The primary objective of this study was to quantify and characterise lipid deposition on soft (hydrogel) contact lenses, particularly those containing siloxane components. Studies involving a variety of <em>in vitro</em> doping and <em>in vivo</em> worn contact lenses were undertaken, in which lipid deposition was analyzed by either TLC or HPLC. Specific experiments were completed to optimize a method to extract the lipid from the lens materials, to compare the total lipid deposition on nine different hydrogel lenses and to analyze the effect that lipid deposition had on wettability. A method for extracting lipid from contact lenses using 2:1 chloroform: methanol was developed. This study also showed that siloxane-containing contact lens materials differ in the degree to which they deposit lipid, which is dependent upon their chemical composition. Small differences in lipid deposition that occur due to using variations in cleaning regimens were not identifiable through TLC, and required more sophisticated analysis using HPLC. Contact lens material wettability was found to be influenced by <em>in vitro</em> lipid deposition. Specifically, conventional hydrogels and plasma surface-treated silicone-hydrogel materials experienced enhanced wettability with lipid deposition. Reverse-phase HPLC techniques were able to quantify lipid deposits with increased sensitivity and accuracy. From the HPLC studies it was found that contact lens material, concentration of the lipid doping solution, and the composition of the lipid doping solution in <em>in vitro</em> deposition studies influenced the ultimate amount and composition of lipid deposits. <em>In vivo</em> HPLC studies showed that the final lipid deposition pattern was influenced by the interaction between the composition of the tear film and the various silicone hydrogel contact lens materials. In conclusion, HPLC analysis methods were more sensitive and quantitative than TLC. Lipid deposition was ultimately influenced by the concentration and composition of the lipid in the tear film and the contact lens material. Contact lens wettability was influenced by the presence and deposition of lipid onto the contact lens surfaces. Finally, this reverse-phase HPLC lipid analysis protocol was not the most sensitive, robust, or accurate. In the future, other methods of analysis should be explored.

Purposes: To use optical coherence tomography (OCT) to image and quantify the effect of various corneal conditions, in terms of corneal, stromal and epithelial thickness, and light backscatter. To assess the changes caused by overnight orthokeratology (Corneal Refractive Therapy; CRT^TM) lens wear, keratoconus and laser in-situ keratomileusis (LASIK) refractive surgery, each of which may lead to topographical alterations in corneal thickness either by temporary moulding, degeneration, or permanent laser ablation, respectively. <br /><br /> Methods: Topographical thickness of the cornea was measured using OCT in all studies. The CRT^TM studies investigated myopic and hyperopic treatment, throughout the day. The myopic studies followed lens wear over a 4 week period, which was extended to 12 months, and investigated the thickness changes produced by two lenses of different oxygen transmissibility. CRT^TM for hyperopia (CRTH^TM) was evaluated after a single night of lens wear. <br /><br /> In the investigation of keratoconus, OCT corneal thickness values were compared to those obtained from Orbscan II (ORB) and ultrasound pachymetry (UP). A new fixation device was constructed to aid in the measurement of topographical corneal and epithelial thickness along 8 directions of gaze. Pachymetry maps were produced for the normal non-lens wearing cornea, and compared with the rigid gas permeable (RGP) lens wearing cornea and the keratoconic cornea. <br /><br /> Thickness changes prior to, and following LASIK were measured and monitored throughout six months. Myopic and hyperopic correction was investigated individually, as the laser ablation profiles differ for each type of procedure. The LASIK flap interface was also evaluated by using light backscatter data to monitor healing. <br /><br /> Results: Following immediate lens removal after myopic CRT^TM, the central cornea swelled less than the periphery, with corneal swelling recovering to baseline levels within 3 hours. The central epithelium decreased and mid-peripheral epithelium increased in thickness, with a more gradual recovery throughout the day. There also seemed to be an adaptation effect on the cornea and epithelium, showing a reduced amount of change by the end of the 4 week study period. The thickness changes did not alter dramatically during the 12 month extended study. In comparing