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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 compare central corneal swelling after eight hours of sleep in eyes wearing four different silicone hydrogel lenses with three different powers., Methods: Twenty-nine neophyte subjects wore lotrafilcon A (Dk, 140), balafilcon A (Dk, 91), galyfilcon A (Dk, 60) and senofilcon A (Dk, 103) lenses in powers -3.00, -10.00 and +6.00 D on separate nights, in random order, and on one eye only. The contra-lateral eye (no lens) served as the control. Central corneal thickness was measured using a digital optical pachometer before lens insertion and immediately after lens removal on waking., Results: For the +6.00 D and -10.00 D, lotrafilcon A induced the least swelling and galyfilcon A the most. The +6.00 D power, averaged across lens materials, induced significantly greater central swelling than the -10.00 and -3.00 D (Re-ANOVA, p<0.001), (7.7±2.9% vs. 6.8±2.8% and 6.5±2.5% respectively) but there was no difference between -10.00 and -3.00 D. Averaged for power, lotrafilcon A induced the least (6.2±2.8%) and galyfilcon A the most (7.6±3.0%) swelling at the center (Re-ANOVA, p<0.001). Central corneal swelling with +6.00 D was significantly greater than -10.00 D lens power despite similar levels of average lens transmissibility of these two lens powers., Conclusions: The differences in corneal swelling of the lens wearing eyes are consistent with the differences in oxygen transmission of the silicone hydrogel lenses. In silicone hydrogel lenses central corneal swelling is mainly driven by central lens oxygen transmissibility., (Copyright © 2013 Spanish General Council of Optometry. Published by Elsevier Espana. All rights reserved.)

Purpose: To evaluate the change in thickness of the anterior, stromal, and posterior corneal laminae in response to hypoxia-induced corneal swelling, by means of ultrahigh-resolution optical coherence tomography (UHR-OCT)., Methods: A UHR-OCT system, operating in the 1060-nm range, was used to acquire in vivo cross-sectional images of human cornea with a 3.2x10-microm (axial x lateral) resolution in corneal tissue. Corneal edema was induced by inserting a thick, positive-powered, soft contact lens, over which the eye was closed and patched for 3 hours. Tomograms were acquired from eight non-contact-lens wearers. Baseline images were obtained before inducing corneal edema, immediately after removal of the patch and the lens, and then every 15 minutes for approximately 2 hours. All images were postprocessed with a segmentation algorithm to identify the laminae visible in the image. The apical thickness of the laminae (epithelium [EPI], epithelial-Bowman's membrane [Ep-BM] complex, stroma, and endothelial-Descemet's membrane [En-DM] complex) were determined at each time interval., Results: There was an interaction between time after removal of the hypoxic stimulus and deswelling of the layers (RM-ANOVA; P<0.001). The epithelial and stromal thickness reduced significantly with time (P=0.001; P<0.001, respectively), whereas the Ep-BM and En-DM complexes did not (P>0.50). All layers except the En-DM complex exhibited a biphasic pattern of recovery., Conclusions: UHR-OCT showed regional differences in swelling due to hypoxic provocation. On removal of the hypoxic stimulus, the rate of recovery varied between layers, and all layers except the En-DM complex exhibited a biphasic recovery.

Purpose: To compare central corneal swelling after 8 hours of sleep in eyes wearing 2 different silicone hydrogel lenses with high oxygen transmissibility., Methods: Twenty neophyte subjects were randomly assigned to wear a comfilcon A lens (CooperVision Inc) in one eye and a lotrafilcon A lens (CIBA Vision) in the contralateral eye for an 8-hour overnight period. The study was repeated with another 20 neophyte subjects wearing comfilcon A in one eye only and no lens in the contralateral control eye. Central corneal thickness was measured with optical pachometry before lens insertion, immediately after lens removal on waking, at 20 and 40 minutes, 1 hour, 2 hours and 3 hours., Results: There was no significant difference between the amount of overnight central corneal swelling induced by the 2 lenses (4.1% +/- 1.9% with comfilcon A vs. 4.0% +/- 1.7% with lotrafilcon A; P>0.05). The swelling of the comfilcon A lens-wearing eyes was significantly higher than that found in the non-lens-wearing contralateral eyes (4.5% +/- 2.1% vs. 3.0% +/- 1.7%; P<0.05)., Conclusions: The same amount of overnight corneal swelling was induced by the 2 study lenses. The higher overnight swelling observed with the comfilcon A lenses compared to the non-lens-wearing eyes is similar to that reported in the literature for studies using lotrafilcon A lenses.

