Modulus and its Effect on Contact Lens
modulus and lens design characteristics may impact fitting success for some patients.
degree of a contact lens material's flexibility, or its resistance to being deformed,
is its modulus of elasticity, commonly referred to simply as modulus. You can think
of modulus as the propensity for a hydrogel or silicone hydrogel lens to act like
a rubber band its tendency to "snap back" after being stretched or deformed.
Comparing the material modulus values of contact lenses can be helpful in clinical
practice, with higher modulus values representing greater lens stiffness and greater
resistance to shape change (Table 1).
Impact of Lens Modulus
is evident clinically in how well a contact lens holds its shape during lens handling
and by the degree to which it conforms to (or lays down on) the cornea and peri-corneal
sclera when worn. Higher modulus is associated with better handling, ease in establishing
whether the lens is inside out and ease of application and removal. On the other
hand, higher modulus may have a clinical downside related to mechanical effects
associated with lens wear by some patients, including contact lens papillary conjunctivitis
(CLPC), superior epithelial arcuate lesions (SEALs), limbal epithelial hypertrophy
(LEH), generation of mucin balls and resistance to full draping on the anterior
ocular segment, resulting in edge fluting (or edge standoff). Fluting is usually
associated with immediate and consistent awareness of the lens on the eye.
The following clinical
case highlights the phenomenon of edge fluting with higher modulus lens materials.
A Clinical Case
myopic female patient successfully wearing Acuvue 2 (Vistakon) hydrogel lenses agreed
to be refit into silicone hydrogel lenses to take advantage of the physiological
benefits provided by a higher-oxygen-transmissible lens. Her eyes were virtually
identical in refraction and corneal topography and so I present only the left
eye here. Of particular note is that her corneas were steep, consistent with the
refractive myopia of –7.50D (Figure 1).
We attempted to
fit the patient with first-generation silicone hydrogels (both lotrafilcon and balafilcon
materials), but both attempts resulted in edge fluting. We also diagnostically fit
various silicone hydrogel and hydrogel lens brands, using different base curves
within brands when available, which demonstrated the influence of lens modulus on
lens fitting performance (Figures 2 and 3). Fluting occurred with each base curve
of the Night & Day (CIBA Vision) lens, the PureVision (Bausch & Lomb) lens
and the flatter base curve of the Acuvue Advance (Vistakon) lens. The steeper base
curve of the Acuvue Advance lens allowed for complete draping of the lens on the
ocular surface. Complete draping also occurred with hydrogel lenses (Acuvue 2 in
each base curve and Proclear [CooperVision]). Ultimately, the patient opted to not
make a change from her habitual contact lenses and she continues to enjoy successful,
regular daily wear of hydrogel lenses.
of various lenses on this patient's eye demonstrates the potential for both material
modulus and lens design features to affect lens fit. The edge fluting that occurred
with some of the lenses fit in this case likely resulted from the greater peripheral
lens thickness of the higher minus lenses coupled with the higher modulus. Both
modulus and design worked together to inhibit the lenses' ability to drape the anterior
design, including base curve and diameter choices, seems to have a greater impact
as the lens material modulus increases. In addition, this case demonstrated the
significance of having a choice of base curves with a lens of lower modulus to avoid
edge fluting for patients who have relatively steep corneas.
demonstrated that some lenses, based upon their higher material modulus in the available
designs, did not fulfill an acceptable on-eye fitting criterion (owing to edge fluting)
on a patient who had steep corneas and moderately high myopia. This case is also
a reminder that hydrogel lenses still play an important role as a vision correction
option for some patients.
Dr. Snyder is an adjunct professor
of optometry at the University of Alabama at Birmingham. Since submitting this article
he has joined Bausch & Lomb as Director of Professional Relations.
Contact Lens Spectrum, Issue: February 2007