Considerations in Contact Lens Use Under Adverse Conditions

Proceedings of a Symposium

Pamela Ebert Flattau, Editor

Working Group on Contact Lens Use Under Adverse Conditions Kenneth Polse, Chair

Committee on Vision

Commission on Behavioral and Social Sciences and Education

National Research Council

National Academy Press
Washington, D.C. 1991



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Considerations in Contact Lens Use Under Adverse Conditions: Proceedings of a Symposium Considerations in Contact Lens Use Under Adverse Conditions Proceedings of a Symposium Pamela Ebert Flattau, Editor Working Group on Contact Lens Use Under Adverse Conditions Kenneth Polse, Chair Committee on Vision Commission on Behavioral and Social Sciences and Education National Research Council National Academy Press Washington, D.C. 1991

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Considerations in Contact Lens Use Under Adverse Conditions: Proceedings of a Symposium NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance. This report has been reviewed by a group other than the authors according to procedures approved by a Report Review Committee consisting of members of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Frank Press is president of the National Academy of Sciences. The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. Robert M. White is president of the National Academy of Engineering. The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Samuel O. Thier is president of the Institute of Medicine The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy's purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Frank Press and Dr. Robert M. White are chairman and vice chairman, respectively, of the National Research Council. This work relates to Department of the Navy contract N0014-80-C-0159 issued by the Office of Naval Research under Contract Authority NR 201-204. However, the content does not necessarily reflect the position or the policy of the government, and no official endorsement should be inferred. The United States government has at least a royalty-free, nonexclusive, and irrevocable license throughout the world for government purposes to publish, translate, reproduce, deliver, perform, dispose of, and to authorize others to do so, all or any portion of this work. Library of Congress Catalog Card No. 90-63927 International Standard Book Number 0-309-04438-3 Additional copies of this report are available from: National Academy Press 2101 Constitution Avenue N.W. Washington, D.C. 20418 S-290 Printed in the United States of America

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Considerations in Contact Lens Use Under Adverse Conditions: Proceedings of a Symposium WORKING GROUP ON CONTACT LENS USE UNDER ADVERSE CONDITIONS KENNETH POLSE (Chair), School of Optometry, University of California, Berkeley (optometry) JOHN W. CHANDLER, Clinical Science Center, University of Wisconsin (ophthalmology) JAMES P. HUGHES (IOM), Oakland, California (occupational medicine) JAMES JENKINS, Department of Theoretical and Applied Mechanics, Cornell University (engineering) DONALD R. KORB, Boston, Massachusetts (optometry) GEORGE MERTZ, Marietta, Georgia (optometry) MIGUEL F. REFOJO, The Eye Research Institute, Boston, Massachusetts (engineering)

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Considerations in Contact Lens Use Under Adverse Conditions: Proceedings of a Symposium COMMITTEE ON VISION SUZANNE MCKEE (Chair), Smith-Kettlewell Eye Research Foundation, San Francisco LYNN COOPER, Department of Psychology, Columbia University RUSSELL LEE DEVALOIS, Department of Psychology and Physiological Optics, University of California, Berkeley MERTON CLYDE FLOM, College of Optometry, University of Houston DAVID L. GUYTON, Wilmer Ophthalmological Institute, Johns Hopkins University DONALD HOOD, Department of Psychology, Columbia University JAMES LACKNER, Ashton Graybiel Spatial Orientation Laboratory, Brandeis University GORDON E. LEGGE, Department of Psychology, University of Minnesota PETER LENNIE, Center for Visual Sciences, University of Rochester LOUIS SILVERSTEIN, VCD Sciences, Scottsdale, Ariz. KENT A. STEVENS, Department of Computer and Information Science, University of Oregon ANDREW B. WATSON, NASA Ames Research Center, Moffett Field, Calif. PAMELA EBERT FLATTAU, Staff Officer JOANNE ALBANES, Research Assistant CAROL METCALF, Administrative Secretary ROSE WHITE, Secretary

