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Purpose: To model between subject variability of corneal swelling (CS) and deswelling after overnight wear of silicone hydrogel (SiHy) contact lenses., Methods: A total of 29 neophyte subjects wore 12 SiHy lenses with central transmissibility range of 31 to 211 Dk/t units on separate nights, in random order, and on one eye only. The contralateral eye served as the control. Central corneal thickness was measured using digital optical pachymetry before lens insertion, immediately after lens removal on waking, then 20, 40 minutes, 1, 2, and 3 hours later. Mixed modelling was conducted for simultaneous analysis of group and between-subject effects of CS and deswelling., Results: The best model for overnight CS versus Dk/t was linear with a random intercept showing constant between-subject differences in CS for different Dk/t values. The best fit for corneal deswelling versus time was a curvilinear random intercept and random slope model. About 90% of the total between-subject deswelling variance in either lens or control eyes was due to the intercept variability with much less (∼10%) being due to the variability of the individual deswelling rate (slope). Subject age, sex, and ametropia were not predictors of individual corneal swelling in the swelling versus Dk/t analysis. Age, however, was a significant (inverse) predictor of the rate of corneal deswelling, only in lens-wearing eyes., Conclusions: A large proportion of variability in corneal swelling is because of subject-specific differences in corneal response to hypoxia. This shows that "low swellers" and "high swellers" actually do exist.

Purpose: To determine the effect of wearing a lens with a unique peripheral optical design on the development and progression of defocus-induced myopia in newly hatched chickens., Methods: Eighty-five newly hatched chickens underwent bilateral retinoscopy and A-scan ultrasound to determine their refractive error and axial length. They were randomly divided into Control and two Test groups, in which each chicken was fitted with a goggle-lens over the right eye, with the left eye remaining untreated. The Control group wore a lens of power -10.00 diopters (D) of standard spherical optical design. The two Test lenses both had a central optical power -10.00 D, but used different peripheral myopia progression control (MPC) designs. For all groups, retinoscopy was repeated on days 3, 7, 10, and 14; ultrasound was repeated on day 14., Results: On day 0 there was no statistical difference in refractive error (mean +6.92 D) or axial length (mean 8.06 mm) between Test and Control groups or treated and untreated eyes (all P 0.05). At day 14, 37 (43.5%) of 85 chickens had not experienced goggle detachment and were included in the final analyses. in this cohort there was a significant refractive difference between the treated eyes of the control group (n = 17) and those of test 1 (n = 14) and Test 2 (N = 6) groups (both P <0.01): Control -4.65 ± 2.11 D, Test 1 +4.57 ± 3.11 D, Test 2 +1.08 ± 1.24 D (mean ± SEM). There was also a significant axial length difference (both P < 0.01): Control 10.55 ± 0.36 mm, Test 1 9.99 ± 0.14 mm, Test 2 10.17 ± 0.18 mm., Conclusions: Use of these unique MPC lens designs over 14 days caused a significant reduction in the development of defocus-induced myopia in chickens; the degree of reduction appeared to be design specific.

