BCLA CLEAR – Medical use of contact lenses

The medical use of contact lenses is a solution for many complex ocular conditions, including high refractive error, irregular astigmatism, primary and secondary corneal ectasia, disfiguring disease, and ocular surface disease. The development of highly oxygen permeable soft and rigid materials has extended the suitability of contact lenses for such applications. There is consistent evidence that bandage soft contact lenses, particularly silicone hydrogel lenses, improve epithelial healing and reduce pain in persistent epithelial defects, after trauma or surgery, and in corneal dystrophies. Drug delivery applications of contact lens hold promise for improving topical therapy. Modern scleral lens practice has achieved great success for both visual rehabilitation and therapeutic applications, including those requiring retention of a tear reservoir or protection from an adverse environment. This report offers a practical and relevant summary of the current evidence for the medical use of contact lenses for all eye care professionals including optometrists, ophthalmologists, opticians, and orthoptists. Topics covered include indications for use in both acute and chronic conditions, lens selection, patient selection, wear and care regimens, and recommended aftercare schedules. Prevention, presentation, and management of complications of medical use are reviewed.     

Quarter of a century of contact lens prescribing trends in the United Kingdom (1996 – 2020)

PurposeTo document contact lens prescribing trends in the United Kingdom over the past quarter of a century.MethodsAn annual survey of contact lens prescribing was conducted each year from 1996 to 2020, inclusive, by asking a random selection of optometrists and contact lens opticians to provide information relating to 10 consecutive contact lens fits between January and March.ResultsOver the 25 year survey period, 2,671 practitioners returned survey forms, reporting a total of 25,575 contact lens fits. The mean (± standard deviation) age of lens wearers was 35 ± 15 years, of which 64 % were female. Over the survey period, rigid lens new fits decreased from 22 % to 2%. The prescribing of silicone hydrogel lenses has increased steadily since their introduction towards the end of the 1990s, and now represent 80 % of soft lens fits. Soft toric lens prescribing has gradually increased to 47 % – a value at which astigmatism ≥ 0.75DC is theoretically corrected in all contact lens wearers. Daily disposable prescribing increased steadily over the survey period and now represents 63 % of lenses prescribed. Extended wear fits remain at very low levels, except for some prescribing for overnight orthokeratology. Multi-purpose lens care solutions are ubiquitous; peroxide and other systems are now seldom prescribed. Rigid lenses and monthly replacement soft lenses are predominantly worn on a full time basis, whereas daily disposable soft lenses are mainly worn part time.ConclusionsThis report documents the evolution of contact lens fitting in the United Kingdom over the past 25 years. The most likely lens fit is a spherical design silicone hydrogel daily disposable contact lens prescribed for a 35 year old female and worn on a part-time basis.     

BCLA CLEAR - Scleral lenses

Scleral lenses were the first type of contact lens, developed in the late nineteenth century to restore vision and protect the ocular surface. With the advent of rigid corneal lenses in the middle of the twentieth century and soft lenses in the 1970’s, the use of scleral lenses diminished; in recent times there has been a resurgence in their use driven by advances in manufacturing and ocular imaging technology. Scleral lenses are often the only viable form of contact lens wear across a range of clinical indications and can potentially delay the need for corneal surgery. This report provides a brief historical review of scleral lenses and a detailed account of contemporary scleral lens practice including common indications and recommended terminology. Recent research on ocular surface shape is presented, in addition to a comprehensive account of modern scleral lens fitting and on-eye evaluation. A range of optical and physiological challenges associated with scleral lenses are presented, including options for the clinical management of a range of ocular conditions. Future applications which take advantage of the stability of scleral lenses are also discussed. In summary, this report presents evidence-based recommendations to optimise patient outcomes in modern scleral lens practice.     

