.... ­ .
­
OXYGEN CONSUMPTION AND
MEASUREMENT
R.M. Hill
22.1 EARLYCLUES
A jungle fighter under compromising condi­
tions, a street trader with keratoconus and a
high myope given to an optimistic indiffer­
ence ... all shared one thing in common:
gross degrees of overwear syndrome (Dallos,
1946). When described by Dallos in the
194Os, such examples were still fairly com­
mon, even though the origins of such stress
were already being explored. Indeed, clinical
experiments with lens apertures and tear
exchange by Dallos himself were pointing
ever more convincingly towards hypoxia as a
principal cause.
On even cursory review, of course, the
earliest literature too was rife with dues of an
oxygen starvation problem. Such phenom­
ena as the gradual development of a 'slight
bluish haze in daylight and colored halos
around lights in the dark' were described as
early as 1889 by A. Muller, a response later
designated 'Sattler's veil'. after Professor
C.H. Sattler of Koeningsberg.
By 1934, Dallos and Sattler, through per­
sonal communications, had even reached the
shared opinion that oedema was the physical
cause and the epithelium the site of that
veiling effect. It was however, left to Finkel­
stein (1952), through his elegant observa­
tions and mathematical analyses, to relate the
two directly.
Contact Lens Practice. Edited by Montague Ruben and Michel Guillon.
Published in 1994 by Chapman & Hall, London. ISBN 041235120 X
22
Other investigators, both earlier and later,
such as Fick, Pannus, Muller-Gladbach, Fis­
cher, Duane, de Roetth and Smelser contrib­
uted basic pieces to the mosaic as well, firmly
linking adequate oxygen to normal corneal
physiology, and hypoxia to a catalogue of
dysfunctions (Hill & Cuklanz, 1967), ranging
from the most subtle fading of sensation as
described by Millodot and O'Leary (1980), to
frank loss of the epithelium.
22.2 HOW MUCH?
By the early 1960s, the first measurements of
corneal oxygen uptake directly on the living
human eye were achieved. These observa­
tions were made by Hill and Fatt (1963) using
several reservoir and contact chamber com­
binations. Retrospectively, it was a mini­
mum clearance scleral lens design having no
membrane, but using balanced saline as a
reservoir, which provided the most consis­
tent (and generally median) data. Although
cumbersome, and lacking substantially in
comfort over the period the subject was
required to wear it (the better portion of an
hour), this saline medium technique did
carry with it the inherent advantage of
known gas constants. The parallel constants
for a series of membrane reservoirs now
commonly used have, however, not been so
universally agreed upon, often making their

