Assessment of corneal reflex and vision-related functions among contact lens wearers: a cross-sectional study

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Methods This cross-sectional study included 89 participants aged 20–45 years, allocated to four groups: soft, hard, scleral, and non-CL wearers (controls). Corneal reflex sensitivity, tear film stability (Schirmer’s test), and visual acuity (Snellen chart) were assessed. The ocular surface disease index (OSDI) and CL dry eye questionnaire-8 (CLDEQ-8) were used to evaluate vision-related function. Data were analyzed using SPSS. Results Scleral CL wearers had the lowest tear production and longest corneal reflex times. Hard CL wearers showed moderate tear production and similar corneal reflex times to scleral lens users. Soft CL wearers had the highest tear film quantity and greater reflex sensitivity, indicating more favorable ocular health. Controls exhibited the greatest tear stability and fastest reflexes. Visual acuity differed significantly, with soft CL wearers achieving the best results among lens users. Scleral lens wearers reported more frequent ocular discomfort, dryness, blurred vision, reading and night driving difficulties, computer and TV-related strain, and sensitivity in windy or low-humidity environments than did individuals in other CL groups. Conclusions CL wear significantly affects tear film production and corneal reflex sensitivity. Soft lenses had the most favorable impact, whereas scleral lenses exhibited the poorest outcomes. Regular ocular examinations and patient education are essential to minimize risks and preserve visual function during prolonged CL use. corneal reflex vision-related functions contact lens tear film Figures Figure 1 Figure 2 Figure 3 Figure 4 Introduction The corneal reflex is a sensory protective mechanism that safeguards the eye from injury by triggering an involuntary blink when the cornea is stimulated[ 1 ]. It functions via contraction of the orbicularis oculi muscles and is responsible for initiating the blink reflex [ 2 ]. This reflex depends on the trigeminal (cranial nerve V) and facial (cranial nerve VII) nerves; damage to either can reduce corneal sensitivity[ 3 ]. The reflex can be assessed by observing eyelid closure in response to corneal touch. An abnormal corneal reflex may indicate trigeminal or facial nerve dysfunction. Stimulation of the trigeminal nerve produces both direct and consensual blinking, whereas facial nerve stimulation results in a consensual but not direct response [ 3 ]. Tear film stability plays a vital role in preserving corneal health, function, and visual clarity. It prevents infection and inflammation, promotes healing, removes debris, and protects against dryness and discomfort. Prolonged contact lens (CL) wear can impair tear film stability, leading to ocular irritation, redness, dryness, and vision disturbances [ 4 ]. Despite advancements in CL quality and biocompatibility, they can still disrupt tear homeostasis by altering tear film stability and modifying the composition of tear molecular constituents [ 5 ]. CLs affect the corneal surface and its natural protective mechanisms [ 5 ], with disruption of the tear film reducing tear production and leading to symptoms such as dryness, irritation, and diminished reflex sensitivity [ 6 , 7 ]. Dry eye syndrome may further reduce corneal reflex sensitivity by diminishing the body’s natural blink reflex [ 7 , 8 ]. Reduced tear volume and film thickness, along with increased osmolarity, can impair vision through light scattering and wavefront aberrations, leading to poor lens performance, especially under conditions of low humidity, high temperature, or variable lighting conditions [ 4 ]. Both blink frequency and efficiency are influenced by tear film quality. Discomfort with SCLs remains a persistent challenge, with many wearers reporting dryness as a common symptom [ 9 ]. Other manifestations include fatigue, irritation, and dryness-related discomfort, which may be associated with a reduced corneal reflex caused by CL wear [ 10 ]. In contrast, HCL wearers are primarily affected by mechanical effects, leading to glucose leakage from damaged epithelial cells and direct diffusion into the tear film [ 11 , 12 ]. Scleral lenses (SCCLs), large-diameter rigid lenses, are increasingly used to manage corneal irregularities and dry eye disease; however, evidence supporting their therapeutic benefits remains limited [ 13 ]. Physiological changes in the cornea due to CL wear have also been documented [ 14 , 15 ]. Some studies have reported reduced nerve function and corneal sensitivity resulting from impaired metabolic processes, which occur due to increased acidosis and altered corneal pH secondary to hypercapnia [ 15 , 16 ]. However, differences in corneal reflex responses among wearers of different CL types remain largely unexplored. Furthermore, a cross-sectional survey revealed low awareness of the complexities associated with CL use [ 17 ]. Therefore, this study aimed to evaluate the effects of different CL types (SCL, HCL, and SCCL) on corneal reflex and vision-related functions among CL wearers. Methods This cross-sectional study enrolled CL and non-CL wearers recruited from optometry and CL clinics at tertiary hospital. Subjects aged 20–45 years from both gender included wearers of soft, hard, and scleral CLs, and age-matched non-wearing controls. The sample size deemed adequate based on previous studies with similar objectives [ 3 , 18 ]. Subjects were divided into four groups: group A (SCL wearers); group B (HCL wearers); group C (SCCL wearers); and group D (controls with no history of CLs wear). CLs groups wore lenses for at least 2 weeks. Subjects with ocular or systemic diseases, or those taking medications that affect the ocular surface were excluded. This study was approved by the Institutional Review Board (IRB) of the Health Sciences Colleges Research on Human Subjects, King Saud University (Approval No. E-24-8804). The procedures followed in the study were in accordance with the World Medical Association and the Declaration of Helsinki. Written informed consent was obtained from all participants for participation in this study. Measurements Measurements included visual acuity (VA), corneal reflex, and Schirmer test collected from all participants. A comprehensive ocular health examination was performed. All assessments were performed on the same day by the principal investigator, an optometrist at the CL clinic. Corneal reflex assessment The corneal blink reflex was assessed by eliciting a blink response. subjects were seated comfortably and instructed to direct their gaze toward the E chart, away from the examiner. The examiner gently stimulated the sclera at the corner of the eye using a cotton thread for 5–10 seconds, taking care to avoid contact and prevent injury. Blink responses from both the ipsilateral (direct response) and contralateral (consensual response) eyes were recorded, and the procedure was then repeated for the other eye [ 19 ]. Measuring the Schirmer test The Schirmer test was used to assess tear production and identify dry eye syndrome [ 20 ]. The test was performed by placing the edge of a strip of filter paper against the inside of the lower eyelid of both eyes. subhects were instructed to gently close their eyes and avoid rubbing them during the procedure to prevent inaccurate results. After 5 minutes, the strips were removed, and the length of the moistened area was measured. Additionally, VA was assessed among all participants wearing different types of CLs using a Snellen chart [ 21 ]. Measuring vision-related functions Ocular discomfort can significantly impair the ability to perform daily activities, particularly when wearing CLs. To evaluate the effect of different CL types on vision-related functions, two questionnaires were administered: the ocular surface disease index (OSDI) [ 22 ] and the contact lens dry eye questionnaire-8 (CLDEQ-8) [ 23 ]. The OSDI is a 12-item survey in which participants rate their experiences with ocular symptoms, vision-related activities, and environmental factors over the past week on a scale from 0 to 4. Items were grouped as follows: Q1–Q5 addressed ocular symptoms, Q6–Q9 addressed functional limitations, and Q10–Q12 addressed environmental triggers [ 24 ]. The CLDEQ-8 was used to assess the severity and frequency of discomfort associated with CL wear, including ocular irritation (Q13), dryness (Q14), blurriness (Q15), heaviness (Q16), and intolerance requiring lens removal (Q17). Each item was rated on a scale from 0 (never) to 4 (always). Statistical analysis Statistical analyses were performed using SPSS software version 22 and Microsoft Excel. Corneal reflex were compared between control non-CL wearers and various CL wearer groups. Analysis of variance (ANOVA) was used to assess differences in ocular and demographic factors among CL types. To determine whether the distribution of VA varied across CL types, the independent-samples Kruskal–Wallis test was applied. Additionally, scores of OSDI and the CLDEQ-8 were compared among CLs groups using Chi-square tests to evaluate the distribution of responses for each symptom and identify significant differences (P < 0.001). Results A total of 89 participants aged between 20–30 years were included. Female participants predominated in all groups, reflecting the higher prevalence of CL use among women. The duration of CL wear varied significantly across groups. Among CL wearers, the mean duration (years) was lowest in the SCL group compared to the HCL and SCCL groups (Table 1 ). Table 1 Comparison of ocular and demographic parameters among different CL users. Parameter N Mean ± SD Min Max ANOVA Age (years) Control 30 21.9 ± 1.35 20.0 25.0 F(3, 85) = 49.94, p < 0.001 Hard CL 23 37.91 ± 7.04 20.0 45.0 Scleral CL 10 37 ± 5.89 28.0 45.0 Soft CL 26 25.12 ± 6.39 20.0 45.0 Duration of CL wear (years) Control 30 0.00 ± 0.00 0.0 0.0 F(3, 85) = 31.59, p < 0.001 Hard CL 23 5.04 ± 2.84 1.0 15.0 Scleral CL 10 4.7 ± 2.1 1.0 8.0 Soft CL 26 3.77 ± 2.49 1.0 11.0 Visual acuity (VA)* Control 30 21.92 ± 5.79 20.0 50.0 F(3, 81) = 6.93, p < 0.001 Hard CL 21 34.29 ± 17.34 20.0 100.0 Scleral CL 10 63.5 ± 72.38 20.0 200.0 Soft CL 24 24.48 ± 8.08 20.0 50.0 Corneal reflex sensitivity Control 30 2.44 ± 0.75 1.1 4.0 F(3, 85) = 38.05, p < 0.001 Hard CL 23 6.53 ± 1.84 3.4 9.0 Scleral CL 10 6.49 ± 1.20 5.0 8.8 Soft CL 26 4.67 ± 1.91 2.0 9.0 Schirmer Test (mm) Control 29 24.28 ± 13.33 4.0 35.0 F(3, 83) = 4.23, p = 0.008 Hard CL 22 16.36 ± 10.37 5.0 35.0 Scleral CL 10 12 ± 4.83 5.0 15.0 Soft CL 26 22.69 ± 11.44 5.0 35.0 * Kruskal–Wallis test applied for VA Variations in ocular and demographic factors between different CL wearer groups Table 1 showed significant variations in ocular and demographic factors among the different CL wearers groups. Participants wearing SCLs continuously demonstrated better ocular health indicators than those wearing HCLs or SCCLs, although the control group consistently had the most favorable results. Corneal reflex sensitivity varied significantly among groups (p < 0.001). The control group showed the highest sensitivity. The SCL group also had relatively better results, with shorter response times than HCL and SCCL users, indicating greater preservation of corneal sensitivity. The Schirmer test revealed a significant difference