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(Investigative Ophthalmology and Visual Science. 2003;44:60-67.)
© 2003 by The Association for Research in Vision and Ophthalmology, Inc.
DOI:  10.1167/iovs.02-0348
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Fenestrations Enhance Tear Mixing under Silicone-Hydrogel Contact Lenses

Kimberly L. Miller,1 Kenneth A. Polse,1 and Clayton J. Radke2

1From Vision Science, School of Optometry; and the 2Department of Chemical Engineering, University of California, Berkeley, California.

PURPOSE. Extended wear of conventional hydrogel soft contact lenses (SCLs) is associated with adverse ocular responses. Some of these ocular events are thought to result from inadequate tear mixing in the postlens tear film (PoLTF). Therefore, strategies to increase tear mixing may improve the safety of extended-wear SCLs. Recently, it has been suggested that placing fenestrations in soft lenses increases tear mixing. In the present study, hydrodynamic modeling and tear-mixing measurements were used to explore the effects of fenestrations on tear exchange under an SCL.

METHODS. Tear mixing, expressed as the time to deplete 95% of fluorescent dye from the PoTLF (T95), was measured in 20 subjects fitted with two pairs of silicone hydrogel SCLs. The lenses were identical except that one pair was fenestrated (F) with 40 holes each 100 µm in diameter. The effect of fenestrations on improving tear mixing is explained and enhancement of tear mixing is predicted, with the use of hydrodynamic modeling.

RESULTS. T95 estimates were significantly lower (P < 0.001) in the F (mean T95 = 18.3 minutes) lenses compared with the standard unfenestrated (S-uF) (mean T95 = 22.6 minutes) lenses ({Delta}T95 = 4.3 minutes, 95% CI = 2.5–6.2) and were in general agreement with the proposed mixing model. Optimization of tear mixing can be achieved by selectively placing fenestrations in the pooling regions before the thinnest regions. The model predictions were sensitive to the distribution of tear-film thickness under the lens.

CONCLUSIONS. Fenestrations improve tear-mixing efficiency. Accurate prediction of the effects of lens parameters on tear mixing, however, demands quantitative measurement of the postlens distribution of tear-film thickness.






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Copyright © 2003 by the Association for Research in Vision and Ophthalmology