Documente Academic
Documente Profesional
Documente Cultură
2008-096-16166
Why does the Cornea need Oxygen?
Energy derived from metabolic processes is used in
vegetative functions, such as:
- Cellular division
- Synthesis of proteins, lipids, etc.
- Construction and maintenance of junctional attachments
- Cellular chemical balance (pH and osmotic)
- Programmed cell maturation
- Repair
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Supply of Nutrients to the Cornea
Aqueous
Glucose
Amino acids
Vitamins Tears Aqueou
s humor
Minerals
Various Sources
Oxygen
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Sources of Corneal Oxygen (without Contact Lens)
Open eye
- Atmosphere
- Tear film
Closed eye
- Limbus
- Palpebral conjunctiva
- The aqueous
- One-third the level of open eye condition!
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Oxygen availability
Open eyes
155mmHg
Closed eyes
55mmHg
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Gaseous Concentrations in the Atmospheric
* at sea level
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Oxygen availability
Oxygen
partial
Oxygen Atmospheric
pressure
% pressure
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Effect of Altitude
8700 m Mt. Everest
21% O2
53 mmHg
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Requirements for Corneal Health
Tears
Immune System
Oxygen
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Effect of Insufficient Oxygen
Supply on the Cornea
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The Cornea
Epithelium
Bowmans layer
Stroma
Descemets membrane
Endothelium
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Compromised Function/tissues
Anoxia
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Compromised Function/tissues
Anoxia
- Suboptimal metabolism
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Compromised Function/tissues
Anoxia
- Suboptimal metabolism
Slowed mitosis
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Compromised Function/tissues
Anoxia
- Suboptimal metabolism
Slowed mitosis /
thinning
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Compromised Function/tissues
Anoxia
- Suboptimal metabolism
Slowed mitosis / thinning
Microcysts
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Compromised Function/tissues
Over-
Dark pupil illuminated
iris
Inclusion
displaying Inclusion
unrevers displaying
ed reversed
Illumination Illumination
(probably a (probably
fluid a
vacuole) microcyst)
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Compromised Function/tissues
Anoxia
- Suboptimal metabolism
Slowed mitosis /
thinning
Microcysts
Vacuoles
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Compromised Function/tissues
Anoxia
- Suboptimal metabolism
Slowed mitosis / thinning
Microcysts
Vacuoles
Edema / swelling
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Compromised Function/tissues
Anoxia
- Suboptimal metabolism
Slowed mitosis / thinning
Microcysts
Vacuoles
Edema / swelling
pH drop
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Compromised Function/tissues
Anoxia
- Suboptimal metabolism
Slowed mitosis / thinning
Microcysts
Vacuoles
Edema / swelling
pH drop
Keratocyte death /
thinning
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Compromised Function/tissues
Anoxia
- Suboptimal metabolism
Slowed mitosis / thinning
Microcysts
Vacuoles Striae
Edema / swelling
pH drop
Keratocyte death / thinning
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Compromised Function/tissues
Anoxia
- Suboptimal metabolism
Slowed mitosis / thinning
Microcysts Striae
Vacuoles Folds
Edema / swelling
pH drop
Keratocyte death / thinning
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Compromised Function/tissues
Anoxia
- Suboptimal metabolism
Slowed mitosis /
thinning
Striae Folds
Microcysts
Limbal redness
Vacuoles& Neovascularisation
Edema / swelling
pH drop
Keratocyte death /
thinning
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Vascularization
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Compromised Function/tissues
Anoxia
- Suboptimal m etabolism
Slowed mitosis
hinging
/t
Microcysts
Striae
Vacuoles
Folds
Edema / swelling
Limbal redness &
pH drop Neovascularisation
Keratocyte death Blebs
/ thinning
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Blebs
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Compromised Function/tissues
Anoxia
- Suboptimal metabolism
sis / thinning
Slowed mito
Microcysts Striae
Vacuoles Folds
eath Blebs
Polymegethism
Pleomorphism
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Compromised Function/tissues
Anoxia
- Suboptimal metabolism
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Compromised Function/tissues
Anoxia
- Suboptimal metabolism
- Reduced barrier function
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Compromised Function/tissues
Anoxia
- Suboptimal metabolism
- Reduced barrier function
Epithelial thinning
Reduced intercellular attachment
Reduced adhesion to bowmans layer
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Compromised Function/tissues
Anoxia
Physical damage
- Abrasion
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Compromised Function/tissues
Anoxia
Physical damage
- Abrasion
- Superior arcuate epithelial lesions (SEALS)
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Compromised Function/tissues
Anoxia
Physical damage
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Effects of insufficient oxygen supply - Summary
Epithelium Stroma Endothelium
Edema Edema Edema
Microcysts Striae and Folds Blebs
Slower mitosis Acidosis Polymegethism
Thinning Keratocyte Death Pleomorphism
Hypoaesthesia Thinning Impaired Hydration Control
Reduced Oxygen Uptake
Vascularization Corneal exhaustion
Compromised Junctional
Integrity
Infectious Keratitis
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A Contact Lenses is a Potential Barrier for
Corneal Oxygen Supply
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Effects of Contact Lens induced Hypoxia
12 - 24% of wearers drop out of
contact lens wear every year
Discomfort most prominent reason
Also reported:
- Stinging and burning*
- Dryness during the day*
- End-of-Day dryness*
- Red eyes*
Is discomfort related to hypoxia?
