CONTACT LENSES

BACKGROUND OF THE INVENTION Field of the Invention

This invention relates to the field of contact lens treatment, and more particularly relates to contact lens disinfection, and especially relates to the neutralization of iodine disinfectants used to treat contact lenses In some aspects, this invention further relates to the simultaneous cleaning and disinfection of contact lenses using iodine as the active disinfectant.

Description of the Related Art

Iodine is a well-known disinfecting agent known to be useful against a variety of organisms, including viruses, bacteria, spores, yeast, molds, protozoa, fungi, worms, nematodes and the like. Because of the wide range of disinfecting capabilities, iodine has been suggested for use as a contact lens disinfectant However, iodine is a strong irritant at higher concentrations and may, when used in concentration required for disinfection, destroy animal proteins and otherwise be harmful Therefore, because of the potential harm to the eye, iodine is preferably neutralized before the disinfected lens is inserted in the eye

Methods disclosing the neutralization of iodine as a contact lens disinfectant are known See U S Patent Nos. 3.91 1.107 and 4,031 ,209 to Krezanoski Both patents disclose neutralizing the iodine in solution by slow dissipation methods and use compounds suitable for human and animal use The neutralizing solution favored by Krezanoski contains sorbic acid and EDTA.

The Krezanoski patents also disclose compounds known as antioxidants that destroy available iodine Examples of these compounds include alcohols, aldehydes, alkenes, alkynes. aromatic hydrocarbons, amides, quinones, hydroxy acids, sugars, amino acids, sulfites, thiosulfates, sulfhydryl containing compounds, and polyunsaturated organics Solutions of such have been found to destroy all of the available iodine at different rates Many such compounds will be satisfactory for

various industrial purposes However, safety and tissue tolerance requirements restrict the number of compounds suitable for human and animal use

U S Patent No 4,312,833 to Clough issued January 26, 1982. also teaches a method of disinfecting contact lenses using iodine In Clough's process, contact lenses are contacted with a solution containing iodine and a reducing agent capable of reducing the available iodine level to substantially zero in a time of at least 30 minutes and at a temperature of from 20° to 25° C The iodine is present as an iodophor and the preferred organic reducing agent is sodium formate

Amino acids have been used to neutralize iodine Histidine is not known to have been previously suggested for use in care regimens for contact lenses, although the oxidation reaction of histidine with an excess of iodine is discussed in a paper by Schutte, L , et al, "The Substitution Reaction of Histidine and Some Other Imidazole Derivatives With Iodine," Tetrahedron. Suppl 7, pp 295-306 ( 1965) One drawback to using an imidazole such as histidine is the formation of an oxidation product that decomposes to a brown degradation product

Schutte, L , and Havinga, E , "The Degradation Reaction of Histidine With Iodine," Recueil 86 385-392 ( 1967) further investigated the I ₂ -degradation of histidine By-products included carbonate, iodoform, oxalic acid, ammonia and iodide products Additionally, they studied the reactions of some imidazole derivatives during the iodination of histamine, the initial formation of a brown precipitate, probably a diiodo product, was observed This dissolved in the fuπher course of reaction It was also suggested that histidine methyl ester follows a different reaction path as no iodoform is formed during its degradation as with the oxidation of histidine and histamine

Alexander, N M , "Reaction of Povidone-Iodine With Amino Acids and Other Impoπant Biological Compounds," Proceeding of the International Symposium on Povidone. pp. 274-288 (University of Kentucky College of Pharmacy, Lexington, Kentucky, 1983) reports studies of the reaction of povidone-iodine with amino acids, peptides and other biological molecules Methionine, histidine, cysteine, tyrosine and tryptophan reacted with povidone-iodine, whereas all of the other common amino acids (such as alanine, arginine. aspartic acid, cystine, glutamic acid, glycine, isoleucine, leucine, lysi e, phenylalanine, proline. serine. threonine, and valine), did not react. -