Purpose: To determine the effects of silicone hydrogel lens wear and lens-solution interactions on ocular surface sensitivity., Methods: Forty-eight adapted lens wearers completed the study, which comprised two phases. Phase 1 included habitual lens wear, no lens wear (7 ± 3 days), and balafilcon A lenses (PV; PureVision; Bausch & Lomb, Rochester, NY) with a hydrogen peroxide-based regimen for 2 weeks; phase 2 included wear of PV with the use of a multipurpose solution containing either polyhexamethylene-biguanide (PHMB) or Polyquad/Aldox (Alcon Laboratories, Fort Worth, TX) preservative, each for 1 week, with a 2-week washout period between solutions. Tactile and pneumatic (mechanical and chemical) stimuli were delivered, and thresholds were determined by Cochet-Bonnet (Luneau Ophthalmologie, Chartres, France) and Belmonte (Cooperative Research Centre for Eye Research and Technology, Sydney, NSW, Australia) pneumatic esthesiometers, respectively. Corneal and conjunctival thresholds and staining scores were assessed at baseline, after 2 and 8 hours of lens wear on day 1 and at the end of each wearing cycle (2 hours)., Results: In phase 1, compared to the no-lens baseline, corneal tactile thresholds increased at the 1-day, 8-hour and the 2-week visits (P < 0.05), whereas conjunctival mechanical thresholds decreased at the 1-day, 2-hour and the 2-week visits (P < 0.05). In phase 2, the chemical thresholds were lower with PHMB-preserved solution compared with the Polyquad/Aldox system at the 1-day, 2-hour and the 1-week visits (P < 0.05). Staining scores correlated inversely with conjunctival chemical thresholds (all P < 0.05)., Conclusions: Ocular surface sensitivity changed in adapted lens wearers, when lenses were refit after a no-lens interval and during lens wear with different care regimens. The corneal staining that was observed with certain lens-solution combinations was accompanied by sensory alteration of the ocular surface-that is, higher levels of staining correlated with increased conjunctival chemical sensitivity. (ClinicalTrials.gov number, NCT00455455.).

Purpose: To investigate changes in epithelial thickness after overnight wear of CRTH rigid gas-permeable (RGP) lenses (Paragon Vision Sciences, Mesa, AZ) for the correction of hyperopia., Methods: Twenty subjects wore a +3.50 D hyperopia-correcting CRTH lens on one eye for a single night in an attempt to induce myopia (first study). The untreated eye served as the control. Corneal and epithelial thickness was measured at nine points across the horizontal meridian by OCT. Measurements were obtained the night before lens wear, immediately after lens removal the next morning, and 1, 3, 6, and 12 hours after removal. Measurements were obtained 28 hours later, to observe recovery. Then, the attempted hyperopic corrections of +1.50 and +3.50 D were evaluated, using CRTH lenses in both eyes of 20 subjects for a single night (second study)., Results: All values were compared to baseline unless otherwise stated. In the first study, the treated eye's central and midperipheral epithelial thickness increased by 21.5% +/- 8.6% and 13.3% +/- 7.6%, respectively, after lens removal (P < 0.001). The control eye's central epithelial thickness (CET) increased by 7.1% +/- 6.0% (P < 0.05). In the second study, CET increased by 17.6% +/- 8.5% (P < 0.001) in the +3.50 D-treated eye and by 13.3% +/- 4.8% (P < 0.001) in the +1.50 D-treated eye. Midperipheral epithelial thickening was 5.9% +/- 4.7% (P < 0.05) in the +3.50 D-treated eye and 6.0% +/- 6.3% (P < 0.05) in the +1.50 D-treated eye., Conclusions: CRTH lenses, designed to correct hyperopia, when worn overnight, caused an increase in CET. The amount of epithelial change seemed to differ with modified lens design.

Purpose: To investigate the relationships of dry eye symptoms and corneal and conjunctival sensitivity to pneumatic stimulation, tear film stability, and clinical ocular surface characteristics in symptomatic and asymptomatic subjects., Methods: Ninety-seven subjects were enrolled and grouped by a questionnaire-based single score for symptoms of ocular dryness (none to trace, non-dry group; mild to severe, symptomatic group); 43 were symptomatic and 54 were non-dry. Corneal (K) and conjunctival (C) sensitivities were measured with a computer-controlled Belmonte pneumatic (room temperature) stimulus. Symptoms were assessed according to the Ocular Surface Disease Index (OSDI). Ocular surface staining with fluorescein (FL) and lissamine green (LG), noninvasive tear film break-up time (NIBUT), and the phenol red thread test (PRT) were assessed., Results: The symptomatic group showed lower K and C thresholds (P < 0.01), greater corneal FL and conjunctival LG staining, and shorter NIBUT than did the non-dry eye group (all others P < 0.05). The OSDI scores were higher in the symptomatic group (P < 0.001). K and C thresholds and NIBUT were inversely correlated with the OSDI and corneal and conjunctival staining (all P < 0.05). The K and C threshold and NIBUT (all P < 0.01) correlated positively. Step-wise multiple regression analysis showed that ocular surface sensitivity and NIBUT were significant predictors of the OSDI., Conclusions: Ocular irritation assessed with the OSDI is associated with ocular surface hyperesthesia to cooling, corneal epitheliopathy, and tear film instability. Although cause and effect are unclear, the analysis showed that altered corneal and conjunctival sensory processing and tear film attributes are essential aspects of what characterizes dry eye.

