We sat down with Dr. Donald Korb at SECO and talked about the history and advancement of contact lenses. He shared how his pioneering achievements in advancing contact lenses began by identifying and solving problems for his patients.
“I came into optometry in a time when contact lenses were just coming up,” says Dr. Korb. “And contact lenses had so many problems.” As his patients came to him with issue after issue with their contact lenses, Dr. Korb became fascinated by what he calls “the basic physiological processes that inhibited having real success with contact lenses.”
Dr. Korb will be known to young ODs as the clinician-scientist who first described the corneal response of central corneal clouding — not to mention giant papillary conjunctivitis, meibomian gland dysfunction, and a host of other never-before-described optometric discoveries. In addition, he co-founded Corneal Sciences, Inc., the company whose guidelines still determine the thickness and form of all modern soft-lens disposable contacts.
When it comes to medical optometry pioneers, Dr. Korb is one of the greats. He’s also a passionate clinician with a keen sense of humor.
In his first job out of grad school, Dr. Korb saw a wide range of contact lens patients, and realized that the biggest problem they were encountering was wear time. “As a result of that, I developed a technique of allowing a clinician, for the first time, to actually see edema with a contact lens,” he says.
The solution to this — fenestration — was another revolutionary moment for the field. Drilling holes in the contact lens to allow fluids and oxygen to circulate allowed contact lens patients to nearly double their wear time.
“I went off on a mad chase to develop the ultimate soft contact lens,” laughs Dr. Korb. This led to the CSI lens — the first true membrane lens — which was 30 or 40 microns thick. “If you take all of the disposable lenses today,” says Dr. Korb, “and you read the patents from those days, they just follow it.”
“What was amazing is that you could put a CSI lens on an individual’s eye, and they couldn’t feel it,” says Dr. Korb. “The concept, of having a membrane lens, just solved a total amount—a broad spectrum of problems.”
The problems the CSI lens didn’t solve, however, it illuminated — for there were some patients who, when wearing the lens, very quickly experienced extreme discomfort and even total intolerance.
“We were intrigued by why one individual could wear the lens and the next person could not,” says Dr. Korb. Dr. Korb and Dr. Dwight Cavanagh, who worked on this project together, examined these patients’ eyes and find no reason that the lenses would cause discomfort to some but not others. Then Dr. Cavanagh suggested squeezing the lids.
“And when we squeezed them, guess what happened?” Dr. Korb said. “Nothing came out! And we kept applying more and more pressure, and we knew that stuff could come out.” They started a program with fellow ophthalmologist Tony Enriquez to solve this problem with nonfunctional but apparently normal lids, and came to the conclusion that the glands were obstructed by keratinized tissue.
This led to the identification of meibomian gland dysfunction, and the treatment methods for dry eye that drive optometric practice today.
It began with warm compresses, Dr. Korb said, because they reasoned that this obstructive material could be melted. “When we treated these people with lid scrubs and with warm compresses, and with expression, you could really improve the results.” Although the investigation began with users of the CSI lens, it ultimately expanded to non-contact lens wearers.
Eventually, this brought Dr. Korb to investigate other methods of heating up meibomian glands. “Basically, I knew, that what we needed: we needed heat. And we needed to apply it for a significant amount of time,” he says. But applying heat to the outer surface of the eye had limited effect. Another form of energy was needed in order to apply heat to the meibomian glands in the posterior segment of the eye.
“We were making progress, and we’d built what we called the hydro-oculator. And for regulatory reasons we went off to the wonderful island of Anguilla, which is in the British Virgin Islands,” says Dr. Korb. They set up a clinic with Dr. Bodfield, and they tested the hydro-oculator. With this machine, they could precisely control the temperature of the eye mask that replaced compresses, but it still wasn’t enough.
“Across the broad spectrum, we were still probably 25, 30 percent getting great results,” Dr. Korb says, but a greater percentage were not showing the improvement they wanted. “That led to the next step, which sort of happened in a manner which usually doesn’t happen: and that is, I was working on an individual with a different type of energy that we would apply from the outside.” And that application was, as he puts it, “modestly successful. And I said, we’re doing this the wrong way! We should be applying the heat not through the lid, but where?” Through the posterior!
So Dr. Korb and a team of biomedical engineers worked on turning the instrument down to body temperature, and tested it on a patient by slowly turning the temperature up until the patient reported a warming sensation—at which point the patient’s meibomian glands burst open and drained.
“It was just unbelievable,” exclaims Dr. Korb. “The secret is to heat from the back, and not the front.”
This major breakthrough led to the LipiFlow Thermal Pulsation System, which Dr. Korb acknowledges was so much bigger than he thought anything could be. “It was a really recalcitrant type of problem, and no matter what we had done, we never had a significant result,” until that moment. But that moment changed everything.
“But to be able to take contact lens patients in a study,” he says, “it basically doubled wearing time, from four hours to seven and half or eight hours after treatment. And you think about how hard that is with fitting, with these individuals. And that’s huge.”
“Remember, the contact lens has to have a favorable tear lake to be effective,” Dr. Korb adds. “And if you don’t have an adequate tear body, and you don’t have adequate lipid on the outside surface of the lens, every time you blink, what happens? The lid wiper—oh, that was another two years of my life,” he laughs. “The lid wiper comes over, and it touches, and it gets roughened. And now you have an abraded lid wiper and sensation.”
“There’s nothing better than having the meibomian glands working with every blink,” Dr. Korb says. “But you asked where we’re going. You know where we are now?”
“We’re at a barrier where we have to next change the blink, reliably.”
“Because a high percentage of the millennium population has reached the point where the combination of the environment, the combination of the task, the combination of the demands and stress, paralyzes blinking. And when you paralyze blinking, what do you do? You obstruct the meibomian glands.”
“In retrospect, it’s all very simple,” Dr. Korb laughs. But we have to remember that complex things are built of the simple, and you can’t solve one without knowing the other. “You have to pick an area that’s reasonable, pick an area that you can get into, and develop the experience. But you’ve got to have the passion. If you’ve got the passion, the rest is easy.”
Watch the entire the video for more from Dr. Korb on the moments and discoveries that defined contact lens development, and for his advice to new grad optometrists!