the two lens materials used for myopic CRT^TM (Dk/t 91 vs. 47), there were differences in stromal swelling, but no differences in the central epithelial thinning caused by lens wear. There was a statistically insignificant asymmetry in mid-peripheral epithelial thickening between eyes, with the lens of lower Dk causing the greater amount of thickening. Hyperopic CRT^TM produced a greater increase in central stromal and central epithelial thickness than the mid-periphery. Once again, the stroma recovered faster than the epithelium, which remained significantly thicker centrally for at least six hours following lens removal. <br /><br /> Global pachymetry measurements of the normal cornea and epithelium found the periphery to be thicker than the centre. The superior cornea and epithelium was thicker than the inferior. In the measurement of the keratoconic cornea, OCT and ORB correlated well in corneal thickness values. UP measured greater values of corneal thickness. The keratoconic epithelium was thinner than normal, and more so over the apex of the cone than at the centre. The location of the cone was most commonly found in the inferior temporal region. Central epithelial thickness was thinner in keratoconics than in RGP lens wearers, which in turn was thinner than in non-lens wearers. <br /><br /> Following LASIK surgery for both myopia and hyperopia, the topographical OCT thickness profiles showed stromal thinning in the areas of ablation. The central myopic cornea showed slight regression at 6 months. During early recovery, epithelial thickness increased centrally in hyperopes and mid-peripherally in myopes. By the end of the 6 month study, mid-peripheral epithelial thickness was greater than the centre in both groups of subjects. The light backscatter profiles after LASIK showed a greater increase in backscatter on the anterior side of the flap interface (nearer the epithelium), than the posterior side (in the mid-stroma) during healing. The flap interface was difficult to locate in the OCT images at 6 months. <br /><br /> Conclusion: All the CRT^TM lenses used in this project produced more corneal swelling than that seen normally overnight without lens wear. In order for these lenses to be worn safely for long periods of time without affecting the health of the cornea, they need to be manufactured from the highest oxygen transmissible material available. The long-term effect of thinning on the epithelium's barrier properties needs to be monitored closely. <br /><br /> Global topographical thickness of the cornea and epithelium was measured using OCT in normal, RGP lens wearing and keratoconic eyes. Corneal and epithelial thickness was not symmetrical across meridians. The epithelium of RGP lens wearers was slightly thinner than normal, but not as thin as in keratoconics, suggesting that the epithelial change seen in keratoconus is mainly due to the condition. <br /><br /> Post-LASIK corneal and epithelial thickness profiles were not the same for myopic and hyperopic subjects, since the ablation patterns vary. Epithelial thickening in the mid-periphery had not recovered by six months in myopes or hyperopes, possibly indicating epithelial hyperplasia. Light backscatter profiles were used to monitor the recovery of the LASIK flap interface, showing the band of light backscatter around the flap interface to decrease as the cornea healed.

<b>Purpose:</b> Assess the relationship between tear film drying and sensation between blinks. <b>Methods:</b> MATLAB sampled a slitlamp video camera, a potentiometer and a microphone while subjects kept one eye open for as long as possible. 23 subjects rated the intensity of the ocular sensation while video and voice data were collected simultaneously. The tear drying on the cornea was measured. <b>Results:</b> The sensation was triphasic. Two linear functions described the latter 2 parts of the data (r &#8805; 0. 95). The correlation between TBUT and the elbow in the time-discomfort function was 0. 72. Extent of tear film drying was linearly correlated to time (median correlation = 0. 88). The correlation between the discomfort elbow and image elbow was 0. 93 with single data pair for each subject. Analysis of sensation characteristics showed significant differences between itching and burning for both intensity and time (p = 0. 03 and p = 0. 02 respectively). <b>Conclusions:</b> Simultaneous recording of ocular surface appearance, discomfort intensity and attributes of sensation provide novel information about the development of discomfort during ocular surface drying. The rapid increase in discomfort proceeding blinking has been quantified and the relationship between the time course of drying and discomfort is elucidated.

