Since the Food and Drug Administration approved the use of hydrophilic lenses as ocular bandages in 1973, they have become the treatment of choice for many corneal problems, not the least being superficial corneal abrasions. Practitioners are opting for the more readily available disposable soft contact lenses because of the limited number of expensive therapeutically approved bandage soft contact lenses. In this study we set out to determine if there is a significant difference in the antibiotic reservoir and delivery effect of these two groups of soft contact lenses. The eyes in this study were divided into three groups: Protek® group, Acuvue® group and control group. Two drops of Tobramycin 0.3% solution were instilled into each eye followed by subsequent isolation of tear samples using diffusion disks. The relative amount of antibiotic in the tears at certain time intervals was inferred using kill zone ring width (KZRW) measures around the diffusion disks. The data were then analyzed using an ANOVA statistical test. From this analysis we found that while there was a significant difference in KZRW between both Protek® versus control and Acuvue® versus control, there was no significant difference between Protek® versus Acuvue®. This study shows that, when used as an antibiotic reservoir and delivery system, the Ciba Protek® therapeutic contact lens and One-day Acuvue® disposable contact lens behave very similarly

Lach, G John

Lebenhagen, Jan

Wehner, Paul

English

CommonKnowledge

Pacific University 
CommonKnowledge 
College of Optometry Theses, Dissertations and Capstone Projects 
5-1999 
Ciba Protek vs. Vistakon One-Day Acuvue: A comparison of 
antibiotic reservoir and delivery effects 
G John Lach 
Pacific University 
Jan Lebenhagen 
Pacific University 
Paul Wehner 
Pacific University 
Recommended Citation 
Lach, G John; Lebenhagen, Jan; and Wehner, Paul, "Ciba Protek vs. Vistakon One-Day Acuvue: A 
comparison of antibiotic reservoir and delivery effects" (1999). College of Optometry. 1281. 
https://commons.pacificu.edu/opt/1281 
This Thesis is brought to you for free and open access by the Theses, Dissertations and Capstone Projects at 
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Ciba Protek vs. Vistakon One-Day Acuvue: A comparison of antibiotic reservoir 
and delivery effects 
Abstract 
Since the Food and Drug Administration approved the use of hydrophilic lenses as ocular bandages in 
1973, they have become the treatment of choice for many corneal problems, not the least being 
superficial corneal abrasions. Practitioners are opting for the more readily available disposable soft 
contact lenses because of the limited number of expensive therapeutically approved bandage soft 
contact lenses. In this study we set out to determine if there is a significant difference in the antibiotic 
reservoir and delivery effect of these two groups of soft contact lenses. The eyes in this study were 
divided into three groups: Protek® group, Acuvue® group and control group. Two drops of Tobramycin 
0.3% solution were instilled into each eye followed by subsequent isolation of tear samples using 
diffusion disks. The relative amount of antibiotic in the tears at certain time intervals was inferred using 
kill zone ring width (KZRW) measures around the diffusion disks. The data were then analyzed using an 
ANOVA statistical test. From this analysis we found that while there was a significant difference in KZRW 
between both Protek® versus control and Acuvue® versus control, there was no significant difference 
between Protek® versus Acuvue®. This study shows that, when used as an antibiotic reservoir and 
delivery system, the Ciba Protek® therapeutic contact lens and One-day Acuvue® disposable contact lens 
behave very similarly. 
Degree Type 
Thesis 
Degree Name 
Master of Science in Vision Science 
Committee Chair 
Ken Eakland 
Keywords 
corneal abrasion, soft contact lens, therapeutic contact lens, disposable contact lens 
Subject Categories 
Optometry 
This thesis is available at CommonKnowledge: https://commons.pacificu.edu/opt/1281 
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CIBA PROTEK® VS. VISTAKON ONE-DAY ACUVUE®: A COMPARISON OF 
ANTIBIOTIC RESERVOIR AND DELIVERY EFFECTS 
By 
G. JOHNLACH 
JAN LEBENHAGEN 
PAUL WEHNER 
A thesis submitted to the faculty of the 
