Any ranking of contact lens here is the opinion of Dr. Chappel OD and everyone is different and so everyone's eyes are different you wouldn't believe how many times I have seen someone who loves lenses I would consider the bottom of the barrel but they love them even after trying my favorite contact lens. If I was going to say contact lens as a whole I would have a little bit of a controversial pick with scleral contact lens which has the best optics, comfort when fitting correctly, and only contact lens fda approved to treat dryness. It is completely different than every other lens on the market. The only downfall in them is you can't get as much oxygen permeability as I would like (which means absolutely no sleeping in the lens) but even with that Dr. Chappel OD wears it. To put it in perspective number one reason why people quit wearing scleral contact lenses is due to the handling of the lens (putting it in and out of your eye). The most common reason most people quit soft lenses is due to comfort and then second is handling and third is vision.
If I was going to going to go to the coolest contact lens that would be ortho-k lens due to it being a lens you sleep in and then wake up and can see without wearing anything! The problem with both of these is complicated to fit and can takes time before they may be 100%, especially for scleral lens, unlike traditional soft lenses which are significantly easier to fit and normally only require one lens.
On that note, Let's talk about the genre of contacts that the majority of people wear which is normal soft lenses. The top 3 best soft contact lenses in my opinion in this order Dailies Total 1, Infuse, and Acuvue Oasys max one day (honestly, I'm not too fond of the two-week lens). Almost all optometrists agree with the top 3 but some may have it in a different order. All three of these contact have one thing in common they are all daily contact lenses! The main reason why most optometrists like dailies compared to monthly or two weeks is because they are more comfortable because they are able to be thinner, decrease the risk of infection and also have the best compliance of any other contact lens modality (monthly or two week). I'm going to go over why I like Dailies Total 1 it was the first water gradient lens which is the oldest of the big three coming out in 2015 but still the only true Dailes water gradient lens on the market (one monthly that water gradient and one born from the water gradient technology). You're probably wondering what does that mean? Well, we need to talk about the two other lens materials on the market silicon hydrogel and hydrogel. The 1st soft lens on the market was hydrogel which had a ton of moisture up to 80 percent but normally between 50-70 percent but the problem is you get a lot less oxygen permeability called dk/t. The average hydrogel dk/t is 20-42 with a majority in under 30. The average oxygen permeability (dk/t) to silicon hydrogel contact lens is 120-160. Let's talk about what these numbers mean so you can get some context. The two big number for dk/t is 33 and 87. Dk/T greater than 33 means no corneal swelling (edema) across the whole cornea when the eyes are open. If you don't nap/sleep in your contact lens like a perfect contact lens wearer would be, then a 33 dk/t would be perfect. Sadly most of us who wear contact lenses aren't perfect and may nap or sleep in them occasionally. This is why hydrogels are not my favorite contact lens is because we aren't perfect robots. I throw this in here as my favorite hydrogel contact lens is Biotrue the most moisture of 80% and the highest dk/t of over 40 of all hydrogel contact lenses. It is also very handy for high astigmatism with the only daily contact lens going to -2.75 on astigmatism.
The other dk/t number is 87 which is the number for when you are sleeping with the lens and not having central corneal edema some new data is saying that number is 104 if you include the whole cornea it data is not perfect on that. This means if you nap or sleep with your contact lens your corneal doesn't swell from lack of oxygen which is big. (You don't sleep in soft contact lenses because of bacteria growth and many other factors). If we do make the mistake of sleeping/napping in contact lenses then better to do it in silicone hydrogel due to almost eliminating one of the problems of sleeping in lenses. (Please do not sleep in your contact lens intentionally) With that let's talk about silicone hydrogels which have a lot lower moisture content but make up for it by getting high oxygen permeability (dk/t) 80-170. Which lowest end silicon hydrogels get twice as much oxygen as the highest hydrogels. But their moisture content is between 25 to 55% Most around 45%. They got great oxygen permeability but terrible moisture content that what makes Dailes Total 1 contact so great it is a water gradient lens material. It combines the best of both worlds where the edge of the lens (the part that actually touches your eye) is close to 100% moisture but the center of the lens (part not touching your eye) it drops down to 33% moisture to get a dk/t of 156 which is the highest dk/t of all daily lens! It basically the best of both worlds! I feel like this blog is long enough and I probably talk more about the other two brands and also scleral contact lenses and ortho-k in a future blog.
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