGP lenses, HEMA- and silicone-hydrogels, and their future perspectives. Finally,
we highlight some particularly impactful materials, emerging materials’ technologies, and future
manufacturing viewpoints.

2. Contact Lens Materials

2.1. Overview
To manufacture CLs, there must be a suitable polymeric material. This opens an incredible
number of possibilities, not only from the range of polymers but to the formula of components
within a given recipe. In addition, there can be considerations for the different types of
polymerization mechanisms to form the same polymer, such as radical vs. catalytic polymerizations
and derivatives. Within this, the polymerization conditions (temperature, initiator type, vessel used,
etc.) can be altered to produce the same polymer but with different properties. Finally, the material
must be suitable for the manufacturing stages, which include the synthesis, inspection, and
packaging processes. The manufacturing stages have their own intricacies, which will be discussed
later; thus, it is easy to quickly get lost in the search for the most suitable CL material. The extent of
variation in materials is why there is such a wide range of CLs available today, and this has been
extensively researched. Figure 2 contains some of the most important factors from a materials
science perspective when designing CLs. From this, an assessment of current CL materials’ pros and
cons is given in Table 1.
Materials 2019, 12, 261 4 of 36

Table 1. General pros and cons of current CL material classes.

CL Material Pros Cons

PMMA Inexpensive, well-understood polymer No oxygen permeability, inflexible on the eye
Expensive regents, requires hydrophilic
RGP High oxygen permeability, durable
comonomer, can be abrasive
HEMA Inexpensive, biocompatible, abundant Low oxygen permeability, protein deposition
hydrogel copolymer possibilities issues
Silicone High oxygen permeability, durable, Expensive regents, requires hydrophilic
hydrogel comfortable comonomer, can be abrasive
Inexpensive, straight-forward
PVA Low oxygen permeability, fixed water content
manufacturing, biocompatible

Figure 2. A CL lens is dependent on many parameters from a material science perspective. Stronger
emphasis on specific characteristics are required, depending on the specific demand placed on the
CL. The final CL material accounts for wear time and comfort. These characteristics are often
dependent on the materials, but also includes manufacturing processes, such as plasma treatment.

For clarity, a polymer is a large macromolecule composed of hundreds or thousands of a

repeating molecule, called a monomer. Each monomer has a covalent bond between each connecting
unit. Some common monomers and polymers used in the production of CLs can be seen in Figure 3.
The process by which the polymer is formed is called polymerization. Another reactive molecule,
the initiator, is used to begin the polymerization. Polymerization initiators are typically selected
based on the interaction with the reactive functional groups within the monomers. Radicals are
formed on the breakdown of the initiator, which then induce the polymerization by stripping a
radical from the monomer functional group. Now the monomer has a free radical within itself,
which reacts with a neighboring monomer functional group by stripping a radical from this group.
The original monomer would have then formed a new bond with the new monomer unit, which
now has a new radical to continue polymerizing. This propagation step is continuously repeated,
thus forming the polymer over time, which extinguishes when there are no more monomers to
consume. The polymerization terminates when the radical is quenched in another manner, such as
by a radical scavenger. The initiator can be chosen for their practicality, such as ultra-violet (UV) or
thermal initiators, which is a huge consideration for the manufacturing method in producing CLs.
Materials 2019, 12, 261 5 of 36

Figure 3. The chemical structures of common monomers and polymers used to produce CLs. This
includes some macromonomers and cross-linking agents. PMMA—poly methyl methacrylate,
PVA—poly vinyl alcohol, PEG—poly ethylene glycol, DMA—dimethyl methacrylate,
HEMA—hydroxy ethyl methacrylate, NVP—N-vinyl pyrrolidone, EGDMA—ethylene glycol
dimethacrylate, PDMS—poly dimethyl siloxane, TRIS—3-[tris(trimethylsiloxy)silyl]propyl
methacrylate.

2.2. Polymerization Mechanisms

Free-radical polymerization (FRP) is a type of chain-growth polymerization mechanism.
Typically, free-radical polymerizations are often not easily controlled, producing high dispersity
(large variations in molecular weights) of the resulting polymers. This can lead to a distribution of
the polymer properties. High strain and tensile modulus polymers are often determined by the
length of the polymer chains [39]. One advantage of FRP is that it is easy to form gelling networks
with, as the polymerization has many initiation sites within the vessel. This allows for the
simultaneous growth of many chains which can physically entangle or cross-link to form the gel
network. Cross-linking is dependent on one of the monomers containing two functional groups,
which enables chemical bonding to two different polymer chains. Cross-linking polymer chains
often improves gelling and increases the modulus of the material. To date, most CLs are produced
using free-radical polymerization [11,13,40–44]. It is facile and doesn’t require expensive reagents,
such as catalysts. Furthermore, unwanted/unreacted chemicals can be removed from the material on
post-fabrication cleaning processes. Catalysts are often composed of heavy metals, which is
something to avoid for human health.
Today, most CLs are produced from a polymerization of two or more monomers [42,45].
Copolymers incorporate the properties of the individual polymers; consequently, copolymerization
is often the first method used in overcoming issues with a single polymer. This principle has
governed the development of CLs for many years. For example, silicone polymers are very
hydrophobic, despite their high oxygen permeability. Therefore, they are not ideal as a
homopolymer CL material. However, copolymers of silicones with a hydrophilic (highly polar)
monomer can solve this problem. Copolymerization may also be used to enhance physical
properties through the cross-linking of polymer chains by adding molecular weight to the chain. In
some cases, adding a soft polymer can reduce the modulus of particularly tough materials (often
silicone-based materials). Hydrophobic comonomers add oxygen permeability to materials that
require improvement to this property, and silicone-based monomers are often used for this purpose.
Table 2 contains the properties of common CL materials and related copolymers, including oxygen
permeability, water content, moduli, and wear time. Wear time is from the perspective of the
Materials 2019, 12, 261 6 of 36

maximum wear time of a CL before eye health issues arise. More exhaustive resources comparing
these properties are given elsewhere [3,4]. The effect of copolymerization is particularly noticeable
for rigid materials derived from PMMA with a large reduction in the modulus, whereas the
hydrogel classes of lenses have a much wider stable range of moduli, but large variations in water
content and oxygen permeability.

Table 2. Generalized properties of some common CL materials.

Oxygen Permeability Water Content Modulus Wear Time

Material
(Dk/t) (wt %) (MPa) (days) *
PMMA 0 0 1000 <1
PMMA-silicone 15 0
Silicone-HEMA
10–100 0 10
(rigid)
HEMA hydrogel 10–50 30–80 0.2–2 1–7
HEMA-NVP
HEMA-MMA
Silicone (PDMS)
60–200 20–55 0.2–2 ~7–28
hydrogel
TRIS-DMA
PDMS-HEMA
PVA 10–30 60–70 <1
* Maximum wear time without extensive complications to the eye before lens disposal.