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Considerations in Contact Lens Use Under Adverse Conditions: Proceedings of a Symposium CONTRIBUTORS MATHEA R. ALLANSMITH, Department of Immunology, Eye Research Institute, Boston, Mass., and Department of Ophthalmology, Harvard Medical School LEO G. CARNEY, College of Optometry, Ohio State University RICHARD J. DENNIS, U.S. Air Force, School of Aerospace Medicine, Brooks Air Force Base, Tex. ROBERT P. GREEN, JR., U.S. Air Force, School of Aerospace Medicine, Brooks Air Force Base, Tex. JAMES T. JENKINS, Department of Theoretical and Applied Mechanics, Cornell University JOSHUA E. JOSEPHSON, Toronto, Ontario STEPHEN D. KLYCE, Louisiana State University Eye Center MORRIS R. LATTIMORE, JR., U.S. Army Aeromedical Research Laboratory, Fort Rucker, Ala. GERALD E. LOWTHER, School of Optometry, Medical Center, University of Alabama, Birmingham ROBERT B. MANDELL, School of Optometry, University of California, Berkeley ANDREW A. MARKOVITS, Department of Ophthalmology, Naval Aerospace Medical Institute, Pensacola, Fla. GEORGE W. MERTZ, Department of Clinical Research, Vistakon Inc. (a division of Johnson & Johnson Vision Product, Inc.), Jacksonville, Fla. MELVIN R. O'NEAL, Armstrong Aeromedical Research Laboratory, Wright-Patterson Air Force Base, Ohio MIGUEL F. REFOJO, Eye Research Institute, Boston, Mass., and Department of Ophthalmology, Harvard Medical School OLIVER D. SCHEIN, Wilmer Eye Institute, Johns Hopkins Hospital, Baltimore, Md. JOHN P. SCHOESSLER, College of Optometry, Ohio State University JAMES F. SOCKS, Alcon Laboratories, Inc., Fort Worth, Tex.

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Considerations in Contact Lens Use Under Adverse Conditions: Proceedings of a Symposium Foreword The Committee on Vision is a standing committee of the National Research Council's Commission on Behavioral and Social Sciences and Education. The committee provides analysis and advice on scientific issues and applied problems involving vision. It also attempts to stimulate the further development of visual science and to provide a forum in which basic and applied scientists, engineers, and clinicians can interact. Working groups of the committee study questions that may involve engineering and equipment, physiological and physical optics, neurophysiology, psychophysics, perception, environmental effects on vision, and treatment of visual disorders. In order for the committee to perform its role effectively, it draws on experts from a wide range of scientific, engineering, and clinical disciplines. The members of this working group were chosen for their expertise in research related to ocular response to contemporary contact lenses and for their familiarity with the application of those research findings to the use of contact lenses in extreme environments. This report summarizes present understanding of the scientific, clinical, and technological issues surrounding the use of contact lenses. Symposium participants discussed the special occupational conditions experienced by military personnel in the aerospace environment that give rise to the question of whether contact lenses should or should not be used. The proceedings of the symposium will serve as the basis for further deliberations by the working group. The results of this symposium will be of particular interest to those involved in the design of contact lenses and those responsible for occupational safety and health matters in the private sector. Suzanne McKee, Chair Committee on Vision

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Considerations in Contact Lens Use Under Adverse Conditions: Proceedings of a Symposium Preface In response to a request from the Triservice Aeromedical Research Panel (TARP), the Committee on Vision established the Working Group on Contact Lens Use Under Adverse Conditions. The working group was asked to: (1) summarize current scientific, clinical, and technological issues in the use of contact lenses, (2) review the operational requirements of military personnel relative to the use of contact lenses, and (3) identify the critical factors to be taken into account by TARP in adopting a formal position on the use of contact lenses by U.S. military personnel. To accomplish these goals, the working group convened a symposium to review what is known about the design and use of contemporary contact lenses. Special emphasis was given to the use of lenses in extreme environmental conditions. Twenty-five specialists from the fields of optometry, ophthalmology, visual psychophysics, and engineering met for two days in November 1988 at Brooks Air Force Base, San Antonio, Texas, in conjunction with the fall meeting of the Triservice Aeromedical Research Panel. Participants essentially provided a tutorial on recent developments in the design and use of contact lenses. The two-day symposium was organized around scientific and clinical considerations in the use of contact lenses. Following a series of briefings by military personnel, members of the first session were asked to address environmental effects on contact lens wear, including the effects of low oxygen and low humidity. The second panel considered environmental conditions and tear chemistry, corneal topography, and biochemical aspects of contact lens wear. The third panel explored preventive measures relative to lens design, including blink rate and mechanical aspects of contact lens performance. The fourth panel addressed issues related to ocular risks, such as infection, inflammation, and endothelial effects. The fifth panel