College of Optomelly 
Pacific University 
Forest Grove, Oregon 
for the degree of 
Doctor of Optometry 
May, 1999 
ADVISOR: KEN EAKLAND, OD 
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FORtS"~ GRO\IE OFHJ1C~iJ 
SIGNATURES OF AUTHORS AND ADVISOR 
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PauJWehner 
BIOGRAPHIES: 
G. John Lach obtained a Bachelor of Arts degree in Biology from St. John's University in 
Collegeville, MN. He has served as a member of the Student Optometric Association and 
the Pacific University Standards and Appeals Committee. He is currently a fourth year 
student at Pacific University College of Optometry. 
Jan Lebenhagen is currently a third year student at Pacific University College of 
Optometry. 
Paul M. Wehner obtained a Bachelor of Science degree in Biology from Pacific University 
and is currently a fourth year student at Pacific University College of Optometry. 
ABSTRACT: 
Since the Food and Drug Administration approved the use of hydrophilic lenses as 
ocular bandages in 1973, they have become the treatment of choice for many corneal 
problems, not the least being superficial corneal abrasions. Practitioners are opting for the 
more readily available disposable soft contact lenses because of the limited number of 
expensive therapeutically approved bandage soft contact lenses. In this study we set out to 
determine if there is a significant difference in the antibiotic reservoir and delivery effect of 
these two groups of soft contact lenses. 
The eyes in this study were divided into three groups: Protek® group, Acuvue® 
group and control group. Two drops of Tobramycin 0.3% solution were instilled into each 
eye followed by subsequent isolation of tear samples using diffusion disks. The relative 
amount of antibiotic in the tears at certain time intervals was inferred using kill zone ring 
width (KZRW) measures around the diffusion disks. The data were then analyzed using 
an ANOVA statistical test. From this analysis we found that while there was a significant 
difference in KZRW between both Protek® versus control and Acuvue® versus control, 
there was no significant difference between Protek® versus Acuvue®. 
This study shows that, when used as an antibiotic reservoir and delivery system, 
the Ciba Protek® therapeutic contact lens and One-day Acuvue® disposable contact lens 
behave very similarly. 
KEY WORDS: corneal abrasion; soft contacts lens; therapeutic contact lens; disposable 
contact lens. 
INTRODUCTION: 
Since the Food and Drug Administration approved the use of hydrophilic lenses as 
ocular bandages in 1973, they have become the treatment of choice for many corneal 
problems, not the least being superficial corneal abrasions. Practitioners are opting for the 
more readily available disposable soft contact lenses because of the limited number of 
expensive therapeutically approved bandage soft contact lenses. In addition to the cost 
effectiveness of disposable lenses, recent studies have shown that they are more effective in 
the treatment of corneal abrasions 1.2• In this study we hope to determine if there is a 
significant difference in the antibiotic reservoir and delivery effect of these two groups of 
soft contact lenses. This ability is one variable which makes therapeutic soft contact lens 
treatment better for ultimate cover from corneal abrasion. 
MATERIALS: 
*Ciba Protek® Therapeutic soft contact lenses 
*Vistakon One-day Acuvue® soft contact lenses 
*Tobramycin 0.3% 
*Polytrim® (Trimethoprim sulfate 1mg/mL, Polymyxin B sulfate 10,000 units) 
*Refresh® Rewetting drops 
*Forceps 
*Mueller-Hinton agar plates 
*Standardized Diffusion discs 
METHODS: 
This study consisted of 14 randomly selected subjects gender nonspecific, all 
optometry students. No requirements were set forth regarding previous contact lens wear. 
This was done specifically to represent the random population presenting clinically with 
corneal abrasions. Comprehensive initial evaluations were done to eliminate any anterior 
segment pathology. 
Each subject was randomly assigned into one of three groups. Group A had a One-
day Acuvue® disposable lens in the right eye and no lens in the other. Group B had an 
Acuvue® in the right eye and a Ciba Protek® therapeutic lens in the left. Group C had a 