Purpose: The aim of the study was to delineate differences in saccade characteristics between a population of athletes and non athletes. Aspects specifically investigated were latency, accuracy, peak velocity, and gain adaptation of saccades using both increasing and decreasing paradigms. Methods: A sample of 28 athletes (varsity badminton and squash players) and 18 non athletes (< 3 hour/week in sports) were studied. Eye movements were recorded at 120Hz using a video based eye tracker (ELMAR 2020). Each subject participated in 2 sessions on separate days. Baseline saccade responses to dot stimuli were measured in both sessions (stimulus size: 5-25 deg). The first session involved a gain decreasing paradigm, induced by displacing the stimulus backwards by 3 degrees from the initial target step (12 deg) for 500 trials. In the 2nd session a gain increase was induced by displacing the stimuli by 3 degrees in the forward direction. The latency and accuracy were calculated from the baseline. The asymptotic peak velocity was calculated from the main sequence (amplitude vs. peak velocity). The amplitude gains, calculated from the adaptation phase, were averaged for every 100 saccade responses. The averaged gains were normalized with respect to the baseline, fitted with a 3rd order polynomial, and differentiated to obtain the rate of change. Differences between the groups were compared using a regression analysis. Results: There were no significant differences in latency, accuracy, and asymptotic peak velocity between athletes and non athletes. No significant differences were seen between the two groups in the magnitude of saccadic adaptation, both for decreasing (- 15% in both groups) and increasing (athletes + 7% and non athletes + 5%) paradigms. However, athletes showed a significantly faster rate of adaptation for the gain increasing paradigm (F = 17. 96[3,6]; p = 0. 002). A significant difference was not observed in the rate of adaptation for the gain decreasing adaptation (F = 0. 856[3,6]; p = 0. 512). Conclusions: The study showed that the athletes do not respond better in terms of reaction time or accuracy of saccades. The significant difference in the rate of change of adaptation between the groups shows that online modification of saccades in the positive direction, although not greater in magnitude, occurs quicker in athletes than non athletes.

<strong>Purpose:</strong> Although orthokeratology (non-surgical corneal reshaping, Corneal Refractive Therapy, CRT®) has been used for almost a half century, contemporary CRT's outcomes and mechanisms still require investigation. A series of studies was designed to examine different aspects of non-surgical corneal reshaping for myopic and hyperopic corrections, including the efficacy and stability of this procedure, the effect of the lens material characteristics (Dk/t), and the corneal or superficial structural change (e. g. corneal/epithelial thickness) in corneal reshaping. <br /> <strong>Methods:</strong> In the CRT® for myopia (CRT1) study, 20 myopes wore CRT® lenses on one eye and control lenses on the contralateral eye (eye randomized) for one night while sleeping. Corneal topography and refractive error were measured the night prior to lens insertion, immediately after lens removal on the following morning and at 20 and 60 minutes and 3, 6 and 12 hours later. In the CRT® for hyperopia (CRTH) study, 20 ametropes wore CRT®H lenses on one eye for one night while sleeping, the contralateral eye (no lens wear) served as control (eye randomized). Corneal topography, aberrations and refractive error were measured the night prior to lens insertion, immediately after lens removal on the following morning and at 1 and 3, 6, 12 and 28 hours later. In the relatively long term (4 weeks) CRT® for myopia (CRT2) study, 23 myopes wore CRT® lenses overnight and removed their lenses on awakening. Visual Acuity (VA), subjective vision, refractive error, aberrations, and corneal topography were measured at baseline, immediately after lens removal on the first day and 14 hours later, and these measurements were repeated on days 4, 10, and 28. The treatment zone size was demarcated by the change in corneal curvature from negative to positive and vice versa, using tangential difference maps from the corneal topographer. In the study of effects of Dk/t on CRT® for myopia (CRTHDK), 20 myopic subjects were fit with Menicon Z (MZ) lenses (Dk/t=90. 6, Paragon CRT®) on one eye and an Equalens II (EII) CRT® lenses (Dk/t=47. 2) on the contralateral eye (eye randomized). Corneal topography, refractive error and aberrations were measured before lens insertion (baseline), and the following day after overnight lens wear, on lens removal and 1, 3, 6, 12 hours later. In the study of short term effects of CRT® for myopia and hyperopia (STOK), 20 ametropes wore CRT® and CRT®H lenses in a random order on one eye (randomly selected). The lenses were worn for 15, 30 and 60 minutes (randomly ordered, with each period taking place on a different day). Refractive error, aberrations, corneal topography, and corneal/epithelial thickness (using OCT) were measured before and after lens wear. The measurements were performed on the control eyes at 60 minutes only. <br /> <strong>Results:</strong> In the CRT1 study, after one night of CRT® for myopia, the central cornea flattened and the mid-periphery steepened, and myopia reduced. In the CRTH