Quantifying tear exchange during rigid contact lens wear using corneoscleral profilometry: A proof of concept study

Tear exchange during contact lens wear is essential for ocular surface integrity, facilitating debris removal, and maintaining corneal metabolism. Fluorophotometry and fluorogram methods are typically used to measure tear exchange, which require hardware modifications to a slit lamp biomicroscope. This manuscript introduces an alternative method using a corneoscleral profilometer, the Eye Surface Profiler (ESP), to quantify tear exchange during corneal and scleral rigid lens wear by assessing fluorescence intensity changes over time.

As a proof of concept, a healthy participant wore a corneal and a scleral rigid lens on separate days. After lens application, 2% sodium fluorescein was instilled, and ESP images were captured at intervals over a 30-min period for corneal and a 90-min period for the scleral lens. Fluorescence intensity data were extracted and analysed using MATLAB, restricted to a region of interest centred on the contact lens. The fluorescence intensity was fitted with an exponential decay curve to quantify tear exchange.

Fluorescence intensity decreased over time for both lenses, with a faster decay rate being observed for the corneal lens. The scleral lens showed an initial ingress of fluorescein into the fluid reservoir, then a slow decay in fluorescence intensity due to limited tear exchange. The decay rate for the corneal lens was approximately four times faster than the scleral lens, with the time to reach 50% decay of ~42 min for the corneal lens compared to ~157 min for the scleral lens.

A new method was developed to quantify tear exchange using a commercially available corneoscleral profilometer, offering a wider field of view than existing techniques. This approach has clinical potential in scleral lens practice for identifying landing zone misalignment and improving the understanding of post-lens tear dynamics, particularly in cases involving scleral lens modifications or patients experiencing midday fogging.