Continuing Education

Michael J. A. Port, MSc, FCOptom, DCLP, FAAO

sponsored by
The College of
Optometrists

Contact lens surface

properties and interactions
The tear film is a complex fluid composed mainly of water, lipids, proteins,
sugars, mucin and carbohydrates. It serves several functions and amongst the
most important are a source of nutrition for the cornea and conjunctiva, and
removal of waste products from these tissues. Once a contact lens is placed on
the eye, there is a synthetic material in a natural environment. This situation
arises in other parts of the body where there has been some synthetic implant
and one of the remaining challenges of biomedical science is to achieve proper
biocompatibility.
In the contact lens field, lens design is well
established and there is a thrust of
endeavour in materials science to produce
lenses showing good biocompatibility. Poor
biocompatibility shows up as deposition of
body substances on the device, e.g. urinary
catheters which become blocked leading
to reduced performance of the device, or
an adverse reaction of the body tissues to
the device, e.g. contact lens-associated
papillary conjunctivitis (CLAPC). In the
case of contact lenses, deposition can lead
to poor vision, discomfort, inflammations
and reduced wearing time. In an ideal
world, a device would be considered
completely biocompatible if the body
tissues and fluids did not adversely and
significantly affect the synthetic device
and the device itself it did not adversely
and significantly affect the physiological
environment. As yet this is rarely
achieved.
The contact lens on an eye is a unique
environment compared to other parts of
the body. We have a synthetic device
which is immersed in tear fluid but also
exposed to the air. The blinking process
itself can vary considerably from one
individual to another and also according
to the task. The nature of the tears is also
very varied between individuals and
profiles of tear components can show wide
variation. Although the eyelid is
lubricated by the tear film, there are bound
to be shear forces exerted by the lid on the
substances adsorbed on the anterior lens
surface. In todays society, the lacrimal
system is not always optimum and factors
such as air conditioning, computer work,
diet and medication can all affect the
nature of tears - usually in an adverse way

so that a percentage of the population has

dry eyes to some degree or another.
Contact lens deposition is a type of
biological interfacial conversion event.
Some features of lens deposition are not
dissimilar to those in other events such as
blood clotting and dental plaque
formation.
Firstly, let us consider the types of
deposition that are seen on contact lenses,
and how they are classified and graded.
The most common categories are:
1. Surface films
2. Discrete spot deposits
3. Plaques and geographic deposits
4. Particulates
5. Discolorations
6. Mixed

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2. whole surface covered with film when

viewed with slit lamp; and
3. film visible to the naked eye (this is
usually seen more distinctly when the
surface liquid has been blotted off)
(Figure 2).
The Rudko classification system has
been modified (Hathaway and Lowther,
1976) and categorises deposits in terms of
degree, type and extent.
Code (degree)
I
Clean
II
Visible under oblique light when
wet using 7x magnification
III
Visible when dry with
the unaided eye
IV
Visible when wet or dry with the
naked eye
Figure 1
A film type deposit observed at low
magnification through a slit lamp microscope

It is useful to describe deposits in terms

of their degree and area of the lens
affected.
Surface films
These deposits are normally observed using
a slit lamp microscope (Figure 1) when
the lens is on the eye. They present as
whitish-grey in colour and the lens lacks its
normal transparency. There are four main
sub-categories:
a. Protein
b. Lipid
c. Bacterial
d. Mineral
e. Mixed

Figure 2
A heavy film deposition on a soft lens easily
seen macroscopically. The effect on visual
acuity and contrast is likely to be significant.
A new lens is also shown for comparison

In terms of films seen on lens surfaces,

a simple description seems sufficient, i.e:
0. lens clear and transparent;
1. patches of film seen with a slit lamp at
about 10x magnification;
JULY 30 1999 OPTOMETRY TODAY

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Contact lens surface properties and interactions

DISTANCE LEARNING MODULE 1 PART 8

Code
C
G
F
P
Co
D

(type)
Crystalline
Granular
Film
Plaque
Coating
Debris

Code
a
b
c
d

(extent on lens surface)

0-25%
25-50%
50-75%
75-100%

Protein film is normally an adsorption

and/or absorption of proteins such as
albumin, lysozyme and lactoferrin. It is
important to remember that when protein
is absorbed into the matrix of a lens, there
is effectively less space for water and the
more protein present in the lens, the lower
the water content of the lens. Besides a lens
losing water because of temperature,
dehydration, tonicity and pH factors, it can
lose water through protein absorption.
Obviously, the size of the protein molecules
and the pore size of the matrix will affect
the rate of deposition. Protein is adsorbed
very quickly indeed from the moment the
lens is put in the eye. It is not a process
which takes days or weeks to start.
Traditionally, it is ionic lenses which attract
protein - the positively charged amino acids
are attracted to the negatively charged
(anionic) lens surface. Protein adsorption
and absorption is essentially a one-way
process and the effects therefore worsen
with time. The major proteins which are
deposited are albumin, lysozyme and the
immunoglobulins. Protein on lens surfaces
can produce an immune response from the
palpebral conjunctiva. Antibodies are
produced and this causes the papillae to
enlarge, resulting in a papillary
conjunctivitis. The tissue is usually
hyperaemic and the clinical appearance
and sequelae are well documented.
Lipid films are rather more greasy in
appearance as one might suspect from an
accumulation of fats and oils. A typical sign
is an imprint from a finger when the lens
has been handled, leaving a fingerprint or
similar appearance on the surface. Lipid
may come from several sources. External
examples would be face and hand
preparations which usually contain oily
substances. Alternatively, the meibomian
glands may be producing abnormal
secretions and these glands should be
checked for signs of infection or
inflammation. There may be some form of
dry eye present and the blink itself may be
incomplete or occur less frequently than
28