between the groups (p = 0.008). The control group demonstrated the highest average tear film stability, serving as the baseline for healthy tear production (Table 1 ). Among lens wearers, the SCL group had higher Schirmer scores than those of the HCL group and the SCCL group, indicating better ocular surface lubrication. The Kruskal–Wallis test showed that VA distribution varied significantly across CL categories (p < 0.001). The SCL group had VA values more comparable to those of the control group than to those of the highly variable SCCL group (p < 0.001). The correlation plots among the variables are shown in Fig. 1 and Table 1 . A notable positive correlation was observed between corneal reflex and CL type (r = 0.355, p = 0.001). However, CL type was not significantly associated with age, sex, VA, or Schirmer test scores. Corneal reflex was inversely correlated with Schirmer test scores (r = − 0.288, p = 0.007), indicating that a weaker corneal reflex was associated with reduced tear production. Corneal reflex was also positively correlated with age (r = 0.663, p = 0.001) and the duration of CL wear (r = 0.693, p = 0.001). These findings suggest that older age, longer CL use, and worse VA are associated with decreased tear production. The OSDI and CLDEQ-8 For the OSDI Symptom Subtotal A (ocular symptoms questions including light sensitivity, gritty sensation, painful eyes, blurred vision, and impaired vision), scores ranged from 3 to 17, with a mean of 9. The OSDI function subtotal B, covering functional limitations such as reading, night driving, using a computer, and watching TV, had a mean score of 9 (range: 1–18). The OSDI environmental subtotal C, which addresses discomfort due to environmental factors such as wind, low humidity, and air-conditioned areas, had a mean score of 6 on a scale of 0 to 15. The cumulative mean CLDEQ-8 score was 24, reflecting the participants' overall level of ocular discomfort and functional impairment. Descriptive statistics for Q1–Q17. Assessment of Ocular symptoms (Q1—Q5 OSDI questionnaire) Light sensitivity (Q1) did not differ significantly between participants (p = 0.127). Foreign-body sensation (Q2) differed significantly between CL groups (p = 0.001). Painful eyes or other adverse eye effects (Q3) also varied significantly (p = 0.004). Blurred vision (Q4) showed a significant difference (p = 0.023) while poor eyesight (Q5) varied significantly (p = 0.004). Frequency distribution graphs for ocular symptoms (Q1–Q5) by CL type are presented in Fig. 1 . In comparison of ocular symptoms between CL wearers groups, the groups' mean score for light sensitivity (Q1) were relatively similar, indicating that light sensitivity was not significantly affected by the type of CL. For foreign body sensation (Q2), SCCL group reported slightly higher mean scores than those of HCL and SCL wearers, though the differences were not statistically significant. This suggests that grittiness or foreign body sensation was experienced similarly across lens types. Painful or sore eyes (Q3), lens type had no significant effect on ocular discomfort. For blurred vision (Q4), SCCL wearers had higher scores than those of HCL and SCL wearers, but the difference was not statistically significant (p = 0.152). In terms of bad eyesight (Q5), SCCL users reported the highest mean scores, while HCL and SCL users reported lower scores. ANOVA revealed a statistically significant difference among the groups (F(2, 51) = 4.69, p = 0.013. Assessment of Functional limitations (Q6—Q9 the OSDI questionnaire) As shown in Fig. 2 , reading difficulties (Q6) were significant (p = 0.023) differ among CL wearers. Driving at night posed significant challenges (Q7, p = 0.012), with nearly 30% of participants experiencing limitations half of the time. A total of 35.2% of participants reported some difficulty using computers or ATMs (Q8), which was statistically significant (p = 0.002). Television watching was notably affected (Q9, p < 0.001), with over half of the participants experiencing limitations sometimes, while others were still impacted to a lesser degree. The corresponding frequency distribution graphs for different types of lens wearers are shown in Fig. 2 . In comparison between CL wearers groups, a significant difference was observed for reading difficulties (Q6, p < 0.05). Post-hoc analysis indicated that SCL users reported the least difficulties, HCL users experienced moderate difficulties and SCCL users reported the greatest difficulties. This suggests that SCL wearers experienced minimal discomfort during reading tasks, HCL wearers had moderate challenges, and SCCL wearers were the most affected. Similar comparisons were made about driving at night (Q7), using a computer (Q8), and watching TV (Q9). Influence of environmental factors on visual performance (Q10–Q12 the OSDI questionnaire) As shown in Fig. 3 responses varied significantly for windy conditions (Q10, p < 0.001). Very dry environments caused significant discomfort (Q11, p = 0.009). In air-conditioned areas (Q12, p < 0.001), 35.2% of the participants reported discomfort at least some of the time, while 50% did not experience any discomfort (Fig. 3 ). In comparison between CL wearers groups, SCL wearers reported the least discomfort, while HCL users experienced moderate difficulties with visual performance under windy conditions (Q10), low humidity (Q11), and air conditioning (Q12). However, these differences were not statistically significant across the different CL types (p > 0.05). Severity and frequency of visual discomfort (CLDEQ-8) Figure 4 present the frequency of ocular discomfort symptoms reported by CL wearers on an average day during the preceding 2 weeks. The assessed symptoms included irritation, dryness, blurriness, heaviness, and intolerance requiring lens. Ocular discomfort and visual problems were significantly more common among CL wearers. Most participants reported experiencing dryness (Q14) and ocular pain (Q13) occasionally (p < 0.001). Fluctuations in vision clarity, such as blurriness or fogginess (Q15), were also frequently observed, with over half of participants reporting occasional occurrences (p < 0.001). Additionally, a significant proportion of participants experienced pain that required lens removal (Q17, p = 0.001) or heaviness and irritation leading to eye covering (Q16, p = 0.039). On a 0–4 scale, mean values for irritation, dryness, blurriness, heaviness, and intolerance were low to moderate across all groups (SCL, HCL, and SCCL), indicating that these symptoms were common but generally not severe, with no statistically significant differences. SCCL wearers reported the lowest mean score for general discomfort, while HCL wearers reported a mean score of 1.04 ± 0.71, comparable to that of SCL users (1.00 ± 1.13). For blurriness, SCCL users had slightly higher mean scores than those of HCL and SCL wearers. SCCL reported the highest ocular heaviness, followed by SCL and HCL wearers. Regarding intolerance, HCL wearers had the highest mean score compared to SCCL and SCL wearers. Overall, the type of CL did not appear to significantly affect the frequency or severity of subjective ocular discomfort, although differences in specific symptom intensity were observed. SCL users reported slightly more dryness, whereas SCCL users generally experienced more blurriness and heaviness (Fig. 4 ). Discussion This study highlighted variations in the Schirmer test, corneal reflex sensitivity, and differences in visual functions among different CL groups. The type of CL was positively correlated with corneal reflex sensitivity and the duration of CL wear. Corneal reflex sensitivity showed strong positive correlations with both age and duration of CL wear. CL-related issues observed in the study included eye discomfort, pain, blurred vision, reduced visual clarity, reading difficulties, night driving, computer use, and TV watching, as well as discomfort under environmental conditions such as wind, low humidity, and air-conditioning. A higher prevalence of CL wear among women was observed across all lens types. These variations in CL usage within the study population reflect broader demographic trends, with women and younger individuals more likely to use CLs for both corrective and cosmetic purposes. The findings are consistent with a large-scale longitudinal survey of CL practitioners across 71 countries, which reported many lenses (65–70%) were fitted to women [ 25 ]. In our study, SCL wearers had better corneal reflex values, likely due to the frequent movement and material properties of soft lenses, which may reduce gradual corneal desensitization. An earlier study suggested that SCL wear may induce differential expression of proteins in the tear fluid, promoting faster recovery of tear homeostasis than that observed with HCLs [ 14 ]. Among HCL wearers, the average corneal reflex was higher than that in SCCL users, indicating a lesser impact on corneal nerve function. The rigid nature of HCLs limits direct physical interaction with the cornea. SCCL wearers demonstrated the lowest corneal reflex values among lens wearers (Table 1 ). HCLs allow higher oxygen transmissibility and greater tear exchange with each blink, which efficiently removes metabolic waste products and cells [ 26 ], whereas tear exchange beneath SCCLs is minimal [ 27 ]. The larger lens size and reduced corneal contact of SCCLs contribute to better nerve function. The SCCL group showed the worse results on the Schirmer test, indicating a significantly reduced tear film quantity. Although SCCLs cover the sclera and create a fluid reservoir that helps maintain tear stability, they are not immune to reductions in tear film over long-term use. These findings regarding the effectiveness of SCCLs for dry eyes align with a recent study showing that SCCL use rapidly alleviates subjective symptoms and clinical signs of dry eye while providing good safety, improved visual function, and enhanced vision-related quality of life [ 28 ]. This suggests that, while lower tear production is associated with a reduced reflex response, longer CL wear duration and older age are linked to stronger corneal reflexes. Although HCLs are generally considered to provide better optical quality than that provided by SCLs [ 29 ], twilight vision testing has shown no significant difference between HCLs and SCLs after 3 months of CL wear [ 30 ]. Previous studies have also reported that the visual acuity provided by HCLs is better than that provided by SCCLs, likely due to tear retention under the lens [ 31 ]. In the present study, SCL wearers achieved the best VA outcomes among all lens users. SCCL and HCL showed moderate disruption of tear film stability. While short-term users maintained relatively stable results, long-term wearers experienced significant reductions in corneal reflex times and tear production [ 32 ]. This suggests that the rigidity of hard lenses may increase friction and mechanical interaction with the corneal surface over prolonged periods [ 32 ]. SCL exhibited the highest variability but generally had a pronounced positive impact on tear film stability [ 33 ]. However, long-term soft lens users experienced greater degradation in tear production and corneal reflex times than observed in other lens types. This may be due to the high-water content of soft lenses, which can accelerate tear evaporation