486 Oxygen consumption and measurement
associated results difficult to interpret in
absolute units.
The average corneal uptake value pub­
lished by Hill and Fatt for the human cornea,
based on their saline reservoir observations,
was 4.8 microlitres per square centimetre of
corneal surface per hour. There was however
another less widely recognized, but perhaps
even more important observation given in
that report, i.e. that the uptake rates mea­
sured where found to slow to as little as 1.5
ul/crrri/h, when the reservoir oxygen tension
fell to 50 mmHg. Such reduced oxygen condi­
tions may exist (on average) chronically
under a contact lens with varying conse­
quences ranging from the clinically undetect­
able (at very low levels and for extended
periods) to the extreme responses reported
by those early investigators listed above.
22.3 NORMAL DIFFERENCE
While the earliest figure for human corneal
oxygen uptake cited by Hill and Fatt (1963)
was a mid-range value, i.e. 4.8 ~.l1/cm2/h from
a span of 3.2 to 7.2 !J,l/cm2/h measured for
near ambient (open eye conditions). Larke et
al. (1981) more recently, on studying 68 male
Caucasians, found an even broader range
among individuals of that population: some
3 to 91JI/cm2/h.
This three-fold variation among subjects
(Larke et al., 1981) was well above the instru­
mental variation (i.e. error threshold) of their
systems (8.1%). Also, when sequences of
measurements were done on a given eye, no
progressive shift occurred, indicating that
irritation or debilitation due to repeated
probe contact was not the basis of such
differences; neither was the time of day
(between 9.00 a.m. and 9.00 p.m.) found to
make a significant difference for any particu­
lar eye.
Differences in the number of epithelial cell
layers among corneas may however be one
basis for that population range. Larke et al.,
(1981) also point out that such natural differ­
ences in corneal oxygen demand 'may pro­
vide part of the explanation of the generally
observed differences in the manner in which
patients respond to contact lens wear.'
22.4 OPEN VERSUS CLOSED EYE
Among the more difficult of the natural cor­
neal factors to analyse is the closed eye
condition. The difficulty in part lies in what
constitutes a state of 'closure.' If, for example,
the lids are held tightly closed by clips, then
oxygen levels of 5% or lower (on a scale
where 21 % = air) may occur, as reported by
Roscoe and Hill (1980). Natural closure, i.e.
with the lid musculature more relaxed and
with a less perfect seal, may result in higher
values (e.g 7% by Benjamin (1982) or even
11 % by Efron and Carney (1979).
Even under those more physiological con­
ditions, however, Benjamin (1982) found that
the new closed-eye oxygen level was estab­
lished in little more than 3 min, and that
'fluttering' of the eyelids could raise that
level measurably. For the average patient,
however, such reduced levels over night
appear to be less than optimum, as 2 to 4%
swelling of the cornea is common on awak­
ening (Mandell & Fatt, 1965; Fatt & Deutsch,
1981)
22.5 THE BLINK
The blink, in the context of corneal oxygen­
ation assumes a special significance of course
with the presence of a contact lens. But the
efficiency of the lid-lens tear pump resulting
can differ markedly between rigid and soft
(hydrophilic) lens types. As shown by Polse
(1979), very little dependence for oxygen
should be placed on the pump in hydrophilic
lens cases, as a 1 % exchange of tears per
blink is about the most to be expected. This
is not to say, however, that such a pump is
entirely without value. It may in fact be very
significant in the clearance of both molecular
level and grosser particles (e.g. desquamated

cells) from under the lens.
In contrast to the soft lens, when acting in
conjunction with a rigid lens the blink can
form, with appropriate design, a highly
effective tear (oxygen) pump system. The
efficiencies of such systems were calculated
by Cuklanz and Hill (1969) by loading the
bowl of a contact lens with a known concen­
tration of sodium ions and then measuring
their progressive escape into the outside tear
pool on successive blinks. The four eye-lens
systems studies were all fitted parallel to the
flattest meridian of the cornea, and using a
first order model (i.e. one that did not com­
pensate for small amounts of backflow), the
proportion of the post-lens tear pool replaced
per blink was found to range from 10 to 17%.
This exchange rate is on the average some 13
times more efficient than for the soft lens
systems described earlier, and is, of course,
the physiological key to those many thou­
sands of oxygen impermeable PMMA lenses
that were fitted with reasonable success over
several decades.
By the end of the 196Os, it was possible to
observe the blink-driven lens-tear pump
directly. This was done by Hill and Schoe­
ssler (1969) by building a sensor right into a
corneal contact lens in such a way that the
oxygen level of the post-lens tear pool could
be continuously monitored. This experiment
revealed a 'saw-toothed' cycle, composed of a
slow 'down-drift' segment (as the cornea
drew oxygen from the post-lens tear pools
during the interval between blinks), fol­
lowed by a rapid up stroke (as the blink
action brought freshly oxygenated tears into
the pool again). For any particular blink
frequency, an average oxygen level would
eventually be established. The faster the
blink rate, the higher that average would be.
In certain systems however, if the blink rate
became very slow, the post-lens tear pool
could become entirely depleted of oxygen
over the latter portion of the inter-blink
interval (Cuklanz & Hill, 1969; Fatt & Hill,
1970).
The equivalent oxygen percentage (EOP) 487
22.6 THE EQUIVALENT OXYGEN
PERCENTAGE (EOP)
Although leading estimates of how a lens
might influence or impair oxygen availabil­
ity at the corneal surface have long been
possible (i.e. by advance physical testing,
such as Dk/L measurements), as have trailing
assessments (e.g. pachometry of a resulting
oedematous state), a rapid response, mini­
mum stress observation involving a particu­
lar lens on a particular eye could be very
useful as well.
Further, such a test should be non­
invasive and its results should be directly
and quantitatively comparable to common
standards and reproducible conditions, such
as a no lens state (i.e. the open eye in air), an
impermeable lens state (e.g. a thick PMMA
lens under non-blink conditions) or to the
response of a reference lens with an oxygen
transmissivity between those two extremes.
Also, such a test of corneal oxygen demand
should lend itself to assessing a closed eye
history, as well as the steady open eye state, or
any blink rate (i.e. lid-lens tear pump) combi­
nation of frequency and gaze positions. The
influences of temperature, humidity, pH, tear
osmolality and other environmental factors
affecting corneal metabolism and lens status
should be detectable and assessable through
such a procedure.
A technique called the equivalent oxygen
percentage (EOP) method was developed in
the late 1960s to approach these require­
ments and needs for contact lens and corneal
studies (Hill, 1977). The rationale for the
method if> reflected in the four effects shown
schematically in Figure 22.1. In Frame (a), an
oxygen probe and reservoir are placed down
onto the surface of a cornea that has been
freely exposed to air. The emptying time of
oxygen from the probe reservoir in this case
is relatively slow, as indicated by the gentle
slope of the graphical trace.
In Frame (b), the same procedure is
repeated except that the cornea in this
488 Oxygen consumption and measurement