normal. If the aqueous phase is reduced in

volume, then there is a greater
concentration of the remaining substances.
Some drugs such as oral contraceptives (de
Vries, 1985) and diuretics (Masterson,
1982) may also have an effect on the lipid
content of the tears. Lipids tend to be
attracted to non-ionic lenses rather than
the ionic materials. The silicone
component of some contact lenses may also
attract lipids (Hart et al, 1987).
Contaminated lens surfaces from furniture
polish aerosols containing silicones may
also mean lipid deposition.
Bacterial spoilation of contact lenses is
potentially very serious because of the risk of
subsequent infection. If the epithelium is
compromised and the antimicrobial
properties of the tears are less effective than
normal, then an infection may follow.
Bacterial films and mineral (inorganic salts)
are not always easy to distinguish and are less
prevalent than protein or lipid films. Suffice
it to say that collections of bacteria (or other
microbes) may well be placed in a nutrient
film that aids replication. They are also to be
found around discrete elevated deposits, as
well as pits and cracks in the lens. As a result,
the bacteria may not be efficiently removed
during the cleaning and disinfection
procedures. Toxins produced by these
bacteria may well cause adverse reactions to
the cornea. Bacteria inhabit the eye as a
matter of course and the eyes natural
defences usually deal with them effectively.
With a new ionic lens, the negative charge
on the hydroxyl group will conventionally
repel the bacteria with a negative charge.
However, surfaces do not remain in a virgin
state for very long and biofilms can attract
and retain bacteria. Replication is
significantly enhanced when bacteria adhere
to a surface. A more acidic environment will
also increase bacterial multiplication. Hence,
raised levels of lactic acid and carbonic acid
in the tears could reduce the pH and affect
the bacterial adhesion.
Mechanisms of bacterial adhesion are
dealt with by Tripathi, Tripathi and
Silverman (1994). New materials which
reduce hypoxia and hypercapnea should be
safer materials. This is especially important
with soft lenses where there is very little tear
exchange behind the lens. Any contact lens
material which reduces bacterial adherence
is reducing the risk of an abnormal ocular
response. There are now surface technologies
which also have antibacterial properties.
Materials which both reduce adherence and
act against the bacteria must be a major step
forward in the search for new extended wear
materials, but would have application even in
daily wear materials.

JULY 30 1999 OPTOMETRY TODAY

One should not forget other microbes

such as protozoa, viruses and fungi. Fungi
can grow in the lens matrix and cause
polymer degradation as well as, and be a
source of fungal infection to, a damaged
epithelium.
Inorganic films are similar in
appearance to protein films and are
composed of insoluble material, e.g.
calcium phosphate, hydroxy appatite,
which has not taken on a crystalline form.
They can effect the surface and bulk
properties of the lens.
Discrete spot deposits
Again, spots originating from organic
material are white in colour and are seen
primarily on hydrogel lenses. They are
usually seen only with a slit lamp under
10x magnification. Size can be anything
from 50m to 500m, but is most
commonly 100-200m. In extreme cases,
they can be larger than 500m and can be
seen macroscopically. Appearance will vary
from tens or hundreds of small spots down
to a single spot.
The morphology and composition are as
follows:
Basal layer which interfaces with the
lens polymer and is composed of
unsaturated fatty acids and calcium
(acts as a stabiliser).
Secondary layer which forms the bulk
of the deposit and is dome shaped.
This is composed of cholesterol,
cholesteryl esters and mucins.
Tertiary layer which is a transparent
layer of protein material.
The formation mechanism is as follows:
1. Collapse of the overlying tear film
when a dry spot occurs on the lens
surface. Some lipids, which may have
migrated to the lens surface, are left
there. When the next blink occurs,
the tear film is re-established.
2. Some lipids on the lens surface will
undergo solubilisation, but some will
undergo diffusion and phase
separation of the unsaturated fatty
acids in the bulk of the lens material.
3. Polymerisation and immobilisation of
unsaturated lipids can then form
islands with free carboxyl groups.
4. Calcium ions are combined and there
is stabilisation of the mass.
5. Rapid lipid build up.
6. Coating of the mass with proteins.
The aetiology is not always the same. One
should be aware of possible causes such as
individual tear chemistry, dry eyes (or sub-