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In addition to disinfection, the contact lens should also be cleaned of any debris This debris is in the form of lipids, mucins and proteins that accumulates as a result of normal contact lens wear Surfactants may remove the looser bound debris but an enzyme, or a combination of enzyme and surfactants, may be needed to remove protein which is harder to remove Cleaning and disinfection may involve two separate steps with the cleaning occurring first but may be performed simultaneously with certain disinfectants and enzymes Single step Systems have a substantially greater compliance rate

Another common compliance issue deals with the rubbing that typically accompanies cleaning and the rinsing that is often required to remove any residual cleaner or debris from the lens A single step cleaning and disinfecting system with no rubbing or rinsing is the goal of manv contact lens solution companies but currently, no solution succeeds in meeting all these requirements

There are many products on the market that remove surface debris from a contact lens Daily cleaners usually contain surfactants Weekly cleaners usually contain proteolytic enzymes Both types of products usually require the lenses to be rubbed and rinsed after use With a daily cleaner, the rub and rinse occurs prior to disinfection while with the enzymatic cleaner, a rinse to remove any lens debris may occur prior to insertion of the lens into the eye An example of cleaning methodology requiring rubbing is provided in U S

Patent No 3,907,985 to Rank issued September 23, 1975 This reference discloses an ophthalmic solution comprising an aqueous solution of polystyrene sulfonate having a molecular weight between 75,000 to 10,000,000, and preferably polyethvlene glycol The solution as disclosed provides a lubricant and cushioning effect to traumatized eyes along with providing a cleaning function The cleaning method disclosed comprises the steps of soaking a lens in the ophthalmic solution followed bv rubbing the lens between the fingers and subsequently rinsing the lens with water Although the reference stated that the disclosed regimen cleaned debris from lenses, there was no specific description of protein removal Iodine is a highly effective contact lens disinfectant from the perspective of antimicrobial efficacy but iodine disinfectant systems have a tendency to discolor lenses -Performance of svstems such as those disclosed by Krezanoski is difficult to control because neutralization is highly dependent on ambient light conditions

Moreover, sorbic acid can be irritating and sorbic acid solutions may have an undesirable color.

Current regimens for the care of nondisposable, soft contact lenses typically require several component products: a daily cleaner, a weekly cleaner, and a disinfectant Regimens combining weekly cleaning and disinfecting are known, but more effective and convenient care regimens have long been sought

SUMMARY OF THE INVENTION

It has now been discovered that it is possible to employ a safe contact lens cleaning and disinfection system utilizing iodine and a dual neutralization system that insures complete neutralization of the iodine with virtually no discolored lenses With a thorough rinse at the end of the regimen, there is no need to soak the contact lens for extended periods of time to complete iodine neutralization It has also been discovered that the disinfection system of this invention may be desirably combined with sulfonate polymer to clean and disinfect in one fast, convenient step, eliminating the need for a separate weekly cleaner.

The disinfecting system of this invention contains an iodophor and a neutralizing solution which contains two neutralizers One neutralizer acts almost instantaneously (reaction between the neutralizer and available iodine will be completed in less than about 5 seconds, preferably less than a second) The second neutralizer acts slower, over a period of minutes The amount of iodine provided in the system is such that active iodine will be at a disinfecting level after the iodophor and rapid neutralizer react The second, slower neutralizer gradually neutralizes iodine at a rate that allows contact iens disinfection to occur Iodine disinfection occurs in a matter of minutes An important aspect of the disinfecting system of this invention is the rinse that occurs after disinfection is complete Inclusion of the rapid neutralizer in a neutralizing solution neutralizes residual iodine on the lens during the rinse The rinsed lenses are safe to be inserted into the eyes and worn

The disinfecting and cleaning system of this invention includes the disinfecting system described above and additionally includes a cleaner Selection of the cleaning component is not narrowly critical A presently preferred cleaner is a sulfonate

polymer, particularly polystyrene sulfonate The cleaner is preferablv such that the cleaning is accomplished simultaneously with the disinfecting Still more preferably, the cleaner is capable of removing debris from the contact lens without rubbing In the more preferred aspects of this invention, separate weekly cleaning is not necessary for the care of contact lenses