Full-density polymers utilize molecular weight and intermolecular forces to provide the
strength of the material; this is partly why PMMA has a high modulus. Other factors, such as the
lens thickness of the final lens, is important too, whereas the properties of very low-density
polymers (10% of full density, 90% air), such as porous materials are sensitive to small changes in
cross-linking [46,47]. Another study demonstrated a reduction the Youngs modulus of up to 40% in
a 90% porous material due to inefficient cross-linking [48]. This could be relevant to very
high-water-content hydrogels on hydration from the final material properties and manufacturing
considerations [49]. In fact, Maldonado-Codina and Efron highlighted the need for improving
processes between polymerization batches and manufacturing methods. Other factors that are
important include homogeneity of the wall vertices, uniform pore size, etc.; all of which are not
guaranteed to be consistent with FRP. Moreover, if we consider SCLs to be porous cellular solids,
these factors must be considered in future designs [50]. Although FRP has been the workhorse for
fabricating excellent CL materials, they may not be producing entirely efficient networks for
functional materials [51]. This could be another reason why there are no drug-delivery CLs on the
market today, in addition to the many reasons stated by Dixon et al. [52]. Alternative polymerization
mechanisms could be of interest to improve the physical properties of CL materials. Other kinds of
methods include catalysts or controlled radical polymerization. One controlled method for radical
polymerization is chain-transfer polymerization. This has been a popular area of growth in polymer
science, including examining the potential in other bio-applications [53–55]. The chain-transfer agent
accurately mediates the growth of the polymer chain, so that the molecular weight can be
pre-designed [39,56,57]. This results in a low-dispersity polymer, meaning the resulting properties
and structure are more reliable than FRP (Figure 4). There are many examples of hydrogels
produced using chain-transfer agents [58–60]. One specific example of reverse addition
fragmentation chain transfer (RAFT) polymerization encompasses silicone-based polymers [61].
Other researchers also used RAFT to modify polyacrylic acid pH-responsive hydrogels for drug
delivery [60]. This opens the potential of RAFT-synthesized silicone- and conventional hydrogels as
CLs. Recently, Zhang et al. synthesized a promising RAFT-polymerized soft contact lens based on
polyallyl methacrylate and PEG components [62]. The lenses had low contact angles (<80°), high Dk
Materials 2019, 12, 261 7 of 36

values (>100 barrers), and elastic moduli ranging from 0.5–1.5 MPa, which are in the range of the CL
parameters given in Table 1.

Figure 4. Schematic for the macromolecular structure differences between FRP and
RAFT-polymerized materials. The RAFT polymer can be used to create a more ordered structure
compared to FRP, which could be important to the macromolecular structure and final application of
the material. Republished with the permission of The Royal Society of Chemistry, from Pushing the
mechanical strength of PolyHIPEs up to the theoretical limit through living radical polymerization,
Y. Luo, A-N. Wang, X. Gao, 8, 2012; permission conveyed through Copyright Clearance Center, Inc.
[51].

2.3. PMMA and Rigid Contact Lenses

2.3.1. PMMA
Today, PMMA CLs occupy a market share of about 1% [15]; however, they are a useful place to
begin to appreciate CLs materials—the properties of polymers that are suitable for ocular wear. One
of the biggest issues with PMMA is that it has little to no oxygen permeability. This is due to the lack
of mobility of polymer chains preventing the flow of oxygen or internal water to mediate the flow of
O2 (Figure 5). This occurs in PMMA due to intermolecular forces, such as dipole–dipole bonding and
physical entanglement that is prevalent between polymer chains. The dipoles are created by the
negatively charged (electrochemical negative) oxygen compared with the adjacent positively
charged (electrochemical positive) carbon and hydrogen atoms. Therefore, neighboring polymer
chains can attract each other to provide thermodynamic stability to the polymer. These
intermolecular forces also mean that PMMA has low free volume (space between polymer chains),
meaning the chains do not rotate or move easily. In addition, PMMA does not contain large pendant
chains that prevent the interaction of neighboring chains. All these factors together prevent the flow
of oxygen through the polymer. However, functionalization of the PMMA surface can improve the
hydrophilicity [63], which would be useful to these CLs.
Materials 2019, 12, 261 8 of 36

Figure 5. Schematic for gas-permeability mechanisms of CL materials from the perspective of

polymer chains. These 2D models represent how oxygen passes (or not) through the molecular
structure of the CL material. These schematics do not show factors such as extensive cross-linking or
the macromolecular structure that would be present in a 3D structure.

In the recent literature, PMMA has typically been utilized as a reference material for
investigating various effects of CLs on the eye [64–67]. These works are some of many with a
particular focus on the effect of the PMMA lens on eye conditions, such as astigmatism [64],
strabismus [68], and blepharoptosis [65]. Aliό et al. fitted patients who had received post-corneal
refractive surgery with a variety of lens types, with RGP lenses showing the best results [64]. An
interesting work by Li et al. showed fabrication of a possible new PMMA hybrid lens with zinc oxide
quantum dots to reduce UV exposure [69]. Very low loadings of ZnO quantum dots (0.017 wt %)
reduced the transmittance of UV light by 50%, yet retained suitable optical transparency expected of
a contact lens (Figure 6). Perhaps the most novel advancement for PMMA lenses was the possibility
of developing nanophotonic lenses [70,71]. Acid- and hydroxyl-functionalized fullerenes (C60) were
attached to PMMA to try to harness the photo- and electro-activity of the fullerene. However, these
nanophotonic lenses have now been a focus of SCL materials instead [72].
However, all may not be bad for PMMA, as van der Worp discussed the relevance of PMMA as
scleral lenses [73]. In addition, PEG grafted onto PMMA is seen as a prosthetic eye replacement [74].
Overall, these are only a few works amongst an enormous amount of literature on contact lenses.
The fact remains that PMMA is a very well-studied polymer; as such, the interest in developing new
materials derived from PMMA is not exciting at present. Simply, the lack of many publications
involving PMMA in the modern literature is strong evidence that PMMA is not relevant in today’s
climate for CLs. The only hope is that PMMA can continue to be used for fundamental
understanding, along with the factors that affect the eye gained when using PMMA as a reference
CL material. For this reason, PMMA will remain a marginalized contact lens material for both
research and commercial purposes.
Materials 2019, 12, 261 9 of 36

Figure 6. PMMA buttons loaded with ZnO quantum dots. The fabricated buttons would be suitable
for lathe-cutting manufacturing to form a final CL. Reprinted (and adapted) with permission from
John-Wiley and Sons [69].

2.3.2. Other Rigid CLs

Modern rigid gas-permeable (RGP) lenses have moved away from PMMA, or significantly
reduced the molar fraction of PMMA in many copolymers. Efron wrote an obituary for RGP lenses
stating the reasons why these lenses are obsolete [75]. Nevertheless, RGP lenses (including PMMA)
still account for about 14% of all lenses fit in the US as of 2017 [15]. Modern research concerning RGP
lenses is in regard to their application, treatment, and effect on eye conditions, rather than
innovations on the material [76–78]. Eggnik et al. reported that a large-diameter RGP lens of
unknown composition was used to improve post-surgery treatment for laser in situ keratomileusis
(LASIK) patients [79]. The success of RGP lenses lies in their rigidity, causing a reshaping of the
cornea, which was useful for some post-surgery treatment [80]. Soft lenses are sometimes unsuitable
for treatment as they are very malleable, and therefore will shape to the user’s eye. These other
works often use commercially manufactured lenses to carry out their research; therefore, it is more
difficult to know the exact composition and methods by which these materials were synthesized.
However, it is known that the typical composition of these lenses are based on fluoro silicone or
siloxane (such as PDMS and TRIS) acrylate moieties, alongside hydrophilic monomers such as
HEMA, NVP, and methacrylic acid (MAA) [4,76]. Baucsh & Lomb were assigned a patent for
polysiloxane, copolymerized with urea moieties prepolymers to from RGP lenses [81]. The urea (or
carbamides (CO(NH2)2) moieties added hydrophilic properties. These vinyl end-capped
prepolymers were then copolymerized with well-known monomers such as NVP, MAA, MMA, and
TRIS to form the RGP lens.
Although Efron’s prediction may not have come to pass, what is true is that there is a lack of
material innovation for RGP lenses. This simply could be due to the fact that RGP lenses are
unfashionable from a research perspective, particularly with the booming field of hydrogels. In fact,
Efron first alludes to this by commenting on the marketing for SCLs over RGP lenses, and that the
lack of finance directed at improving these materials has caused their decline. Smart or wearable
biosensors show promise for RGP lens materials [82], but even this field is being dominated by SCL
materials [83]. Perhaps the route to reinvigorating RGP lenses is through the growth of augmented
reality (AR) technology. Patents for the design of an AR contact lens have been assigned to
companies such as Samsung and RaayonNova in 2016 and 2017, respectively [84,85]. However, it is
likely that the first lenses will borrow heavily from existing RGP lens materials. This is in contrast to
other smart CLs, which are often based on SCL materials [86].
Materials 2019, 12, 261 10 of 36