Protek® in the right eye and no lens in the other. Patients were allowed to insert the 
contact lens themselves under supervision unless assistance was required. Several minutes 
for adaptation to the lenses were allowed for reflex tearing to subside before proceeding 
with antibiotic drop instillation. 
Tobramycin 0.3% solution was used as our antibiotic since it is the clinically 
accepted standard for treatment of superficial corneal abrasions. Following accepted 
clinical procedures an initial drop of the antibiotic was administered accompanied by 30 
seconds of puncta] occlusion followed by another drop and occlusion. At the point of the 
second drop's instillation the timer was started for the first eye, this was designated time 0 
minutes. The same procedure was followed for the fellow eye two minutes thereafter so as 
to allow the future procedures ample time to be completed. 
Tear samples were then obtained from each eye, and introduced onto cultured agar 
plates. Previously calculated time intervals of 5, 10, 15, 20, and 30 minutes were used for 
tear sampling. Tear samples were isolated by inserting a standardized 6.5mm diameter 
untreated diffusion disc into the lower cul-de-sac. A standard of 5 seconds was used as the 
time the disc remains inserted, as this was found to provide the most sufficient tear 
absorption, with minimal patient discomfort. One set of alcohol sterilized forceps were 
used for insertion and removal of the discs for each subject. 
Diffusion disks were plated on Mueller-Hinton agar streaked just prior to plating 
with a culture of Staphylococcus aureus . S. aureus was selectively used because of the 
known sensitivity to the antibiotic Tobramycin. Each plate was divided up into three 
equivalent sections to contain one diffusion disc each. This set up granted sufficient room 
for any large kill zones that might be expressed. 
Upon completion of tear sampling, the contact lenses were removed, a drop of 
Polytrim® placed in each eye prophylactically and the patients were instructed to contact the 
experimenters should any complications occur. 
Mueller-Hinton agar plates with the plated diffusion discs were incubated at 37oc 
for 24 hours at which time the zones of inhibition were measured. Zones were measured 
by two separate experimenters with a millimeter mle. The assumption was made that the 
zone of inhibition created around the diffusion disc corresponds to the amount of antibiotic 
contained within the tear volume. 
RESULTS: 
Each subject's data of kill zone ring width (.KZRW), which can be found in 
appendix 1-3, was averaged and standard errors calculated (table 1). Due to the nature of 
the measuring scale, and that measures were intra-subject an analysis of variance (ANOV A) 
statistical test was used to analyze the KZRW data. For statistical purposes on the ANOV A 
test, subjects were removed at random from each group: three from Acuvue® and one from 
the Ciba Protek® group. The asterisked rows in appendices 1-3 designates those data were 
removed. 
The means and standard errors of the KZRW tear sample data followed a general 
decreasing trend from time 5 minutes to time 30 minutes reflecting a decreasing 
concentration of antibiotic present in the tears over time. All calculated data is shown in 
table 1. The graph also expresses this by plotting the means and standard errors against 
time (graph 1). 
Statistical analysis of the data revealed several interesting relationships: Acuvue® 
verses Protek® verses control F(2,14)=4.78; p=0.02, which implies that there is a 
significant difference (p<0.05) in KZRW between the three groups. Acuvue® verses 
Protek® verses control over time F(4,28)=110.62; p=O, which implies that the KZRW 
behaves differently over time between the three groups. Protek verses control 
F(1,7)=12.55; p=O.Ol, which implies that there is a significant difference in KZRW 
between Protek® and control. Acuvue verses control F(1,7)=8.93; p=0.02, which implies 
that there is a significant difference in KZRW between Acuvue® and control. Acuvue® 
verses Protek® F(l,7)=0.01; p=0.89, which implies that there is no significant difference 
in KZRW between Acuvue® and Protek®. Acuvue® verses Protek® over time 
F(4,28)=0.45; p=0.77, which implies that there is no significant difference in KZRW 
between Acuvue® and Protek® over time. 
Table 1: Kill Zone Ring Width (KZRW) 