(a)
r7 ~L
.c:»;
Air IlL1

~ Emptying time

(b)
Impermeable PMMA r7 ~L
contact lens
IE

~ ~ Emptying time

(c)

Semi-permeable
r~~
~
contact lens

.r:»; ri1
~ Emptying time

(d)
Goggle r: ~~
1;/00 21
~
~ ~ Emptying time

Figure 22.1 Corneal responses to four oxygen conditions. (a) Just following a prolonged period in air;
note the slow emptying rate of the measuring probe's oxygen reservoir. (b) Just following a prolonged
period under an impermeable PMMA contact lens; note the very rapid reservoir emptying rate. (c) Just
following a prolonged period under a semi-permeable contact lens. (d) Just following prolonged
exposure to an oxygen percentage (contained by a goggle over the eye), which produces immediately
afterwards, a reservoir emptying rate equal ('equivalent') to that caused by the semi-permeable contact
lens.

instance has an immediate past history of
oxygen impermeability (e.g. thick PMMA
contact lens wear). The reservoir exhaustion
rate here is very rapid, indicating that the
cornea during that period of wear had fallen
to, and had been maintained at, some very
much lower oxygen level. The steepness of
the graphical slope (in mmHg/s units) is
directly related to the relative severity of that
hypoxic condition. In Frame (c), the reservoir
exhaustion rate following semi-gas perme-
able lens wear is somewhere between those
two extreme conditions in Frames (a) and (b).
A means of calibrating the oxygen passing
performance of that semi-permeable lens is
shown in Frame (d), wherein a series of
known oxygen percentages are maintained
in a goggle over the cornea, until that par­
ticular percentage is identified which pro­
duces the identical reservoir exhaustion rate
(graphical slope) as did the semi-permeable
contact lens being tested. Once that slope