2.4. HEMA-Derived Hydrogels

HEMA and related hydrogels are a high-water content, oxygen-permeable polymeric material.
These hydrogels can have water content between 20–80% depending on the comonomers, with a
hydrogel composed of only HEMA containing about 38% water. HEMA’s highly polar properties
mean these CLs have generally suitable wetting properties, meaning they are comfortable. The
oxygen permeability of these gels is suitable for longer wear, but not to the same extent of
silicone-based lenses. HEMA-derived hydrogels form an important part of the market, occupying
about 22% [15]. HEMA is commonly copolymerized with monomers such as EGDMA, MAA, and
NVP. NVP and MAA increase the water content of hydrogels due the strong hydrophilic character
arising from amine, carboxylic acid, hydroxyl groups, etc. Therefore, these comonomers also
influence the wettability of the surface [87,88]. The mechanical properties can be improved by using
a cross-linking molecule, such as ethylene glycol dimethacrylate (EGDMA). EGDMA has two
functional groups allowing the formation of covalent bonds between two individual polymer chains.
This increases the mass of the polymer dramatically, and improves its ability to form a gel network.
However, the crosslinks also reduce the polymer-chain motion, which can be a factor in swelling and
oxygen transport [88]. The water content and cross-linking affect the modulus and oxygen
permeability of the hydrogels (Figure 7). As such, a balance must be reached between these
parameters when designing a CL for a particular application.

Figure 7. Schematic on the effect of cross-linking on the modulus, water-content percentage, and
oxygen permeability. The increased cross-linking prevents (green) the polymer chains from swelling,
compared with lower-modulus gels.

To improve CL materials, it is vital to better understand the properties of these hydrogels. The
properties of HEMA-based hydrogels were shown to vary as a function of use by patients [89].
Tranoudis et al. measured the properties of lenses, such as total diameter, oxygen permeability, and
the back optic zone radius, at temperatures ranging from 20–35° and before/after 6 h of wear. All the
materials were altered with statistical significance; however, according to the summary tables,
HEMA-VP 70% (meaning 70% water content) was moderately stable. In another study, the authors
showed that free-to-bound water content was an important factor for the rate of dehydration and
oxygen transport in SCLs [90]. The bound water to the polymer may be a factor in stability of
hydrogels, such as HEMA-VP 70%, compared with other gels. Tranoudis et al. published another
paper to more accurately characterize the tensile properties of the same organic hydrogels [91]. They
Materials 2019, 12, 261 11 of 36

concluded that hydrogels with high water content did not necessarily correlate with poor
mechanical properties. This is largely true, and is an uncomplicated way of summarizing the data.
However, comparing different polymer systems can be difficult due to the different intermolecular
forces that exist to provide stability (or lack of) based on different chemical compositions. There are
properties of the polymer structure which could reveal more factors that affect the mechanical
properties of hydrogels. Explanations by Ashby may reveal the reasons for inconsistent properties
between batches of the same polymeric material [50]. Porous cellular solids with varying wall
thicknesses and lengths between vertices are some of the factors that influence the mechanical
properties of porous materials. Therefore, it is important to study the polymer’s physical structure
and polymerization mechanisms. Use of 1H Nuclear Magnetic Resonance (NMR) relaxation times by
Woźniak-Braszak et al. was a novel characterization method used to probe the dynamics of free
water in contact lenses [92], where they showed an increase in free water in four-week-old lenses
compared with new lenses (83% to 71%, respectively). These studies together provide a more
detailed understanding of hydrogels, which in turn can be used for the better design of CLs.
Currently, modification of the HEMA-hydrogel structure is paving the way for new lenses,
innovations, and applications. Protein deposition on the eye remains a concern, particularly for SCL
materials based on HEMA [93,94]. Common comonomers, such as MAA and NVP, increase the
protein deposition. Both comonomers introduce hydrophilicity and electrochemical charge to the
hydrogel, which attracts the proteins from the tear film [93]. Lord et al. also showed that the protein
uptake could affect the water content of a HEMA-MAA hydrogel. This could be related to
observations by Tranoudis et al. where a HEMA-MAA hydrogel lost 15% water content across a 6 h
period [89]. An interesting report by Borazjani et al. regarding the bacteria adhesion of Pseudomonas
aeruginosa, a risk factor in keratitis, to a HEMA-hydrogel was no less than that of a silicone hydrogel
[95]. Borazjani et al. also reported that adhesion of the bacteria was more related to the strain of
bacteria than the lens material. Another study by Szczotka-Flynn et al. demonstrated that biofilms of
bacteria (particularly Pseudomonas aeruginosa) were resistant to the antimicrobial action of CL
solutions [96]. Dutta et al. looked into the literature of this area by considering the material type,
length of wear, and bacterial strains on the cumulation of the bacteria on contact lenses [97]. New
strategies to prevent this have been in development since the early 2000s, including further
modification of the lens material. A more detailed and extensive article on antimicrobial strategies
was published by Xiao et al. [98].
Grafting additional substances to HEMA has proven to be an effective method of modification
for improved lens functionality [99–101]. Some specific examples include grafts to reduce the protein
deposition or increase the anti-microbial action of contact lenses. A successful product based on a
HEMA hydrogel lens incorporated with silver nanoparticles (AgNPs) has been on the market in the
UK (MicroBlock®). Other researchers looked at the impact of the monomer composition of the
HEMA hydrogel contact lens on AgNP uptake and performance [102]. They noticed that
HEMA-MAA-EGDMA gels had the strongest affinity to the nanoparticles, soaking in AgNPs from
10 to 20 ppm. Other interesting antimicrobial graft materials include melimine and polymyxin B.
Melimine is a synthesized antimicrobial peptide consisting of 29 amino acid units, and was
covalently bonded to HEMA-MAA-EGDMA using an acidic (pH = 5) buffer to induce the reaction to
the pendant acid groups on the lens [103]. This post-hydrogel modification may not be entirely
practical for manufacturing, but is interesting due to the excellent properties of the resulting
hydrogels. Polymyxin B is another anti-microbial macromolecule, and was grafted using an
azobisisobutyronitrile (AIBN) free-radical initiator during hydrogel synthesis [104]. The action of
polymyxin B induces greater water permeability of bacterial cells, eventually leading to bursting
through the increased water uptake. Sato et al. modified HEMA by copolymerization with moieties
such as 2-methacryloxy ethyl phosphate (MOEP) to facilitate drug delivery [105]. The MOEP adds
additional anionic character, which was used to bind a model drug to the hydrogel. The drug release
profile was a superior HEMA-MAA hydrogel due the stronger ionic group based on the chemical
changes with pH.
Materials 2019, 12, 261 12 of 36

Other modification materials include the incorporation or grafting of surfactants. A surfactant

consists of a hydrophobic and hydrophilic component, and is primarily used to promote the
reduction in surface tension between two immiscible liquids. Bengani et al. employed the novel use
of polymerizable surfactants attached to HEMA hydrogels to enhance wettability and lubricating
properties [106]. They achieved a 10° reduction in water-contact angle with about 2.4 wt %
surfactant, which was covalently bonded to the hydrogel by UV polymerization. The low-surfactant
loading meant that the HEMA-hydrogels remained below 45% water content, which indicates the
power of such a technique. In this case, the hydrophilic component interacts with the aqueous tear
film and the hydrophobic part remains in the hydrogel (Figure 8). There is much modern literature
that still reports high rates of contact lens discontinuation due to discomfort and dryness [107–109].
This emphasizes the importance of new techniques, such as surfactant loading/grafting employed by
Bengani et al. Other uses of surfactants include use as a drug delivery system for cyclosporine A in
modified HEMA-hydrogels [110]. In this case, the surfactant leached out of the hydrogel with the
drug encapsulated within surfactant aggregates (Figure 9). This is now becoming a more researched
topic, using a larger number of surfactants to deliver drugs [111–114]. These works have used a
diverse range of surfactants, from cationic to non-ionic, with molecular weights ranging from about
400–12,500 g mol−1. This wide variation in surfactant properties is interesting, suggesting that the
hydrogel structure is highly adaptable to such modifications.

