Predicting extended wear complications from overnight corneal swelling

PURPOSE. To examine the hypothesis that the corneal overnight swelling resp onse (ONSR) is a predictor of ocular complications in contact lens extended wear (EW). METHODS. The Berkeley Contact Lens Extended Wear Study (CLEWS) was a random ized, concurrently controlled clinical trial in which more than 200 subject s in EW with rigid gas-permeable (RGP) lenses were observed for 1 year. Aft er adapting to EW, subjects were randomized to either medium or high oxygen -permeable (Dk) RGP lenses and underwent clinical assessments. keratometry, and corneal pachometry at 3-month intervals. RESULTS. The ONSR was directly related to lens Dk (P = 0.01) and exhibited substantial variability across subjects. The probability of remaining free of complications over time was not significantly lower for subjects with a mild ONSR compared with those with greater edema (P = 0.84). The risk of de velopment of keratopathy was not significantly related to the ONSR (relativ e risk = 1.00). CONCLUSIONS. The corneal ONSR is not a good predictor of ocular complicatio ns in I year of RGP EW. Lenses that cause little or no corneal edema are no t necessarily safer for overnight wear.