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.

隐形眼镜代表了一种广泛使用的视力矫正形式，全球有超过 1.4 亿佩戴者。虽然通常耐受性良好，但隐形眼镜会导致角膜感染（微生物角膜炎），年发病率约为每 10,000 名佩戴者约 2 至约 20 例，有时会导致永久性视力丧失。研究表明，隐形眼镜相关微生物角膜炎的发病机制复杂且多因素，可能需要多种合谋因素，从而损害健康角膜对感染的内在抵抗力。在这里，我们概述了我们对戴隐形眼镜有时使角膜易受感染的机制的看法，主要关注我们在过去三十年中自己的研究工作。这包括对健康角膜构成屏障功能背后的宿主因素的研究，当内在抵抗力不受影响时其对细菌挑战的反应，病原体毒力机制，以及隐形眼镜佩戴影响改变宿主-微生物相互作用的结果。对于几乎所有的这项工作，我们都利用了细菌铜绿假单胞菌，因为它是晶状体相关微生物角膜炎的主要原因。虽然在角膜分离株中还不常见，但已经出现了对几乎所有目前可用的抗生素都具有抗性的铜绿假单胞菌临床分离株，导致美国 CDC（疾病控制中心）将铜绿假单胞菌添加到其最严重的威胁列表中。使这种担忧更加复杂的是，用于生物传感和增强现实的先进隐形眼镜的开发，以及近视发病率的不断上升，可能预示着未来会出现威胁视力的角膜感染。值得庆幸的是，基因组学、蛋白质组学、代谢组学和成像方面的技术进步与隐形眼镜相关铜绿假单胞菌的新兴模型相结合 感染有望解决问题 - 并且可能危及生命的感染会影响其他组织。