during prolonged wear [ 33 ]. SCCLs provided better tear film stability than that observed with both HCLs and SCLs [ By vaulting over the cornea and resting on the sclera, scleral lenses minimize direct contact with the corneal surface and create a tear reservoir that preserves hydration. This design makes scleral lenses particularly suitable for long-term use, especially in individuals with underlying ocular surface conditions [ 34 ]. Chalmers et al. demonstrated that rigid gas-permeable lenses (HCLs) offer better tear stability than soft lenses, suggesting careful monitoring due to their impact on corneal reflex sensitivity [ 32 ]. HCL wearers reported fewer adverse symptoms, reflecting better ocular comfort than that in scleral and soft lens wearers. It was suggested that HCLs allow for better corneal oxygenation and reduced tear film disruption, which explains the improved outcomes in this group [ 32 ]. A comparative assessment of ocular symptoms among different types of CL wearers, using the OSDI (Q1–Q5), showed that lens type had a major impact on perceived vision, with SCCL wearers reporting significantly lower subjective visual performance than other types of CL wearers. The CLDEQ-8 and OSDI results further indicated that SCCL wearers experienced more discomfort, dryness, and difficulty performing activities such as reading and driving [ 35 ]. These findings align with those of Schiffman et al., who emphasized that lens design and extended wear duration can exacerbate ocular surface irritation and tear instability. This study has some limitations. The tear breakup time test (TBUT) was not considered when assessing the tear film among the different CL groups. The sample size was relatively small, which may limit the generalizability of the findings. Overall, the findings demonstrate the significant impact of CL type and duration of wear on tear film stability and corneal reflex. Maintaining tear film stability is critical for a healthy ocular surface and proper ocular lubrication. Disruption of this balance caused by CL wear can lead to dryness, discomfort, and, over time, more severe complications. These results underscore the importance of understanding the unique effects of each lens type and the proper lens use and care in preserving ocular health. Limiting the duration of CL wear and considering alternative optical correction, such as spectacles, may help reduce adverse effects. Proper health education regarding lens care and the risk of prolonged use is essential for maintaining ocular health. Innovations in lens design, including moisture-retention technologies and materials that minimize friction, may further improve tear film stability and corneal protection. Routine evaluation of tear film stability and corneal health is recommended, especially for long-term lens wearers. In conclusion, CL type and duration of wear significantly influence tear film stability, corneal reflex sensitivity, and visual performance. Soft lenses preserve corneal reflex and tear production while scleral lenses provide better tear film stability, whereas hard lenses yield moderate outcomes. These findings highlight the importance of regular monitoring, proper lens care, and limiting prolonged wear to prevent ocular surface complications. Clinically, the study underscores the need to guide lens selection, optimize wear schedules, and develop lens designs that enhance hydration and reduce friction to preserve ocular health. Declarations Conflicts of interest: The authors declare no conflicts of interest. Funding: This study was supported by the College of Applied Medical Sciences Research Centre and the Deanship of Scientific Research at King Saud University. Author Contribution 1 and 2 contributed to the study conception and design. Material preparation1,2,3 contributed in data collection and analysis1 and 4, data analysis ans writting the first draft of the manuscript.All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript. Acknowledgements: The authors gratefully acknowledge the College of Applied Medical Sciences Research Centre and the Deanship of Scientific Research at King Saud University for funding this study. We also thank Editage and Cactus Communications for editorial support, medical writing assistance, table assembly, creation of high-resolution images, copyediting, fact-checking, and referencing. References Vereertbrugghen A, Galletti JG. Corneal nerves and their role in dry eye pathophysiology. Exp Eye Res. 2022;222:109191. https://doi.org/10.1016/j.exer.2022.109191 . Labetoulle M, Baudouin C, Calonge M, Merayo-Lloves J, Boboridis KG, Akova YA, et al. Role of corneal nerves in ocular surface homeostasis and disease. Acta Ophthalmol. 2019;97(2):137–45. https://doi.org/10.1111/aos.13844 . Navascues-Cornago M, Sun T, Read ML, Morgan PB. The short-term effect of contact lens wear on blink characteristics. Cont Lens Anterior Eye. 2022;45(5):101596. https://doi.org/10.1016/j.clae.2022.101596 . Buch J, Riederer D, Scales C, Xu J. Tear film dynamics of a new soft contact lens. Ophthalmic Physiol Opt. 2023;43(5):1070–1078. https://doi.org/10.1111/opo.13169 . Boost M, Cho P, Wang Z. Disturbing the balance: effect of contact lens use on the ocular proteome and microbiome. Clin Exp Optom. 2017;100(5):459–72. https://doi.org/10.1111/cxo.12582 . Gurnani B, Kaur K. Contact Lens–Related Complications. Treasure Island, FL: StatPearls Publishing; 2023. Waghmare SV, Jeria S. A review of contact lens-related risk factors and complications. Cureus. 2022;14(10):e30118. https://doi.org/10.7759/cureus.30118 . Golebiowski B, Papas EB, Stapleton F. Corneal and conjunctival sensory function: the impact on ocular surface sensitivity of change from low to high oxygen transmissibility contact lenses. Invest Ophthalmol Vis Sci. 2012;53(3):1177–81. https://doi.org/10.1167/iovs.11-8416 . McMonnies CW. Could contact lens dryness discomfort symptoms sometimes have a neuropathic basis? Eye Vis (Lond). 2021;8(1):12. https://doi.org/10.1186/s40662-021-00236-4 . Musgrave CSA, Fang F. Contact lens materials: a materials science perspective. Materials (Basel). 2019;12(2):261. https://doi.org/10.3390/ma12020261 . Baca JT, Finegold DN, Asher SA. Tear glucose analysis for the noninvasive detection and monitoring of diabetes mellitus. Ocul Surf. 2007;5(4):280–93. https://doi.org/10.1016/S1542-0124(12)70094-0 . Farandos NM, Yetisen AK, Monteiro MJ, Lowe CR, Yun SH. Contact lens sensors in ocular diagnostics. Adv Healthc Mater. 2015;4(6):792–810. https://doi.org/10.1002/adhm.201400504 . Qiu SX, Fadel D, Hui A. Scleral lenses for managing dry eye disease in the absence of corneal irregularities: what is the current evidence? J Clin Med. 2024;13(13):3838. https://doi.org/10.3390/jcm13133838 . Manicam C, Perumal N, Wasielica-Poslednik J, Ngongkole YC, Tschäbunin A, Sievers M, et al. Proteomics unravels the regulatory mechanisms in human tears following acute renouncement of contact lens use: a comparison between hard and soft lenses. Sci Rep. 2018;8(1):11526. https://doi.org/10.1038/s41598-018-30032-5 . Pang K, Lennikov A, Yang M. Hypoxia adaptation in the cornea: current animal models and underlying mechanisms. Animal Models Exp Med. 2021;4(4):300–10. https://doi.org/10.1002/ame2.12192 . Rivera RK, Polse KA. Effects of hypoxia and hypercapnia on contact lens-induced corneal acidosis. Optom Vis Sci. 1996;73(3):178–83. https://doi.org/10.1097/00006324-199603000-00009 . AlSarhan RS, Abuageelah BM, Alahmadi AA, Alfaifi MH, Alghamdi KM, Alamri A. Use, misuse, and complications of contact lens among the general population of the Kingdom of Saudi Arabia. Cureus. 2023;15(12):e51368. https://doi.org/10.7759/cureus.51368 . Pastor-Zaplana JÁ, Gallar J, Acosta MC. Effects of contact lens wearing on corneal sensitivity and reflex functions. Acta Ophthalmol. 2022;100(S275). https://doi.org/10.1111/j.1755-3768.2022.0605 . Pullen RL Jr. Testing the corneal reflex. Nursing. 2005;35(11):68. https://doi.org/10.1097/00152193-200511000-00058 . Stevens S. Schirmer’s test. Community Eye Health. 2011;24(76):45. https://www.mountsinai.org/health-library/tests/schirmer-test . Caltrider D, Gupta A, Tripathy K. Evaluation of visual acuity. StatPearls [Internet]; 2025 January. Treasure Island, FL: StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK564307/ . Özcura F, Aydin S, Helvaci MR. Ocular Surface Disease Index for the diagnosis of dry eye syndrome. Ocul Immunol Inflamm. 2007;15(5):389–93. https://doi.org/10.1080/09273940701486803 . Chalmers RL, Begley CG, Moody K, Hickson-Curran SB. Contact Lens Dry Eye Questionnaire-8 (CLDEQ-8) and opinion of contact lens performance. Optom Vis Sci. 2012;89(10):1435–42. https://doi.org/10.1097/OPX.0b013e318269c90d . Bakkar MM, El-Sharif AK, Al Qadire M. Validation of the Arabic version of the ocular surface disease index questionnaire. Int J Ophthalmol. 2021;14(10):1595–601. https://doi.org/10.18240/ijo.2021.10.18 . Morgan PB, Efron N. Global contact lens prescribing 2000–2020. Clin Exp Optom. 2022;105(3):298–312. https://doi.org/10.1080/08164622.2022.2033604 . Muntz A, Subbaraman LN, Sorbara L, Jones L. Tear exchange and contact lenses: a review. J Optom. 2015;8(1):2–11. https://doi.org/10.1016/j.optom.2014.12.001 . Iqbal A, Fisher D, Alonso-Caneiro D, Collins MJ, Vincent SJ. Quantifying tear exchange during rigid contact lens wear using corneoscleral profilometry: a proof of concept study. Ophthalmic Physiol Opt. 2025;45(3):598–606. https://doi.org/10.1111/opo.13450 . Lu C, Han D, Zeng L, et al. Short-term efficacy and safety of scleral lenses in the management of severe dry eye in a Chinese population. J Clin Med. 2025;14(3):658. https://doi.org/10.3390/jcm14030658 . Hong X, Himebaugh N, Thibos LN. On-eye evaluation of optical performance of rigid and soft contact lenses. Optom Vis Sci. 2001;78(12):872–80. https://doi.org/10.1097/00006324-200112000-00009 . Krolo I, Bećirević AK, Radman I, Sabol I, Ravlić MM, Ratković M, et al. Impact of soft and rigid gas-permeable contact lenses on visual performance in mesopic conditions. Indian J Ophthalmol. 2024;72(suppl 2):S229-32. https://doi.org/10.4103/IJO.IJO_628_23 . Pullum KW, Buckley RJ. A study of 530 patients referred for rigid gas permeable scleral contact lens assessment. Cornea. 1997;16(6):612–22. https://doi.org/10.1097/00003226-199711000-00003 . Chalmers RL, Keay L, McNally JJ. Impact of rigid gas-permeable lenses on tear film stability. Optom Vis Sci. 2000;77(4):171–2. https://doi.org/10.1097/00006324-200004000-00003 . Guillon JP, Maïssa C, Wong S. Tear film changes in soft lens wearers as a function of lens type. Eye Contact Lens. 2005;31:26–31. Schornack MM. Scleral lenses: a review. Eye Contact Lens. 2013;39:249–58. Schiffman RM, Christianson MD, Jacobsen G, Hirsch JD, Reis BL. Reliability and validity of the Ocular Surface Disease Index. Arch Ophthalmol. 2000;118(5):615–21. https://doi.org/10.1001/archopht.118.5.615 . Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 19 Apr, 2026 Reviews received at journal 16 Apr, 2026 Reviewers agreed at journal 13 Apr, 2026 Reviews received at journal 29 Mar, 2026 Reviewers agreed at journal 27 Mar, 2026 Reviewers agreed at journal 26 Mar, 2026 Reviewers agreed at journal 23 Mar, 2026 Reviewers agreed at journal 22 Feb, 2026 Reviewers agreed at journal 20 Feb, 2026 Reviewers invited by journal 17 Feb, 2026 Editor assigned by journal 07 Jan, 2026 Submission checks completed at journal 07 Jan, 2026 First submitted to journal 05 Jan, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8525049","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":595148912,"identity":"57701131-5f36-4602-b137-e29ac8f0a5f6","order_by":0,"name":"Kholoud Bokhary","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA4UlEQVRIiWNgGAWjYBACCQkGZmYQg58HzGcmQYtkD8laDM4Qq0VydvNh44Kae4mbzxx/JsFQYZ3YwH/4AV4t0jLHkpNnHCtO3Ha2x0yC4Ux6YoNEmgFeLXISOcaHedgSEred52GTYGw7DNTCQIyWfwmJm/vZn0kw/gNq4T/+Ab/DgFqSedsSEjfwNphJMDYAtTDk4LdFcs6xZGPevgTjGWfOGFskHEs3bpPIKcCrReJ282Fpnm8Jsv096Q9vfKixlu3nP74BrxYYcGwAkQlAzEaUeiCwJ1bhKBgFo2AUjEAAANGcQzQAsdcgAAAAAElFTkSuQmCC","orcid":"","institution":"King Saud University","correspondingAuthor":true,"prefix":"","firstName":"Kholoud","middleName":"","lastName":"Bokhary","suffix":""},{"id":595148913,"identity":"1a349c08-7d60-4738-ac3b-195052d97bba","order_by":1,"name":"Shouq Alzaid","email":"","orcid":"","institution":"King Saud University","correspondingAuthor":false,"prefix":"","firstName":"Shouq","middleName":"","lastName":"Alzaid","suffix":""},{"id":595148914,"identity":"947827e7-4d44-4998-ac02-1eb66c01c04d","order_by":2,"name":"Reem Alqahtani","email":"","orcid":"","institution":"King Saud Medical City","correspondingAuthor":false,"prefix":"","firstName":"Reem","middleName":"","lastName":"Alqahtani","suffix":""},{"id":595148915,"identity":"f5300e9c-09bc-4f02-a8e8-5641d08f373e","order_by":3,"name":"Hala Jamous","email":"","orcid":"","institution":"King Saud bin Abdulaziz University for Health Sciences","correspondingAuthor":false,"prefix":"","firstName":"Hala","middleName":"","lastName":"Jamous","suffix":""}],"badges":[],"createdAt":"2026-01-05 22:38:19","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8525049/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8525049/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":103302082,"identity":"cc999f35-8f06-49f6-84a1-4c0262ceb4a1","added_by":"auto","created_at":"2026-02-24 08:22:49","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":404426,"visible":true,"origin":"","legend":"\u003cp\u003eFrequency distribution graphs for ocular symptoms (Q1–Q5) among different types of CL wearers.\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-8525049/v1/56ed3ae10fa623b72a4d3d98.jpeg"},{"id":103505855,"identity":"3a0f0dc5-dedc-44b5-94bd-4b5ab0e7ab68","added_by":"auto","created_at":"2026-02-26 13:33:15","extension":"jpeg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":342657,"visible":true,"origin":"","legend":"\u003cp\u003eFrequency distribution graphs for the functional restrictions experienced by different types of CL wearers were assessed using the OSDI questionnaire (Q6–Q9).\u003c/p\u003e","description":"","filename":"floatimage2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-8525049/v1/99f1c6d80d7cc4776efd78fb.jpeg"},{"id":103302081,"identity":"dcc08ddb-1c4b-4402-b58b-6a4d1d37d778","added_by":"auto","created_at":"2026-02-24 08:22:49","extension":"jpeg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":274106,"visible":true,"origin":"","legend":"\u003cp\u003eFrequency distribution graphs for effects of environmental factors on different types of CL wearers, as assessed using the OSDI questionnaire (Q10–Q12).\u003c/p\u003e","description":"","filename":"floatimage3.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-8525049/v1/1e216d3b008a683f91cc97d9.jpeg"},{"id":103302084,"identity":"7e22c869-a299-4118-9d3b-74219e3073c2","added_by":"auto","created_at":"2026-02-24 08:22:50","extension":"jpeg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":456393,"visible":true,"origin":"","legend":"\u003cp\u003eFrequency distribution graphs for vision variations and ocular discomfort symptoms experienced by different types of CL wearers, as assessed by the CLEDQ-8 (Q13–Q17).\u003c/p\u003e","description":"","filename":"floatimage4.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-8525049/v1/7906406f1046524308c751ad.jpeg"},{"id":103509503,"identity":"d5aca8ad-06b3-4112-bb7e-d7984264a5d1","added_by":"auto","created_at":"2026-02-26 13:59:24","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2215272,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8525049/v1/41292ef6-e52c-494d-be07-21ae1f911755.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Assessment of corneal reflex and vision-related functions among contact lens wearers: a cross-sectional study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe corneal reflex is a sensory protective mechanism that safeguards the eye from injury by triggering an involuntary blink when the cornea is stimulated[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. It functions via contraction of the orbicularis oculi muscles and is responsible for initiating the blink reflex [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. This reflex depends on the trigeminal (cranial nerve V) and facial (cranial nerve VII) nerves; damage to either can reduce corneal sensitivity[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. The reflex can be assessed by observing eyelid closure in response to corneal touch. An abnormal corneal reflex may indicate trigeminal or facial nerve dysfunction. Stimulation of the trigeminal nerve produces both direct and consensual blinking, whereas facial nerve stimulation results in a consensual but not direct response [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eTear film stability plays a vital role in preserving corneal health, function, and visual clarity. It prevents infection and inflammation, promotes healing, removes debris, and protects against dryness and discomfort. Prolonged contact lens (CL) wear can impair tear film stability, leading to ocular irritation, redness, dryness, and vision disturbances [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eDespite advancements in CL quality and biocompatibility, they can still disrupt tear homeostasis by altering tear film stability and modifying the composition of tear molecular constituents [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. CLs affect the corneal surface and its natural protective mechanisms [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e], with disruption of the tear film reducing tear production and leading to symptoms such as dryness, irritation, and diminished reflex sensitivity [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Dry eye syndrome may further reduce corneal reflex sensitivity by diminishing the body\u0026rsquo;s natural blink reflex [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Reduced tear volume and film thickness, along with increased osmolarity, can impair vision through light scattering and wavefront aberrations, leading to poor lens performance, especially under conditions of low humidity, high temperature, or variable lighting conditions [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Both blink frequency and efficiency are influenced by tear film quality.\u003c/p\u003e \u003cp\u003eDiscomfort with SCLs remains a persistent challenge, with many wearers reporting dryness as a common symptom [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Other manifestations include fatigue, irritation, and dryness-related discomfort, which may be associated with a reduced corneal reflex caused by CL wear [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. In contrast, HCL wearers are primarily affected by mechanical effects, leading to glucose leakage from damaged epithelial cells and direct diffusion into the tear film [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Scleral lenses (SCCLs), large-diameter rigid lenses, are increasingly used to manage corneal irregularities and dry eye disease; however, evidence supporting their therapeutic benefits remains limited [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e \u003cp\u003ePhysiological changes in the cornea due to CL wear have also been documented [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Some studies have reported reduced nerve function and corneal sensitivity resulting from impaired metabolic processes, which occur due to increased acidosis and altered corneal pH secondary to hypercapnia [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. However, differences in corneal reflex responses among wearers of different CL types remain largely unexplored. Furthermore, a cross-sectional survey revealed low awareness of the complexities associated with CL use [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Therefore, this study aimed to evaluate the effects of different CL types (SCL, HCL, and SCCL) on corneal reflex and vision-related functions among CL wearers.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThis cross-sectional study enrolled CL and non-CL wearers recruited from optometry and CL clinics at tertiary hospital. Subjects aged 20\u0026ndash;45 years from both gender included wearers of soft, hard, and scleral CLs, and age-matched non-wearing controls. The sample size deemed adequate based on previous studies with similar objectives [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Subjects were divided into four groups: group A (SCL wearers); group B (HCL wearers); group C (SCCL wearers); and group D (controls with no history of CLs wear). CLs groups wore lenses for at least 2 weeks. Subjects with ocular or systemic diseases, or those taking medications that affect the ocular surface were excluded.\u003c/p\u003e \u003cp\u003e This study was approved by the Institutional Review Board (IRB) of the Health Sciences Colleges Research on Human Subjects, King Saud University (Approval No. E-24-8804). The procedures followed in the study were in accordance with the World Medical Association and the Declaration of Helsinki. Written informed consent was obtained from all participants for participation in this study.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eMeasurements\u003c/h2\u003e \u003cp\u003eMeasurements included visual acuity (VA), corneal reflex, and Schirmer test collected from all participants. A comprehensive ocular health examination was performed. All assessments were performed on the same day by the principal investigator, an optometrist at the CL clinic.