BCLA CLEAR - Effect of contact lens materials and designs on the anatomy and physiology of the eye

This paper outlines changes to the ocular surface caused by contact lenses and their degree of clinical significance. Substantial research and development to improve oxygen permeability of rigid and soft contact lenses has meant that in many countries the issues caused by hypoxia to the ocular surface have largely been negated. The ability of contact lenses to change the axial growth characteristics of the globe is being utilised to help reduce the myopia pandemic and several studies and meta-analyses have shown that wearing orthokeratology lenses or soft multifocal contact lenses can reduce axial length growth (and hence myopia).However, effects on blinking, ptosis, the function of Meibomian glands, fluorescein and lissamine green staining of the conjunctiva and cornea, production of lid-parallel conjunctival folds and lid wiper epitheliopathy have received less research attention. Contact lens wear produces a subclinical inflammatory response manifested by increases in the number of dendritiform cells in the conjunctiva, cornea and limbus. Papillary conjunctivitis is also a complication of all types of contact lenses. Changes to wear schedule (daily disposable from overnight wear) or lens materials (hydrogel from SiHy) can reduce papillary conjunctivitis, but the effect of such changes on dendritic cell migration needs further study. These changes may be associated with decreased comfort but confirmatory studies are needed. Contact lenses can affect the sensitivity of the ocular surface to mechanical stimulation, but whether these changes affect comfort requires further investigation.In conclusion, there have been changes to lens materials, design and wear schedules over the past 20+ years that have improved their safety and seen the development of lenses that can reduce the myopia development. However, several changes to the ocular surface still occur and warrant further research effort in order to optimise the lens wearing experience.     

Patient attitudes and behavior regarding hygiene and replacement of soft contact lenses and storage cases

Purpose

To review important aspects of contact lens compliance and to survey contact lens replacement frequency, steps in lens care and hygiene and replacement of the lens storage case via online surveys.

Methods

Random US samples (n = 645 and 787) of frequent replacement contact lens wearers answered questions on contact lens wear in online, sponsor-masked surveys.

Results

Wearers of lenses prescribed by their practitioner for 2 weekly replacement reported that they replaced lenses as follows: within 2 weeks 45%, within 3 weeks (minor stretching) 68%, within 4 weeks 89%, ≥8 weeks (extreme stretching) 4%, compared to Monthly wearers who reported: within 4 weeks 37%, within 5 weeks (minor stretching) 57%, ≥8 weeks 23% (≥8 weeks extreme stretching, Chi-square p = 0.001). Median frequency for cleaning lens storage case was 2–3 times per week, while 33% reported cleaning monthly or less often. Median lens storage case replacement was every 4–6 months, while 48% reported annual replacement or less often. Most patients cleaned their lens case with hot or cold tap water (72%).

Conclusions

These internet surveys revealed significant non-compliance with lens care steps, case hygiene and lens replacement schedule. More than half of the contact lens wearers surveyed were not compliant with their 2-weekly or monthly schedule. Lenses prescribed for longer replacement intervals can lead to more extreme stretching of lens life. To encourage better patient habits, eye care providers should reinforce their recommended frequency of replacement of lenses and storage cases and should reinforce care and hygiene steps at each patient visit.     

Prescribing daily disposable contact lenses in the UK.

Patterns of prescribing daily disposable contact lenses in the UK were determined by mining through data gathered from annual contact lens fitting surveys conducted over the past 12 years. Spherical, toric and multifocal design daily disposable lenses represent a substantial proportion of all contact lenses prescribed, reflecting the significant ocular health and lifestyle advantages offered by this lens category.     

Clinical evaluation of a custom-made toric soft lens.

PURPOSE: The fitting of toric soft contact lenses is often complicated by interference between the toric optics and the geometry need to stabilise the lens on the eye. The use of a spherical trial lens to determine the parameters of a toric soft contact lens can lead to unintended positioning and movement of the lens ordered. The purpose of this study was to evaluate clinically the success. PURPOSE: The fitting of toric soft contact lenses is often complicated by interference between the toric optics and the geometry needed. METHOD: The design of the lenses used was such that optical correction and stabilisation were separated. The lenses had a back tonic surface limited to the central optical zone and base down prism stabilisation in the periphery. The empirical system used corneal radii, spectacle refraction and horizontal visible iris diameter as lens design parameters. RESULTS: This multi-centre trial, comprised of 105 patients (193 eyes), revealed an overall success rate of 86%. The total number of lenses ordered to achieve success was 1.46 per eye in new patients and 1.69 per eye in patients who were failures with other toric soft lenses. In 14% of the cases success could not be achieved despite ordering several lenses (up to 4 lenses/eye). Many of these patients (60%) were also failures with other toric soft lenses. CONCLUSION: It is concluded that in new patients successful toric soft contact lens fitting can be achieved with an empirically based method. When refitting former toric soft lens failures, we recommend discontinuation after two further unsuccessful fittings.     