Purpose: To demonstrate that corneal light-backscatter can be measured objectively during corneal swelling by optical coherence tomography (OCT)., Methods: One eye (randomly selected) of 20 non-contact-lens wearers (10 men and 10 women; mean age, 35.6 +/- 9.6 years) was patched during 3 hours of soft contact lens (SCL) wear. The contralateral eye acted as the control. Central corneal images were captured before and after SCL wear at 20-minute intervals over 100 minutes using optical coherence tomography (OCT) to obtain corneal thickness and light-backscatter profiles. OCT backscattered light of the epithelial layer (decided by the thickness measurements) and 10 equally divided layers of the remaining cornea were analyzed with a custom software program. Two baseline measurements were taken at different visits before lens wear to test the repeatability of light-backscatter measurements., Results: From two baseline measurements, repeated measurements showed good repeatability of normalized backscatter results. Immediately after contact lens removal, total central corneal thickness increased significantly by 13.8% +/- 2.3% (mean +/- SD) compared with baseline (P = 0.0001, paired t-test) and then decreased during the deswelling course. Corneal backscattered light changed significantly (repeated-measures ANOVA [Re-ANOVA]: F((50, 950)) = 2.22, P = 0.0001) after lens wear, and a significant increase in backscatter was found in the epithelial layer (36.4%) and the most posterior corneal layer (35.6%) immediately after lens removal (post hoc test, P = 0.005). There was a strong correlation (r = 0.9375, P < 0.05) between the change in backscatter and corneal swelling during the deswelling period. The backscatter recovery rate was approximately the same for both epithelial and posterior layers after lens removal., Conclusions: Light-backscattering analysis with OCT seems to be a promising and repeatable method of objectively measuring corneal backscatter. This study has demonstrated that corneal backscattered light increased in the anterior and posterior layers of the cornea during corneal swelling induced by contact lens wear and eye closure.

Purpose: To investigate topographical thickness changes of the epithelium and total cornea measured with optical coherence tomography (OCT) after overnight wear of rigid gas-permeable lenses., Methods: Reverse geometry design CRT (Dk=100) rigid (test) lenses (Paragon Vision Sciences, Mesa, AZ) were randomly fitted on one eye of each of 20 neophyte subjects (mean age, 24.6 +/- 2.7 years) and the other eye was fitted with an alignment tricurve rigid lens of the same material (control). Epithelial and total corneal thickness was measured at intervals of 10 degrees across a 10-mm zone of the horizontal meridian of the cornea, before and after overnight wear. Refractive error was measured with an autorefractor. These measurements were repeated 20 and 60 minutes and 3, 6, and 12 hours after lens removal., Results: After one night of lens wear, myopia decreased in the test eye by 1.18 +/- 0.81 D, which was significantly different from baseline (P<0.001). No significant change was found in the control eye. Twelve hours after removal, two thirds of the myopic reduction was still present. Different topographical swelling patterns were induced by the two lens designs, with greatest swelling occurring in the center with the control lens and in the midperiphery with the test lenses (polynomial regression: P<0.005). Significantly greater central corneal swelling was found with the control lens than the test lens (6.9% +/- 3.1% vs. 4.9% +/- 2.0%, respectively, P=0.006). The effect on epithelial thickness differed between lenses and depended on both position and time (F(48,912)=2.3; P=0.000). Immediately after removal of the test lens, the central epithelium was 5.1% +/- 4.5% thinner than baseline, and all other locations (P<0.005 post hoc tests) and the epithelium in the midperiphery showed significant thickening (1.9% on the temporal side and 2.4% on the nasal side, both P<0.006 compared with the baseline). There were no significant changes in epithelial thickness with the control lens during the study period (post hoc tests: P>0.05)., Conclusions: The optical coherence tomograph is a sensitive instrument that can detect small changes in epithelial and corneal thickness across the entire cornea. Topographical thickness changes of the epithelium and total cornea induced by one night of reverse-geometry lens wear appear to be associated with the decrease of myopia.

