Download Overnight Corneal Reshaping (Orthokeratology) in Adolescents

Overnight Corneal Reshaping
(Orthokeratology)
in
Adolescents
S. Lance Forstot, MD, FACS
The author has no financial interest
in the subject matter of this poster
Introduction
Orthokeratology (OK) which was born in the
1960’s, died by the mid-1980’s from the fact
that fitting rigid contact lenses to reduce
uncorrected visual acuity was basically
unsuccessful.
With the advent of corneal topographic
analysis, high Dk gas permeable lenses, and
reverse geometric lens designs
Overnight Corneal Reshaping (OCR) was
revived in the 1990’s.
Introduction
The first rigid gas permeable lens approved
by the FDA for overnight orthokeratology
was in 2002.
(Paragon CRT – Corneal Refractive Therapy)
(Paragon Vision Sciences)
The lens was approved for patients with
myopia limit -6.00D sphere
and -1.75D astigmatism
We began fitting patients with this lens that
year.
Introduction
Our Initial Results
29 patients (56 eyes)
successful fit
continued in lenses
–
–
–
–
UCVA
20/15 7 (12.5%)
20/20 44 (91%)
20/25 4 (98%)
20/30* 1 (100%)
• (monovision J2)
7 patients (14 eyes)
successful fit
discontinued lens wear
UCVA
– 20/15
– 20/20
– 20/25
– 20/30
0
10 (71%)
2 (86%)
2 (100%)
OCR is an effective way to improve UCVA
Method
We prospectively studied all patients
fit with OCR lenses. For this poster we
retrospectively reviewed all charts on
adolescent patients
( < 16 years of age)
fit with OCR lenses to evaluate the
safety
Results
12 adolescent patients were fit with
OCR lenses
Age range: 6-15 years
(median 13)
Follow-up: 1.5-7.5 years
Results
8 patients continue in OCR lenses
1 patient was discontinued during the
fitting period for a keratitis
1 patient d/c lens @ 1.5 years
1 patient d/c lens @ 5 years
1 patient lost to follow-up @ 6 years
Results
11 patients had a total of 59 years
follow-up
22 eyes with 118 years follow-up
No patient had any complication with
OCR lens wear
(No abrasions, ulcers, infections)
Addendum
OCR in 2 other Ophthalmology Centers
Koffler Vision Group
Wohl Eye Center
• 16 patients fit with OCR
• 4 dropouts
• 40 patients fit with OCR
• 11 dropout or lost to f/u
• 3 with 3 months or less of f/u
• 12 wearing OCR lenses
– Age: 11-16
– (1-3 years of wear)
• 26 wearing OCR lenses
– Age: 9-16
– (10mos.- 6yrs. 11 mos.)
• 27.5 years of wear
No complications
• 108.2 years of wear
No complications
3 Ophthalmology Centers
Fitting OCR lenses
• 49 Adolescent Patients (11-12-26)
• 194.7 years of uncomplicated wear
• 98 Eyes
• 399.4 years of uncomplicated wear
Conclusions
OCR is an effective means of myopia
correction in adolescents
Literature indicates all types of contact lens
wear has the potential for corneal infection
including OCR, however
OCR appears to be safe in adolescents
with proper patient selection and
with proper patient and family
instruction on lens care and warning
signs of problems
Study Limitations
• Relatively small sample size
• Bias of patient sample
• Patients lost to follow-up