Contact lens-related corneal infection: Intrinsic resistance and its compromise |
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| Affiliation: | 1. College of Optometry, State University of New York, New York, USA;2. School of Optometry and Vision Science, University of New South Wales, Sydney, Australia;3. Deakin Optometry, Deakin University, 75 Pigdons Road, Waurn Ponds, Victoria, 3216, Australia;1. Nova Southeastern University, College of Optometry, Ft. Lauderdale, FL, USA;2. Pacific University, College of Optometry, Forest Grove, OR, USA;3. Marshall B. Ketchum University, College of Optometry, Fullerton, CA, USA;4. The Ohio State University, College of Optometry, Columbus OH, USA;5. University of Waterloo, School of Optometry, Waterloo, Ontario, Canada;6. Harvard University, T. H Chan School of Public Health, Boston, MA, USA;7. University of Houston, College of Optometry, Houston, TX, USA;1. School of Optometry, University of California, Berkeley, CA, 94720, USA;2. Graduate Group in Vision Science, University of California, Berkeley, CA, 94720, USA;3. CooperVision UK R & D Facility, Chandlers Ford, Eastleigh, Hants, SO534LY, UK;4. CooperVision Inc, Advanced Development Center, Pleasanton, CA, 94588, USA;5. College of Pharmacy, Touro University California, Vallejo, CA, 94592, USA;6. Graduate Groups in Microbiology, Infectious Diseases & Immunity, University of California, Berkeley, CA, 94720, USA;1. Anglia Ruskin University, Vision and Hearing Sciences Research Centre, Cambridge, CB1 1PT, United Kingdom;2. Ophthalmic Research Group, Aston University, Aston Triangle, Birmingham, B4 7ET, United Kingdom;3. Anglia Ruskin University, The Cambridge Centre for Sport and Exercise Sciences, Cambridge, CB1 1PT, United Kingdom;1. Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA;2. Infectious Disease Institute, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA;3. Tej Kohli Cornea Institute, L. V. Prasad Eye Institute, Hyderabad, India |
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| Abstract: | Contact lenses represent a widely utilized form of vision correction with more than 140 million wearers worldwide. Although generally well-tolerated, contact lenses can cause corneal infection (microbial keratitis), with an approximate annualized incidence ranging from ~2 to ~20 cases per 10,000 wearers, and sometimes resulting in permanent vision loss. Research suggests that the pathogenesis of contact lens-associated microbial keratitis is complex and multifactorial, likely requiring multiple conspiring factors that compromise the intrinsic resistance of a healthy cornea to infection. Here, we outline our perspective of the mechanisms by which contact lens wear sometimes renders the cornea susceptible to infection, focusing primarily on our own research efforts during the past three decades. This has included studies of host factors underlying the constitutive barrier function of the healthy cornea, its response to bacterial challenge when intrinsic resistance is not compromised, pathogen virulence mechanisms, and the effects of contact lens wear that alter the outcome of host-microbe interactions. For almost all of this work, we have utilized the bacterium Pseudomonas aeruginosa because it is the leading cause of lens-related microbial keratitis. While not yet common among corneal isolates, clinical isolates of P. aeruginosa have emerged that are resistant to virtually all currently available antibiotics, leading the United States CDC (Centers for Disease Control) to add P. aeruginosa to its list of most serious threats. Compounding this concern, the development of advanced contact lenses for biosensing and augmented reality, together with the escalating incidence of myopia, could portent an epidemic of vision-threatening corneal infections in the future. Thankfully, technological advances in genomics, proteomics, metabolomics and imaging combined with emerging models of contact lens-associated P. aeruginosa infection hold promise for solving the problem - and possibly life-threatening infections impacting other tissues. |
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| Keywords: | Corneal infection Contact lens Epithelial barrier function Para-inflammation Innate defenses |
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