Purpose: To demonstrate the feasibility of indirectly measuring the precorneal tear film thickness and pre- and postlens tear film (PLTF) thickness using optical coherence tomography (OCT)., Methods: Central corneal thickness (C(1)) which includes the tear film (T) of both eyes of 40 non-contact lens wearers was measured using OCT after calibration. The mean age of the 40 subjects was 31.2 +/- 9.3 years with a mean horizontal K-reading of 7.87 mm. Rigid contact lenses with base curves 0.3- to 0.5-mm steeper than the flattest K of the eye were fitted to measure real corneal thickness (C(2)), independently of the postlens tear film. T was calculated by T = C(1) - C(2). To measure pre- and postlens tear film thickness, Focus Night & Day and Acuvue lenses (Vistakon, Johnson & Johnson Vision Care, Jacksonville, FL) were fitted on both eyes. Central soft lens thickness (L(1)), which includes the prelens tear film (P), was measured by OCT in situ and in saline in a wet cell (L(2)). P was calculated by P = L(1) - L(2). Thickness of the central cornea plus the postlens tear film (C(3)) was measured during lens wearing. Postlens tear film (PLTF) was calculated by PLTF = C(3) - C(2). RESULTS. The mean +/- SD precorneal tear film thickness was 3.3 +/- 1.5 microm (range, 0-6.9) before lens insertion and 4.7 +/- 2.3 microm (range, 0.7-11.0) after lens fitting, which was significantly thicker (paired t-test: P < 0.01). The prelens tear film thickness was 3.9 +/- 2.6 and 3.6 +/- 2.1 microm (mean +/- SD; paired t-test: P = 0.52) and the postlens tear film thickness was 4.5 +/- 2.3 and 4.7 +/- 3.1 microm (paired t-test: P = 0.08) on and under Focus Night & Day and Acuvue lenses, respectively. Post hoc tests showed that precorneal (baseline) and prelens tear films were equivalent, and each was different (thinner; Tukey honestly significant difference P < 0.05) from the postlens tear film., Conclusions: OCT can noninvasively measure the thickness of the precorneal and prelens tear film as well as the postlens tear film. The thickness of the normal precorneal tear film is approximately 3 micro m and becomes thicker after lens fitting. The postlens tear film is thicker than the precorneal and prelens tear films with soft contact lenses. The thickness of both pre- and postlens tear films appears to be independent of the investigated lens types.

Purpose: To determine changes in topographical thickness of the epithelium and total cornea after hydrogel (2-hydroxyethyl methacrylate; HEMA or soft lens) and PMMA rigid contact lens wear with eyes closed, as measured by optical coherence tomography (OCT)., Methods: Epithelial and total corneal thickness in 18 neophyte eyes was measured with OCT at intervals of 10 degrees across a 10-mm zone of the horizontal meridian of the cornea, before and after 3 hours of soft and rigid contact lens wear with the eye closed. These measurements were repeated 20 minutes after removal of the lenses., Results: Lens type, time, and location were found to be significant main influences (P < 0.0001) on corneal swelling in patched eyes, by three-way ANOVA, and there was a significant three-way interaction among lens type, time, and location (F((16,272)) = 1.78, P = 0.033). However, there was no significant main effect and interaction of epithelial thickness (F((16, 272)) = 0.33, P = 0.99). Immediately after removal of the lenses, total corneal thickness in the horizontal meridian was significantly greater with both soft and PMMA lenses (P < 0.001) at each location with each lens, compared with the baseline measurements. With both lenses, the increase in actual thickness and percentage of corneal swelling at the center was greater than at each peripheral point (excluding the first 10 degrees points; P < 0.005). HEMA lenses caused greater corneal swelling than the PMMA lenses at each location immediately after removal of the lenses (P < 0.005)., Conclusions: This study shows that corneal swelling is dependent on lens type and corneal location when eyes are closed, but epithelial thickness across the horizontal corneal meridian does not change during lens wear with eyes closed. OCT is an efficient method of measuring topographical corneal and epithelial thickness in response to contact lens wear.

