Oxygen transfer in the corneal-contact lens system

The clinical results of contact lens wearers indicate that materials which theoretically are adequate to prevent corneal hypoxia and edema do not perform optimally under actual wearing conditions. Optimization of the cornea-tear-lens system requires an analysis of the modes of oxygen transport, mass transfer resistances, and characteristic dimensions. The lens properties are a function of polymer composition. Thus, investigations for ideal lens materials may result in limitless test copolymers and graft polymers of siloxane, methylmethacrylate, 2-hydroxyethyl-methacrylate, vinylpyrollidone, vinylacetate, and cellulose acetate butyrate of varying degrees of cross-linking and crystallinity. In an attempt to channel research efforts, this review will state the developments to date and the desirable properties of an optimal cornea-tear-lens system. The logic should encompass a theory and model whereby parameters are identified and varied within satisfactory physiological limitations, and experiments which provide data indicative of the in vivo conditions. The parameters must reflect the inherent transport properties of the corneal-contact lens system. Contact lenses may be categorized as soft, gas-permeable rigid/hydrophobic flexible, or hard. The major differences between these three categories are the properties: equilibrium water content or degree of hydration, tendency for water pervaporation and/or dehydration, surface hydrophobicity, thermal conductivity, oxygen diffusivity and solubility, lens thickness, rest height over corneal tear, flexibility, lens mobility over the cornea, cross-linking, crystallinity, stagnant boundary layer resistances, and manufacturing processes. Aside from complications presented by lens coatings and cleansing solutions, the most common problems experienced by lens wearers include corneal edema, dehydration involving the lens and the cornea, "blurry" vision due to localized corneal anoxia, debris trapped under the lens, and deposits on th surface of the lens. All of the aforementioned phenomena are either explicitly or implicitly associated with transport processes through and around the lens. Convection of tear fluid under a lens during a blink, diffusion of oxygen and water through the lens and the stagnant boundary-layer effect for mass transfer in the tear between blinks, and the overall nonisothermal effects on the transport of oxygen and water between the cornea and ambient conditions are reviewed.