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Dr. Chelsea Bray, head of the Advanced Contact Lens Service, is using her new tenure-track role to make a difference through patient care and research.

When Dr. Chelsea Bray was a nearsighted kid growing up in Barry’s Bay, a small town in the Ottawa Valley, she desperately wanted contact lenses, but her parents and optometrist considered her too young until she was in Grade 8. Now, as head of the Advanced Contact Lens Service of the ��ݮ��Ƶ Eye Institute, she fits kids as young as four for contact lenses that slow the progression of myopia.

Contact lenses have come a long way in the last few decades, and Bray counts herself as privileged to have seen that evolution. Now she’ll help contribute to further progress – she has moved from a teaching-focused role at the University of ��ݮ��Ƶ School of Optometry and Vision Science to being a tenure-track assistant clinical professor with time to devote to scholarly activities and research.

Bray rediscovered her fascination with contact lenses while she was at optometry school in ��ݮ��Ƶ, so when she graduated in 2014, she opted to do a residency in that area, supervised by her mentor, the late Dr. Gina Sorbara. By gaining advanced skills in specialty contact lenses, she felt she’d be able to really make a difference in people’s lives.

It was an exciting time because the specialty contact lens landscape was changing rapidly. Scleral lenses – large, rigid lenses that dome over the cornea – were regaining popularity. Now they’re commonly used for a wide range of corneal diseases and degenerations, such as ones that cause severe glare and can’t be corrected with glasses. Scleral lenses can also be used to treat severe dry eye and correct higher-order aberrations.

“With specialty contact lenses, we can give people back their sight,” says Bray. “There are people who can’t see well with glasses no matter what – they might have misshapen corneas or corneal scarring, which would be like having a bumpy or cone-shaped windshield in front of your eyes. Rigid contact lenses can act as the regular surface these patients need.”

For patients who need custom scleral lenses, these can be made by using a mold of the patient’s cornea and sclera, the white part of the eye. The lenses are then filled with clear fluid, which remains between the lens and the patient’s cornea, filling in the irregularities.

“A lot of the time, these patients can only get to 20/100 or worse vision with glasses, which means they need to be 20 feet away to see something that someone with 20/20 vision can see from 100 feet away. We can often improve vision to 20/25 or 20/20 again with specialty contact lenses, which is very rewarding,” says Bray.

One of Bray’s research interests is keratoconus, a condition in which the cornea thins and bulges into a cone shape. When she was in optometry school, she was taught it affected one in 2,000 people, but newer studies show it’s far more common than that, though it varies by population.

“You need corneal topography or tomography to truly diagnose keratoconus, because it can be subtle,” says Bray. “With these instruments becoming more widespread, it’s being picked up a lot more.”

Depending on the patient and the severity of the disease, there are a variety of ways to treat the disease and help a patient see better. Often, rigid gas-permeable contact lenses or scleral lenses can help even patients with moderate to advanced keratoconus.

It’s still an exciting time to be working in contact lenses because technology is advancing at a fast pace. To give one example, with advances in optics, multifocal contact lenses have gotten better, with multifocal lenses for astigmatism now available. The result is that people can comfortably wear contact lenses at any age, even into their 80s and 90s.

“If someone tried multifocals 10 years ago and didn’t like them, it’s worth trying again,” says Bray.

Myopia control techniques for children have also advanced tremendously, with options available in hard and soft contact lenses, glasses and eye drops. Ortho-K rigid contact lenses to reshape the cornea have seen a resurgence due to their effectiveness in slowing down the progression of myopia. The result is that children’s myopia doesn’t become as severe, which will help prevent ocular diseases and conditions that can cause vision loss later in life.

More developments are on the horizon, such as contact lenses that deliver drugs – something University of ��ݮ��Ƶ researchers are working on – and smart contact lenses that offer augmented reality experiences.

“Just in the last decade, things have really exploded, though it does mean you need to keep on top of it,” says Bray. “It’s great to be in a place like the ��ݮ��Ƶ Eye Institute, where we’re not only up on all the latest but are contributing to developments.”