Contact lens surface properties and interactions

DISTANCE LEARNING MODULE 1 PART 8

clinical dry eye), low pH, poor lens

cleaning, nature of the lens polymer and
interfacial reactions. These larger complex
spots are termed mulberry deposits or
jelly bumps (Figure 3) and they are about
200-800m in size. They are very difficult
to remove especially as they grow into the
lens matrix rather than merely sit on the
surface. Deposits of this nature may be
removed using intensive oxidative or
enzymatic cleaners, but as soon as the lens
is worn once more, deposits start again on
the same sites.
Clinically, they can produce a variety of
symptoms and these are dependent on the
size and nature of the elevation. There may
be a reduction in vision, mechanical
irritation to the palpebral conjunctiva
(with associated follicular or papillary
conjunctivitis), very occasionally some
mild trauma to the epithelium if the
deposit is on the back of the lens, and the
bound protein may start an auto-immune
response as might a protein film.
There are various ways that deposits
can be analysed in the laboratory. The
initial interactions and deposits can be
investigated using:
High pressure liquid
chromatography (HLPC)
Fluorescence spectroscopy
Electrophoresis
Immunological techniques
The morphology of the deposits can be
examined by light microscopy and
scanning electron microscopy (SEM),
where higher magnifications are needed.
The chemical composition can be
determined by:
Histochemistry
Fluorescence spectroscopy
Fourier transform infrared (FTIR)
Energy dispersive X-ray analysis
X-ray photon spectroscopy (SPS)
Plaques and geographic deposits
Organic lens plaques tend to be made up of
several layers and typically might have an
inner layer of unsaturated fatty acids (tear
lipids), a central layer of mucin and an
outer proteinaceous layer.
The inorganic deposits are again white
in nature and have discreet boundaries.
The shapes can be regular or irregular.
They can usually be seen macroscopically
and are thought to be calcium related but
in a much more severe form than a film.
Crystalline deposits may be covered with
translucent film. Calcium, phosphate and
carbonate ions concentrate on the lens
surface and no longer remain soluble with
the resultant formation of these crystalline

deposits. They sometimes have a granular

appearance.
Particulate deposits
The most common deposits in this category
are rust spots and are seen in soft lenses
(Figure 4). They show a typical orangebrown colour. Usually, there are only one or
two such deposits unless the lens wearer
has an occupation such as a grinder where
multiple deposits can occur if the eyes are
not protected adequately. The ferrous
particles are usually airborne, but could be
transferred by hand to the lens. If they are
small and embedded in the lens, there may
be no response from the eye, but if they are
large and elevated from the surface, there
may be symptoms of discomfort. On
occasion, the rusted particle leaves the lens
but a rust coloured stain remains.
Discolorations
Now that disinfecting solutions do not
usually contain traditional preservatives
such as thiomersal and chlorhexidene,
there is less lens discoloration seen. The
stain usually covers the whole lens and is
uniformly distributed, but occasionally
there is a patchy appearance.
Brown and yellow-brown stains are
commonly related to melanin and tyrosine.
Nicotine has been implicated as a
precursor to melanin-like substances, but
may also have a direct effect from cigarette
smoke. Adrenaline and vasoconstrictors
used topically in the eye may give rise to
similar discoloration.
Thiomersal preservatives contain
mercury and this gives rise to grey
discolorations from quite a light colour to a
dark grey (Figure 5). Chlorhexidene can
cause yellow-green or grey-green stains and
these will fluoresce under UV light.
Sorbic acid and potassium sorbate are
used as preservatives and when these
interact with protein, they may cause
yellow-brown, yellow-green and grey-green
discolorations.
One should be aware that medications
can also cause lens discoloration. For
example, epinephrine can oxidise to form
melanin pigments which have a spotty
brown-black appearance. Tetrahydrazaline
can produce a brown colour.
Mixed deposits
Although the above has focused on
individual types of deposition, it should be
noted that not all deposits appear singly.
One may well get mixed lipid and protein
deposits, for example, and it is not at all
easy for practitioners to state definitively
whether the deposition is specific or mixed

Figure 3
Large mulberry or jelly bump
deposits on a soft lens

Figure 4
A rust spot on a soft lens. Size is likely to be 200m
to 500m. The ferrous particle may or may not
remain in the lens

Figure 5
Two hydrogel lenses showing discolorations - one a
pink colour and the other a grey

(Figure 6). It is analogous to examination

of palpebral conjunctiva when it is
sometimes difficult to state whether
elevations are papillae, follicles or both.
Remedies for deposited lenses
Thankfully, deposited lenses are often
recognised from the patients signs and
symptoms. They may well complain of
poorer wearing times, vision being poorer
or variable, and general discomfort. The
deposits themselves on and in the lens may
reduce the oxygen transmissibility of the
lens and exacerbate any hypoxia which may
be present. The slit lamp can be used

JULY 30 1999 OPTOMETRY TODAY

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Contact lens surface properties and interactions

