FEA-Based Stress-Strain Barometers as Forecasters for Corneal Refractive Power Change in Orthokeratology.

PURPOSE: To improve the effectivity of patient-specific finite element analysis (FEA) to predict refractive power change (RPC) in rigid Ortho-K contact lens fitting. Novel eyelid boundary detection is introduced to the FEA model to better model the effects of the lid on lens performance, and stress and strain outcomes are investigated to identify the most effective FEA components to use in modelling. METHODS: The current study utilises fully anonymised records of 249 eyes, 132 right eyes, and 117 left eyes from subjects aged 14.1 ± 4.0 years on average (range 9 to 38 years), which were selected for secondary analysis processing. A set of custom-built MATLAB codes was built to automate the process from reading Medmont E300 height and distance files to processing and displaying FEA stress and strain outcomes. Measurements from before and after contact lens wear were handled to obtain the corneal surface change in shape and power. Tangential refractive power maps were constructed from which changes in refractive power pre- and post-Ortho-K wear were determined as the refractive power change (RPC). A total of 249 patient-specific FEA with innovative eyelid boundary detection and 3D construction analyses were automatically built and run for every anterior eye and lens combination while the lens was located in its clinically detected position. Maps of four stress components: contact pressure, Mises stress, pressure, and maximum principal stress were created in addition to maximum principal logarithmic strain maps. Stress and strain components were compared to the clinical RPC maps using the two-dimensional (2D) normalised cross-correlation and structural similarity (SSIM) index measure. RESULTS: On the one hand, the maximum principal logarithmic strain recorded the highest moderate 2D cross-correlation area of 8.6 ± 10.3%, and contact pressure recorded the lowest area of 6.6 ± 9%. Mises stress recorded the second highest moderate 2D cross-correlation area with 8.3 ± 10.4%. On the other hand, when the SSIM index was used to compare the areas that were most similar to the clinical RPC, maximum principal stress was the most similar, with an average strong similarity percentage area of 26.5 ± 3.3%, and contact pressure was the least strong similarity area of 10.3 ± 7.3%. Regarding the moderate similarity areas, all components were recorded at around 34.4% similarity area except the contact pressure, which was down to 32.7 ± 5.8%. CONCLUSIONS: FEA is an increasingly effective tool in being able to predict the refractive outcome of Ortho-K treatment. Its accuracy depends on identifying which clinical and modelling metrics contribute to the most accurate prediction of RPC with minimal ocular complications. In terms of clinical metrics, age, Intra-ocular pressure (IOP), central corneal thickness (CCT), surface topography, lens decentration and the 3D eyelid effect are all important for effective modelling. In terms of FEA components, maximum principal stress was found to be the best FEA barometer that can be used to predict the performance of Ortho-K lenses. In contrast, contact pressure provided the worst stress performance. In terms of strain, the maximum principal logarithmic strain was an effective strain barometer.

Long-term effects of tear film component deposition on the surface and optical properties of two different orthokeratology lenses.

PURPOSE: To understand the effects of long-term deposition of tear film components on the surface and optical properties of orthokeratology (ortho-k) lenses, two different lenses, Brighten 22 and Optimum Extra, were tested here. METHODS: Ortho-k lenses were immersed in artificial tears and cleaned with a commercial care solution repeatedly for up to 90 days. Both the daily and accumulated lysozyme deposition amounts using an Enzyme-Linked ImmunoSorbent Assay were then analyzed. The base curve, central thickness, power, and transmission of visible light, ultraviolet A, and ultraviolet B were analyzed before and after repeated tear film component deposition procedures. The surface roughness using atomic force microscopy was observed and an energy dispersive spectrometer was used to analyze the composition of the deposits. RESULTS: The highest levels of lysozyme were adsorbed on both lens materials during the first four days of the procedure and became saturated by day 6. For both lens materials, contamination on the lenses was easily observed by day 30, and the degree of surface roughness was higher. The transmission levels of different light spectrums were reduced showing that the optical characteristics of both lenses were also affected. CONCLUSIONS: The results provide in vitro evidence that lysozyme could not be completely removed from orthokeratology lenses. Both surface and optical properties were affected by the deposition of tear film components. However, only one commercial multipurpose care solution was used to clean the lens in this study when the main ingredient was a surfactant, and the results might be different when other care regimens with other key ingredients are used. In addition, whether tear film component deposition might result in increased risks of infection or corneal abrasion will require further investigation.

Investigation of the relationship between contact lens design parameters and refractive changes in Ortho-K.