Figure 8. Schematic for the interaction between the aqueous tear film and a surfactant bonded with a
hydrogel lens. Reprinted from Journal of Colloid and Interface Science, 445, Bengani, L.C.; Scheiffele,
G.W.; Chauhan, A.; Incorporation of polymerizable surfactants in hydroxyethyl methacrylate lenses
for improving wettability and lubricity, 60, Copyright 2014, with permission from Elsevier [106].
Materials 2019, 12, 261 13 of 36

Figure 9. Drug-loaded hydrogel loaded with surfactants. The aggregation and leaching of the
surfactant acts as a drug delivery vehicle. Reprinted from Biomaterials, 30, Kapoor, Y.; Thomas, J.C.;
Tan, G.; John, V.T.; Chauhan, A. Surfactant-laden soft contact lenses for extended delivery of
ophthalmic drugs, 867, Copyright 2008, with permission from Elsevier [110].

In summary, HEMA-hydrogel CLs are in an exciting place. The ability to design new materials
is due to the flexible hydrogel structure composed from many functional groups. Essentially, the
core of the hydrogel has remained relatively unchanged, due to the principal properties that matter
to CLs, such as oxygen permeability, water content, wettability, etc. Modern HEMA hydrogel lenses
have evolved through modification of the hydrogel structure through techniques such as
encapsulation and grafting. Some of the materials used for modification were surfactants,
nanoparticles, and anti-microbial agents, all of which are diverse in themselves. As such, the works
presented here are only the beginning of an emerging field. There were also efforts to better
understand the mechanical properties of the HEMA-hydrogels, such as dehydration rates, bound
and free water content, and factors influencing protein absorption into the hydrogels. From a better
understanding of hydrogel properties, new manufacturing processes can evolve to further improve
the material specifications. This is encouraging progress for designing better materials, which will
only keep evolving as more and more chemical modification techniques and materials are
employed.

2.5. Silicone-Derived Hydrogels

Silicone-based hydrogels are the most common type of CL material today, occupying about
64% of the US market [15]. This includes silicone, silioxanes, fluorosiloxanes, and derivative
materials. Their popularity is linked to the fact that these CLs have the highest oxygen permeability
of all contact lens materials (>100 Dk, typically). Silicone CLs are often durable, originating from the
high Si–O bonding energy, often with a higher modulus than conventional polymer hydrogels. This
typically applies to RGP lenses, as the modern silicone hydrogel has a similar modulus to
HEMA-derived hydrogels. The high modulus is linked to causing irritation to the eye, such as the
conjunctiva of the inner eyelid [4]. In fact, the discomfort and dryness of silicone-based lenses are
two of the main reasons for users’ discontinuation [107,109,115,116]. Specifically, the wettability of
the lens and the incompatibility with the cornea environment in vivo requires detailed study to
improve these parameters [117]. The patent literature contains much about improving the
wettability of lenses, with companies such as CooperVision [118] and Johnson and Johnson [119]
having filed for patents to develop such lenses. This includes using many combinations of
Materials 2019, 12, 261 14 of 36

comonomers with silicone monomers. However, similarly to the preceding sections, modern silicone
lenses have not deviated from the base materials since they were first developed. Nowadays, new
chemical techniques look to evolve the silicone CL material beyond its predecessors.
Silicone hydrogels have commonly been subject to post-fabrication processes. Some, such as
plasma treatment, are used to improve lens wettability by manufacturers [120–122]. This technique
has been proven very effective; however, there are still a number of issues relating to silicone CLs
[123]. Santos et al. suggested that protein absorption of commercial silicone hydrogel lenses was
independent of the plasma treatment [124]. They summarized that the inherent hydrophobic
character of the lenses helped in reducing the deposition. With this in mind, new chemical
modification techniques, with or without plasma treatment, are becoming of interest. The use of
hydrophilic and hydrophobic lipids by Bhamla et al. investigated the wetting and dewetting
character of a Balafilicon A lens [125]. They showed that a hydrophobic lipid (meibum) could reduce
the wetting area on the lens surface by nearly 70% in 50 s. Lin et al. modified the lens surface to
adhere polyelectrolyte monolayers (PEMs) of chitosan and hyaluronic acid [126]. Chitosan is a
naturally derived polymer (from chitin) with high bioavailability originating from the hydroxyl and
amine groups within the structure, lending itself to lens modification. They modified the
plasma-treated silicone surface to create negatively charged groups, which allowed the formation of
the positively charged chitosan layer. Then, the negatively charged hyaluronic acid formed a layer
on this surface to form alternative layers. The contact angle was reduced from 90° in the mother lens
to up to 50° in the PEM-modified lenses. Similarly, a modified chitosan was also used successfully by
Tian et al. to form a chitosan layer on the surface of the lens (Figure 10) [127]. Hydroxypropyl
trimethyl ammonium chloride chitosan is a quaternary ammonium salt and is positively charged,
which facilitates the formation of self-assembled layers. These pendant chemical groups could lead
to further modification of the lens. Thissen et al. modified silicone lenses with a poly ethylene oxide
(PEO) graft to the surface for anti-biofouling properties [128]. First, they used plasma
polymerization to adhere allyl amine to the surface of the lens, and then used a reducing solution of
sodium cyanoborohydrate and PEO to complete the PEO graft. A similar process using acrylic acid
was performed by Dutta et al. to attach a melamine-derived peptide (Mel4) to the surface of a range
of silicone lenses (lotrafilcon A, lotrafilcon B, somofilcon A, senofilcon A, and comfilcon A) [129].
They also used an acid buffer solution to covalently bond the Mel4 peptide to the surface of the
lenses [130]. The peptide improved the anti-microbial properties of the lenses without causing other
irritations to the tested subjects (rabbits).

Figure 10. Schematic for the adhesion of a self-assembled layer onto the surface of silicone hydrogel.
Reprinted (and adapted) from Colloids and Surfaces A, 558, Tian, L.; Wang, X.; Qi, J.; Yao, Q.;
Oderinde, O.; Yao, C.; Song, W.; Shu, W.; Chen, P.; Wang, Y. Improvement of the surface wettability
of silicone hydrogel films by self-assembled hydroxypropyltrimethyl ammonium chloride chitosan
mixed colloids, 422, Copyright 2018, with permission from Elsevier [127].
Materials 2019, 12, 261 15 of 36