study, after one night of CRT® for hyperopia, the central cornea steepened and the para-central region flattened, myopia was induced or hyperopia was reduced, all aberrations except for the astigmatism increased and signed spherical aberration (SA) shifted from positive to negative. In the CRT2 study, after 4 weeks of CRT® lens wear, in general, the treatment zones stabilized by day 10, vision improved, myopia diminished, total aberration and defocus decreased and higher order aberrations (HOAs) including coma and SA increased. The visual, optical and subjective parameters became stable by day 10. In the CRTHDK study, after one night of CRT® (MZ vs. EII) lens wear, the central corneal curvature and aberration were similar with a slight exception: The mid-peripheral corneal steepening was greater in the EII (lower Dk/t) lens-wearing eyes compared to the MZ (higher Dk/t) eyes. In the STOK study, after brief CRT® and CRT®H lens wear, significant changes occurred from the 15 minutes time point: The corneal shape and optical performance changed in a predictable way; the central cornea swelled less than the mid-periphery after CRT® lens wear, whereas the central cornea swelled more than the para-central region after CRT®H lens wear; the central epithelium was thinner than the mid-periphery after CRT® lens wear and was thicker than the para-central region after CRT®H lens wear. <br /> <strong>Conclusion:</strong> After one night of lens wear, CRT® and CRTH® lenses were effective for myopia and hyperopia correction, respectively. In the 4 week CRT study, the treatment zone size changed during the first 10 days. Its size was associated with VA, refractive error, aberrations, and subjective vision. In the CRTHDK study, after one night of lens wear, changes in corneal shape were slightly different, with more mid-peripheral steepening in the lower Dk lens-wearing eyes compared to the higher Dk lens-wearing eyes. Changes in central corneal shape and optical performance were similar in both eyes. In the STOK study, CRT® lenses for myopia and hyperopia induced significant structural and optical changes in as little as 15 minutes. The cornea, particularly the epithelium, is remarkably moldable, with very rapid steepening and flattening possible in a small amount of time.

The wettability of contact lenses has become an area of intense research, with the belief that the more "hydrophilic" or wettable the lens surface is, the more comfortable the lens may be, as the posterior surface of the eyelid will move more smoothly over it, hence increasing comfort. <br /><br /> There are many ways to assess the wettability of a given material, namely sessile drop,¹ captive bubble ² or Wilhelmy plate. ³ This thesis used the sessile drop method to determine the surface wettability of various hydrogel contact lens materials, by measuring the advancing contact angle made between the lens surface and a pre-determined volume of HPLC-grade water. This was followed by measuring the surface wettability following periods in which the lens materials were soaked in various contact lens care regimens. Further studies determined wettability of lens materials after various periods of in-eye wear and finally a study was undertaken to evaluate if a novel biological technique could be used to differentiate proteins that deposit on hydrogel lens materials that may affect wettability and cause discomfort. <br /><br /> A variety of hydrogel lenses, taken directly from their packaging and after soaking in various care regimens, were analyzed to determine their sessile drop advancing contact angles, in vitro. These studies indicated that poly-2-hydroxyethylmethacrylate (pHEMA)-based lenses are inherently more wettable than silicone-based lenses, unless they have a surface treatment that completely covers the hydrophobic siloxane groups. Additionally, certain combinations of lens materials and care regimens produce inherently more wettable surfaces when measured in vitro. <br /><br /> Suitable methods to assess contact lens wettability ex vivo, or after subjects had worn lenses for set periods of time, were developed. It was determined that using latex gloves to remove lenses had no impact upon the lens surface wettability and that rinsing of the lens surface after removal from the eye was required to determine the wettability of the underlying polymer. <br /><br /> The final wettability studies involved an analysis of various lens materials from clinical studies conducted within the Centre for Contact Lens Research (CCLR). These studies investigated differences in wettability between silicone hydrogel lenses manufactured from differing polymers and variations in ex vivo wettability of several combinations of lens materials and solutions, worn for varying periods of time. <br /><br /> A novel method to investigate proteins extracted from lenses using 2D-Difference in Gel Electrophoresis (DIGE) found that this technique could be used to analyze proteins extracted from contact lenses. The data obtained showed that there was no difference between a group of subjects who were symptomatic of lens-induced dryness or a control group, and that care solutions had a minimal influence on the pattern of deposition seen. <br /><br /> The overall conclusion of these studies is that hydrogel lens wettability is affected by the polymer composition and that care regimen components can modify the surface wettability.

