Overnight orthokeratology lens wear can inhibit the central stromal edema response

Abstract

Purpose: To investigate the overnight corneal edema response during overnight orthokeratology (OK).

Methods: Eighteen young adult myopic subjects wore reverse-geometry lenses in Boston XO material (nominal Dk/t 46 x 10(-9) cm.mL O2/s.mL.mmHg) on an overnight wearing schedule for 1 month. Another 10 subjects wore conventional rigid gas-permeable (GP) lenses of similar Dk/t in one eye only, on an identical schedule. Corneal stromal thicknesses in the center, midperiphery, and periphery were measured by optical pachometry in the morning after lens removal, after 1, 4, 10, and 30 nights of wear. Changes from baseline for OK, GP and no-lens eyes were compared by repeated-measures ANOVA and protected post hoc t-tests.

Results: The central stroma swelled significantly less in OK than in GP eyes (P < 0.001, ANOVA), and less than with no lens wear (P < 0.001, ANOVA) throughout the study. Overnight edema levels consistent with Dk/t were found on day 1 in the midperiphery (3.5 mm from apex) and periphery (5.0 mm) with both OK and GP lenses. The overnight edema response decreased significantly through the study with both lens types. Recovery to baseline stromal thickness during the day was demonstrated for GP eyes and for OK eyes in the central and peripheral cornea.

Conclusions: Overnight wear of reverse-geometry OK lenses inhibited the central stromal edema response. Overnight edema levels consistent with Dk/t were found in the corneal midperiphery and periphery. Adaptation of the edema response occurred with continuing overnight lens wear. The results suggest that central pressure exerted by the flat-fitting base curve of the OK lens acts locally as a "clamp" to inhibit overnight central corneal swelling.