Corneal Remolding Therapy

 
 

Orthokeratology


Orthokeratology

Orthokeratology, or “ortho-k,” is the process of reshaping the eye with specially-designed rigid gas permeable (GP) contact lenses. The goal of ortho-k is to flatten the front surface of the eye and thereby correct mild to moderate amounts of nearsightedness and astigmatism.

How ortho-k works
The GP lenses for ortho-k are applied at bedtime and worn overnight. While you sleep, the lenses gently reshape the front surface of your eye (the cornea) to correct your vision, so you can see clearly without glasses or contact lenses when you’re awake. The effect is temporary – generally enough to get you through a day or two – so you must wear the reshaping lenses each night to maintain good vision during the day.

 

How come I have never heard of this?

Ortho K technology has been around over 40 years.  However, it is only within the past 10 years where the technology has caught up to really develop customized lenses to fit a broader patient base.  In addition, it is with the development of newer materials and the additional studies of myopia control in children that has really started to make Ortho K a growing method of vision correction!  With the main risk factors similar to those of wearing soft contact lenses, ortho-K is one of the safest ways to be free of glasses.

Who is a candidate for ortho-k?
Ortho k is a great option for anyone who has a low to moderate amount of nearsightedness and wants to be free of glasses or contact lenses.  The final determination will be made by Dr. Trinh who will determine if your prescription falls within the therapeutic ranges.

Children:
Recent multi center research over the past 10 years has demonstrated a significant decrease in progression of nearsightedness in children who were treated with OrthoKeratology lenses.  Multiple research studies have demonstrated an average decrease in progression of myopia in children between 40-50%.  Until recently, doctors have only been able to tell parent's that the only method of treating myopia was with glasses and that progression was ultimately going to happen.  Based on these new research developments we no longer have to wait and see what will happen with the progression of myopia, but rather can take action to decrease the likelihood of progression.  This is especially important in patients who have family history of very high myopia, which can increase risk for complications such as retinal detachments and retinal thinning.
UC Berkeley School of Optometry has recently established a myopia control clinic in 2014 which uses a combination of Ortho-keratology lenses, specialty lenses and drops that have demonstrated slowing of progression of myopia.


Laser Eye Surgery Candidates:
Laser Eye Surgery is a great procedure, but may not be for everyone.  As a result Ortho Keratology can offer a great alternative to someone looking to be free of glasses and contact lenses due to convenience, but just is not ready to take the plunge into LASIK surgery.

Athletes:  Ortho K is great for athletes who compete in sports where contact lenses can get in the way such as swimmers, golfers, marathon runners, cyclists, surfers and tri-athletes.  Since the correction lasts 24-48 hours for intensive sports that can require extended hours of comfort with conventional contact lenses, Ortho K lenses provide a much more natural vision for greater performance.


What results can you expect from ortho-k?

The goal for ortho-k is to correct your vision to 20/20 without eyeglasses or contact lenses during the day. In FDA trials of both CRT and VST lenses, more than 65% of patients were able to achieve 20/20 visual acuity after wearing the reshaping lenses overnight. More than 90% were able to see 20/40 or better (the legal vision requirement for driving without glasses in most states).  Success rates for ortho-k tend to be higher for mild prescriptions. Call our office to find out if your prescription is within the range that can be successfully treated with ortho-k.

How long does ortho-k take?

Though you may see some improvement in your vision after a day or two of overnight ortho-k, it can take several weeks for the full effect to be apparent. During this time, your vision will not be as clear as it was with glasses or contacts, and you are likely to notice some glare and halos around lights. It’s possible you may need a temporary pair of eyeglasses for certain tasks, like driving at night, until your vision is fully corrected by the ortho-k lenses.

Is ortho-k comfortable?

Some people have comfort issues when attempting to wear gas permeable contact lenses during the day. But since ortho-k GP lenses are worn during sleep, comfort and lens awareness are generally not a problem.

How much does Ortho K cost? 

OrthoKeratology is about half the cost of LASIK surgery.  The therapeutic procedure ranges from $1600 to $2500 depending on the complexity of the case and the prescription.  Lower prescriptions will often be correctable with one mold, where as higher prescriptions will require several molds.

Can I have LASIK after ortho-k?

Yes, it’s possible to have LASIK surgery after orthokeratology. However, since ortho-k lenses reshape your cornea, you must stop wearing the lenses for a period of time (usually several months) so your eyes can return to their original shape and stabilize. Be sure to tell your LASIK surgeon that you’ve worn ortho-k lenses, so they can advise you how long you should wait before having the surgery..

 
 

Jeffrey J. Walline. (2012) Myopia Control with Corneal Reshaping Contact Lenses. (FULL TEXT) Invest. Ophthalmol. Vis. Sci. VOL 53 no. 11 PG 7086 doi: 10.1167/iovs.12-10996 MyopiaPrevention.org comment: This is a commentary on Pauline Cho's article (2012) about the ROMIO findings. Quoting "Myopia affects a significant proportion of the world population, and corneal reshaping contact lenses were shown to slow the progression of the disease significantly. Thus, the findings of the randomized clinical trial reported by Cho and Cheung potentially could affect millions of people almost immediately.