Other materials were of interest as new grafting or encapsulation components into

silicone-based hydrogels. Tuby et al. used Zn-CuO particles as an anti-microbial film on CLs
composed of silicone hydrogels (Bausch&Lomb) [131]. They used a base bath (pH = 8) loaded with
the nanoparticles to soak into the lenses to induce uptake of the nanoparticles by the hydrogel. They
also commented that the nanoparticles did not leech easily from the structure, which would be an
important safety concern. Jung et al. used a polymer nanoparticle (propoxylated glyceryl triacrylate)
to deliver the drug timolol, which is used for glaucoma treatment [132]. The lenses also incorporated
the nanoparticles through a soaking method, which was a phosphate buffer solution (pH ≈ 7.4).
Although the nanoparticles did not affect optical transparency, they noted an undesirable decline in
the water content, oxygen permeability, and modulus. Willis et al. grafted hydrophilic
phosphorylcholine (PC) to the surface of silicone lenses using several Michael-type addition steps
[133]. The coating reduced the water contact angle by nearly 50°, which was an impressive result.
One concern they had was the lowering modulus by 0.5 MPa in the PC-treated lenses compared with
unmodified lenses. Wang et al. used an interpenetrating network of silicone and PC to synthesize
the hydrogel to achieve similar wettability results [134]. A 35–80 nm layer of PC was also grafted
onto silicone using UV light (305 and 365 nm) to induce the polymerization graft [135]. The surface
graft did not affect the oxygen permeability and modulus, but reduced the lysozyme and fibrinogen
deposition and water contact angle. Wang et al. grafted polyethylene glycol methacrylate (PEGMA)
to silicone using UV light again, and again the hydrogels retained excellent properties, such as >140
Dk and >1 MPa elastic modulus [136]. Synthesis of silicone hydrogels also incorporating PEGMA by
Lin et al. successfully reduced the lysozyme and human serum albumin (HSA) deposition by 82%
and 77%, respectively [45]. However, the increasing volumes of PEGMA affected other properties of
the lens, such as increasing brittleness above 20% PEGMA content. The PEGMA polymer brush is a
known anti-biofouling material [137,138]. Its low cost and easy incorporation is likely worth pursing
for other CLs. These studies highlight the impact of surface modification techniques on improving
CL properties. However, manufacturing aspects need to be considered to realize these modifications
in a new generation of CLs.
In summary, silicone hydrogel lenses are targets for highly biocompatible coatings that can be
grafted/encapsulated to the surface of, or within, the lenses by chemistry techniques. In these
experiments, the performance of the lens was improved, particularly towards anti-biofouling
applications. Hydrophilic anti-biofouling materials are being applied more often to silicone
hydrogel CLs [139]. This emphasizes the innovations which silicone-based hydrogel lens materials
are undergoing. For silicone hydrogel, there is a two-fold benefit of these anti-biofouling materials:
(1) These hydrophilic grafts/modifications are the route to anti-biofouling behavior, and; (2) they are
hydrophilic, increasing the wetting character of the lens. This effect is also relevant to HEMA-based
lenses; however, it is more impactful to silicone lenses, given their inherent wettability
disadvantages and market size. Continued improvements to these materials will result in continued
market dominance for silicone-based hydrogel CLs.

2.6. Other Contact Lens Materials

2.6.1. Polyvinyl Alcohol Hydrogels

PVA is a synthetic polymer that contains many hydroxy (–OH) groups, one in each repeating
monomer unit. This is the source of PVA’s excellent hydrophilic and biocompatible properties [140].
As such, it is clear why this material is an interesting contact lens material. PVA hydrogels were of
attention to several researchers in the early 1990s [17,18]. Even without modification, PVA CL
hydrogels were also shown to have lower protein absorption rates than HEMA and MMA/VP
hydrogels [18]. However, it wasn’t until the late 1990s that this material broke into the market in the
form of the Nelfilcon A lens [16]. These lenses have a Dk of about 26 barrers and high wettability,
which is acceptable for daily wear. Produced by CIBA vision, the PVA hydrogel was synthesized
using water as the solvent and produced inside a transparent mold to allow UV initiation of the
polymer solution. Water was an environmentally friendly choice of solvent which also did not
Materials 2019, 12, 261 16 of 36

hinder the polymerization stages. Buhler et al. formed the PVA hydrogel by adding a new functional
group to facilitate cross-linking between chains [16]. In acidic conditions and a suitably reactive
dialdehyde group, PVA can be functionalized with a stable cyclic-acetal group. This can then
crosslink with other PVA chains to form a crosslinked hydrogel. More recently, PVA has been used
as a tool for producing more comfortable lenses [141,142] or to facilitate the loading of a colored
pigment into the lens [143]. One of the comfort mechanisms include elution of an unbound PVA
polymer from the contact lens into the tear film. Non-crosslinked PVA with an approximately 47,000
molecular weight was soaked into a cross-linked PVA lens. The high molecular weight and
bioavailability meant that PVA leeched out of the lens to lubricate the eye as a sort of artificial tear
component [142,144]. Researchers identified that the higher molecular weight species took longer to
elute from the lens than lower molecular weight species. Although these examples are strictly not
using PVA hydrogels, they highlight the importance of this material for other ophthalmic
applications. This even extends to areas such as corneal replacement [145].
There has been some investigation into the modification of PVA hydrogel CLs. Xu et al.
modified the PVA structure with β-cyclodextrins (β-CDs) to improve drug-loading of puerarin and
acetazolamide [146]. They functionalized both the β-CDs and PVA with a methacrylate moiety with
N,N-dimethyl-4-pyridinamine and glycidyl methacrylate to achieve the necessary functionality.
Then, both methacrylated species were copolymerized to form the hydrogel. This method also
resulted in incorporation of 30 wt % of β-cyclodextrin. Sun et al. also used a functionalized β-CD
polymer incorporated into a PVA film for the delivery of voriconazole [147]. A β-CD solution
containing dissolved voriconazole was mixed with a PVA solution and then used to form
electrospun nanofibers. PVA cross-linked with cellulose offers another a potential route to improved
contact lens materials [148,149]. Cellulose is a naturally occurring polymer with enormous potential
for bio-applications [150]. Mihranyan chemically bound the cellulose microcrystal “whiskers” onto
the surface of PVA using a 2,2,6,6-tetramethyl-1-piperidine oxoammonium salt (TEMPO)-mediated
surface oxidation [149]. The TEMPO technique is a special technique used for regioselective
oxidation of cellulose to preserve crystallinity [151]. The technique only functionalizes the surface of
the material. Although the physical properties of the PVA hydrogels improved, the opaque material
would not be ideal as a CL material. Tummala et al. incorporated nanocellulose, a transparent
version of cellulose, as nanofibrils or nanocrystals into a PVA hydrogel, improving the physical
properties [148]. In addition, the lens retained excellent optical properties, with >90% transparency
to visible light (Figure 11). They used a mixed solvent system of water:dimethyl sulfoxide (DMSO) at
ratios between 60–80% DMSO content to facilitate the solvation of the nanocellulose components.
These nanocellulose PVA hydrogels were investigated for their light-scattering properties by
Tummala et al. in another work [152]. The hydrogel composition and angle of light affected the
scattering of light in the range of 3% to 40%, with the nanocellulose-functionalized PVA hydrogel
reducing the scattering. The nanocellulose hydrogels were then used to encapsulate
acrylic-acid-functionalized chitosan nanoparticles as a vehicle for a lysozyme-triggered release of a
model drug. Lysozyme (0.2 mM)-mediated hydrolysis of the chitosan-functionalized nanoparticle
would trigger the release of the drug.
Materials 2019, 12, 261 17 of 36

Figure 11. Optical image (left) and the transmittance data (right) for PVA hydrogels incorporating
nanocellulose. Reprinted (adapted) with permission from Tummala, G.K.; Rojas, R.; Mihranyan, A.;
Poly(vinyl alcohol) hydrogels reinforced with nanocellulose for ophthalmic applications: general
characteristics and optical properties, Journal of Physical Chemistry B, 2016, 120, 13094. Copyright
2016 American Chemical Society [148].

The PVA hydrogel is a relatively new class of hydrogel lens compared with silicone- and
HEMA-hydrogels. The low cost, high bioavailability, and wettability properties mean PVA
hydrogels will remain important to the CL industry. This means there is a lot of design space for
investigation into modifying the structure to improve lens functionality. There are an increasing
number of modification techniques and materials that have yet to be explored with PVA hydrogels.
The secondary alcohol groups within the polymer chain are very easily modified for grafting, as
shown by cellulose or β-cyclodextrin incorporation. As with HEMA- and silicone-hydrogels, the
grafting or encapsulation of anti-microbial agents is just one of many interesting avenues of research
that is possible for PVA hydrogels.