In one embodiment of this invention, the disinfectant, iodine, is preferably provided as a tablet The amount of active iodine provided is such that a disinfecting amount remains after the initial rapid neutralization Sulfonate cleaners, if used, are preferably included in the tablet However, other cleaners may be included in either the tablet or in the neutralizing solution, as will be apparent to one of ordinary skill in the art

In another embodiment of this invention, iodine is provided as a stabilized solution A problem w ith using stabilized iodine solutions as a contact lens disinfectant is that the iodine concentrations of such solutions are very high compared to the concentrations required to disinfect contact lenses For example, stabilized iodine solutions for ophthalmic use contain from about 100 to 1000 ppm iodine and typically contain about 300 ppm iodine Instability of iodine solutions increases as concentrations are reduced below these levels Contact lens disinfection, however, requires only about 50 ppm iodine The vast excess of iodine in stabilized solutions increases the incidence of lens discoloration and iodine retention in the lens When using the disinfection system of this invention w ith a stabilized iodine solution, the amount of rapid neutralizer is selected to reduce the available iodine in stabilized solutions to levels required for contact lens disinfection and the amount of the slower neutralizer is selected to complete neutralization in a time that allows for lens disinfection In this embodiment, the neutralizers may be provided in tablet form, although a solution is still preferred The present lens cleaning and disinfecting preferably takes place in a single step It is eas\ to use with a short amount of time required The lenses are disinfected and effective cleaning occurs every time the lenses are cycled through the regimen This results in lenses that are more comfortable, with less eye irritation

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DETAILED DESCRIPTION OF THE INVENTION

The disinfecting system of this invention comprises three components: an iodine component and two neutralizing components. The iodine component is preferably provided separate from the two neutralizing components. In the embodiment of this invention where the neutralizing components are used to rinse residual iodine from contact lenses, the neutralizing components will preferably be provided as a solution and the iodine component will preferably be provided as a tablet. However, in another preferred embodiment of this invention, the iodine component is provided as a stabilized solution and the neutralizing components are provided in tablet or powder forms or as a solution, preferably as a solution. Stabilized iodine solutions are well known in the art and will not be further described here. See, for example, European Patent Publication Number 476.777 by Dagra Pharma B.V., entitled "An Ophthalmic Preparation Comprising a Povidone-iodine Solution ." Iodine is preferably provided as an iodophor. Any iodophor that provides active iodine upon solution is suitable for use in the present invention Iodophors are commercially available and will provide a known amount of active iodine from the iodophor complex upon dissolving in aqueous solution It is believed that the active iodine is responsible for the disinfection properties noted in the solutions of the present invention. The iodine associated with the iodophor complex and the active iodine free in the solution are collectively referred to as the total available iodine in the system. Particularly useful carriers that associate with iodine to create iodophors include a variety of high molecular weight polymeric materials such as starch and various synthetic polymers. Preferred synthetic polymers are polyvinyl pyrrolidone and copolymers of polyvinyl pyrrolidone such as vinyl acetate polyvinyl pyrrolidone, polyvinyl oxazolidone, caprolactam, polyvinyl alcohols, amides and phenols. Specific examples of iodophors useful in this invention include polyvinylpyrrolidone-iodine, polyvinyl alcohol-iodine, polyvinyl oxazolidone-iodine, polyvinyl imidazole-iodine, polyvinyl morpholone-iodine, polyvinyl caprolactam-iodine, nonylphenoiethoxylate- iodine, soluble starch-iodine, betacyclodextrin-iodine, polyoxyethylenepolyoxypropylene condensate-iodine, and ethoxylated linear alcohol- iodine, with polyvinyl pyrrolidone-iodine being the most preferred. An added benefit of using polyvinyl pyrrolidone-iodine in the disinfection system is that the polyvinyl

pyrrolidone remaining after dissolution and neutralization of the iodophor serves as a wetting agent for the contact lens.

The iodophor may be provided as a solid or liquid to the disinfection system of the present invention. However, the iodophor is most conveniently provided in a solid form (e.g., tablet or powder, etc.). The amount of iodophor required to yield a desired amount of active iodine will vary slightly among different iodophors. USP grade polyvinyl pyrrolidone-iodine (PVP-I _; ) contains about 9% to about 12% total available iodine.