"Three previously reported controlled studies indicated a slowing of eye growth association with corneal reshaping contact lens wear but none of the studies assigned subjects randomly to treatment, therefore increasing the potential for bias. With the information presented by Cho and Cheung, we finally have definitive information from a randomized clinical trial that can be shared with patients."

Pauline Cho and Sin-Wan Cheung. (2012) Retardation of Myopia in Orthokeratology (ROMIO) Study: a 2-year randomized clinical trial. (FULL TEXT) Invest. Ophthalmol. Vis. Sci. Oct 11, 2012 Vol. 53 no. 11, doi: 10.1167/iovs.12-10565 MyopiaPrevention.org comment: This from their conclusion: "On average, subjects wearing ortho-k lenses had slower increase in axial elongation by 43% compared to subjects wearing single-vision glasses."

20% of the 7-8 year old orthok patients progressed at greater than 1.00D/yr while 63% of the control group did so. Rates slowed down significantly by ages 9-10 when only 13% of the controls and 9% of the orthok patients progressed at that rate. Significantly, this a randomized clinical trial.

Takahiro Hiraoka, Tetsuhiko Kakita, Fumiki Okamoto1, Hideto Takahashi and Tetsuro Oshika. (2012) Long-Term Effect of Overnight Orthokeratology on Axial Length Elongation in Childhood Myopia: A 5-Year Follow-Up Study. (ABSTRACT) Investigative Ophthalmology & Visual Science June 25, 2012 vol. 53 no. 7 3913-3919 doi 10.1167/iovs.11-8453 MyopiaPrevention.org comment: Forty three 10 year old students wore either orthok lenses or glasses to correct their vision for five years. For the first three years orthok slowed the progression of myopia compared to the controls, but the differences were not significant after three years. Overall, the orthok students progressed 42% less than the spectacle wearers. There were no severe complications throughout the study.

Jacinto Santodomingo-Rubido, Cesar Villa-Collar, Bernard Gilmartin and Ramon Gutierrez-Ortega. (2012) Myopia Control with Orthokeratology Contact Lenses in Spain (MCOS): Refractive and Biometric Changes. (ABSTRACT) Investigative Ophthalmology & Visual Science Published online before print June 22, 2012 doi 10.1167/iovs.11-8005 MyopiaPrevention.org comment: This prospective study compared the myopic progresion of two groups of children, one wearing single vision spectacle lenses and one wearing orthokeratology lenses. The primary measure was axial length. The spectacle wearers progressed .69 mm and the orthok group progressed .47 mm, a slowing of approximately 32% for the orthok group.

T. Kakita, T. Hiraoka, T. Oshika.(2011) Influence of Overnight Orthokeratology on Axial Length Elongation in Childhood Myopia. (ABSTRACT) Investigative Ophthalmology & Visual Science January 2011 (Published online before print) doi: 10.1167/iovs.10-5485 MyopiaPrevention.org comment: Formerly a poster presentation listed here: Presentation ARVO 2010 Program:2195 Poster:A294 (ABSTRACT) . A prospective study of 210 eyes over two years with spectacle wearing students as controls matched for age, refractive error, gender, visual acuity and axial length. Over the two year study, the Ortho-K group's axial length grew by .39mm and the control group by .61, a 36% reduction in myopic progression as measured by axial length.

Peter E. Wilcox, David P. Bartels.(2010) Orthokeratology for Controlling Myopia: Clinical Experiences. (FULL TEXT) Contact Lens Spectrum May 2010 39-42 MyopiaPrevention.org comment: An anecdotal case report study for five patients showing a progression rate of .03 diopters per year for children fit with ortho-k lenses. They outline their CANDY plan (Controlling Astigmatism and Nearsightedness in Developing Youth.)

H.A. Swarbrick, A. Alharbi, K. Watt, E. Lum..(2010) Overnight Orthokeratology Lens Wear Slows Axial Eye Growth in Myopic Children. (ABSTRACT) Presentation ARVO 2010 Program:1721 Poster:A178 MyopiaPrevention.org comment: A poster presentation. Fourteen myopic children were fitted with ortho-k lenses in one eye and and daily wear lenses in the other eye. Lenses were worn for six months followed by a two week period of no lens wear and then lens-eye combinations were reversed and the lenses worn for six more months. For each eye when wearing the ortho-k lenses there were no significant change in axial lengths. Thus ortho-k is shown to stop myopia over a short term.