Purpose: To investigate the relationship between Ortho-K contact lens design parameters and refractive power change of the eye through a parametric mathematical representation. Methods: The current study utilises fully anonymized records of 249 eyes, 132 right eyes, and 117 left eyes from subjects aged 14.1 ± 4.0 years on average (range 9-38 years) which were selected for secondary analysis processing. The data were split into 3 groups (G1 up to 35 days wear, from 10 to 35 days, G2 up to 99 days wear, more than 35-99 days & G3 more than 100 days wear) according to the length of time, in days, that the lenses were worn. Corneal shape was measured before and after contact lens wear using the Medmont E300 topographer, from which height and distance files were read by a custom-built MATLAB code to construct the corneal anterior surface independently. Changes in refractive power pre and post-Ortho-K wear were determined using constructed tangential refractive power maps from which both centrally flattened and annular steepened zones were automatically bounded, hence used to determine the refractive power change. Results: On average, flat Sim-K and steep Sim-K were reduced after Ortho-K lens wear by 1.6 ± 1.3 D and 1.3 ± 1.4 D respectively. The radius of the base curve was correlated with the mean central flattened zone power change strongly in G1 (R = 0.7, p < 0.001) and moderately in G2 (R = 0.4) and G3 (R = 0.4, p < 0.001). Hence, a strong correlation with the base curve was recorded in group G1 and moderate in G2 and G3. The reverse curve was very strongly correlated to the mean central flattened zone power change in G1 (R = 0.8, p < 0.001) and strongly correlated with G2 (R = 0.6, p < 0.001) and G3 (R = 0.7, p < 0.001). The reverse curve was also strongly correlated with the mean annular steepened zone power change among all groups G1, G2, and G3 (R = 0.7, R = 0.6 and R = 0.6) respectively (p < 0.001). Conclusions: Although the central corneal refractive power change was strongly correlated to the Ortho-K lens base curve, it characterized only 50% of the target power change. However, the annular steepened zone refractive power change appears to be a clearer predictor of target power change, as there appears to be a one-to-one inverse relationship with the target refractive power correction. Differences between these results and the literature may be a result of the topography software smoothing effect.

The Effect of Different Cleaning Methods on Protein Deposition and Optical Characteristics of Orthokeratology Lenses.

Orthokeratology lenses are commonly used for myopia control, especially in children. Tear lipids and proteins are immediately adsorbed when the lens is put on the cornea, and protein deposition may cause discomfort or infection. Therefore, we established an in vitro protein deposition analysis by mimicking the current cleaning methods for orthokeratology lens wearers for both short-term and long-term period. The results showed that the amounts of tear proteins accumulated daily and achieved a balance after 14 days when the lens was rubbed to clean or not. Protein deposition also affected the optical characteristics of the lens regardless of cleaning methods. Our results provided an in vitro analysis for protein deposition on the lens, and they may provide a potential effective method for developing care solutions or methods that can more effectively remove tear components from orthokeratology lenses.

Surface Antifouling Modification on Polyethylene Filtration Membranes by Plasma Polymerization.

Surface modification on microporous polyethylene (PE) membranes was facilitated by plasma polymerizing with two hydrophilic precursors: ethylene oxide vinyl ether (EO1V) and diethylene oxide vinyl ether (EO2V) to effectively improve the fouling against mammalian cells (Chinese hamster ovary, CHO cells) and proteins (bovine serum albumin, BSA). The plasma polymerization procedure incorporated uniform and pin-hole free ethylene oxide-containing moieties on the filtration membrane in a dry single-step process. The successful deposition of the plasma polymers was verified by Fourier-transform infrared (FTIR), scanning electron microscopy (SEM), and X-ray photoelectron spectroscopy (XPS) analyses. Water contact angle measurements and permeation experiments using cell and protein solutions were conducted to evaluate the change in hydrophilicity and fouling resistance for filtrating biomolecules. The EO1V and EO2V plasma deposited PE membranes showed about 1.45 fold higher filtration performance than the pristine membrane. Moreover, the flux recovery reached 80% and 90% by using deionized (DI) water and sodium hydroxide (NaOH) solution, indicating the efficacy of the modification and the good reusability of the modified PE membranes.

Effectiveness and safety of overnight orthokeratology with Boston XO2 high-permeability lens material: A 24 week follow-up study.

OBJECTIVE: To examine the effectiveness of overnight orthokeratology lenses made with Boston XO2, highly gas-permeable lens material for the temporary correction of myopia. METHODS: Myopic individuals from 9 to 62 years of age were eligible. Participants ≤ 12 years of age were required to have myopia ≤-4.00 D and astigmatism ≤ 1.50 D, and for those 13-62 years of age myopia ≤-5.00 D and astigmatism ≤ 3.00 D. All participants were required to have normal healthy eyes and not be receiving any ocular medications or systemic medications likely to affect the results of visual acuity. Participants wore the lenses for a minimum of 7h during sleep, and were evaluated on day 1 and weeks 1, 2, 4, 12, and 24. Success was defined as LogMAR ≤ 0.1. RESULTS: A total of 126 participants (63.5% females) with a mean age of 20.4 ± 11.5 years were recruited. Baseline LogMAR, and vertical and horizontal corneal curvature were 0.8, 7.7 mm, and 7.9 mm, respectively, in both eyes. A consistent decrease in LogMAR was noted from day 1 to week 12. The success rate increased with length of time (from 33.9% to 100% for the right eye and from 35.5% to 100% for the left eye from day 1 to week 24). No severe complications were noted. CONCLUSION: Overnight orthokeratology with lenses made of Boston XO2 material are effective and safe for the temporary reduction of myopia.