Acuvue Time 5 10 15 20 30 
(min) 
(mm) 50.00 23.00 10.00 6.00 2.50 
total 
mean 4.55 2.09 0.91 0.55 0.23 
S.d . 2.44 1.14 0.83 0.61 0.41 
s.e. 0.74 0.34 0.25 0. I 8 0.12 
Protek Time 5 10 15 20 30 
(min) 
(mm) 34 17 11 5.5 3.5 
total 
mean 3.78 1.89 1.22 0.61 0.39 
S.d. 1.50 0.99 0.83 0.70 0.70 
s.e. 0.50 0.33 0.28 0.23 0.23 
Control Time 5 10 15 20 30 
(min) 
(mm) 21.50 4.50 0.50 0.00 0.00 
total 
mean 2.69 0.56 0.06 0.00 0.00 
S.d. 0.80 0.82 0.18 0.00 0.00 
s.e. 0.28 0.29 0.06 0.00 0.00 
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TIME (min) 
DISCUSSION: 
The benefits of using soft contact lenses to decrease pain and healing time has been 
well documented 2. With the increasing number of disposable contact lenses on the market, 
their use in treating superficial corneal abrasions is becoming more widespread than ever 
before. This study demonstrated that in terms of antibiotic reservoir and delivery effect, the 
Ciba Protek® therapeutic lens and Vistakon One-day Acuvue® disposable lens behave very 
similarly. While there was a significant difference between both experimental groups and 
the control, it was found that there was no significant difference between Protek® and 
Acuvue® in total KZRW, or in KZRW over time. 
Several other questions were uncovered in the process of running the trials of this 
experiment. We found ourselves wondering how the results would differ if the lenses 
were actually soaked in antibiotic solution for five minutes prior to insertion, which is the 
clinical protocol for collagen shields. We made the decision to insert the lenses and then 
instill antibiotic drops based on current clinical practice. The other interesting question 
arose after seeing the results, and how quickly the ability to isolate the antibiotic from the 
tear value dropped off after instilling two drops of antibiotic. This reinforces the idea that, 
especially with deeper or more serious corneal abrasions, 1-2 drops every 4-6 hours may 
be inadequate to stave off potentially sight threatening opportunistic infections. 
Appendix 1: Acuvue Lenses 
Time (min) 5 10 15 20 30 
subj #1 11 (mm 4.00 2.50 1.50 0.50 
#2 4.00 1.50 1.00 0.50 0.00 
#3* 4.50 1.00 0.00 0.00 0.00 
#4 2.50 2.50 1.50 0.00 0.00 
#5* 3.00 2.50 1.00 1.00 0.00 
#6 4.50 3.00 1.50 1.00 1.00 
#7 6.00 1.00 0.00 0.00 0.00 
#8* 5.00 3.00 1.00 1.50 1.00 
#9 4.50 2.00 1.50 0.50 0.00 
#10 2.00 0.00 0.00 0.00 0.00 
#11 3.00 2.50 0.00 0.00 0.00 
total 50.00 23.00 10.00 6.00 2.50 
mean 4.55 2.09 0.91 0.55 0.23 
s.d. 2.44 1.14 0.83 0.61 0.41 
s.e. 0.74 0.34 0.25 0.18 0.12 
Appendix 2: Protek Lenses 
Time (min) 5 10 15 20 30 
subj #1 2[_mm) 1.00 1.00 0.00 0.00 
#2 5.00 4.00 2.50 1.00 0.50 
#3 4.00 1.00 0.50 0.00 0.00 
#4 5.00 2.00 1.00 0.00 2.00 
#5 3.00 1.50 1.00 1.00 0.00 
#6 5.50 2.50 2.50 2.00 1.00 
#7 4.50 1.50 1.00 0.50 0.00 
#8* 1.00 1.00 0.00 0.00 0.00 
#9 4.00 2.50 1.50 1.00 0.00 
total 34.00 17.00 11.00 5.50 3.50 
mean 3.78 1.89 1.22 0.61 0.39 
s.d. 1.50 0.99 0.83 0.70 0.70 
s.e. 0.50 0.33 0.28 0.23 0.23 
Appendix 3: Control 
Time (min) 5 lO 15 20 30 
subj #1 4 (mm' 1.50 0.00 0.00 0.000 
#2 2.00 0.00 0.00 0.00 0.00 
#3 3.50 0.00 0.00 0.00 0.00 
#4 2.00 0.00 0.00 0.00 0.00 
#5 3.00 0.00 0.00 0.00 0.00 
#6 2.00 2.00 0.00 0.00 0.00 
#7 3.00 1.00 0.50 0.00 0.00 
#8 2.00 0.00 0.00 0 .00 0.00 
total 21.50 4.50 0.50 0.00 0.00 
mean 2.69 0.56 0.06 0.00 0.00 
S.d. 0.80 0.82 0.18 0.00 0.00 
s.e. 0.28 0.29 0.06 0.00 0.00 
ACKNOWLEDGMENTS: 
This project was made possible by funding from BSK, and the contributions of 
both the Ciba corporation and Vistakon corporation. We would also like to thank the 
following people for their help: Launa Kind, Karl Citek, O.D., Bob Yolton, O.D., Diane 
Yolton, O.D., and our advising doctor and mentor, Ken Eakland, O.D. 
REFERENCES 
1. Gruber, E. The Acuvue Disposable Contact Lens as a Therapeutic Bandage Lens. Ann 
Ophthalmol 1991 ;23 :446-44 7. 
2. Lindahl, K. et. al. Applications of Hydrophilic Disposable Contact Lenses as 
Therapeutic Bandages. CLAO 1991;17(4):241-243. 


Ciba Protek vs. Vistakon One-Day Acuvue: A comparison of antibiotic reservoir and delivery effects

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Ciba Protek vs. Vistakon One-Day Acuvue: A comparison of antibiotic reservoir and delivery effects

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