match is made, the test lens can then be said
to have caused the cornea to behave as if it
had been living in an atmosphere equivalent
to that percentage of oxygen which mim­
icked it in the goggle experiments - hence
the equivalent oxygen percentage (EOP) des­
ignation. Standard calibration curves based
on statistically constructed goggle experi­
ments have been generated, originally for
rabbit, and now for the human cornea as well
(Benjamin, 1982; Roscoe & Wilson, 1984).
The 'air' experiment in Frame (a) is of
course a kind of 'natural' (i.e. open eye, best
oxygen condition) control, against which the
performances of test lenses can be directly
compared. However only certain flexible
'pure' silicon rubber lenses have approached
that level of oxygen passage (Hill, 1977).
Another control, in diametric contrasi: to
the 'air' condition, is the tight impermeable
(e.g. a thick PMMA) lens condition. Under
static circumstances, such a lens fitted 'paral­
lel' to the eye surface can produce a state of
near maximum hypoxia within 120 s. A
nitrogen filled goggle can be used to create
this extreme condition as well, but may differ
slightly in the final steady state level of
oxygen achieved, as the two methods vary in
several fundamental ways. For example, a
100% nitrogen atmosphere may actually
drain oxygen from the eye, acting like an
infinite sink for that gas; carbon dioxide may
be vented in an unusually efficient way for
the same reason. A gas impermeable (contact
lens) shell, on the other hand, would not
draw oxygen from the eye by such an aque­
ous to atmosphere gradient, and would tend
as well to block carbon dioxide escape by
containing it in the post-lens tear pool. For
contact lens testing, then, the impermeable
plastic control rather than the 'infinite' nitro­
gen sink would seem to be the more appro­
priate model to use for lens testing.
It should be noted that the fundamental
steps for determining an EOP value, as
described above, related to how the cornea
responds to a test lens under 'static' or
The equivalent oxygen percentage (EOP) 489
'steady state' conditions, i.e, without a lid­
lens pump acting, and following the estab­
lishment of a steady flow of oxygen into the
cornea based on the tension gradient across
it, the associated tear and tissue resistances,
and the on-going oxygen demands of the
cornea. The 'static' EOP, then, should be
reflective of (or related to) the transmissivity
properties of a test lens only. As the lid-lens
pump is unique for each lens-eye examina­
tion, the 'static' EOP offers the unique
advantage of 'factoring out' the pump vari­
able.
Should it be desirable, however, to know
for a given eye the summed effects of pump
and transmissivity, a 'dynamic' EOP can be
measured, i.e. following a sufficient
sequence of blinks for the regular oscillations
of oxygen within the tear pool to remain
about a stable average. Efron and Carney
(1981) have demonstrated for example, using
the dynamic EOP, the very small oxygen
contribution made by the lid-lens pump in
hydrophilic lens systems. Their measure­
ments directly confirm the fluorescein obser­
vations described by PoIse (1979), who found
very little tear exchange per blink under
hydrophilic lenses as well. Although Efron
and Carney did not include rigid lenses
directly in their study, the dynamic EOP for
these lens types based on the earlier ion
tracking measurements of Cuklanz and Hill
(1969) might be predicted to be substantially
higher, most particularly, however, because
the success of earlier impermeable (i.e.
PMMA) lens systems relied entirely on tear
pump exchange for corneal oxygen.
While determination of oxygen passage
through a given lens and at a particular site
(e.g. the centre) would be the most funda­
mental yield of the static procedures above,
an EOP evaluation over a range of material
thicknesses can be very useful to the manu­
facturer and practitioner alike - to the
former, for determining the thinnest warp­
free dimension for a test material while
achieving the highest oxygen throughout.
 490 Oxygen consumption and measurement
For the practitioner, knowing the oxygen
limitations of materials helps in the choice of
the most effective trade-offs between that
property and others of special importance in
the ultimate choice of lenses. An 'EOP curve'
is such a summary of 'static' condition oxy­
gen performances across the lens thickness
spectrum, and can be used to determine
lems chronically resulted however from
. oxygen availability at local sites under a lens
using the Dk value alone as a performance
or, knowing its average thickness, the aver­
index: (1) deriving the Dk is dependent on
age EOP performance for the entire lens.
EOP values generated in this laboratory
have three inherent characteristics: (1) they
are relative to an altitude of 235 metres above
sea level, thus approximating the tension
environments of a large proportion of the
contact lens wearing population; (2) being