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003e\u003c/h3\u003e\n\u003cdiv class=\"Heading\"\u003e\u003cb\u003eCorneal reflex assessment\u003c/b\u003e\u003c/div\u003e \u003cp\u003eThe corneal blink reflex was assessed by eliciting a blink response. subjects were seated comfortably and instructed to direct their gaze toward the E chart, away from the examiner. The examiner gently stimulated the sclera at the corner of the eye using a cotton thread for 5\u0026ndash;10 seconds, taking care to avoid contact and prevent injury. Blink responses from both the ipsilateral (direct response) and contralateral (consensual response) eyes were recorded, and the procedure was then repeated for the other eye [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e\n\u003ch3\u003eMeasuring the Schirmer test\u003c/h3\u003e\n\u003cp\u003eThe Schirmer test was used to assess tear production and identify dry eye syndrome [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. The test was performed by placing the edge of a strip of filter paper against the inside of the lower eyelid of both eyes. subhects were instructed to gently close their eyes and avoid rubbing them during the procedure to prevent inaccurate results. After 5 minutes, the strips were removed, and the length of the moistened area was measured. Additionally, VA was assessed among all participants wearing different types of CLs using a Snellen chart [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e\n\u003ch3\u003eMeasuring vision-related functions\u003c/h3\u003e\n\u003cp\u003eOcular discomfort can significantly impair the ability to perform daily activities, particularly when wearing CLs. To evaluate the effect of different CL types on vision-related functions, two questionnaires were administered: the ocular surface disease index (OSDI) [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e] and the contact lens dry eye questionnaire-8 (CLDEQ-8) [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe OSDI is a 12-item survey in which participants rate their experiences with ocular symptoms, vision-related activities, and environmental factors over the past week on a scale from 0 to 4. Items were grouped as follows: Q1\u0026ndash;Q5 addressed ocular symptoms, Q6\u0026ndash;Q9 addressed functional limitations, and Q10\u0026ndash;Q12 addressed environmental triggers [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. The CLDEQ-8 was used to assess the severity and frequency of discomfort associated with CL wear, including ocular irritation (Q13), dryness (Q14), blurriness (Q15), heaviness (Q16), and intolerance requiring lens removal (Q17). Each item was rated on a scale from 0 (never) to 4 (always).\u003c/p\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eStatistical analyses were performed using SPSS software version 22 and Microsoft Excel. Corneal reflex were compared between control non-CL wearers and various CL wearer groups. Analysis of variance (ANOVA) was used to assess differences in ocular and demographic factors among CL types. To determine whether the distribution of VA varied across CL types, the independent-samples Kruskal\u0026ndash;Wallis test was applied. Additionally, scores of OSDI and the CLDEQ-8 were compared among CLs groups using Chi-square tests to evaluate the distribution of responses for each symptom and identify significant differences (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 89 participants aged between 20\u0026ndash;30 years were included. Female participants predominated in all groups, reflecting the higher prevalence of CL use among women. The duration of CL wear varied significantly across groups. Among CL wearers, the mean duration (years) was lowest in the SCL group compared to the HCL and SCCL groups (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of ocular and demographic parameters among different CL users.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParameter\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eMin\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eMax\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eANOVA\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cb\u003eAge (years)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eControl\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e21.9\u0026thinsp;\u0026plusmn;\u0026thinsp;1.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e20.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e25.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eF(3, 85)\u0026thinsp;=\u0026thinsp;49.94, \u003c/p\u003e \u003cp\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHard CL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e37.91\u0026thinsp;\u0026plusmn;\u0026thinsp;7.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e20.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e45.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eScleral CL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e37\u0026thinsp;\u0026plusmn;\u0026thinsp;5.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e28.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e45.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSoft CL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e25.12\u0026thinsp;\u0026plusmn;\u0026thinsp;6.39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e20.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e45.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cb\u003eDuration of CL wear (years)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eControl\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e0.00\u0026thinsp;\u0026plusmn;\u0026thinsp;0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eF(3, 85)\u0026thinsp;=\u0026thinsp;31.59, \u003c/p\u003e \u003cp\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHard CL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e5.04\u0026thinsp;\u0026plusmn;\u0026thinsp;2.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e15.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eScleral CL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e4.7\u0026thinsp;\u0026plusmn;\u0026thinsp;2.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e8.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSoft CL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e3.77\u0026thinsp;\u0026plusmn;\u0026thinsp;2.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e11.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cb\u003eVisual acuity (VA)*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eControl\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e21.92\u0026thinsp;\u0026plusmn;\u0026thinsp;5.79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e20.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e50.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eF(3, 81)\u0026thinsp;=\u0026thinsp;6.93, \u003c/p\u003e \u003cp\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHard CL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e34.29\u0026thinsp;\u0026plusmn;\u0026thinsp;17.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e20.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e100.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eScleral CL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e63.5\u0026thinsp;\u0026plusmn;\u0026thinsp;72.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e20.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e200.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSoft CL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e24.48\u0026thinsp;\u0026plusmn;\u0026thinsp;8.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e20.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e50.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cb\u003eCorneal reflex sensitivity\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eControl\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e2.44\u0026thinsp;\u0026plusmn;\u0026thinsp;0.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e4.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eF(3, 85)\u0026thinsp;=\u0026thinsp;38.05, \u003c/p\u003e \u003cp\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHard CL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e6.53\u0026thinsp;\u0026plusmn;\u0026thinsp;1.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e9.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eScleral CL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e6.49\u0026thinsp;\u0026plusmn;\u0026thinsp;1.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e5.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e8.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSoft CL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e4.67\u0026thinsp;\u0026plusmn;\u0026thinsp;1.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e9.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cb\u003eSchirmer Test (mm)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eControl\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e24.28\u0026thinsp;\u0026plusmn;\u0026thinsp;13.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e4.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e35.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eF(3, 83)\u0026thinsp;=\u0026thinsp;4.23, \u003c/p\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.008\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHard CL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e16.36\u0026thinsp;\u0026plusmn;\u0026thinsp;10.37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e5.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e35.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eScleral CL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e12\u0026thinsp;\u0026plusmn;\u0026thinsp;4.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e5.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e15.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSoft CL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e22.69\u0026thinsp;\u0026plusmn;\u0026thinsp;11.44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e5.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e35.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003e* Kruskal\u0026ndash;Wallis test applied for VA\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e\n\u003ch3\u003eVariations in ocular and demographic factors between different CL wearer groups\u003c/h3\u003e\n\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e showed significant variations in ocular and demographic factors among the different CL wearers groups. Participants wearing SCLs continuously demonstrated better ocular health indicators than those wearing HCLs or SCCLs, although the control group consistently had the most favorable results.\u003c/p\u003e \u003cp\u003eCorneal reflex sensitivity varied significantly among groups (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The control group showed the highest sensitivity. The SCL group also had relatively better results, with shorter response times than HCL and SCCL users, indicating greater preservation of corneal sensitivity. The Schirmer test revealed a significant difference between the groups (p\u0026thinsp;=\u0026thinsp;0.008). The control group demonstrated the highest average tear film stability, serving as the baseline for healthy tear production (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Among lens wearers, the SCL group had higher Schirmer scores than those of the HCL group and the SCCL group, indicating better ocular surface lubrication. The Kruskal\u0026ndash;Wallis test showed that VA distribution varied significantly across CL categories (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The SCL group had VA values more comparable to those of the control group than to those of the highly variable SCCL group (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The correlation plots among the variables are shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e and Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. A notable positive correlation was observed between corneal reflex and CL type (r\u0026thinsp;=\u0026thinsp;0.355, p\u0026thinsp;=\u0026thinsp;0.001). However, CL type was not significantly associated with age, sex, VA, or Schirmer test scores. Corneal reflex was inversely correlated with Schirmer test scores (r = \u0026minus;\u0026thinsp;0.288, p\u0026thinsp;=\u0026thinsp;0.007), indicating that a weaker corneal reflex was associated with reduced tear production. Corneal reflex was also positively correlated with age (r\u0026thinsp;=\u0026thinsp;0.663, p\u0026thinsp;=\u0026thinsp;0.001) and the duration of CL wear (r\u0026thinsp;=\u0026thinsp;0.693, p\u0026thinsp;=\u0026thinsp;0.001). These findings suggest that older age, longer CL use, and worse VA are associated with decreased tear production.