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Considerations in Contact Lens Use Under Adverse Conditions: Proceedings of a Symposium reviewed limitations of contemporary materials with respect to selection criteria and task performance, including follow-up care. The program offered ample opportunity for formal and informal group discussion. The edited proceedings of the discussion together with the formal papers of the participants are the contents of this report. In addition to the specialists who participated in the symposium, a number of people contributed in important ways to this project. Robert Miller of the Brooks Air Force Base staff facilitated arrangements for the symposium. Roger Wiley and his staff at the U.S. Army Aeromedical Research Laboratory assisted the working group in arranging for presentations by U.S. military personnel both at the symposium and at meetings of the working group. Pamela Ebert Flattau, the committee's study director, provided valuable assistance in organizing the symposium and preparing the proceedings report. As always, Carol Metcalf, the committee's administrative secretary, provided efficient and skillful support. Kenneth Polse, Chair Working Group on Contact Lens Use Under Adverse Conditions

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Considerations in Contact Lens Use Under Adverse Conditions: Proceedings of a Symposium Contents     CONTACT LENSES AND THE EYE: BASIC CONSIDERATIONS   1     Environmental Gases and Contact Lens Wear Gerald E. Lowther   3     Hypoxia George W. Mertz   14     Contact Lenses and Corneal Energy Metabolites in the Rabbit Morris R. Lattimore, Jr.   24     Environmental Conditions and Tear Chemistry Leo G. Carney   34     Tear Evaporation Considerations and Contact Lens Wear Miguel F. Refojo   38     Mechanical Aspects of Soft Contact Lenses James T. Jenkins   44     CONTACT LENSES AND THE EYE: COMPLICATIONS   51     Medical Problems Associated With Contact Lens Use Robert P. Green, Jr.   53     Adverse Reactions Associated With Contact Lens Use Oliver Schein   58     Corneal Topography and Contact Lenses Stephen D. Klyce   68     Treatment of Giant Papillary Conjunctivitis Mathea R. Allansmith   74

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Considerations in Contact Lens Use Under Adverse Conditions: Proceedings of a Symposium     Endothelial Effects From Contact Lens Wear John P. Schoessler   84     CONTACT LENSES AND THE EYE: PRACTICAL CONSIDERATIONS IN EVERYDAY AND MILITARY LIFE   95     Corneal Effects of Extreme Environments: Considerations for Pilots Wearing Contact Lenses Joshua E. Josephson   97     Effect of Aircraft Cabin Altitude and Humidity on Oxygen Tension Under Soft and Hard Gas-Permeable Contact Lenses Melvin R. O'Neal   106     Ocular Occupational Health Concerns: Considerations for Pilots Wearing Contact Lenses Joshua E. Josephson   119     Lens Performance Considerations Gerald E. Lowther   128     Vision Performance With Contact Lenses Robert B. Mandell   135     An Overview of U.S. Army Aviation and Contact Lens Issues Morris R. Lattimore, Jr.   142     Contact Lens Wear in the Aerospace Environment Richard Dennis   148     Use of Soft Contact Lenses by Tactical Aircrews Richard Dennis   152     Job Demands in Naval Aviation Andrew Markovits   156     Extended-Wear Lenses: The U.S. Navy's Experience James Socks   159