DISTANCE LEARNING MODULE 1 PART 8

designed for this application. When

measuring the back optic zone radius, the
lens is illuminated from the side and the
observer can evaluate the lens against a
black background (Figure 7). Lens
movement and centration can also be
affected by deposition - perhaps more
significantly for multifocal, toric and
lenticulated lenses. Significant deposition
can result in a red eye (especially the
palpebral conjunctival tissue) due to
mechanical
irritation
and/or
an
inflammatory response.
Now that frequent replacement lenses
and disposable lenses are very common,
the treatment of deposited lenses is less
necessary. However, there are some
categories of re-useable lenses that are
relatively expensive and re-processing is
needed.
Figure 6
A mixed type of deposit that has probably been
rubbed with surfactant in the middle of the lens, but
not cleaned well on the periphery of the lens

Figure 7
Dark field illumination. A plan view of a soft lens in
an Optimec instrument whilst the BOZR is
measured. The lens coating would show up as a
whitish-grey under direct illumination, but there is
some fluorescence here which gives a bluish tinge to
the deposition

Figure 8
High magnification of a very heavy surface film that
has started to break off the lens surface

effectively to identify most significant

deposits but it is recommended to look at
lenses under dark field illumination as
deposition, is more readily seen in some
cases. An Optimec instrument is useful for
this purpose although not specifically
30

Surfactant cleaning
This is an essential step with lenses that are
not worn once and thrown away. If a lens
has to be used again, it should be subjected
to surfactant cleaning and a disinfection
process. Some wearers may omit the
cleaning step with a surfactant. Users of
hydrogen peroxide systems are probably
the major offenders. The main purpose of
cleaning lenses between finger and thumb
whilst using a surfactant cleaner is to
physically remove the loosely attached
deposition. This will include mucin,
bacteria, polysaccharides, debris as well as
other substances such as proteins which
have not denatured. Removing large
numbers of microbes in this way makes the
actual disinfection process more efficient.
Rubbing with a surfactant cleaner and
rinsing off well afterwards is of paramount
importance in lens hygiene. Some cleaners
are alcohol-based and these will dissolve
some organic materials more easily.
In the case of RGP lenses, a polymeric
bead cleaner has a mildly abrasive action
and lipids and protein which are firmly
attached can be physically removed from
the lens surface. However, practitioners
should always sound a note of caution to
users of these products. Some wearers are
far too vigorous in the rubbing action and
the abrasive effect has been known to
change the power of the lens and/or make
the centre so thin that the lens is fragile
and prone to warpage.
An electro-mechanical cleaner has
been developed (Ifejika, 1998) which can
significantly enhance the performance of
multipurpose solutions - both from the
cleaning and disinfection aspects. The
disinfection performance is impressive
even when plain saline is used. It is

JULY 30 1999 OPTOMETRY TODAY

conceivable that the device could be very

useful for the disinfection of diagnostic
lenses.
Enzymes have been used for many years
and there are products available which
claim to remove proteins and lipids.
However, not all types of lipid and protein
respond equally well to such treatments.
Deposits such as jelly bumps are rarely
seen due to use of frequent replacement
regimes. Practitioners can easily establish
an interval for lens changing which means
that deposition does not occur to an extent
which compromises vision and comfort
(Figure 8).
Changing lens material is useful when
one identifies a specific deposit. For
example, if protein deposition is a problem
and the lens in use is an ionic material, a
change to a non-ionic lens is always worth
a try. Conversely, if lipid deposition is a
problem, then a change from a non-ionic
lens to an ionic one may give good results.
Where there are mixed deposits, the use of
a zwitterionic material such as Proclear
can be advantageous as there is minimal
deposition of both lipids and protein. This
particular soft lens offers reduced
dehydration and reduced bacterial
adhesion.
It remains to be seen if new products
such as PureVision exhibit significant
deposition after some months of use. Early
silicone elastomer lenses had to be surface
treated in order to make them hydrophilic
but so often, the surface treatment was
destroyed in use making vision extremely
poor.
Discolorations can be dealt with in
several ways. Some will respond to an
oxidative process, and soaking in hydrogen
peroxide 3% for some hours may clear the
lens. In cases where protein has been
involved, removal of this component can
reduce the discoloration. In some cases,
nothing will help and a new lens or a new
disinfection regime without the traditional
preservatives is the only answer.
Evaluation of the tears
It is difficult to retain a normal aqueous
and lipid layer on a contact lens, especially
on RGP lenses. A tearscope is useful to
assess the normal pre-corneal tear film
(Guillon, 1986) as well as a pre-lens tear
film. It is also useful and simple for the
practitioner to measure the non-invasive
break-up time and front surface drying
time. With the lens in situ, the patient is
asked to stop blinking. The practitioner
observes the front surface of the lens with a
slit lamp (low magnification) and counts
the seconds until a break in the tear film