Prescribing soft contact lenses for astigmatism

There have been continued improvements in toric soft lens design over the past three decades. Data that we have gathered from annual contact lens fitting surveys demonstrate a commensurate increase in toric lens fitting as a proportion of all soft lenses fitted. The current toric lens prescribing rate (34% of all lenses when cosmetic tints, monovision and multifocal lenses are ignored) is roughly equivalent to the rate that would be achieved if all cases of astigmatism 1.00 D or more were fitted with toric lenses. Toric lenses tend to be fitted more to males and prescribed for monthly rather than daily replacement.     

Temporal considerations in contact lens discomfort

PurposeTo determine the relative contributions to perceived discomfort during contact lens wear of contact time with the lens and the time of day at which wear begins, using a wearing framework similar to that of regular users.MethodsTwenty-three participants reported ocular discomfort using a 1–100 visual analogue rating scale, when prompted by email, during one day without contact lenses and on three other days while wearing soft contact lenses for twelve hours. Contact lens wear began at a different time on each day. The effect of start time on the change in discomfort during the wearing period was evaluated.ResultsThe average (± 95 % CI) change in discomfort over 12 h without contact lenses was -0.3 ± 3.5. The corresponding values during contact lens wear were 23.5 ± 14.6 when starting wear before 8am, 16.8 ± 11.0 when starting between 8am & 10am and 22.7 ± 8.4 when starting after 10am. While the increased discomfort was significant irrespective of start time (p < 0.01), there were no statistically significant differences between start times (p = 0.98).ConclusionDiscomfort during contact lens wear is associated with the length of time lenses are on-eye but not with the time of day when lenses are placed on-eye. This relationship is variable in the population and does not, of itself, explain why contact lenses become uncomfortable during wear. Active monitoring of participant compliance should be a consideration in all studies involving time critical responses.     

Calculated tear oxygen tension under contact lenses offering resistance in series: piggyback and scleral lenses.

BACKGROUND: Models of oxygen delivery to the cornea with contact lens wear have considered the customary situation of one lens being worn on the cornea. However, two lenses, such as a rigid lens piggybacked on a soft lens, may be worn by patients with special ocular and visual needs. This paper extends existing single lens models to circumstances where two lenses offer resistance to oxygen in series. METHODS: Theoretical oxygen tensions are calculated for tear layers trapped beneath piggyback contact lens systems (and scleral lenses) and the anterior corneal surface with a simple single chamber corneal model using a personal computer software spreadsheet. RESULTS: Acceptable values are anticipated for contact lens materials of modern oxygen permeability values of approximately 60-100 Fatt Dk units under open eye conditions. CONCLUSIONS: The results of this spreadsheet model of oxygen supply to the anterior corneal surface offer a useful guide to clinicians concerned about providing their patients with physiologically acceptable piggyback lens systems.     

BCLA CLEAR - Evidence-based contact lens practice

Evidence-based contact lens practice involves finding, appraising and applying research findings as the basis for patient management decisions. These decisions should be informed by the strength of the research study designs that address the question, as well as by the experience of the practitioner and the preferences and environment of the patient. This reports reviews and summarises the published research evidence that is available to inform soft and rigid contact lens history and symptoms taking, anterior eye health examination (including the optimised use of ophthalmic dyes, grading scales, imaging techniques and lid eversion), considerations for contact lens selection (including the ocular surface measurements required to select the most appropriate lens parameter, lens modality and material selection), evaluation of lens fit, prescribing (teaching self-application and removal, adaptation, care regimen and cleaning instructions, as well as minimising risks of lens wear through encouraging compliance) and an aftercare routine.     