2.6.2. Hyaluronic-Acid-Modified Hydrogels

Hyaluronic acid (HA) is a hydroscopic biopolymer that naturally occurs within the human
body. HA has already been mentioned in previous sections. Here, we explain why this material is
significantly impacting CL research. This is an important material for a wide range of
tissue-engineering purposes [153]. From the chemical structure, we can see why it is useful for
incorporating into CL materials (Figure 12). The amino acid and hydroxyl groups present in each
repeating unit provide the necessary hydrophilic character, leading to high biocompatibility. As
such, this material has been of interest in developing ophthalmic treatments, such as lubricating
solution [154] or contact lens modification [155]. The incorporation of HA was shown not to affect
the surface morphology of the CL even after 12 h of wear, showing the stability of these
modifications [156]. HA is typically a graft/encapsulating material to other established CL
hydrogels. The commercial success of HA is apparent with the Bausch&Lomb Biotrue™ solution
and Open30 (by Safilens) lenses incorporating HA as a lubricating agent. Other ophthalmic
treatments and modifications include HA use as a treatment for dry eyes, [157,158] modification of
the lens material [126,159,160], and drug-delivery mechanism [161–163].
Materials 2019, 12, 261 18 of 36

Figure 12. Chemical structure of hyaluronic acid. The repeating unit within the polymer is
hydrophilic with many highly polar groups, such as the amine, acid, and hydroxy groups.

HA was investigated as a reusable wetting agent, and considered as a vehicle for the delivery of
timolol within a silicone hydrogel lens [164]. HA is hydroscopic, meaning it was used to add water
content to a material without a significant reduction in the other hydrogel components of DMA and
TRIS [160]. All of the silicone hydrogels Paterson et al. produced had a water contact angle of less
than 50°, emphasizing the wettability qualities of HA. The wetting agent was a copolymer of PEG
and HA, which was first copolymerized before being soaked into the HA-modified silicone
hydrogels. Van Beek et al. crosslinked/physically entrapped HA into HEMA hydrogels by using
1-ethyl-3-(3-dimethylaminopropyl)-carbondiimide (EDC)/diaminobutane-4 dendimer to provide the
necessary functionality for a reaction [159]. Furthermore, HA in very low amounts (5 g/L solution)
reduced the water contact angle of the hydrogels by about 15–25°. These HA-modified hydrogels
also showed less lysozyme absorption, which can often be a criticism of HEMA-derived hydrogels.
However, large molecular weight (Mw) HA (169 kDa) had reduced optical transparency between
500–800 nm versus the lower Mw HA (35 kDa). On the other hand, the 169 kDa HA was responsible
for the lowest amount of protein deposition. Korogiannaki et al. covalently bonded HA to the
surface of HEMA by using a nucleophilic Michael-addition thiol-ene “click” chemical reaction [165].
These lenses retained an optical transparency level of >92%, and decreased the water contact angle
and rate of lens dehydration. A more detailed mechanism of the covalent bonding of HA to the
HEMA hydrogel structure was presented by Deng et al. [166] “Click” chemistry was used with
adipic acid dihydrazde (ADH) to anchor HA to HEMA. HEMA was first oxidized to provide the
functionality for bonding the ADH-HA anchor. The lens properties virtually remained unchanged,
such as the modulus and optical properties (Figure 13). They also measured a reduction in the rate of
dehydration of the lens compared with the unmodified lenses. Weeks et al. used UV light to
covalently bond a methacrylate modified HA to HEMA and silicone hydrogel lenses [167]. In all
cases, the HA-modified hydrogels had a greatly reduced water-contact angle and reduction of
lysozyme absorption. They also pointed out that HA with little or no methacrylation on the surface
would not prevent the interaction of the protein with the surface of the hydrogel, whereas if HA was
entrapped inside the hydrogel, the protein could not interact with the surface at as many points,
preventing its deposition.
Materials 2019, 12, 261 19 of 36

Figure 13. Optical properties of HA-HEMA, oxidized-HEMA (OX-HEMA), and unmodified HEMA
lenses. The transparent hydrogels can be seen just above the ruler markings. Reprinted (adapted)
with permission from Deng, X.; Korogiannaki, M.; Rastegari, B.; Zhang, J.; Chen, M.; Fu, Q.;
Sheardown, H.; Filipe, C.D.M.; Hoare, T. “Click” chemistry-tethered hyaluronic acid-based contact
lens coatings improve lens wettability and lower protein adsorption, ACS Applied Materials and
Interfaces, 2016, 8, 22064. Copyright 2016 American Chemical Society [166].

HA is an increasingly popular material for the modification of both HEMA-hydrogel and

silicone-hydrogel CLs. The high bioavailability and straightforward incorporation methods have
already seen recent commercial success for HA. In these cases, HA was a lubricating agent rather
than any physical/chemical modification of the lens material. Recent works regarding HA are
exciting, demonstrating the ability that HA can alter, tune, or improve the properties of contact
lenses. HA can be entrapped or chemical-bound to the hydrogel to provide increased wettability or
resistance to protein deposition. One of the most limiting factors for the wider application of HA is
the high cost. Although dilution can reduce the cost, the effectiveness of HA will diminish. Once this
issue has been overcome, HA will be commonly incorporated into new lenses.

3. Outlook for CL Materials

3.1. Drug Delivery

Today, CLs are increasingly seen as a tool for specific ophthalmic treatments that require
delivery of a drug to the eye. The low bioavailability (about 5%) of common ophthalmic treatments,
such as eye drops, is a concern to delivering effective treatments [168]. In turn, practitioners rely on
new lenses to be developed to improve these treatments, which is reliant on material scientists
developing new materials. This is evident by the publication of review papers in the last few years
[27,28,169]. These reviews contain significant detail on the latest drug delivery mechanisms,
materials, and relevant literature of modern drug delivery, including general drug delivery within
the body. The majority of the referenced literature is after the year 2000, indicating the significant
advances and interest in the field within the last 20 years. In this paper, we highlight the trends in
the CL materials used for ocular drug delivery. Some of the methods investigated include
drug-loading by nanoparticle- or polymeric encapsulation [170–173], β-cyclodextrin delivery
[40,174–176], molecular imprinting [177–179], and solution soaking [37,180–182]. Molecular
imprinting involves fabrication of the hydrogel alongside the drug. Typically, increasing
crosslinking and addition of a porogenic solvent facilitates this by creating more cavities for residing
the drug [179]. The nanoparticles used in these examples, which were all polymeric, encapsulated
the drug. The biocompatible polymers responded to the ocular environment to release the drug.
Ethyl cellulose and lactic-co-glycolic acid are two examples [171,172] These are all of scientific
interest; however, more should be done to access their practical application. This can include clinical
trials or practicality of manufacturing.
Materials 2019, 12, 261 20 of 36

The properties of an incorporated material into CLs can be used as improved drug-binding
mechanisms [183]. For example, incorporation of ionic monomers can create binding sites for a polar
drug to bind to (Figure 14), meaning the lens can retain the drug until it is placed onto the eye. MAA,
for example, is one comonomer commonly used for the formation of hydrogels, but which also has
an anionic group to facilitate drug-binding. Another clever use of new materials was the use of
pendent- or copolymerized cyclodextrins for introducing both hydrophilic and hydrophobic
character to the CL [174,176]. The inside of the 7-unit ring of cyclodextrin is hydrophobic, ideal for
drug complexing, whereas the outside of the molecule is hydrophilic to provide the lens with
suitable biocompatibility (Figure 15). Dos Santos et al. loaded hydrocortisone and acetazoamide into
a HEMA-hydrogel lens, achieving a release profile of several days [174]. An alternative method has
involved, using vitamin E to essentially create a barrier to improve the release profile of loaded
drugs [25,184,185]. The hydrophobic barrier interacts with the drug, which greatly increases the
permeation time rather than simply eluting from the lens. Vitamin E contains a large hydrocarbon
side chain and methyl groups to provide the necessary hydrophobic character. In another
experiment by Kim et al., vitamin E was easily incorporated into commercial silicone-hydrogel
lenses such as ACUVUE®, OASYS™, O2OPTIX™, and NIGHT&DAY™ [184]. Some of the delivered
drugs included cysteamine [186,187] and pirfenidone [188]. Typically, vitamin E was incorporated
into the hydrogel through soaking, and the hydrophobic character means it is unlikely to leech out,
compared with a hydrophilic component such as PVA. This is a straightforward process that could
be adopted into more widespread usage to improve elution times of drugs from CLs. Although,
strictly speaking, there was no fundamental change to the hydrogel networks, the work is worthy of
inclusion given the profound impact on drug-release profiles. Some examples used straightforward
incorporation methods, which could be a manufacturing consideration.