Contact lens surface properties and interactions

DISTANCE LEARNING MODULE 1 PART 8

occurs. If this time is shorter than the

normal interblink period, deposition
problems are likely to occur. One must
therefore investigate the tasks being
undertaken by the wearer. Tasks involving
concentration, e.g. driving, computer work
and reading, can result in longer interblink
periods. Non-demanding tasks usually give
rise to eight to 12 blinks per minute, i.e.
about one blink every six seconds. With
demanding tasks, this can easily change to
one blink every 12 seconds.
Front surface drying time (FSDT) is a
continuation of the front surface break-up
time. One simply allows the process to
proceed until the whole of the front surface
has dried and the time for this to occur is
recorded. The end-point can be seen when
the lens surface is covered with the residues
of the tear film and it assumes a granular,
dull appearance rather than the normal
glass-like appearance of the tear film. In
this test, one is looking at the ability of the
lipid layer to inhibit evaporation as well as
the volume of water on the lens surface. A
tear film with poor lipid quality and low
aqueous volume will give a short FSDT.
Other factors which may influence the
FSDT are the ability of the material to
attract water to it (hydrophilicity), and the
ability of the material to spread water
across it (wettability).

Figure 9
Cohesion and adhesion forces, (a) with mercury on glass with a contact angle of about
130 and (b) with water on PMMA with a contact angle of about 60

Figure 10
The surface tension of a
liquid drop. Inward pull of
surface tension results in a
spherical shape

SURFACE PROPERTIES
Forces acting on molecules of the same type
are known as cohesive forces. Forces acting
between different substances are known as
adhesive forces. An example is shown in
Figure 9. Mercury has a high cohesive
force which keeps a drop in a spherical
shape. There is also relatively little
adhesive force between the mercury and
glass. Conversely, when a drop of water is
placed on PMMA, water has a lower
cohesive force and the adhesive force
between the PMMA and water is higher
than that between mercury and glass - as a
result, the water spreads further than the
mercury.
Critical surface tension
If a liquid has a surface tension below this
value, it will spread on a given solid surface.
If it has the same value or higher, the liquid
will not spread on the solid but it will form
drops. In the latter case, the surface is nonwetting.
Surface tension
This is a tension force developed on a
surface as a result of asymmetrical
molecular interactions at an interface. In

Figure 11
The attractive forces between the molecules of a homogeneous liquid in the inner bulk
are contrasted to the forces at the liquids surface. The surface tension of a liquid is
created by the unopposed pull of the surface molecules which have higher potential
energy than the bulk molecules

the interior of a liquid drop, each molecule

is surrounded by others. Since it is subject
to attraction in all directions, the
molecular forces cancel each other out.

However, conditions are different at the

surface compared to the inner bulk
(Figures 10 and 11). The molecules at
the surface are attracted to each other and

JULY 30 1999 OPTOMETRY TODAY

31

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Figure 12
The relationship of the three interfaces when a drop of liquid is
placed on a solid surface; both the solid and liquid are in air

Figure 13a
An advancing contact angle ()
where liquid from a syringe is
increasing the volume of the drop.
The drop is encroaching on to
unwetted solid

to the molecules beneath, although there is

no outward attraction to balance the
inward pull. Due to this inward pull, the
surface molecules continuously attempt to
enter the bulk of the drop, lowering the
total surface area until it reaches a
minimum size. For a given liquid volume,
the minimum surface area is achieved by
assuming a spherical shape. Rocher (1975)
suggested that the molecules on the surface
have an excess of potential energy
compared to the bulk molecules. The
potential energy per unit area was called
the surface tension, or surface-free energy.
When a drop of liquid is placed on a
surface, the various forces interact until an
equilibrium is reached. The contact angle is
often referred to and is shown in
Figure 12.

Table 1
SOLUTION

CONTACT ANGLE
HIGHEST
LOWEST

Boston IV (Prymesoak)

26 (Delta (B&L))

63

Equalens

32 (Delta)

42 (ReNu)

32

Figure 13b
A receding contact angle () where
liquid is being withdrawn from the drop
up the syringe. The circumference of
the drop is moving to an area which
has already been wet

There are three interfaces to consider:

1. Air-solid (AS)
2. Liquid-air (LA)
3. Liquid-solid (LS)
The relationship between all three
and the contact angle is given by:
ST( SA) - ST (LS) = ST(LA) Cos
(where ST is the surface tension).
The contact angle can be either advancing,
receding or in equilibrium. In the case of an
advancing angle, it is easy to imagine a
drop of liquid being slowly expelled from a
syringe onto a flat solid surface (Figure
13a). As the size of the drop expands, it is
gradually moving to an unwetted area and
this results in a larger contact angle. If the
liquid is then withdrawn into the syringe,
then the drop becomes smaller, but is
moving on a wet area and hence the angle
is smaller (Figure 13b). The equilibrium
angle is obtained when there is no increase
or decrease in the size of the drop and the
contact angle will lie between the
advancing angle and the receding angle. In
the case of rigid contact lens materials,

