Do thinner rigid gas permeable contact lenses provide superior initial comfort?

To test the hypothesis that thinner rigid gas permeable (RGP) contact lenses provide superior initial comfort, RGP lenses of 3 center thicknesses, 0.08, 0.12, and 0.16 mm, in otherwise matched parameters, were worn for 30 min by 17 unadapted subjects in a controlled, double masked, randomized study. Comfort ratings (0 to 100) after 30 min of wear were 42 +/- 30, 55 +/- 27, and 57 +/- 28 for the 0.08-, 0.12-, and 0.16-mm thick lenses, respectively (p = 0.04, multiple analysis of variance (MANOVA)), and 93 +/- 13 for the hydrogel control lens. The thinnest RGP lens was significantly less comfortable than its thicker counterparts (p = 0.03, Univariate F-test). There were no differences among the test lenses in edge shape, front surface wettability, or static lens fittings, and small differences in movement, vertical decentration, and front surface geometry were not significantly related to comfort. We hypothesize that the greater flexibility of the thinnest lens resulted in greater deformation of the lens during a blink cycle, causing transient peripheral lens lifting and interaction with the upper eyelid, thereby reducing comfort. In conclusion we found that thinner RGP lenses do not provide an initial comfort advantage and that very thin and, as a corollary, very flexible, RGP lenses can actually be less comfortable initially than stiffer, but otherwise matched, designs.