The amount of iodophor required can be easily determined by one of ordinary skill in the art. Iodine is preferably provided in tablets which, upon dissolution and after reaction with the rapid neutralizer, produce a disinfecting amount of iodine. A disinfecting amount is that amount necessary to disinfect contact lenses Selection of a disinfecting amount is within the skill of the art. Preferably, the concentration of active iodine in solution after reaction with the rapid neutralizer is within the range from about 20 to about 80 ppm, preferably 30-70 ppm, more preferably 40 to 60 ppm.

Iodine is preferably provided in amounts which, upon dissolution and before reaction with the rapid neutralizer, produce concentrations of active iodine in solution within the range from about 30 to about 1000 ppm, preferably 40-500 ppm, more preferably 40-100 ppm. The first of the two neutralizing components of the disinfecting system of this invention completes its reaction with available iodine almost instantaneously— preferably the reaction is complete in less than five seconds, more preferably less than one second. Selection of a suitable neutralizer is generally within the skill of the art. Preferred rapid neutralizers include inorganic sulfites and thiosulfates, methionine, cysteine, and ascorbic acid. Inorganic thiosulfates, especially sodium thiosulfate, are particularly preferred rapid neutralizers. The amount of rapid neutralizer employed will generally be such that a disinfecting amount of iodine remains after mixing the neutralizing component and the iodine component of the system. Thus, in the embodiment of this invention where the disinfected lens is rinsed with neutralizing solution, the "excess" iodine is directly related to the rapid neutralizer concentration in the rinse solution When the iodine component is provided as a tablet and the neutralizing components are provided as a solution which is to be used as a rinse, the

amount of rapid neutralizer in the solution is preferably within the range of about 50- 100 ppm, more preferably about 60-80 ppm

The second of the two neutralizing components of the disinfecting system of this invention gradually neutralizes iodine at a rate that allows contact lens disinfection to occur The reaction between the second neutralizing component and available iodine is preferably complete in about 3 to about 30 minutes, more preferably about 5- 10 minutes Selection of a suitable neutralizer is generally within the skill of the art Preferred slower neutralizers include imidazoles, mixtures of sorbic acid and EDTA (ethylene diamme tetraacetic acid), and sodium formate Imidazoles are particularly preferred, especially histidine and histidine derivatives The amount of slower neutralizer employed will generally be sufficient to neutralize the disinfecting amount of iodine remaining after mixing the neutralizing component and the iodine component of the system The amount of slower neutralizer is generally related to the disinfecting amount of iodine which is selected as described above, to the desired time of the disinfecting neutralizing cycle, and to the pH of the system The reaction time of the slower neutralizer is surprisingly dependent on system pH The pH of the solution formed b\ mixing the iodine and neutralizing components is preferably in the range of about 6 to about 8, more preferably about 6 8 to about 7 6 When the iodine component is provided as a tablet and the neutralizing components are provided as a solution which is to be used as a rinse, the amount of slower neutralizer in the solution is preferably within the range of about 100-2000 ppm more preferably aoout 500-1500 ppm

As mentioned, imidazoles are preferred slower neutralizers The weakly basic imidazole ring neutralizes iodine at a rate that allows for contact lens disinfection Histidine is a particularly preferred imidazole since it is a naturally-occurring am o acid However, side reactions with some imidazoles can produce precipitates and colored solutions For example, colored byproducts may be formed upon further decomposition of the lodinated ring See Schutte, L , and Havinga, E "The Degradation Reaction of Histidine With Iodine," Recueil. Vol 86, pp 385-392 ( 1967) Without ishing to be bound by any theory of operability, it is believed that this problem can be overcome bv tying up the electrons of the amino group to prevent attack-on the lodinated imidazole ring, dissipating the overall charge of the amino nitrogen Substitution of an electron-withdrawing group on the amino nitrogen will

generally be effective Examples of suitable electron-withdraw ing groups include amides, i ides, phenyls, substituted phenyls, perfluoro alkvls. and sulfonamides A preferred solution to this problem is to use N-alpha-acetyl histidine as the slower neutralizer When an acetyl group is attached to the amino nitrogen of histidine, attack on the imidazole ring is blocked

