To prevent corneal edema in most patients, contact lenses must transmit oxygen to the following minimum degree: (a) in daily wear, 24.1 × 10−9 (cm × ml O2)/(s × ml × mm Hg), and (b) in extended wear, 34.3 × 10−9 (cm × ml O2)/(s × ml × mm Hg). High Dk/L ratings are particularly important for patients wearing extended wear lenses and for those with exceptionally high corneal oxygen demand. Nevertheless, it is well known that other lens performance properties can be compromised by manipulating material or design parameters to increase the Dk/L rating. Increasing the Dk/L of hydrogel lenses, for example, may lead to problems such as fragility, dehydration, and corneal adherence. Similarly, high-DK/L, rigid gas-permeable lenses may exhibit poor surface wettability and flexural resistance, base curve radius changes, and possible corneal adherence. Because such problems can compromise visual acuity, affect ease of handling, or decrease comfort, nonoxygen factors may exert a stronger influence on successful lens wear than high oxygen transmissibility alone for most patients. Among the nonoxygen factors important for contact lens wear are good movement, surface wettability, resistance to deposit buildup, and flexural resistance. Clinicians must consider these properties, along with oxygen transmission ratings, when fitting patients with contact lenses. Lenses that exhibit good overall performance, in my view, provide the greatest probability of successful wear.
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