JULY 30 1999 OPTOMETRY TODAY

there are many factors which affect

the measurement of contact angle.
These are:
conditioning of the lens (how it is
cleaned, dried and hydrated);
solution used;
size of the drop;
temperature;
humidity;
method of manufacture of the lens
(forming and polishing);
surface treatment;
surface roughness;
age of the lens; and
method employed to measure the
contact angle.
For example, merely using a proprietary
conditioning (wetting and soaking)
solution as opposed to water can reduce
the contact angle from 63 to 29 for
PMMA. As one might expect, different
RGP materials produce different results in
different conditioning solutions. For
example, when Boston IV and the
Equalens were conditioned in six different
solutions, the results in Table 1 were
observed (Shirafkan, 1997).
The reader should be very aware of all
the above variables when values for
wetting angles are considered. Fatt (1984)
found that for PMMA, the contact angles
could vary from 13 to 73 merely by
varying the conditioning and preparation
of the lens.
The subject of wettability and contact
angles has received considerable interest
over the years and as a result there are very
many methods to measure wettability and
contact angles.
These are:
1. Goniometer (Zisman, 1964)
2. Measurement of drop dimensions
(Farnariere et al, 1984)
3. Photographic method
(Li and Hausner, 1992)
4. Projection method (Ng et al, 1976)
5. Laser assisted method
(Bush et al, 1988)
6. Reflecting method (Good et al, 1979)
7. Captive bubble technique
(Gaudin et al, 1963)
8. Adherent bubble technique
(Fatt, 1990)
9. Wilhelmy plate method
(Sarver et al, 1984)
10. Direct meniscus method
(Madigan et al, 1986)
11. Tilting plate method
(Aveyard et al, 1973)
12. Rotating rod method
(Adam et al, 1934)
13. Capillary rise method (Atkins, 1994)
14. Interferometry (Garner, 1981)

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A novel approach was made by

Shirafkan (1997) in measuring wettability
by the use of the contact angle. Instead of
using a sessile drop, he used liquid which
was adherent to the lens, but not separated
from a larger volume (Figure 14). With
the lens and liquid arranged in this way, he
then used the laser method (Knick et al,
1991) to actually determine the contact
angle. This had the advantage of not
having to make a drop of a given volume or
letting the drop evaporate over time. The
method can be used with rigid and soft
lenses.
The front surface of the lens is
completely immersed in the liquid and
then withdrawn so that a receding angle is
measured. If the lens was withdrawn more
than 2.2mm, the liquid separated and so
withdrawal had to be less than this value.
The smallest variance was produced when
withdrawal was between 1.8mm and
2.1mm. Mean values for PMMA and
deionised distilled water were between 55
and 56 and standard deviations were
never greater than 1. The Boston IV and
Equalens showed contact angles of 35
and 20 respectively. However, when all
three materials were conditioned in
proprietary soaking solutions, the wetting
angles decreased to 4-10 in 87% of cases.
In a separate experiment, the same
method was used to investigate different
materials before and after wear on one
subject. The results are shown in Figure
15 and are not significantly different from
those shown in previous years (principally
by Benjamin et al, 1984, 1986, 1992;
Shirafkan, 1995). In effect, most rigid lens
materials show a decreasing wetting angle
with time once the lens is in the eye and
this value stabilises after about 30 minutes
at around 10. In other words, tear
components are laid down on the lens
surface to produce a more wettable surface
than the material itself. Therefore, for the
majority of patients with normal tears and
blinking patterns, the wettability of the
lens material is of little consequence.
Shirafkan carried out a very similar
experiment with soft lenses. Eleven
different hydrogel materials were
investigated in the same manner as
described above. In vitro wetting angles
varied from 5-11 with lathe cut lenses
showing the higher angles compared to the
moulded lenses. After wear, all lenses
showed wetting angles of approximately
2, once again demonstrating that a
natural organic film or coating can
significantly increase the wettability
(Figure 16). This is in agreement with the
findings of Guillon et al (1997).

Figure 14
The arrangement of apparatus to measure the contact angle with a laser. The laser beam
strikes a point on the circumference of the liquid adherent to the lens surface. Two lines
are produced on a protractor and the angle between these lines is the contact angle

Figure 15
The wetting angles of five rigid lenses of different material. Each material is shown with a
pre-wear and post-wear wetting angle. The angles were determined using the adherent
liquid-laser method

Surface hydrophilicity
The wettability of a surface can be assessed
using the contact angle (or wetting angle)
as a measurement of this property. It relates
to how well a liquid spreads across a
surface. Hydrophilicity is different in as
much as this property determines the
strength of attraction of a liquid to a lens
surface. In Figure 17, a contact lens has its
front surface immersed in a liquid (a). The
lens is gradually withdrawn from the liquid
and a point is reached when the separation
force is at its maximum (b), and then as the
lens is further withdrawn, the separation
force declines (c) and, finally, there is a
separation of the lens surface from the

liquid. This is represented in diagrammatic

form in Figure 18. A measurement of the
maximum force at this critical distance
of withdrawal is a measure of the
hydrophilicity.
Shirafkan (1997) showed that the
flatter the front surface radius of the lens,
the greater the maximum force. He also
showed that the polishing time for a rigid
lens could influence this parameter. For
example, in Polycon II material:
One minute of polishing
Three minutes of polishing
Five minutes of polishing