N-alpha-acetyl histidine neutralizes active iodine over a period of minutes, leaving minimal time for iodine to migrate into the lens matrix A faint yellow color may be present on the surfaces of some lenses However, the color can be easily rinsed off or neutralized by rinsing the lenses with a solution containing the fast neutralizer of this invention

Other components used in conventional contact lens care regimens may be combined with the disinfecting system of this invention For example, a cleaner may be combined with the disinfecting system to simultaneously clean and disinfect lenses The selection of the cleaner is not narrow ly critical Some conventional contact lens cleaners such as poloxamme are not suitable because they are incompatible w ith iodine As a further example, the neutralizers are preferably provided as a solution and the solution will be preserved Selection of suitable preservatives is well within the skill of the art A presently preferred preservative is polyhexamethlylene biguanide Other components include chelating agents, tonicity adjusting agents, and buffers The preferred neutralization component is substantially iso-osmotic and has a substantially neutral pH

An iodine chromophore may be added to the disinfecting system to allow iodine neutralization to be seen visually This has the benefit of encouraging compliance with the lens care regimen and discouraging consumers from putting active iodine in their eyes The chromophore is preferably incorporated into the lodophor- containing tablet The indicator provides a color to the disinfecting solution, indicating the continued presence of oxidative disinfectants The iodine chromophore may be any color producing complex comprising iodine or iodine derivative ions associated with an amylose-containing compound or complex "Chromophore" refers to any color- producing compound An amylose is the linear, helical component of starch

Preferred amylose-containing compositions are starch and hydrolyzed starches such as dextrins, with maltodextπn being particularly preferred

When the iodophor-containing tablet initially contacts the neutralizing solution, the indicator will turn the solution purple. The rapid neutralizing agent will reduce the amount of iodine but the solution will retain the purple hue. It is the second, slower acting neutralizer that will cause the solution to turn clear, indicating the neutralization of the iodine in solution.

In one embodiment of this invention, iodine is preferably provided as a tablet. Tablet preparation is done using techniques well known in the art

This invention will be further illustrated by reference to the following Examples

Example 1

Preparation of Neutralizing Solution with Two Neutralizers To 3500 grams (gm) of purified water, add weight (gm) percent % Boric Acid 50.0 1.25

Sodium Borate 14.0 0.35

Disodium EDTA 0 4 0 01

Sodium Chloride 12 4 0 29

Tetronic® 1 107 (BASF) 0 2 0.005 Sodium Thiosulfate, pentahydrate 0.2S 0 007

N-alpha-Acetyl-L-histidine 3 6 0 09

Pipette into the solution 2.37 mL of 1350 8 ppm stock solution of polyaminopropyl biguanide (PHMB HCL 20% solution, from ICI Americas as Cosmocil CQ) The final solution was brought up to a volume of 4000 gm with purified water before the pH and osmolality was recorded The pH of this solution was 7 4 and the osmolality was 320.

Example 2

Preparation of Rapid Disinfecting Tablet (90 ppm Active Iodine) An iodine disinfecting tablet designed to be dissolved in 10 mLs of reducing solution was prepared having the following formulation 7 5 mg PEG-8000, 325 mesh particle size

8 2 mg PVP-Iodine, micronized

12 0 mg Maltπn® M040 (Grain Processing Corp )

65 0 mg lactose anhydrous

10 0 mg sodium polystyrene sulfonate, micronized 14 0 mg citric acid, anhydrous

32 8 mg sodium bicarbonate

7 5 mg sodium benzoate 80 mesh

Prior to compounding, the Maltπn M040 was milled and passed through a #200 mesh sieve Sodium benzoate was also milled and passed through a #80 mesh sieve Lactose, citric acid and the maltπn were dried at 65 - 75 degree C The PEG, PVP-Iodine, polystyrene sulfonate and maltrin were then hand mixed and passed through a #50 mesh sieve The citric acid, sodium bicarbonate and part of the lactose were separately mixed for 20 minutes This mixture was then combined with the PVP- Iodine mixture and the remaining lactose added After mixing for 30 minutes in a V- Blender. the sodium benzoate is added for an additional mixing period of 5 minuies Tableting was done with a 7 mm punch for a tablet weight of 1 7 0 mg