Many individuals with impaired vision experience a decreased quality of life. Quality of life is defined as "the degree to which an individual enjoys the important possibilities of their life. " Vision rehabilitation outcomes primarily focus on the functional impacts of interventions, with less attention being paid to any associated psychosocial impacts. This study examines the relationship between measures of visual function status and psychosocial status in individuals acquiring low vision assistive devices for the first time. One hundred and twenty subjects were evaluated after purchasing their first low vision device from a University-based low vision clinic. The measures used were the National Eye Institute Visual Function Questionnaire (NEI-VFQ 25) and the Psychosocial Impact of Assistive Devices Scales (PIADS). The NEI-VFQ 25 measures the status of visual function, while PIADS is a device impact measure, which explores the psychosocial impact of devices on three domains: competence, adaptability, and self-esteem. This study determines the strength of association between these two measures at initial and follow-up administrations, and between each subsequent measure as a result of the time interval between administrations, in addition to assessing whether or not a change in stability for the measures occurred over time. Modest strengths of associations were anticipated and the short time interval was not expected to be a factor in change in stability of the measures. The expectation was that subjective reports of functional changes should have a moderate correlation with psychosocial impact.

<b>Purpose:</b> Assess the relationship between tear film drying and sensation between blinks. <b>Methods:</b> MATLAB sampled a slitlamp video camera, a potentiometer and a microphone while subjects kept one eye open for as long as possible. 23 subjects rated the intensity of the ocular sensation while video and voice data were collected simultaneously. The tear drying on the cornea was measured. <b>Results:</b> The sensation was triphasic. Two linear functions described the latter 2 parts of the data (r &#8805; 0. 95). The correlation between TBUT and the elbow in the time-discomfort function was 0. 72. Extent of tear film drying was linearly correlated to time (median correlation = 0. 88). The correlation between the discomfort elbow and image elbow was 0. 93 with single data pair for each subject. Analysis of sensation characteristics showed significant differences between itching and burning for both intensity and time (p = 0. 03 and p = 0. 02 respectively). <b>Conclusions:</b> Simultaneous recording of ocular surface appearance, discomfort intensity and attributes of sensation provide novel information about the development of discomfort during ocular surface drying. The rapid increase in discomfort proceeding blinking has been quantified and the relationship between the time course of drying and discomfort is elucidated.

Purpose: The aim of the study was to delineate differences in saccade characteristics between a population of athletes and non athletes. Aspects specifically investigated were latency, accuracy, peak velocity, and gain adaptation of saccades using both increasing and decreasing paradigms. Methods: A sample of 28 athletes (varsity badminton and squash players) and 18 non athletes (< 3 hour/week in sports) were studied. Eye movements were recorded at 120Hz using a video based eye tracker (ELMAR 2020). Each subject participated in 2 sessions on separate days. Baseline saccade responses to dot stimuli were measured in both sessions (stimulus size: 5-25 deg). The first session involved a gain decreasing paradigm, induced by displacing the stimulus backwards by 3 degrees from the initial target step (12 deg) for 500 trials. In the 2nd session a gain increase was induced by displacing the stimuli by 3 degrees in the forward direction. The latency and accuracy were calculated from the baseline. The asymptotic peak velocity was calculated from the main sequence (amplitude vs. peak velocity). The amplitude gains, calculated from the adaptation phase, were averaged for every 100 saccade responses. The averaged gains were normalized with respect to the baseline, fitted with a 3rd order polynomial, and differentiated to obtain the rate of change. Differences between the groups were compared using a regression analysis. Results: There were no significant differences in latency, accuracy, and asymptotic peak velocity between athletes and non athletes. No significant differences were seen between the two groups in the magnitude of saccadic adaptation, both for decreasing (- 15% in both groups) and increasing (athletes + 7% and non athletes + 5%) paradigms. However, athletes showed a significantly faster rate of adaptation for the gain increasing paradigm (F = 17. 96[3,6]; p = 0. 002). A significant difference was not observed in the rate of adaptation for the gain decreasing adaptation (F = 0. 856[3,6]; p = 0. 512). Conclusions: The study showed that the athletes do not respond better in terms of reaction time or accuracy of saccades. The significant difference in the rate of change of adaptation between the groups shows that online modification of saccades in the positive direction, although not greater in magnitude, occurs quicker in athletes than non athletes.