Figure 14. Drug-binding and releasing mechanism for a contact lens with ionic sites within the
structure. Reprinted from Journal of Controlled Release, 281, Xu, J.; Xue, Y.; Hu, G.; Lin, T.; Gou, J.;
Yin, T.; He. H.; Zhang, Y.; Tang, X. A comprehensive review on contact lens for ophthalmic drug
delivery, 97, Copyright 2018, with permission from Elsevier [27].
Materials 2019, 12, 261 21 of 36

Figure 15. Chemical structure of beta-cyclodextrin. The inner environment of cyclodextrin is

hydrophobic, suitable for drug-binding, whereas the outside is hydrophilic, providing suitable
bioavailability.

Modern CL materials have shown much-improved drug delivery capacity than current
ophthalmic treatments, such as eye drops. Further modification of the base CL polymer structure is
required to improve drug delivery. Molecular grafts, particle encapsulation, and soaking are the
most common methods for modification. Despite evidence of the improving performance of these
materials, more must be done in order to take these materials to the point of commerciality. The
biggest barrier to the market is the cost of clinical trials, as well as the manufacturing requirements.
Another note of interest is that most of these successful works have been based on HEMA-hydrogels
[189]. HEMA-based hydrogels have an abundance of easily accessible chemical functional groups for
modification, rather than silicone. In some cases, silicone-based hydrogels were more suitable to host
drugs, such as the vitamin E barrier [27]. This represents an interesting position for CL materials,
where the requirement of increased hydrophilicity for comfort and oxygen permeability has driven
the increased usage of silicone-hydrogels over HEMA-hydrogel lenses. Conventionally, many drugs
are chosen based on a strong hydrophobic character [190]. Development of suitable drug-delivery
lenses will mostly depend on the intended time of treatment, and the length of wear that facilitates
this. In turn, the length of wear will best define what type of CL material should be used and what
modification should support the drug release.

3.2. Emerging CL Materials Technologies

In this section, we will discuss several emerging materials technologies that could be relevant to
future CL materials. Biocompatible materials have become of great interest to the scientific
community, particularly as new materials have been innovated [191–194]. These biocompatible
materials could be an avenue for CL researchers to develop novel materials. The necessity for
biocompatibility is an obvious reason why these materials could be of interest. Two such areas that
have seen particular growth are double-network/interpenetrating hydrogels and pH-responsive
polymers. Although some interest has been expressed in areas such as liquid crystal CLs [195,196],
the number of research publications remains somewhat limited compared to these other
technologies. Briefly, the liquid crystal contact lens is of interest to treating presbyopia, due to the
Materials 2019, 12, 261 22 of 36

liquid crystal’s on/off character to alter the lens power in the region of +2.00 D. The liquid crystal lens
has anisotropic refractive indexes, realigning the molecules when a voltage is applied. Commonly,
the lens design often involves PMMA to support the liquid crystal phases [197]. Perhaps the biggest
difficulties with these lenses is ensuring ocular health, comfort, and a power source.
Double-network/interpenetrating hydrogels combine two gels by interconnecting the gel
networks together, resulting in a new gel composite (Figure 16). Essentially, the network of one gel is
intertwined with the other, rather than the formation of a traditional copolymer gel. This is a subtle,
but significant, difference—e.g., a double network gel could be formed by two polymers with
different functional groups, meaning they could not be copolymerized. Figure 16 also shows that
these hydrogels can be formed pre- and post-formation of one gel. Formation of these new materials
has been shown to improve the bioavailability/compatibility of hydrogels [198,199]. Some of the
materials investigated are commonly known CL- or modification-materials, such as HA, chitosan,
thiol-functionalized PEG, poly-2-hydroxyethly acrylate (HEA), and polyacrylamide (PAA). With the
large number of materials used in CL synthesis, this method could produce a unique
double-network contact lens with improved functionality.
Double-network hydrogel formation is fundamentally a chemical technique to improve the
bulk properties of the material. These hydrogels could be manufactured in the same manner as
current CL hydrogels, yet enhance the CL properties. This area is of interest to the CL community; a
patent was assigned to Stanford University in 2010 for interpenetrating polymer-network contact
lenses [200]. One example by Yañez et al. used interpenetrating networks composed of HEMA and
polyvinyl pyrrolidone (PVP) to develop new comfortable SCLs [201]. PVP was
semi-interpenetrating and leeched from the lens as a comfort mechanism rather than a true
double-network hydrogel. These gels have been tailored for applications involving tissue
engineering, emphasizing the robustness of the gel [202]. The inner eyelid (conjunctiva) and cornea
are two different environments sensitive to the properties of the CL. Castellino et al. combined
PDMS-MAA-HEMA to form an interpenetrating hydrogel network [203]. Their purpose was to form
a general bioavailable material, rather than a material for specific ophthalmic applications. Wang
and Li synthesized a double-network hydrogel of TRIS and HEMA-phosphorylcholine (PC) as a
potential ophthalmic material [134]. At higher PC (20%) content, the double-network gels had a low
water-contact angle (50°) and a high modulus (7 MPa). These are very attractive qualities for CL
hydrogels, which could be further developed. Other double networks of silicone have been
investigated for other research fields, suggesting it could be more widely used for CLs [204–206].
These works incorporated organic components, which would be essential for ocular
biocompatibility. This type of hydrogel could be the next evolution of contact lenses.
Materials 2019, 12, 261 23 of 36

Figure 16. A double-network hydrogel combines the properties of two hydrogels. The gel networks
are interpenetrating, meaning they form a new gel that retains the properties of each individual gel.
Reprinted with permission from John-Wiley and Sons [199].

We have already discussed some of the more popular drug-delivery materials in a previous
section. However, there are new concepts within biocompatible hydrogels as potential
drug-delivery mechanisms [207,208]. Temperature- and pH-responsive polymers are materials that
change their macromolecular conformation when exposed to a specific temperature or
acidic/alkaline conditions (hence, pH-responsive) [209]. For pH-responsive polymers, there are four
principal mechanisms by which the conformation is changed, and this is summarized in Figure 17.
The acidic/alkaline conditions of the body can induce protonation, stripping the coating and
conformation changes to the polymer and allowing release of the drug. As such, they are becoming
exciting as drug-delivery mechanisms within the human body [210]. The concept was recently
investigated for drug-delivery contact lenses [211]. Researchers here used a film of cellulose acetate
to deliver betaxolol hydrochloride over a sustained period. They showed that 25% of the drug was
delivered to rabbits in the first 3 h of use, and 66% had been delivered within 72 h [211]. The
cellulose acetate film was attached to a CL composed of HEMA-NVP-TRIS. Cellulose is a
biopolymer and therefore has high biocompatibility, meaning it is suitable for the ocular
environment.
Temperature-responsive polymers, when exposed to sufficient heat, undergo conformation
changes, which allows the release of the embedded/encapsulated drug. Once the conformation
change is complete, the drug will be released in the highly aqueous environment [212,213]. These
papers describe in detail the mechanisms of these polymers [212,213]. This could be relevant to
contact lenses, as typically there is a significant difference between the storage/room temperature
and the eye. A lens composed of such a polymer would undergo a conformation change on insertion
to the eye. This temperature difference could be harnessed for drug-delivery CLs. Polyethylene
glycol (PEG) has seen growth in this area as a block-copolymer graft to other moieties, such as
poly(N-isopropylacrylamide) (p(NIPAAm)) and HEMA. Silicone rubbers have even been mentioned
as potential drug-delivery vehicles by Fenton et al. [207]. These materials are known for their ocular
compatibility, meaning there is design space to be explored for improved drug-delivery contact
lenses. Jung et al. studied more common contact materials, such as HEMA, due to the ability to
modify conformation with differing conditions, such as nanoparticle loading into the lens [214].
Materials 2019, 12, 261 24 of 36

Figure 17. Mechanisms of action for pH-responsive drug-delivery polymers. Reprinted from
Biomaterials, 85, Kanamala, M.; Wilson, W.R.; Yang, M.; Palmer, B.D.; Wu, Z. Mechanisms and
biomaterials in pH-responsive tumour targeted drug delivery; a review, 152, Copyright 2016, with
permission from Elsevier [210].