ALSO: Higher risk for infections,
inflammations, ulcers
*Fonn et al: 1993, 1995
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Sources of Corneal Oxygen (with Contact Lenses)
Tear pump
- Important factor for rigid, pas permeable lenses
- Not relevant for soft contact lenses
Through the contact lens
(requires: Oxygen transmissibility of the lens
material, the actual lens)
-Especially important for soft contact lenses, as
tear
pump not relevant
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Sources of Corneal Oxygen (with Contact Lenses)
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Long-term Corneal Health with Silicone-Hydrogel Lenses
Absence of chronic tissue changes
Epithelial permeability
Bacterial adherence
- Lin, Polse, et al
- Ren, Cavanagh et al
Microcysts
- Sweeney and others ~ Cell size & viability
- Stapleton et al
Endothelial polymegathism
- Tighe et al, Guillon et al
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Limbal Redness
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GHOSTING and empty vessels
Longterm low DK - DW/EW
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Safe and Successful Contact Lens Wear
Oxygen availability
Adequate movement
Coating and deposit control
Optical (and visual) performance
Minimal physical pressure
Ocular compatibility
Surface wettability
Microbe-free
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The real critical oxygen requirement
for contact lens wear is 20.9%
(Efron and Brennan, Contax 1987)
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Overnight Corneal Edema
When no lens edema = 2%
When Dk/t = 87 then edema = 4.0%
When Dk/t = 107 then edema = 3.5%
When Dk/t = 125 then edema = 3.2%
When Dk/t = 175 then edema = 2.5%
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Range of Overnight Oedema Responses to Low Dk/t
To eliminate hypoxia
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Dk/t Demand
Indicator #1 Limbal Redness
Papas
- Estimate of the peripheral
Dk/t required to eliminate
limbal redness on average
is 125 units for DW
Maldonado-Codina et al
- Detected significant
differences in DW limbal
redness between lenses
with 26 and 86 units
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Central Dk/t or Average Dk/t?
Holden-Mertz criteria of:
-24 x 10-9 units to avoid end-of-first day edema
-87 x 10-9 units to avoid 4.0% overnight edema
(125 X 10-9 units to avoid 3.2% overnight edema)
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CORNEAL SWELLING vs
OXYGEN TRANSMISSIBILITY (Dk/t)
Holden and Mertz, 1984
15
14 y = 63.812x-0.621
13
12
11 Dk/t for 4.0% = 87
10
9
8 Dk/t for 3.5% = 107
7 Dk/t for 3.2% = 125
6
5
4
3
2
1
0
0 50 100 150
Dk/L (x10-9)
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Hydrogel Patient Cycle
Current HEMA
Lenses
Keep It
Going and
Growing!
BREATHABLE LENS
5X more oxygen
Improve
Ocular Health
See
Feel
Whiter, Brighter,
End-of-day
Healthy-looking Eyes
Comfort
AIR OPTIX AQUA
Oxygen
Range of Overnight Oedema Responses to Low
Dk/t
Low Dk/t
lenses
High Dk/t patient Benefits
1. CIBA VISION data on file, 2008. 2. Alvod L, Hall J, Keyes D, et al. Corneal oxygen distribution with contact lens wear. Cornea. 2007; 26 (6):654-64. 3. Mueller N, Caroline P, Smythe J, et al.
A comparison of overnight swelling response with two high Dk silicone hydrogels. Optom & Vis Sci. 2001:78(12S):199.
ACUVUE is a registered trademark and OASYS is a trademark of Johnson & Johnson Vision Care, Inc. Biofinity is a registered trademark of CooperVision, Inc.
PureVision is a registered trademark of Bausch & Lomb, Inc.
Surface
Brand B Brand C
Brand A
Patented Surface Treatment
Contributes to Healthy Lens Wear
AIR OPTIXTM
:00 15:00
Elapsed Time in Minutes
Photos taken after these lenses have been allowed to sit in air
for 15 minutes. The benefit of a low water content can be
clearly seen in the difference in lens dehydration in AIR OPTIX
and NIGHT&DAY.
The lower the water content the less in air dehydration.
Lens Design
Advantages of Aspheric design
AIR OPTIX
Product specifications
Material: lotrafilcon B
Water content: 33%
Handling tint: light blue
Powers: -0.25 to -8.00, 0.25D steps
-8.50 to -10.00, 0.50D
steps
Package: +0.25
6 lensto +6.00,
pack 0.25D steps
/ 3 lens
Replacement schedule: pack
4 weeks
Diameter (mm): 14.2
Base curve (mm): 8.6
Center thickness (mm): 0.08@ -3.00D
Dk/t: 138@ -3.00D
Wearing schedule: daily wear or up to 6 nights extended wear for 4
Fitting: weeks no refit required for existing wearers of
O2OPTIXTM
2008-03-0296
a Novartis company