done on a living eye, EOP values relate only
to eye temperature conditions; and (3) in the
case of hydrophilic lenses, the water level of
the tested lens is set to approximately 90% of
the label value in order to reside within the
hydration range characteristic of most ambi­
ent wearing conditions.
22.7 OTHER OXYGEN ESTIMATES
The Dk/L estimate of lens performance dif­
fers from the in vivo method above in that it
does not involve an eye in its measurement
process. It is, rather, a physical or 'bench'
measurement of oxygen passage, and as such
serves as a predictor of what a lens may
provide on the eye (i.e. its 'static' or non-lid­
lens pump contribution). Reference to Fatt
(1978) is recommended for a detailed
description of the Dk/L method.
Being a physical test which can be done
under carefully controlled and replicated
conditions, the Dk/L estimate does have the
potential for good accuracy and repeatability.
As with all such critical testing procedures,
however, best absolute (and comparative, i.e.
between lenses) results can be expected only
when samples are measured within the same
laboratory.
Initially the most popular index (or refer­
ence value) taken from that physical testing
procedure was the Dk, or oxygen permeabil­
ity value, of the material from which a test
lens was to be made (obtained by multiply­
ing the Dk/L of a lens or flat which was
actually measured by L, the thickness of the
tested specimen in centimetres). Two prob­
knowing the exact thickness at the site(s) of
measurement of a test lens (or better, a
uniform thickness flat). Maintaining a con­
stant thickness in hydrophilic cases and
then measuring it accurately remains a
challenge; and (2) as lenses or flats (of the
same material) are made progressively
thinner (particularly in the range of com­
mon myopia prescriptions), the calculated
Dk, may not be constant throughout (i.e.
the ratings for thinner samples tend to be
relatively poorer than their performances
should actually merit (Fatt & Chaston,
1982).
Use of a directly measured Dk/L, i.e. lens
or flat transmissivity, combined with the
application of a carefully calibrated system
for determining thickness (or better average
thickness for the whole lens), should provide
a more reliable measure of oxygen passage
than a Dk (i.e. material permeability) for a
particular polymer being studied.
Also, as the performance of an ophthalmic
plastic must ultimately be judged under 'in
the eye' conditions, the convention of mea­
suring all Dk/L values at eye temperature
should be encouraged. Such a convention
would (1) eliminate different Dk/L values
being cited for the same specimen due to
different testing temperatures; and (2) make
comparisons with EOP findings (which are
only made at eye temperature) legitimate
then in all cases.
Can reasonable agreement be found
among predictors of oxygen performance? As
the EOP and Dk/L procedures can both be
done without the presence of the lid-lens
 Some exceptional subjects and circumstances
tear pump, a comparison of their results
should be possible. The more fundamental
question then becomes: How well does each
predict the other?
Several sets of independent observations
and assessments have been made upon
which equations containing these two pre­
dictors have been based. Three of the more
recent analyses are:
1. Fatt and Chaston's (1982) model fitted to
the data of Novicky and Hill (1981). Their
equation for relating those two numbers is:
EOP = 2.06 X 108 (Dk/L) -0.07
The correlation coefficient of the two based
on the original data was found to be +0.94.
2. Holden and Mertz's (1984) model fitted
to EOP data from Hill's laboratory for vari­
ous lens types during the period of 1975 to
1980 for which Dk/L values could be
obtained. Their equation for relating these
two measures is:
EOP (%) = 6.915 X In (Dk/L X 109 ) -9.778
The correlation coefficient of the two from
that database was found to be +0.995.
3. Roscoe's (1984) model derived from his
own EOP and Dk/L data base on the same
lenses yielding the equation:
EOP (%) = '7.2 X 10~ Dk/L - 0.50
The correlation coefficient for those two
measures fOT the open eye was found to be
+0.96.
For the closed eye, the relationship found
was:
EOP (%) = 1.4 X 108 Dk/L - 0.27
with a correlation coefficient of +0.99.
Similarly, relationships between corneal
swelling (pachometry) due to lens induced
hypoxia and lens Dk/L have now been dem­
onstrated by Holden and Mertz (1984) with
correlation coefficient values for 'Day 1 maxi­
mum' swelling responses, and the 'first
491
overnight' swelling response with lens trans­
missivity, being - 0.96 and - 0.92, respec­
tively.
The EOP and DklL procedures might be
classed as 'leading indicators' (i.e. by hav­
ing early feasibility and by being immedi­
ate in outcome) of long-term wear results to
be expected from an experimental material.
Corneal enzyme analyses, e.g SOH and
LOH/MOH determinations under labora­