A wearable device to monitor ocular comfort

Purpose: To develop and evaluate a wearable device (the lens awareness logger, LAL) to record subjective lens awareness during contact lens wear.Methods: The LAL is a compact electronic event-logging device incorporating a tactile switch and belt-clip. Forty contact lens wearers (20 symptomatic and 20 asymptomatic) took part in a clinical evaluation of the LAL device. Subjects were instructed to wear their habitual soft contact lenses for 2 days (>8 h wear) and use the LAL device. Subjects activated the LAL device immediately prior to lens application and deactivated it following lens removal. If a subject became aware of their contact lenses at any point throughout the wear period they were instructed to depress the button on the LAL device.Results: The mean number of lens awareness events per hour was 1.3, although there was substantial variation between subjects (standard deviation 1.4). The distribution of lens awareness events throughout the contact lens wearing period showed significantly elevated awareness following lens application and prior to lens removal (p < 0.0001). In addition, symptomatic subjects had a statistically higher percentage of LAL events in the second half of the lens-wearing day compared with asymptomatic subjects (p = 0.02). The LAL findings for each subject appear consistent across the two days (i.e. no fatigue or learning effect). The LAL device was well accepted by subjects with 38 of the 40 subjects reporting it was either 'very easy' or 'fairly easy' to use.Conclusion: The LAL device was able to monitor ocular comfort throughout a period of contact lens wear and was well accepted by subjects. The ability of the LAL device to track ocular awareness events through the day, with high temporal resolution, means it is likely to be a key tool to further understanding of contact lens associated discomfort and dry eye disease.     

In-eye performance of soft contact lenses made from different materials.

The in-eye performance of soft contact lenses may be affected by the material from which they are fabricated and may alter during wear. This study describes clinical and laboratory experiments that were conducted in order to examine the in-eye performance of eight soft contact lenses manufactured from different materials; these materials (and nominal water contents) were: HEMA/VP 40%, HEMA/VP 55%, HEMA/VP 70%, VP/MMA 55%, VP/MMA 70%, HEMA 40%, HEMA/MAA 55% and HEMA/MAA 70% (HEMA: 2-hydroxy-ethyl methacrylate, VP: vinyl pyrrolidone, MMA: methyl methacrylate, MAA: methacrylic acid). Two lenses from each of the eight soft contact lens groups were used in experiments concerning their parameter stability. Six subjects were fitted with lenses for 1 day. Verification of back optic zone radius, total diameter, back vertex power, centre thickness and water content was undertaken at 20 degrees C. In vitro measurements of total diameter were taken at 35 degrees C before lens fitting and after 6 h of lens wear. In vivo measurements of lens centration, up-gaze lag, post-blink movement, total diameter and subjective assessment of comfort were taken (a) immediately after lens insertion (1 min), (b) 20 min later and (c) 6 h later (same day). The majority of differences of the in vivo parameters between lens types (with respect to lens centration, lag, movement on blink, lens total diameter and comfort) were not found to be statistically significant throughout the 6 h wearing period. It was also found that lenses increase in diameter when first placed on the eye and decrease in diameter when they were removed from the eye. The information generated in study concerning the in-eye performance of soft contact lens materials may assist the contact lens industry and contact lens practitioners in developing and prescribing soft lenses with optimal performance characteristics.     

Polymer-interaction driven diffusionof eyeshadow in soft contact lenses

Soft contact lenses used for the correction of ametropia are often made of hydrogel and silicone-hydrogel materials. Since they are placed directly on the surface of the eye and they are hydrated by tears, eye cosmetics can compromise the lens performance and, even worse, can be transported from an external environment to the ocular surface through the contact lens.The diffusion of the dye component of a purple eyeshadow in soft contact lenses of different materials is here evaluated. Diffusivity is found to be typically higher in silicone-hydrogels than in hydrogels. In hydrogels, diffusivity is greater in the case of lower oxygen transmissibility. Despite differences between materials, absorbed mass of dye is much larger (10–100 times) than the expected mass by simple hydration and swelling of the contact lens. The most contaminated materials are also resistant to cleaning solutions. The results indicate that, notwithstanding the complexity of contact lens networks, diffusion of dye is found to follow Fick’s law and it is driven by polymer-dye interaction, which governs lens hydration and swelling.     

A decade of contact lens prescribing trends in the United Kingdom (1996-2005).