Purpose: To compare central corneal swelling and light scatter after 8 hours of sleep in eyes wearing high- and low-Dk hydrogel lenses and to the contralateral control eyes., Methods: Twenty neophyte subjects wore a Lotrafilcon A (Dk, 140; Ciba Vision, Duluth GA) silicone hydrogel lens and an Etafilcon A (Dk, 18; Acuvue; Vistakon, Jacksonville, FL) 58% water content hydrogel lens of similar center thickness in random order in the right eye only, for overnight 8-hour periods. The contralateral nonwearing left eyes served as controls. Central corneal thickness was measured using an optical pachometer and light scatter using a Van den Berg stray-light meter before lens insertion, after lens removal on waking, and every 20 minutes for the next 3 hours., Results: Central corneal swelling induced by the Etafilcon A lens on eye opening was significantly higher than with the Lotrafilcon A lens (8.66%+/-2.84% versus 2.71%+/-1.91%; P<0.00001). Light scatter induced by the Etafilcon A lens on eye opening was significantly higher than with the Lotrafilcon A lens (46.09+/-5.62 versus 42.78+/-6.07 Van den Berg units, P = 0.0078). The swelling of the control eyes paired with the Etafilcon A lens-wearing eyes was also slightly but significantly higher than that of the control eyes paired with the Lotrafilcon A lens-wearing eyes (2.34%+/-1.26% versus 1.44%+/-0.91%; P = 0.0002). Light-scatter measurements were not significantly different between control sets of eyes but showed the same trend., Conclusions: In neophyte subjects, corneal swelling of the contralateral control eyes appears to be influenced by the swelling of the fellow lens-wearing eyes-that is, the swelling of the contralateral control eye was significantly lower when there was less swelling of the fellow eye wearing the high-Dk lens. Although there was no statistically significant difference in light-scatter measurements between the control sets of eyes, a trend similar to the corneal swelling results was observed, which could be used to support the suggestion that this may be a sympathetic physiological response rather than an unusual sampling coincidence.

Recent reports suggest that the aphakic eye develops less corneal edema than the phakic eye during hydrogel contact lens wear. Measurements were made of several ocular characteristics that might account for this difference in nine unilateral aphakic subjects. The measurements showed that compared with the phakic eye, the aphakic eye averaged a 15% lower epithelial oxygen uptake rate, 18% fewer endothelial cells, 85% loss of corneal sensitivity, and 8% thinner corneal epithelium. Both eyes of each subject were exposed to a reduced oxygen environment for 2 hr in separate experiments: (1) by wearing a thick hydrogel contact lens and closing the eyes, and (2) by exposing the eye to 100% nitrogen gas. In the gel lens-closed eye experiment the aphakic cornea swelled an average of 7.5%, compared with 11.0% for the phakic cornea. For the nitrogen gas experiment the results were 4.3% and 6.2%, respectively. Eighty-five percent of the edema was in the stromal layer. The lower swelling response for the aphakic eye was significant (p less than 0.01) in both experiments. Corneal swelling after hypoxia is considered to be caused by an increase in corneal osmolarity resulting from an increase in the rate of production of lactic acid. The reduced corneal swelling in the aphakic eye, when compared with the phakic eye, could therefore be the result of either (1) a reduction in the overall metabolic activity of the epithelium, as indicated by the lower epithelial oxygen uptake rate and the thinner corneal epithelium in the aphakic eye, or (2) an increased efflux of lactic acid from the cornea resulting from an increased endothelial permeability to lactate.