These emerging materials technologies offer interesting new routes for future CL development.
We have provided some approaches, such as novel materials in the form of liquid crystals, or
evolving the CL material through methods such as double-network hydrogels. In addition,
temperature- and pH-responsive polymers are growing drug-delivery vehicles, but have not yet
been widely explored for CLs. What is encouraging is the fact that many of these methods involve
many of the same materials used for current CLs, meaning adapting to CLs is a clear possibility in
the near future. However, despite these encouraging signs, there are significant challenges for the
ocular environment, which remain prominent given the aging population worldwide [215]. This
includes specific aspects, such as anti-fungal drug delivery, which are not yet ready for commercial
specifications [216]. The biggest challenge for these materials is the efforts in other CL research, as
previously discussed.

4. Manufacturing Perspectives
The final part of developing a CL is how the new material will be manufactured. New
technologies have emerged to enhance CL properties, such as plasma processing, to introduce
hydrophilicity to silicone lenses. CL manufacturing is an ever-evolving area, with manufacturers
constantly improving their methods. It is probably fair to say there is much the public does not know
about the specific CL manufacturing methodologies. This includes operating conditions, speed of
lathes, tip-edge parameters, and exact chemical recipes, amongst a huge number of parameters. For
researchers, this can be a difficult area to evaluate, given such lack of information. However,
Materials 2019, 12, 261 25 of 36

researchers can still analyze the products from manufacturers to help shape the direction of their
research. There is literature concerning the differences in the mechanical properties of common
HEMA-derived hydrogel lenses based on the manufacturing technique (Figure 18) [49]. The
polymerization and manufacturing method were responsible for the differences in the hydrogel
properties. Improving the polymerization steps during manufacturing could improve the properties
of the lens materials. The manufacturing- or process-driven development is likely pursued for
economical or environmental reasons, or both. For example, Nelfilcon A PVA lenses use water as the
solvent, which is much easier to handle than organic solvents and does not require further
processing [16]. Here, we will discuss some specialist manufacturing techniques seen in other
applications of optics that could be used for CL manufacturing. We also discuss some aspects of
manufacturing, such as molding, and the materials that have been investigated in recent literature.
Materials are an important consideration for the molding processes, i.e., both cast- and
spin-molding. The interaction between the mold surface and polymer solution will affect the surface
finish of the CL. Some examples of common molding materials are polypropylene [42] and quartz
[16]. Polypropylene is useful due to the ease of handling and high melt temperatures. The polymer is
hydrophobic, meaning manufacturers choose this with the intent that the contact lens will not
adhere strongly to the mold surface on polymerization (particularly hydrophilic materials).
Similarly, quartz (SiO2) has non-sticking qualities that are useful for manufacturing lenses. This is a
practical consideration to reduce defect occurrence in the final CLs. The recent patent literature has
many examples of the new materials being considered as a lens mold material [217–220]. These
patents are assigned to CLs manufacturers, showing the commercial implications of improving this
aspect of manufacturing. Some of the mold materials include alicyclic polymers or
polyoxymethylene, which are non-polar and polar, respectively. The mold material can influence the
adhesion to the mold, which, in turn, could influence the resulting wettability properties of the
hydrogels.

Figure 18. Tensile and Young’s modulus data for HEMA-based hydrogel lenses produced by
different manufacturing methods. Reprinted with permission from John-Wiley and Sons [49].

Ultra-precision- and nano-manufacturing is an area of research that could be applied to CLs to

enhance the physical and optical properties of the material [221–223]. These techniques have been
successfully implemented in a number of areas, including biomedical device manufacturing, optics,
and more [224]. Ultra-precision lathes are now used in the production of specialty CLs to obtain
nanometer control of the surface, which can control the wettability characteristics of polymers [225]
and glass surfaces [226]. However, to date, this has not been extensively applied to contact lenses, or
at least cannot be seen in the published literature. However, the control of wettability is possible by
using machining techniques [227]. Freeform optics are a special type of optical lenses with irregular
contouring on a non-symmetrical surface. Improvements in optical performance have seen their use
in applications relating to imaging, illumination, and aerospace interests [228,229]. This is an
increasingly important area of precision manufacturing, requiring consideration of the design, as
well as machining and evaluation aspects [230]. Furthermore, servo-control machining could be
Materials 2019, 12, 261 26 of 36

feasible to fabricate freeform optical CLs for specialty applications, such as myopia control. Fast
servo-manufacturing of freeform optics has even been shown to be feasible on polymers such as
polystyrene [231]. This suggests that the use of a similar technique could be employed on a
pre-hydrated CL material. The usage of such precision manufacturing techniques to intraocular lens
manufacturing was also reported [232]. All of these techniques are subject to the effect which the
resulting material will have on the ocular environment, such as the effect on the tear film, protein
deposition, optical properties, etc. Finally, there is a cost component to manufacturing in a
commercial space that would also need to be considered.

5. Conclusions
The purpose of this review was to bring together state-of-the-art research on contact lenses and
their modification. Modern CL research aims to better deliver ophthalmic treatments or improve
existing issues with contact lenses. Overall, modern CL materials are an evolution of the well-known
lens materials based on HEMA and silicone hydrogels. These hydrogels grafted or incorporated
various bioavailable components, such as PEG, HA, chitosan, β-cyclodextrin, cellulose, and other
moieties. These biomaterials are very biocompatible due to their inherent chemistry. The
biomaterials field is exciting and dynamic, where new and improved biocompatible,
drug-delivering materials are constantly being developed. One of the biggest hurdles to overcome is
the cost and practicality of incorporating such species to a new lens. We highlighted some emerging
fields related to CLs due to the materials involved or which have only recently been applied to CLs.
The application of new manufacturing methods can offer other solutions to specific challenges for
CLs: new mold materials, surface contouring, etc. CL materials are now resilient and modifiable, and
are thus suitable for these improving manufacturing processes. Advances in precision
manufacturing, such as the production of freeform optics or modification of surface properties to
improve wettability could be applied to future CLs. In summary, future CL materials will continue
to push the boundaries of the biocompatibility and materials sciences to better tailor to the needs of a
growing CL-using population.

Author Contributions: C.S.A.M. conducted the literature survey and prepared the manuscript. F.F. designed
the manuscript structure and finalized the paper.

Funding: This work was supported by the Science Foundation Ireland (Nos. 15/RP/B3208 & 16RC3872) and the
National Natural Science Foundation of China (Nos. 51320105009 & 61635008).

Acknowledgments: In this section you can acknowledge any support given which is not covered by the author
contribution or funding sections. This may include administrative and technical support, or donations in kind
(e.g., materials used for experiments).

Conflicts of Interest: The authors declare no conflict of interest.

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