<strong>Purpose:</strong> Although orthokeratology (non-surgical corneal reshaping, Corneal Refractive Therapy, CRT®) has been used for almost a half century, contemporary CRT's outcomes and mechanisms still require investigation. A series of studies was designed to examine different aspects of non-surgical corneal reshaping for myopic and hyperopic corrections, including the efficacy and stability of this procedure, the effect of the lens material characteristics (Dk/t), and the corneal or superficial structural change (e. g. corneal/epithelial thickness) in corneal reshaping. <br /> <strong>Methods:</strong> In the CRT® for myopia (CRT1) study, 20 myopes wore CRT® lenses on one eye and control lenses on the contralateral eye (eye randomized) for one night while sleeping. Corneal topography and refractive error were measured the night prior to lens insertion, immediately after lens removal on the following morning and at 20 and 60 minutes and 3, 6 and 12 hours later. In the CRT® for hyperopia (CRTH) study, 20 ametropes wore CRT®H lenses on one eye for one night while sleeping, the contralateral eye (no lens wear) served as control (eye randomized). Corneal topography, aberrations and refractive error were measured the night prior to lens insertion, immediately after lens removal on the following morning and at 1 and 3, 6, 12 and 28 hours later. In the relatively long term (4 weeks) CRT® for myopia (CRT2) study, 23 myopes wore CRT® lenses overnight and removed their lenses on awakening. Visual Acuity (VA), subjective vision, refractive error, aberrations, and corneal topography were measured at baseline, immediately after lens removal on the first day and 14 hours later, and these measurements were repeated on days 4, 10, and 28. The treatment zone size was demarcated by the change in corneal curvature from negative to positive and vice versa, using tangential difference maps from the corneal topographer. In the study of effects of Dk/t on CRT® for myopia (CRTHDK), 20 myopic subjects were fit with Menicon Z (MZ) lenses (Dk/t=90. 6, Paragon CRT®) on one eye and an Equalens II (EII) CRT® lenses (Dk/t=47. 2) on the contralateral eye (eye randomized). Corneal topography, refractive error and aberrations were measured before lens insertion (baseline), and the following day after overnight lens wear, on lens removal and 1, 3, 6, 12 hours later. In the study of short term effects of CRT® for myopia and hyperopia (STOK), 20 ametropes wore CRT® and CRT®H lenses in a random order on one eye (randomly selected). The lenses were worn for 15, 30 and 60 minutes (randomly ordered, with each period taking place on a different day). Refractive error, aberrations, corneal topography, and corneal/epithelial thickness (using OCT) were measured before and after lens wear. The measurements were performed on the control eyes at 60 minutes only. <br /> <strong>Results:</strong> In the CRT1 study, after one night of CRT® for myopia, the central cornea flattened and the mid-periphery steepened, and myopia reduced. In the CRTH study, after one night of CRT® for hyperopia, the central cornea steepened and the para-central region flattened, myopia was induced or hyperopia was reduced, all aberrations except for the astigmatism increased and signed spherical aberration (SA) shifted from positive to negative. In the CRT2 study, after 4 weeks of CRT® lens wear, in general, the treatment zones stabilized by day 10, vision improved, myopia diminished, total aberration and defocus decreased and higher order aberrations (HOAs) including coma and SA increased. The visual, optical and subjective parameters became stable by day 10. In the CRTHDK study, after one night of CRT® (MZ vs. EII) lens wear, the central corneal curvature and aberration were similar with a slight exception: The mid-peripheral corneal steepening was greater in the EII (lower Dk/t) lens-wearing eyes compared to the MZ (higher Dk/t) eyes. In the STOK study, after brief CRT® and CRT®H lens wear, significant changes occurred from the 15 minutes time point: The corneal shape and optical performance changed in a predictable way; the central cornea swelled less than the mid-periphery after CRT® lens wear, whereas the central cornea swelled more than the para-central region after CRT®H lens wear; the central epithelium was thinner than the mid-periphery after CRT® lens wear and was thicker than the para-central region after CRT®H lens wear. <br /> <strong>Conclusion:</strong> After one night of lens wear, CRT® and CRTH® lenses were effective for myopia and hyperopia correction, respectively. In the 4 week CRT study, the treatment zone size changed during the first 10 days. Its size was associated with VA, refractive error, aberrations, and subjective vision. In the CRTHDK study, after one night of lens wear, changes in corneal shape were slightly different, with more mid-peripheral steepening in the lower Dk lens-wearing eyes compared to the higher Dk lens-wearing eyes. Changes in central corneal shape and optical performance were similar in both eyes. In the STOK study, CRT® lenses for myopia and hyperopia induced significant structural and optical changes in as little as 15 minutes. The cornea, particularly the epithelium, is remarkably moldable, with very rapid steepening and flattening possible in a small amount of time.