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e\n\u003ch3\u003eThe OSDI and CLDEQ-8\u003c/h3\u003e\n\u003cp\u003eFor the OSDI Symptom Subtotal A (ocular symptoms questions including light sensitivity, gritty sensation, painful eyes, blurred vision, and impaired vision), scores ranged from 3 to 17, with a mean of 9. The OSDI function subtotal B, covering functional limitations such as reading, night driving, using a computer, and watching TV, had a mean score of 9 (range: 1\u0026ndash;18). The OSDI environmental subtotal C, which addresses discomfort due to environmental factors such as wind, low humidity, and air-conditioned areas, had a mean score of 6 on a scale of 0 to 15. The cumulative mean CLDEQ-8 score was 24, reflecting the participants' overall level of ocular discomfort and functional impairment. Descriptive statistics for Q1\u0026ndash;Q17.\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eAssessment of Ocular symptoms (Q1\u0026mdash;Q5 OSDI questionnaire)\u003c/h2\u003e \u003cp\u003eLight sensitivity (Q1) did not differ significantly between participants (p\u0026thinsp;=\u0026thinsp;0.127). Foreign-body sensation (Q2) differed significantly between CL groups (p\u0026thinsp;=\u0026thinsp;0.001). Painful eyes or other adverse eye effects (Q3) also varied significantly (p\u0026thinsp;=\u0026thinsp;0.004). Blurred vision (Q4) showed a significant difference (p\u0026thinsp;=\u0026thinsp;0.023) while poor eyesight (Q5) varied significantly (p\u0026thinsp;=\u0026thinsp;0.004). Frequency distribution graphs for ocular symptoms (Q1\u0026ndash;Q5) by CL type are presented in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003eIn comparison of ocular symptoms between CL wearers groups, the groups' mean score for light sensitivity (Q1) were relatively similar, indicating that light sensitivity was not significantly affected by the type of CL. For foreign body sensation (Q2), SCCL group reported slightly higher mean scores than those of HCL and SCL wearers, though the differences were not statistically significant. This suggests that grittiness or foreign body sensation was experienced similarly across lens types. Painful or sore eyes (Q3), lens type had no significant effect on ocular discomfort. For blurred vision (Q4), SCCL wearers had higher scores than those of HCL and SCL wearers, but the difference was not statistically significant (p\u0026thinsp;=\u0026thinsp;0.152). In terms of bad eyesight (Q5), SCCL users reported the highest mean scores, while HCL and SCL users reported lower scores. ANOVA revealed a statistically significant difference among the groups (F(2, 51)\u0026thinsp;=\u0026thinsp;4.69, p\u0026thinsp;=\u0026thinsp;0.013.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eAssessment of Functional limitations (Q6\u0026mdash;Q9 the OSDI questionnaire)\u003c/h2\u003e \u003cp\u003eAs shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, reading difficulties (Q6) were significant (p\u0026thinsp;=\u0026thinsp;0.023) differ among CL wearers. Driving at night posed significant challenges (Q7, p\u0026thinsp;=\u0026thinsp;0.012), with nearly 30% of participants experiencing limitations half of the time. A total of 35.2% of participants reported some difficulty using computers or ATMs (Q8), which was statistically significant (p\u0026thinsp;=\u0026thinsp;0.002). Television watching was notably affected (Q9, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), with over half of the participants experiencing limitations sometimes, while others were still impacted to a lesser degree. The corresponding frequency distribution graphs for different types of lens wearers are shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003eIn comparison between CL wearers groups, a significant difference was observed for reading difficulties (Q6, p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Post-hoc analysis indicated that SCL users reported the least difficulties, HCL users experienced moderate difficulties and SCCL users reported the greatest difficulties. This suggests that SCL wearers experienced minimal discomfort during reading tasks, HCL wearers had moderate challenges, and SCCL wearers were the most affected. Similar comparisons were made about driving at night (Q7), using a computer (Q8), and watching TV (Q9).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003e\u003cb\u003eInfluence of environmental factors on visual performance (Q10\u0026ndash;Q12 the OSDI questionnaire)\u003c/b\u003e\u003c/h2\u003e \u003cp\u003eAs shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e responses varied significantly for windy conditions (Q10, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Very dry environments caused significant discomfort (Q11, p\u0026thinsp;=\u0026thinsp;0.009). In air-conditioned areas (Q12, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), 35.2% of the participants reported discomfort at least some of the time, while 50% did not experience any discomfort (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). In comparison between CL wearers groups, SCL wearers reported the least discomfort, while HCL users experienced moderate difficulties with visual performance under windy conditions (Q10), low humidity (Q11), and air conditioning (Q12). However, these differences were not statistically significant across the different CL types (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eSeverity and frequency of visual discomfort (CLDEQ-8)\u003c/h2\u003e \u003cp\u003eFigure \u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e present the frequency of ocular discomfort symptoms reported by CL wearers on an average day during the preceding 2 weeks. The assessed symptoms included irritation, dryness, blurriness, heaviness, and intolerance requiring lens. Ocular discomfort and visual problems were significantly more common among CL wearers. Most participants reported experiencing dryness (Q14) and ocular pain (Q13) occasionally (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Fluctuations in vision clarity, such as blurriness or fogginess (Q15), were also frequently observed, with over half of participants reporting occasional occurrences (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Additionally, a significant proportion of participants experienced pain that required lens removal (Q17, p\u0026thinsp;=\u0026thinsp;0.001) or heaviness and irritation leading to eye covering (Q16, p\u0026thinsp;=\u0026thinsp;0.039). On a 0\u0026ndash;4 scale, mean values for irritation, dryness, blurriness, heaviness, and intolerance were low to moderate across all groups (SCL, HCL, and SCCL), indicating that these symptoms were common but generally not severe, with no statistically significant differences. SCCL wearers reported the lowest mean score for general discomfort, while HCL wearers reported a mean score of 1.04\u0026thinsp;\u0026plusmn;\u0026thinsp;0.71, comparable to that of SCL users (1.00\u0026thinsp;\u0026plusmn;\u0026thinsp;1.13). For blurriness, SCCL users had slightly higher mean scores than those of HCL and SCL wearers. SCCL reported the highest ocular heaviness, followed by SCL and HCL wearers. Regarding intolerance, HCL wearers had the highest mean score compared to SCCL and SCL wearers. Overall, the type of CL did not appear to significantly affect the frequency or severity of subjective ocular discomfort, although differences in specific symptom intensity were observed. SCL users reported slightly more dryness, whereas SCCL users generally experienced more blurriness and heaviness (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study highlighted variations in the Schirmer test, corneal reflex sensitivity, and differences in visual functions among different CL groups. The type of CL was positively correlated with corneal reflex sensitivity and the duration of CL wear. Corneal reflex sensitivity showed strong positive correlations with both age and duration of CL wear. CL-related issues observed in the study included eye discomfort, pain, blurred vision, reduced visual clarity, reading difficulties, night driving, computer use, and TV watching, as well as discomfort under environmental conditions such as wind, low humidity, and air-conditioning.\u003c/p\u003e \u003cp\u003eA higher prevalence of CL wear among women was observed across all lens types. These variations in CL usage within the study population reflect broader demographic trends, with women and younger individuals more likely to use CLs for both corrective and cosmetic purposes. The findings are consistent with a large-scale longitudinal survey of CL practitioners across 71 countries, which reported many lenses (65\u0026ndash;70%) were fitted to women [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn our study, SCL wearers had better corneal reflex values, likely due to the frequent movement and material properties of soft lenses, which may reduce gradual corneal desensitization. An earlier study suggested that SCL wear may induce differential expression of proteins in the tear fluid, promoting faster recovery of tear homeostasis than that observed with HCLs [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Among HCL wearers, the average corneal reflex was higher than that in SCCL users, indicating a lesser impact on corneal nerve function. The rigid nature of HCLs limits direct physical interaction with the cornea. SCCL wearers demonstrated the lowest corneal reflex values among lens wearers (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). HCLs allow higher oxygen transmissibility and greater tear exchange with each blink, which efficiently removes metabolic waste products and cells [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e], whereas tear exchange beneath SCCLs is minimal [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. The larger lens size and reduced corneal contact of SCCLs contribute to better nerve function.\u003c/p\u003e \u003cp\u003eThe SCCL group showed the worse results on the Schirmer test, indicating a significantly reduced tear film quantity. Although SCCLs cover the sclera and create a fluid reservoir that helps maintain tear stability, they are not immune to reductions in tear film over long-term use. These findings regarding the effectiveness of SCCLs for dry eyes align with a recent study showing that SCCL use rapidly alleviates subjective symptoms and clinical signs of dry eye while providing good safety, improved visual function, and enhanced vision-related quality of life [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. This suggests that, while lower tear production is associated with a reduced reflex response, longer CL wear duration and older age are linked to stronger corneal reflexes.