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: The purpose of this study was to measure central and topographical corneal swelling in response to contact lens wear and eye closure, to determine whether the swelling induced by soft and polymethyl methacrylate (PMMA) lenses is different, and to determine whether the anterior and/or posterior corneal shape alters with corneal swelling., Methods: An Orbscan II corneal topographer was used to measure corneal swelling and the shape of the anterior and posterior corneal surfaces of 16 neophytes before and after wearing soft and PMMA contact lenses with near-zero oxygen transmissibility. The lens-wearing eye was patched for 3 h., Results: The mean 15.1% +/- 3.8% (+/- SD) central corneal swelling with soft lenses was significantly >12.6% +/- 4.1% with PMMA lenses. Topographical corneal swelling was significantly greater with soft vs. PMMA lenses. However, the difference between central and peripheral corneal swelling was much greater with PMMA lenses. With both lenses, the cornea swelled significantly more in the center than the periphery. The anterior best-fit sphere radius remained unchanged in response to soft lenses (0.00 +/- 0.04 mm) and steepened slightly but significantly with PMMA lenses (-0.04 +/- 0.05 mm). The posterior best-fit sphere radius flattened significantly with both lenses (0.12 +/- 0.07 mm with soft and 0.14 +/- 0.08 mm with PMMA lenses)., Conclusions: Corneal swelling (greater centrally than peripherally) flattens the posterior surface of the cornea and is independent of lens type. Although the anterior best-fit sphere radius steepened with PMMA, the magnitude is probably clinically unimportant. Both lens types produced greater central vs. peripheral corneal swelling. However, the soft lens induced significantly greater overall swelling than PMMA. Because their oxygen transmission was the same, these results suggest that there is lateral diffusion of oxygen from the peripheral area of the cornea (that is not covered by the lens) toward the center.

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 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 determine the relation between optical coherence tomography (OCT) and optical pachymetry (OP) measurements of corneal swelling induced by hypoxia., Design: Experimental study., Methods: One randomly selected eye of 20 noncontact lens wearers (10 males and 10 females, age 35.6 +/- 9.6 years) was patched during 3 hours of soft contact lens (SCL) wear while the contralateral eye acted as control. Central corneal thickness of both eyes was measured before and after SCL wear using OCT and OP in randomized order., Results: Baseline central corneal thickness was 523.6 +/- 33.0 microm (mean +/- standard deviation [SD]) measured with OCT and 490.6 +/- 25.5 microm with OP. Immediately after contact lens removal, corneal thickness measured with OCT increased by 13.8 +/- 2.3% compared with 12.1 +/- 1.8% (paired t test: P <.001) measured with OP. Thereafter, corneal thickness decreased at the rate of 5.6% per hour for OCT and 5.4% per hour for OP. The difference in thickness between instruments before lens insertion, which was 33 microm compared with the difference after lens removal (edematous cornea), which ranged from 46 to 41 microm. The difference between instruments decreased during the corneal deswelling period after lens removal. The correlation coefficient between OCT and OP was 0.914 before lens insertion and 0.932 after lens removal., Conclusion: This study has demonstrated the difference of corneal thickness measured with OCT and OP. Although both instruments are correlated highly in all conditions tested, OCT may overestimate corneal thickness in normal and edematous corneas.

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.