JULY 30 1999 OPTOMETRY TODAY

Maximum force
380mg
405mg
360mg

33

sponsored by

Contact lens surface properties and interactions

DISTANCE LEARNING MODULE 1 PART 8

Figure 16
The wetting angles of eleven hydrogel materials of different water content. All the postwear values are approximately the same at 2. The angles were determined using the
adherent liquid-laser method

Thus, for this particular material,

polish, weight on polishing head used
and a polishing time of around three
minutes gave the optimal hydrophilicity.
A further experiment showed that
new lenses exhibited a greater
hydrophilicity than lenses which had
been worn (Figure 19). Interestingly,
PMMA showed the best post-wear
hydrophilicity. Older readers will recall
that PMMA lenses were actually quite
successful in many ways, although the
wettability and oxygen permeability are
considerably better in contemporary
materials.
A similar picture is seen with soft
lenses. The higher the water content,
the greater the hydrophilicity. Also,
when the lenses have been worn, the
very coating that makes the lens more
wettable makes the surface less
hydrophilic. This is shown in Figure 20.
To the practitioner this is a valuable
lesson. A material has two important
surface properties - its wettability and its
hydrophilicity, which are not the same.
To choose a material with a low wetting
angle is not always very significant as the
tear components which coat the lens
will tend to give the same wettability
values for all lenses. At the same time as
tear components are laid down, the
hydrophilicity of soft and rigid lenses is
reduced. Conversely, patients with
unusual tears and blinking patterns may
well find that certain materials give
them better wearing times and comfort
than others.

Figure 17
In order to assess hydrophilicity, the contact lens has its front surface immersed in liquid
(a). The lens is withdrawn gradually until a maximum force is registered (b). Further
withdrawal results in the force reducing (c) and eventually the liquid separates from the lens

Figure 18
Changes in the withdrawal force as a function of withdrawal distance.
As can be seen, the maximum force needed occurs at a specific or
critical distance and this maximum force value gives the hydrophilicity

34

JULY 30 1999 OPTOMETRY TODAY

Figure 19
The pre-wear and post-wear values for hydrophilicity as
represented by the maximum force values for five different rigid
lenses

Contact lens surface properties and interactions

DISTANCE LEARNING MODULE 1 PART 8

Acknowledgements
The author is indebted to the following
main sources of material:

Figure 20
The pre-wear and post-wear values for hydrophilicity as represented by the maximum
force values in three different soft lens materials

About the author

Dr A. Shirafkan, PhD thesis,

City University, London.
Dr R. Bowers, lecture series given to
City University students.
Dr B. Tighe, Contact lens
materials. Contact Lenses (1997)
4th Ed, Butterworth-Heinemann,
Oxford.
Eds Ruben, M. and Guillon M.
(1994) Contact lens spoilation in
Contact Lens Practice, Chapman &
Hall, London.
The International Association of
Contact Lens Educators (IACLE) for
slides used in Figures 1, 3-6 and 8.
References
For a full set of references please fax
01252-816176.

Michael Port is a senior lecturer in the Department of Optometry and Visual Science at
City University. He is responsible for second year clinical practice and contact lenses.

Multiple choice questions

Contact lens surface properties and interactions
Please note there is only ONE correct answer.
1. Which of the following would not
be classed as a biological
interfacial conversion event?
a. Formation of dental plaque
b. Blood clotting
c. Protein deposition on contact
lenses
d. Contact lens-associated
papillary conjunctivitis
2. A classification system for lens
deposits was described by:
a. Holden
b. Rudko
c. Tighe
d. Harris
3. Protein tends to be deposited
more easily on which type of
material?
a. Ionic hydrogels
b. Non-ionic hydrogels
c. Zwitterionic hydrogels
d. Surface treated silicone
elastomers
4. An anionic material will have:
a. no charge
b. a positive charge
c. a negative charge
d. positive and negative charges

5. The most significant effect of

calcium in the formation of
discrete lipid deposits is to:
a. give a white appearance
b. attract cholesterol
c. stabilise fatty acids
d. coat the lipid material
6. On a jelly bump deposit the mass
is usually coated with:
a. calcium
b. protein
c. lipid
d. mucin
7. Round orange-brown deposits,
which are approximately 500m in
diameter, would normally be
caused by:
a. melanin
b. nicotine
c. thiomersal
d. ferrous particles
8. When measuring the front surface
drying time on a contact lens, the
surface will finally have which type
of appearance?
a. Whitish film
b. Clear lens surface with
no water present
c. Granular dull appearance
d. Bright glass-like appearance