Example 3 Disinfecting Activity

The antimicrobial activity of the iodophor and neutralizer solution was tested by exposing the test organism at about I O x 10 ⁷ to about 1 0 x 10 ^s colony forming units per milli ter (CFU/mL) to 10 mL of each composition at room temperature for the intervals of 1 , 2 5 or 5 minutes (the solution was swirled at approximately 3 minutes) An aliquot of each inoculated sample was removed at the measured time, diluted in a neutralizing bath -Engiey) and plated with neutralizing agar The agar plates -were incubated for 2 to 5 days and plate counts were determined to calculate reduction in CFU/ L for each organism

A disinfecting solution made from the tablet and neutralizing solution previously described was tested in duplicate against the following organisms S atireus ATCC 6538P, /' aentginosa ATCC 9027, S marce cens ATCC 13880 C albicans ATCC 1023 1. and F solani ATCC 3603 1 Log reduction values are shown in Table 1

Table 1

1 minute 2 5 minutes 5 minutes

S. aitrei/s 0 3 >4 3 >4 3 S. atireus 0 1 >4 3 >4,3

P. aentginosa 1 1 >4 4 >4 4 P. aeritginos 1 0 >4 4 >4 4 S marcescens 0 0 3 0 >4 2 S. marcescens 0 1 >4 2 >4 2 C. albicans 0 0 2 2 3 4 C. albicans 0 0 2 0 3 8 F solani 0 0 >3 9 >3 9 F. solani 0 0 3 7 >3 9

For disinfecting contact lenses, the International Standards Organization requires a greater than 3 log reduction for bacteria (ISO/CEN4) The iodophor and neutralizer solution satisfied the ISO criteria for both trials at the 2 5 minute time point when tested with S atireus and F aentginosa and met the requirements for at least one of the two trials of S ai cescens At the 2 5 minute time point, the solution met ISO criteria for yeast and mold (greater than 1 log reduction) against C alhcans and F solani at the 2 5 minute time point for both trials

At the 5 minute time point all organisms tested met the ISO criteria for a contact lens disinfecting solution

Example 4

Comparison of Currently Marketed Lenses

In this Example, currently marketed lenses were subjected to the disinfection regimen to identify which lenses needed a post disinfection rinse with the neutralizing solution The lenses were subjected to the following regimen:

1 Place lenses in basket of 10 mL lens case

2 Place 1 disinfecting tablet (from Example 2), 10 mL of neutralizer (from Example 1 ) and the lens basket containing the lens into the lens case

3 After approximately 3 minutes, swirl the case gently The solution should be purple.

4 Let lenses stand for a total of 10 minutes

5 Remove the lenses from the case Lenses may be ready to wear. If yellow color is present on lens surface, further handling may be necessary (see Table 2).

Table 2

LENS TRADE NAME MATERIAL ACTION

Acuvue® (Johnson & Johnson) etafilcon A Remove from system No further handling

Surevue® (Johnson & Johnson) etafilcon A Remove from system No further handling

Newvue® (Ciba Vision) vivfilcon A Remove from system No further handling

Optima FW® Visibility polymacon Remove from system

(Bausch &. Lomb) No further handling

Medalist® (Bausch & Lomb) polymacon Remove from system 10 sec/side rinse

Focus® (CibaVision) vivfilcon A Remove from system No further handling

Cibasoft® (CibaVision) tefilcon Remove from system 10 sec/side rinse

Optima® Toric (Bausch & Lomb) hefilcon B Remove from system 10 sec/side rinse

SeeQuence II® (Bausch & Lomb) polymacon Remove from system 10 sec/side rinse

CSI Clarity Clear® (Pilkington) crofilcon A Remove from system 10 sec/side rinse

Rinsing was done with the neutralizing solution from Example