tory conditions may prove to be useful
advance (pre-human trial) estimates of
material performance as well (Rengstorff &
Hill, 1974; Fullard & Carney, 1984).
Pachometry, for the purpose of monitoring
corneal swelling, lends itself very well to the
tracking of those changes over extended
periods in the daily or extended wear. Par­
ticularly where weeks or months may be
involved, pachometry can be considered a
highly useful, non-invasive 'intermediate
indicator' of hypoxic responses (Holden et
al.,1983).
One example of a promising 'following
indicator' may be endothelial polymegath­
ism. Although this long-term result of lens
wear may have multiple bases (e.g. pH,
enzyme or waste disturbances), its relatively
greater prominence in association with
impermeable (e.g. PMMA) materials, versus
its lesser development or near absence in
association with progressively more perme­
able materials, suggest oxygen deprivation to
be a primary aetiological factor (Schoessler,
1983).
22.8 SOME EXCEPTIONAL SUBJECfS AND
CIRCUMSTANCES
Apart from normal variations of corneal
demand and the superimposed effects of
environment e.g. blink rates (Carney & Hill,
1982), closed eye periods (Efron & Carney,
1979), altitude (Hill, 1981), several other fac­
tors may influence the oxygen demand of the
cornea. Just four examples will be mentioned
here:
492 Oxygen consumption and measurement
22.8.1 DEMANDS OF THE OXYGEN
DEPRIVED CORNEA
Responses of the cornea immediately follow­
ing periods of reduced oxygen exposure have
been studied recently (Benjamin, 1981; Ben­
jamin & Hill, 1985). Two kinds of questions
were dealt with. First, how little reduction of
oxygen would the cornea 'notice'; and sec­
ond, were there any 'discontinuities' in the
responsiveness of the cornea as the concen­
trations of oxygen were progressively
reduced.
In answer to the first question, the effect
of reducing the oxygen percentage to even
three-quarters of its normal level, i.e. down
to 16%, was readily apparent. Clear detect­
ability from normal at that level suggests
then that a point somewhere between 16%
and a full atmosphere is where the 'hypoxic
threshold' must for most subjects reside.
Holden et al.'s (1983) value of 17.9%, was
given as the ideal minimum contact lens
transmissivity to avoid abnormal corneal
swelling patterns due to extended wear
lenses, may be an even closer indication of
that threshold (Holden & Mertz, 1984).
The other observation from Benjamin's
relative deprivation studies was that when
responses to progressive levels of oxygen
deprivation were analysed on a rate basis,
i.e. by looking at the acceleration of the
cornea's oxygen demand, a level is reached,
at about the 1.5% EOP, where a very
marked increased in oxygen uptake takes
place. This level happens to correspond to
the original lower limit set by PoIse and
Mandell (1970) as a minimum oxygen level
for daily contact lens wear, and represents
by today's standards a fairly discernible
level of slit lamp evident change. The 5%
EOP level corresponds to the upper end of
the Mandell and Farrell range, and is still
accepted by many today as a daily wear
minimum standard, with about 3% EOP
corresponding to the current lower limit
(Mandell & Farrell, 1980). The 1.5 to 2.5%
range of PoIse and Mandell would, for most
patients today, be considered to indicate
measurable changes. And indeed, that
lower range limit does correspond very
closely to the average change point in oxy­
gen uptake behaviour of those seven
human corneas described by Benjamin
(1982). Holden and Mertz, in 1984, recom­
mended an EOP minimum for daily wear of
9.9%.
22.8.2 DEMANDS OF THE ANAESTHETIZED
CORNEA
Since ophthalmic office visits may involve
topical anaesthetic procedures (i.e. for
intra-ocular pressure measurements) as
well as contact lens care, the possible
effects of ophthalmic analgesics on corneal
metabolism becomes an area of practical
concern.
The first in vivo measurements to explore
the effects of specific agents on corneal
oxygen uptake were reported by Augs­
burger and Hill (1972). Their results
revealed a range of responses depending
on the particular agents and concentrations
used. Most severe in its effects was cocaine.
Using a concentration of 1.0% (a 4-drop
application) was found to depress the nor­
mal oxygen flux level by as much as 20%.
The effects of 0.5% (a 4-drop application)
was very similar. Fewer drops of each of
those same concentrations did result in less
flux depression however.
Benoxinate, at a concentration of 0.4 % (a
4-drop application) caused only a very mild
flux depression (not statistically significant
from no drug at all).
More recently Roscoe and Wilson (1983)
examined further the effects of topical anaes­
thesia on EOP values. The agent they inves­
tigated was proparacaine 0.25%. Their
conclusion was that the presence of this drug
did not produce a significantly different oxy­
gen uptake result from the anaesthetic-free
state.