9. A grey discoloration is likely to

be due to which substrate?
a. Chlorexidene
b. Thiomersal
c. Benzalkonium
d. Potassium sorbate
10. Contact angles are
not measured using:
a. moir fringes
b. a goniometer
c. a captive bubble
d. a Wilhelmy plate
11. Hydrophilicity is:
a. a measure of lens wettability
b. the attraction of a liquid
to a surface
c. a property related to
the contact angle
d. the opposite of surface rugosity
12. An equilibrium contact angle
would be:
a. greater than the advancing angle
b. smaller than the receding angle
c. somewhere between the
advancing and receding angles
d. the Sine of the angle a drop of
liquid makes with a solid
substrate

An answer return form is included in this issue. It should be completed and returned to:
CPD Initiatives (CDM8), Optometry Today, Victoria House, 178-180 Fleet Road, Fleet, Hampshire GU13 8DA, by September 8, 1999.

JULY 30 1999 OPTOMETRY TODAY

35

Contact lens surface properties and interactions

DISTANCE LEARNING MODULE 1 PART 8

Multiple choice answers

The effect of contact lens wear on the ocular environment
Here are the correct answers to
Module 1 Part 7 which
appeared in our July 2 issue
1. The minimum percentage of oxygen
required to avoid corneal swelling
in the closed eye situation is
considered to be:
a. 10%
b. 13%
c. 18%
d. 21%
c is correct
In 1948, Holden and Mertz showed that
18% of oxygen is needed in the closed eye
situation to avoid corneal swelling greater
than the physiological amount normally
occurring overnight.
2. In currently available hydrogel
contact lenses, increasing the
water content:
a. decreases the refractive index
b. increases the refractive index
c. has no effect on the refractive index
d. increases lens tensile strength
a is correct
With current hydrogel lenses, increasing the
water content lowers the refractive index.
3. All of the following hypoxic induced
changes are reversible except:
a. epithelial microcysts
b. stromal striae
c. vascularisation
d. endothelial guttatae
c is correct
Although the vessels may empty of blood
on cessation of lens wear or refitting, the
vessels themselves remain a permanent
feature.
4. The antigenic load of a contact
lens depends on all of the
following except:
a. the health of the conjunctiva
b. the surface characteristics of the
contact lens
c. the surface area of the contact lens
d. corneal sensitivity
d is correct
There is no connection between the
antigenic load of a contact lens and
corneal sensitivity

36

5. The greatest reduction in corneal

sensitivity following contact lens
wear is induced by:
a. RGP lenses
b. low water content hydrogel lenses
c. high water content hydrogel lenses
d. PMMA lenses
d is correct
Millidot first reported in 1984 that the
greatest reduction in corneal sensitivity
follows the wearing of PMMA lenses.
6. Long-term contact lens wear
induces all of the following except:
a. increased corneal light scatter
b. stromal thinning
c. changes in the bacterial flora of the
conjunctiva
d. increased tear evaporation
c is correct
Contact lens wear alone is not thought to
modify the spectrum of bacteria found in
the conjunctival sac, although where
bacterial infection occurs the spectrum of
bacteria involved is different from that in
non wearers.
7. The chemical agent found in
contact lens care systems, most
likely to produce a toxic ocular
response, is thought to be:
a. chlorhexidine
b. polyhexanide
c. hydrogen peroxide
d. thiomersal

9. The resistance to microbial infection

of the cornea is reduced in contact
lens wear by all of the following
except:
a. epithelial fragility
b. relative hypoxia
c. corneal warping
d. reduced sensitivity
c is correct
Corneal warping is not known to reduce the
resistance of the cornea to infection.
10. Which one of the following is
the most frequently found gram
negative bacteria associated with
keratitis in contact lens wearers:
a. pseudomonas aeruginosa
b. serratia species
c. proteus species
d. candida albicans
a is correct
In several studies, Pseudomonas
aeruginosa has been isolated as
the causative organism in 70% of all
culture positive cases of lens-related
infections.
11. Contact lens wear has
the following effect on tears:
a. increases evaporation
b. decreases evaporation
c. increases viscosity
d. decreases viscosity

d is correct
Although all of the above have been
recorded as producing a toxic ocular
response, the most frequent reports and
the most severe responses have been with
thiomersal.

a is correct
Tomlinson and Cedarstaff first
demonstrated that contact lens wear
increases the rate of tear evaporation in
1982.

8. The disinfection system least

likely to produce an adverse
reaction in the eye is:
a. chlorine based
b. heat
c. polyquad
d. hydrogen peroxide

12. When compared to the general

population, atopic patients
tend to have:
a. thicker corneas
b. thinner corneas
c. larger diameter corneas
d. smaller diameter corneas

b is correct
There are no reports of lenses disinfected
by heat having an adverse effect on the
eye. There may be adverse effects on the
lenses.

b is correct
Atopic patients have been found to have a
greater number of corneas in the lower end
of the normal distribution of corneal
thickness.

JULY 30 1999 OPTOMETRY TODAY