\u003c/p\u003e \u003cp\u003eAlthough HCLs are generally considered to provide better optical quality than that provided by SCLs [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e], twilight vision testing has shown no significant difference between HCLs and SCLs after 3 months of CL wear [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. Previous studies have also reported that the visual acuity provided by HCLs is better than that provided by SCCLs, likely due to tear retention under the lens [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. In the present study, SCL wearers achieved the best VA outcomes among all lens users.\u003c/p\u003e \u003cp\u003eSCCL and HCL showed moderate disruption of tear film stability. While short-term users maintained relatively stable results, long-term wearers experienced significant reductions in corneal reflex times and tear production [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. This suggests that the rigidity of hard lenses may increase friction and mechanical interaction with the corneal surface over prolonged periods [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eSCL exhibited the highest variability but generally had a pronounced positive impact on tear film stability [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. However, long-term soft lens users experienced greater degradation in tear production and corneal reflex times than observed in other lens types. This may be due to the high-water content of soft lenses, which can accelerate tear evaporation during prolonged wear [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eSCCLs provided better tear film stability than that observed with both HCLs and SCLs [ By vaulting over the cornea and resting on the sclera, scleral lenses minimize direct contact with the corneal surface and create a tear reservoir that preserves hydration. This design makes scleral lenses particularly suitable for long-term use, especially in individuals with underlying ocular surface conditions [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. Chalmers et al. demonstrated that rigid gas-permeable lenses (HCLs) offer better tear stability than soft lenses, suggesting careful monitoring due to their impact on corneal reflex sensitivity [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. HCL wearers reported fewer adverse symptoms, reflecting better ocular comfort than that in scleral and soft lens wearers. It was suggested that HCLs allow for better corneal oxygenation and reduced tear film disruption, which explains the improved outcomes in this group [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eA comparative assessment of ocular symptoms among different types of CL wearers, using the OSDI (Q1\u0026ndash;Q5), showed that lens type had a major impact on perceived vision, with SCCL wearers reporting significantly lower subjective visual performance than other types of CL wearers. The CLDEQ-8 and OSDI results further indicated that SCCL wearers experienced more discomfort, dryness, and difficulty performing activities such as reading and driving [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. These findings align with those of Schiffman et al., who emphasized that lens design and extended wear duration can exacerbate ocular surface irritation and tear instability.\u003c/p\u003e \u003cp\u003eThis study has some limitations. The tear breakup time test (TBUT) was not considered when assessing the tear film among the different CL groups. The sample size was relatively small, which may limit the generalizability of the findings.\u003c/p\u003e \u003cp\u003eOverall, the findings demonstrate the significant impact of CL type and duration of wear on tear film stability and corneal reflex. Maintaining tear film stability is critical for a healthy ocular surface and proper ocular lubrication. Disruption of this balance caused by CL wear can lead to dryness, discomfort, and, over time, more severe complications. These results underscore the importance of understanding the unique effects of each lens type and the proper lens use and care in preserving ocular health. Limiting the duration of CL wear and considering alternative optical correction, such as spectacles, may help reduce adverse effects. Proper health education regarding lens care and the risk of prolonged use is essential for maintaining ocular health. Innovations in lens design, including moisture-retention technologies and materials that minimize friction, may further improve tear film stability and corneal protection. Routine evaluation of tear film stability and corneal health is recommended, especially for long-term lens wearers.\u003c/p\u003e \u003cp\u003eIn conclusion, CL type and duration of wear significantly influence tear film stability, corneal reflex sensitivity, and visual performance. Soft lenses preserve corneal reflex and tear production while scleral lenses provide better tear film stability, whereas hard lenses yield moderate outcomes. These findings highlight the importance of regular monitoring, proper lens care, and limiting prolonged wear to prevent ocular surface complications. Clinically, the study underscores the need to guide lens selection, optimize wear schedules, and develop lens designs that enhance hydration and reduce friction to preserve ocular health.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eConflicts of interest:\u003c/h2\u003e \u003cp\u003eThe authors declare no conflicts of interest.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding:\u003c/h2\u003e \u003cp\u003eThis study was supported by the College of Applied Medical Sciences Research Centre and the Deanship of Scientific Research at King Saud University.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003e1 and 2 contributed to the study conception and design. Material preparation1,2,3 contributed in data collection and analysis1 and 4, data analysis ans writting the first draft of the manuscript.All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgements:\u003c/h2\u003e \u003cp\u003eThe authors gratefully acknowledge the College of Applied Medical Sciences Research Centre and the Deanship of Scientific Research at King Saud University for funding this study. We also thank Editage and Cactus Communications for editorial support, medical writing assistance, table assembly, creation of high-resolution images, copyediting, fact-checking, and referencing.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eVereertbrugghen A, Galletti JG. Corneal nerves and their role in dry eye pathophysiology. Exp Eye Res. 2022;222:109191. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.exer.2022.109191\u003c/span\u003e\u003cspan address=\"10.1016/j.exer.2022.109191\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLabetoulle M, Baudouin C, Calonge M, Merayo-Lloves J, Boboridis KG, Akova YA, et al. Role of corneal nerves in ocular surface homeostasis and disease. Acta Ophthalmol. 2019;97(2):137\u0026ndash;45. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1111/aos.13844\u003c/span\u003e\u003cspan address=\"10.1111/aos.13844\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNavascues-Cornago M, Sun T, Read ML, Morgan PB. The short-term effect of contact lens wear on blink characteristics. Cont Lens Anterior Eye. 2022;45(5):101596. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.clae.2022.101596\u003c/span\u003e\u003cspan address=\"10.1016/j.clae.2022.101596\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBuch J, Riederer D, Scales C, Xu J. Tear film dynamics of a new soft contact lens. Ophthalmic Physiol Opt. 2023;43(5):1070\u0026ndash;1078. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1111/opo.13169\u003c/span\u003e\u003cspan address=\"10.1111/opo.13169\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBoost M, Cho P, Wang Z. Disturbing the balance: effect of contact lens use on the ocular proteome and microbiome. Clin Exp Optom. 2017;100(5):459\u0026ndash;72. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1111/cxo.12582\u003c/span\u003e\u003cspan address=\"10.1111/cxo.12582\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGurnani B, Kaur K. Contact Lens\u0026ndash;Related Complications. Treasure Island, FL: StatPearls Publishing; 2023.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWaghmare SV, Jeria S. A review of contact lens-related risk factors and complications. Cureus. 2022;14(10):e30118. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.7759/cureus.30118\u003c/span\u003e\u003cspan address=\"10.7759/cureus.30118\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGolebiowski B, Papas EB, Stapleton F. Corneal and conjunctival sensory function: the impact on ocular surface sensitivity of change from low to high oxygen transmissibility contact lenses. Invest Ophthalmol Vis Sci. 2012;53(3):1177\u0026ndash;81. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1167/iovs.11-8416\u003c/span\u003e\u003cspan address=\"10.1167/iovs.11-8416\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMcMonnies CW. Could contact lens dryness discomfort symptoms sometimes have a neuropathic basis? Eye Vis (Lond). 2021;8(1):12. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/s40662-021-00236-4\u003c/span\u003e\u003cspan address=\"10.1186/s40662-021-00236-4\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMusgrave CSA, Fang F. Contact lens materials: a materials science perspective. Materials (Basel). 2019;12(2):261. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3390/ma12020261\u003c/span\u003e\u003cspan address=\"10.3390/ma12020261\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBaca JT, Finegold DN, Asher SA. Tear glucose analysis for the noninvasive detection and monitoring of diabetes mellitus. Ocul Surf. 2007;5(4):280\u0026ndash;93. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/S1542-0124(12)70094-0\u003c/span\u003e\u003cspan address=\"10.1016/S1542-0124(12)70094-0\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFarandos NM, Yetisen AK, Monteiro MJ, Lowe CR, Yun SH. Contact lens sensors in ocular diagnostics. Adv Healthc Mater. 2015;4(6):792\u0026ndash;810. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1002/adhm.201400504\u003c/span\u003e\u003cspan address=\"10.1002/adhm.201400504\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eQiu SX, Fadel D, Hui A. Scleral lenses for managing dry eye disease in the absence of corneal irregularities: what is the current evidence? J Clin Med. 2024;13(13):3838. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3390/jcm13133838\u003c/span\u003e\u003cspan address=\"10.3390/jcm13133838\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eManicam C, Perumal N, Wasielica-Poslednik J, Ngongkole YC, Tsch\u0026auml;bunin A, Sievers M, et al. Proteomics unravels the regulatory mechanisms in human tears following acute renouncement of contact lens use: a comparison between hard and soft lenses. Sci Rep. 2018;8(1):11526. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1038/s41598-018-30032-5\u003c/span\u003e\u003cspan address=\"10.1038/s41598-018-30032-5\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePang K, Lennikov A, Yang M. Hypoxia adaptation in the cornea: current animal models and underlying mechanisms. Animal Models Exp Med. 2021;4(4):300\u0026ndash;10. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1002/ame2.12192\u003c/span\u003e\u003cspan address=\"10.1002/ame2.12192\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRivera RK, Polse KA. Effects of hypoxia and hypercapnia on contact lens-induced corneal acidosis. Optom Vis Sci. 1996;73(3):178\u0026ndash;83. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1097/00006324-199603000-00009\u003c/span\u003e\u003cspan address=\"10.1097/00006324-199603000-00009\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAlSarhan RS, Abuageelah BM, Alahmadi AA, Alfaifi MH, Alghamdi KM, Alamri A. Use, misuse, and complications of contact lens among the general population of the Kingdom of Saudi Arabia. Cureus. 2023;15(12):e51368. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.7759/cureus.51368\u003c/span\u003e\u003cspan address=\"10.7759/cureus.51368\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePastor-Zaplana J\u0026Aacute;, Gallar J, Acosta MC. Effects of contact lens wearing on corneal sensitivity and reflex functions. Acta Ophthalmol. 2022;100(S275). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1111/j.1755-3768.2022.0605\u003c/span\u003e\u003cspan address=\"10.1111/j.1755-3768.2022.0605\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePullen RL Jr. Testing the corneal reflex. Nursing. 2005;35(11):68. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1097/00152193-200511000-00058\u003c/span\u003e\u003cspan address=\"10.1097/00152193-200511000-00058\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eStevens S. Schirmer\u0026rsquo;s test. Community Eye Health. 2011;24(76):45. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.mountsinai.org/health-library/tests/schirmer-test\u003c/span\u003e\u003cspan address=\"https://www.mountsinai.org/health-library/tests/schirmer-test\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCaltrider D, Gupta A, Tripathy K. Evaluation of visual acuity. StatPearls [Internet]; 2025 January. Treasure Island, FL: StatPearls Publishing. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.ncbi.nlm.nih.gov/books/NBK564307/\u003c/span\u003e\u003cspan address=\"https://www.ncbi.nlm.nih.gov/books/NBK564307/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e\u0026Ouml;zcura F, Aydin S, Helvaci MR. Ocular Surface Disease Index for the diagnosis of dry eye syndrome. Ocul Immunol Inflamm. 2007;15(5):389\u0026ndash;93. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1080/09273940701486803\u003c/span\u003e\u003cspan address=\"10.1080/09273940701486803\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChalmers RL, Begley CG, Moody K, Hickson-Curran SB. Contact Lens Dry Eye Questionnaire-8 (CLDEQ-8) and opinion of contact lens performance. Optom Vis Sci. 2012;89(10):1435\u0026ndash;42. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1097/OPX.0b013e318269c90d\u003c/span\u003e\u003cspan address=\"10.1097/OPX.0b013e318269c90d\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBakkar MM, El-Sharif AK, Al Qadire M. Validation of the Arabic version of the ocular surface disease index questionnaire. Int J Ophthalmol. 2021;14(10):1595\u0026ndash;601. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.18240/ijo.2021.10.18\u003c/span\u003e\u003cspan address=\"10.18240/ijo.2021.10.18\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMorgan PB, Efron N. Global contact lens prescribing 2000\u0026ndash;2020. Clin Exp Optom. 2022;105(3):298\u0026ndash;312. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1080/08164622.2022.2033604\u003c/span\u003e\u003cspan address=\"10.1080/08164622.2022.2033604\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMuntz A, Subbaraman LN, Sorbara L, Jones L. Tear exchange and contact lenses: a review. J Optom. 2015;8(1):2\u0026ndash;11. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.optom.2014.12.001\u003c/span\u003e\u003cspan address=\"10.1016/j.optom.2014.12.001\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIqbal A, Fisher D, Alonso-Caneiro D, Collins MJ, Vincent SJ. Quantifying tear exchange during rigid contact lens wear using corneoscleral profilometry: a proof of concept study. Ophthalmic Physiol Opt. 2025;45(3):598\u0026ndash;606. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1111/opo.13450\u003c/span\u003e\u003cspan address=\"10.1111/opo.13450\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLu C, Han D, Zeng L, et al. Short-term efficacy and safety of scleral lenses in the management of severe dry eye in a Chinese population. J Clin Med. 2025;14(3):658. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3390/jcm14030658\u003c/span\u003e\u003cspan address=\"10.3390/jcm14030658\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHong X, Himebaugh N, Thibos LN. On-eye evaluation of optical performance of rigid and soft contact lenses. Optom Vis Sci. 2001;78(12):872\u0026ndash;80. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1097/00006324-200112000-00009\u003c/span\u003e\u003cspan address=\"10.1097/00006324-200112000-00009\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKrolo I, Bećirević AK, Radman I, Sabol I, Ravlić MM, Ratković M, et al. Impact of soft and rigid gas-permeable contact lenses on visual performance in mesopic conditions. Indian J Ophthalmol. 2024;72(suppl 2):S229-32. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.4103/IJO.IJO_628_23\u003c/span\u003e\u003cspan address=\"10.4103/IJO.IJO_628_23\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePullum KW, Buckley RJ. A study of 530 patients referred for rigid gas permeable scleral contact lens assessment. Cornea. 1997;16(6):612\u0026ndash;22. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1097/00003226-199711000-00003\u003c/span\u003e\u003cspan address=\"10.1097/00003226-199711000-00003\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChalmers RL, Keay L, McNally JJ. Impact of rigid gas-permeable lenses on tear film stability. Optom Vis Sci. 2000;77(4):171\u0026ndash;2. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1097/00006324-200004000-00003\u003c/span\u003e\u003cspan address=\"10.1097/00006324-200004000-00003\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGuillon JP, Ma\u0026iuml;ssa C, Wong S. Tear film changes in soft lens wearers as a function of lens type. Eye Contact Lens. 2005;31:26\u0026ndash;31.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSchornack MM. Scleral lenses: a review. Eye Contact Lens. 2013;39:249\u0026ndash;58.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSchiffman RM, Christianson MD, Jacobsen G, Hirsch JD, Reis BL. Reliability and validity of the Ocular Surface Disease Index. Arch Ophthalmol. 2000;118(5):615\u0026ndash;21. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1001/archopht.118.5.615\u003c/span\u003e\u003cspan address=\"10.1001/archopht.118.5.615\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"international-ophthalmology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"inte","sideBox":"Learn more about [International Ophthalmology](https://www.springer.com/journal/10792)","snPcode":"10792","submissionUrl":"https://submission.nature.com/new-submission/10792/3","title":"International Ophthalmology","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"corneal reflex, vision-related functions, contact lens, tear film","lastPublishedDoi":"10.21203/rs.3.rs-8525049/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8525049/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cb\u003ePurpose\u003c/b\u003e\u003c/p\u003e \u003cp\u003eTo evaluate the effects of soft, hard, and scleral contact lenses (CLs) on corneal reflex sensitivity and vision-related functions in CL wearers.\u003c/p\u003e\u003cp\u003e\u003cb\u003eMethods\u003c/b\u003e\u003c/p\u003e \u003cp\u003eThis cross-sectional study included 89 participants aged 20\u0026ndash;45 years, allocated to four groups: soft, hard, scleral, and non-CL wearers (controls). Corneal reflex sensitivity, tear film stability (Schirmer\u0026rsquo;s test), and visual acuity (Snellen chart) were assessed. The ocular surface disease index (OSDI) and CL dry eye questionnaire-8 (CLDEQ-8) were used to evaluate vision-related function. Data were analyzed using SPSS.\u003c/p\u003e\u003cp\u003e\u003cb\u003eResults\u003c/b\u003e\u003c/p\u003e \u003cp\u003eScleral CL wearers had the lowest tear production and longest corneal reflex times. Hard CL wearers showed moderate tear production and similar corneal reflex times to scleral lens users. Soft CL wearers had the highest tear film quantity and greater reflex sensitivity, indicating more favorable ocular health. Controls exhibited the greatest tear stability and fastest reflexes. Visual acuity differed significantly, with soft CL wearers achieving the best results among lens users. Scleral lens wearers reported more frequent ocular discomfort, dryness, blurred vision, reading and night driving difficulties, computer and TV-related strain, and sensitivity in windy or low-humidity environments than did individuals in other CL groups.\u003c/p\u003e\u003cp\u003e\u003cb\u003eConclusions\u003c/b\u003e\u003c/p\u003e \u003cp\u003eCL wear significantly affects tear film production and corneal reflex sensitivity. Soft lenses had the most favorable impact, whereas scleral lenses exhibited the poorest outcomes. Regular ocular examinations and patient education are essential to minimize risks and preserve visual function during prolonged CL use.\u003c/p\u003e","manuscriptTitle":"Assessment of corneal reflex and vision-related functions among contact lens wearers: a cross-sectional study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-24 08:22:45","doi":"10.21203/rs.3.rs-8525049/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-04-19T09:10:24+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-16T11:05:07+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"289971759665987243717432490630909922230","date":"2026-04-13T23:56:42+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-29T09:27:53+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"42187413765958566143915238741920680370","date":"2026-03-27T04:27:50+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"166909499631405742983317228248939651693","date":"2026-03-27T02:36:38+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"29836357642983237537304021636347383711","date":"2026-03-23T09:15:26+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"55105366940934537086989232855086302582","date":"2026-02-22T14:10:33+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"87747900027205442796917759716688238734","date":"2026-02-20T10:13:14+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-02-17T13:38:37+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-01-07T06:23:20+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-01-07T06:19:43+00:00","index":"","fulltext":""},{"type":"submitted","content":"International Ophthalmology","date":"2026-01-05T22:21:31+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"international-ophthalmology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"inte","sideBox":"Learn more about [International Ophthalmology](https://www.springer.com/journal/10792)","snPcode":"10792","submissionUrl":"https://submission.nature.com/new-submission/10792/3","title":"International Ophthalmology","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"f67b3463-32f2-406e-b44c-369909a89428","owner":[],"postedDate":"February 24th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-12T04:38:39+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-24 08:22:45","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8525049","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8525049","identity":"rs-8525049","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}