PURPOSE: To document contact lens prescribing trends in the United Kingdom over the past decade (between 1996 and 2005). METHODS: An annual survey of contact lens prescribing trends was conducted each year by asking a random selection of optometrists and dispensing opticians to provide information relating to 10 consecutive contact lens fits between January and March. RESULTS: Over the 10-year survey period, 1251 practitioners returned survey forms representing a total of 12,050 contact lens fits. The mean (+/-standard deviation) age of lens wearers was 33+/-13 years of which 64% were female. Over the survey period, rigid lens new fits decreased from 22% to 4%. Low water content lenses reduced from 20% to 2% of new soft lens fits. Soft toric lenses gradually increased to the point where they accounted for the expected proportion of patients with astigmatism>or=1.00DC (i.e. >20% of soft lens fits). Monthly and daily disposable lenses accounted for >90% of all soft lens fits between 2003 and 2005. The proportion of new soft fits and refits prescribed as extended wear has gradually increased, stabilizing at about 5% of new fits and 12% of refits. Multi-purpose lens care solutions increased from 60% of all care systems in 1997 to 91% in 2005. Rigid lenses and monthly replacement soft lenses are predominantly worn on a full time basis, whereas daily disposable soft lenses are mainly worn part time. CONCLUSIONS: This survey indicates that technological advancements such as the development of new lens materials, manufacturing methods and lens designs have had a significant impact on the contact lens market over a relatively short period of time.     

Pharmaceutical-loaded contact lenses as an ocular drug delivery system: A review of critical lens characterization methodologies with reference to ISO standards

Therapeutic contact lenses for ocular drug delivery have received considerable interest as they can potentially enhance ocular bioavailability, increase patient compliance, and reduce side effects. Along with the successful in vitro and in vivo studies on sustained drug delivery through contact lenses, lens critical properties such as water content, optical transparency and modulus have also been investigated. Aside from issues such as drug stability or burst release, the potential for the commercialization of pharmaceutical-loaded lenses can be limited by the alteration of lens physical and chemical properties upon the incorporation of therapeutic or non-therapeutic components.This review outlines advances in the use of pharmaceutical-loaded contact lenses and their relevant characterization methodologies as a potential ocular drug delivery system from 2010 to 2020, while summarizing current gaps and challenges in this field. A key reference point for this review is the relevant ISO standards on contact lenses, relating to the associated characterization methodologies. The content of this review is categorized based on the chemical, physical and mechanical properties of the loaded lens with the shortcomings of such analytical technologies examined.     

The effect of contact lens wear on dynamic ocular surface temperature.

AIM: To determine the dynamic emitted temperature changes of the anterior eye during and immediately after wearing different materials and modalities of soft contact lenses. METHOD: A dynamic, non-contact infrared camera (Thermo-Tracer TH7102MX, NEC San-ei) was used to record the ocular surface temperature (OST) in 48 subjects (mean age 21.7 +/- 1.9 years) wearing: lotrafilcon-A contact lenses on a daily wear (LDW; n=8) or continuous wear (LCW; n=8) basis; balafilcon-A contact lenses on a daily wear (BDW; n=8) or continuous wear (BCW; n=8) basis; etafilcon-A contact lenses on a daily disposable regimen (EDW; n=8); and no lenses (controls; n=8). OST was measured continuously five times, for 8s after a blink, following a minimum of 2h wear and immediately following lens removal. Absolute temperature, changes in temperature post-blink and the dynamics of temperature changes were calculated. RESULTS: OST immediately following contact lens wear was significantly greater compared to non-lens wearers (37.1 +/- 1.7 degrees C versus 35.0 +/- 1.1 degrees C; p < 0.005), predominantly in the LCW group (38.6 +/- 1.0 degrees C; p < 0.0001). Lens surface temperature was highly correlated (r=0.97) to, but lower than OST (by -0.62 +/- 0.3 degrees C). There was no difference with modality of wear (DW 37.5 +/- 1.6 degrees C versus CW 37.8+/-1.9 degrees C; p=0.63), but significant differences were found between etafilcon A and silicone hydrogel lens materials (35.3 +/- 1.1 degrees C versus 37.5 +/- 1.5 degrees C; p < 0.0005). Ocular surface cooling following a blink was not significantly affected by contact lens wear with (p=0.07) or without (p=0.47) lenses in situ. CONCLUSIONS: Ocular surface temperature is greater with hydrogel and greater still with silicone hydrogel contact lenses in situ, regardless of modality of wear. The effect is likely to be due to the thermal transmission properties of a contact lens.     

Ultraviolet transmittance of the Vistakon disposable contact lenses.