22.8.3 DEMANDS OF mE HEALING CORNEA
Hill and Keates (1969) noted that, even when
the epithelium of the cornea was completely
removed, the flow of oxygen into the cornea
continued at about 20% of the pre-wound
level. This residual flux appears to be
accounted for principally by the substantial
gradient of oxygen tension between atmo­
sphere and aqueous, although stromal cell
uptake may account for a very small fraction
of that flow as well.
The oxygen demand course of the denuded
cornea as epithelial replacement progresses
was recently explored in greater detail by
Mauger and Hill (1985). Two phases of the
healing sequence were found and replicated
for six corneas followed over a 10-day period,
post-injury. The initial hypoflux period, last­
ing about 48 hours, would be expected of
course to be based on the absence and then
gradual build-up of very modest cell num­
bers within the wound zone. Reduced oxy­
gen uptake during that time may also be due,
however, to an inhibition of cell division
over that period, during which energy is
now known to be derived from stored glyco­
gen within those cells (Kuwabara et al., 1976).
The healing cornea then enters a second
phase in which a substantially greater than
normal oxygen uptake rate develops - the
hyperflux period, which peaked here in the
Mauger and Hill (1985) study at about 4 days
following the wound and then declined to
the pre-wound baseline by about the tenth
day. The cause(s) of that increased rate may
be the exceptional activities of those cells,
which include migration, adhesion and cell
division. The latter has been reported to
begin with a lifting of miotic inhibition
following the initial migration period (Arey
& Corode, 1943). It may be, then, that the
presence of a bandage lens during that
hyperflux period should be weighed very
carefully, i.e. with regard to the benefits of
mechanical protection versus the possible
delay of healing due to the relative hypoxia
Overview 493
imposed. A compromise would be to retain
the protective presence of a lens, but to
assure that that is of the very highest Dk/L
value possible.
22.8.4 DEMANDS OF rns APHAKIC EYE
CORNEA
Recently, the impression of many contact
lens fitters is that the cornea of the aphakic
eye is less demanding of oxygen, was
explored by Polse, Holden and Sweeney
(1983). They compared the eyes of 12 unilat­
eral aphakes, all of whom had undergone
uncomplicated intracapsular cataract extrac­
tion. Ten of the aphakic eyes had oxygen
uptake rates below their paired phakic
mates. Although the mean difference of
uptake rates between phakic and aphakic
eyes was not great, it was found to be signifi­
cant at the P < 0.005 level.
22.9 OVERVIEW
It appears then; that we have now experience
in three discernible phases of the oxygen
demand problem: (1) the identification and
reconfirmation of hypoxic effects on the cor­
nea: (2) the quantification of those short­
term, intermediate and long-term deficits in
terms of the demand behaviour and physical
changes in the cornea; and (3) the apprecia­
tion of demand differences among patients
and with particular ambient conditions. All
three, but most certainly the last, have pro­
vided substantial challenges to the contact
lens fitter for nearly a century now.
As this survey indicates, however, enor­
mous progress has been made over that
period, and those gains have every indica­
tion of continuing. Among those frontiers
even now being more fully explored: (1) site
differences in oxygen demand across the
surface of the cornea, i.e. between the lower
exposed cornea, and that region chronically
covered by the upper lid (Benjamin & Hill,
1988a): (2) the rapidity of demand increase
494 Oxygen consumption and measurement
immediately following lid closure, and the
degree of relief associated with lid 'flutter'
(Benjamin & Hill. 1986); and (3) the individu­
ality of oxygen demand among normal,
healthy corneas, and the implications of
those differences (Benjamin & Hill, 1988b). In
many areas,· the more subtle, but in the
long-term most critical, thresholds and toler­
ances associated with corneal oxygen
demand may just now be coming into view.
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