With increasing scientific evidence demonstrating the harmful effects of ultraviolet (UV) radiation on different ocular tissues, contact lens manufacturers are incorporating UV blocking monomers into their contact lenses. This study evaluated the transmittance spectra of Vistakon's disposable soft contact lenses (1 Day Acuvue, Acuvue, Surevue, and Vistavue). All except Vistavue contain a UV blocking agent. Transmittance for each lens was recorded from 200 to 400 nm on a Shimadzu UV 160U Dual Beam Recording Spectrophotometer. The results indicate that lenses which incorporate the UV blocking monomer significantly reduced the transmission of W radiation while untreated lenses did not. Our findings indicate that 1 Day Acuvue, Surevue, and Acuvue meet the American National Standards Institution (ANSI) Standard Z80.20 for Class 2 UV blockers: a maximum of 30% transmittance of UVA wavelengths and 5% transmittance of UVB wavelengths. In contrast, the Vistavue lens demonstrated negligible UV blockage. Our technique, in which contact lenses were placed directly in front of a measuring beam, was accurate and simpler than previously reported methods and may be useful in future studies. We found that UV blocking soft contact lenses can be a viable alternative for spectacles in protecting internal ocular structures from UV radiation. However, the external structures of the eye remain at risk and would continue to benefit from the use of UV blocking sunglasses or spectacle lenses.     

Review of 20 years of soft contact lens wearer ocular physiology data

BackgroundSince the introduction of Silicone hydrogel (SiHy) contact lenses 20 years ago, industry has continued to modify lens materials, designs, lens care products and manufacturing processes, striving to improve contact lens physiological performance, comfort, and convenience for wearers. The purpose of this study was to investigate whether the ocular health of habitual soft contact lens wearers today is better than it was in previous decades.MethodsBaseline ocular physiology data for 3624 participants from a The Brien Holden Vision Institute clinical trials database were retrospectively reviewed. Records were grouped into 3 time periods; A: >2 decades ago (1997–1999), B: one decade ago (2009–2014) and C: recent years (since 2015). Physiology data for both neophytes and habitual contact lens wearers included; bulbar, limbal and upper palpebral conjunctival redness, corneal and conjunctival staining and conjunctival indentation from contact lenses.ResultsCorneal staining levels are similar between neophytes and contact lens wearers at time points A and C but worse for contact lens wearers at time point B. Limbal redness was greater in contact lens wearers than in neophytes at time point A but at time points B and C they are not different to the non-contact lens wearing population. In recent years, most ocular physiological variables in habitual contact lens wearers are similar to neophytes.ConclusionsWhile there have been changes over the past two decades in ocular physiological responses to contact lens wear, it appears that ocular health with current day contact lens wear is similar to no lens wear in most respects.     

Water properties of soft contact lens materials.

The properties of water in soft contact lenses such as the water content, free-to-bound water ratio, and the extent to which soft lenses dehydrate during wear, are key determinants of their in eye performance and oxygen transmissibility characteristics. This study describes clinical and laboratory experiments that were conducted in order to examine the state of water in eight soft contact lenses manufactured from different materials. Specifically, lenses made from the following eight materials (and nominal water contents) were used: HEMA/VP 40%, HEMA/VP 55%, HEMA/VP 70%, VP/MMA 55%, VP/MMA 70%, HEMA 40%, HEMA/MAA 55% and HEMA/MAA 70% [HEMA = 2-hydroxy-ethyl methacrylate, VP = vinyl pyrrolidone, MMA = methyl methacrylate, MAA = methacrylic acid]. Differential scanning calorimetry (DSC) was used for measuring the free water content in the materials listed above. Some noticeable differences in water properties among soft contact lens materials having approximately the same water contents were revealed. Low water content materials exhibited a simple endotherm and all water melted around 0 degrees C. On the other hand, medium and high water content materials exhibited multiple melting endotherms, representing a broad range of interactions between water and the polymer. Low water content soft contact lenses have approximately the same amount of bound water as those with much higher water contents. Six subjects were then fitted with the same lenses for one day. In vitro measurements of water content and oxygen transmissibility were taken at 35 degrees C, both before lens fitting and after 6 h of lens wear. Water content and oxygen transmissibility were correlated with the water properties of the soft contact lens materials. The relative change in lens water content (%deltaWC) and relative change in lens oxygen transmissibility (%deltaDk/t) were calculated and correlated with the water properties of the eight soft contact lens materials. It was concluded that (a) oxygen transmissibility, free water content and free-to-bound water ratio are increased when the water content of a contact lens is increased and (b) water content, free water content and free-to-bound water ratio cannot be used for the prediction of soft contact lens dehydration in vivo.