E. Okada, K. Kimbara, K. Iyanaga, N. Tabei, T. Hidaka, M. Nagasaki, T. Yokoyama, H. Kamezawa, N. Mizuki.(2010) Longitudinal Analysis of Orthokeratology Outcome for Myopia Correction in Comparison With Other Lenses and Spectacles (ABSTRACT) Presentation ARVO 2010 Program:1528 Poster:D819 MyopiaPrevention.org comment: A poster presentation. Orthokeratology patients under 18 did not increase in refractive power over the five years of the study compared with progression rates of soft, hard and spectacle lenses, but the data presented in the abstract does not allow determination of subject parameters such as age or refractive state and the drop out rate is not clear.

Queirós A, González-Méijome JM, Jorge J, Villa-Collar C, Gutiérrez AR.(2010) Peripheral refraction in myopic patients after orthokeratology. (ABSTRACT) Optom Vis Sci. 2010 May;87(5):323-9. MyopiaPrevention.org comment: Peripheral refractions were studied for 28 eyes that had ortho-k. Ortho-K created myopic reduction for the central retina and a myopic shift beyond 25 degrees. Between 30 and 35 degrees the amount of myopia induced almost exactly matches the amount of myopic reduction centrally. This proves that corneal peripheral steepening seen in topography after ortho-k is transferred optically to the retina.

Queirós, Antonio; González-Méijome, Jose Manuel; Villa-Collar, Cesar; Gutiérrez, Angel Ramon; Jorge, Jorge (2010) Local Steepening in Peripheral Corneal Curvature After Corneal Refractive Therapy and LASIK. (ABSTRACT) Optometry & Vision Science: Post Author Corrections, 8 April 2010 [cited 2010 Apr 15] MyopiaPrevention.org comment: LASIK and Ortho-K have similar corneal shapes with ortho-k having an area of corneal steeping 1mm smaller and higher mid peripheral steeping than LASIK, perhaps creating a greater peripheral myopic focus, which may "have implications" for myopia control.

Queirós, António; González-Méijome, José Manuel; Jorge, Jorge; Villa-Collar, César; Gutiérrez, Angel R.(2010) Peripheral Refraction in Myopic Patients After Orthokeratology. (ABSTRACT) Optometry & Vision Science. Post Author Corrections, 1 April 2010 doi: 10.1097/OPX.0b013e3181d951f7 [cited 11 April 2010] MyopiaPrevention.org comment: Changes in the peripheral refraction after orthokeratology were essentially unchanged at 25 degrees peripheral to centration but at 30 and 35 degrees, a myopic shift was highly correlated (1:1) with the amount of central (axial) treatment. It would appear that the circular treatment zones molded onto the cornea create a myopic focus shift starting at about 30 degrees.

Cary M. Herzberg (2010) An Update on Orthokeratology. Contact Lens Spectrum (FULL TEXT) March 2010 MyopiaPrevention.org comment: This is a summary of where orthokeratology technology stands today by the president of the Orthokeratology Academy of America.

Joseph Ruskiewicz.(2009) Ortho-K: An Answer for Myopia Control. (FULL TEXT) Review of Optometry Vol. No: 146:03 Issue: 3/15/2009 MyopiaPrevention.org comment: Quoting: "Myopia is a costly, life-long problem. But, orthokeratology can help control myopia and prevent further progression." This is not a review or research article, but rather a narrative about the advantages of ortho-k with a couple of case reports.

J J Walline, L A Jones, L T Sinnott. (2009) Corneal reshaping and myopia progression. (FULL TEXT) British Journal of Ophthalmology VOL 93 PG 1181-1185 doi:10.1136/bjo.2008.151365 MyopiaPrevention.org comment: Twenty eight subjects wore orthok lenses for two years and were matched with another study as a control. Axial length changes were less in the orthok group. Although there are many limits to the design study, it presented further evidence that a rigorous study was needed.

Jacinto Santodomingo-Rubido, César Villa-Collar, Bernard Gilmartin and Ramón Gutiérrez-Ortega. (2009) Myopia Control with Orthokeratology Contact Lenses in Spain (MCOS): Study Design and General Baseline Characteristics. (FULL TEXT) J Optom 2009;2:215-222 Vol.02 no. 04 doi: 10.3921/joptom.2009.215 MyopiaPrevention.org comment: Baseline data for a prospective study comparing the axial length growth of myopic white European children and their spectacle wearing counterparts. The control group was well matched. Average myopia was about -2.00 D and average age was about 9.7 years. The study will also collect any adverse event data. Expected completion date: 2013.

S. Barry Eiden, Robert L. Davis, Edward S. Bennett, and Julie O. DeKinder. (2009) The SMART Study: Background, Rationale, and Baseline Results (FULL TEXT) Contact Lens Spectrum October 2009 MyopiaPrevention.org comment: This is the preliminary set-up report for the SMART (Stabilization of Myopia through Accelerated Reshaping Technologies) trial. First year results have not been published as of 4/1/2010. This study uses a "wash-out" period each year where the ortho-k molding lenses are removed until the cornea stabilizes, then wearing is resumed. Preliminary results show that myopia is reduced significantly in the ortho-k group but both the control and treatment group had an essentially equal changes in vitreous chamber depth (an increase) and axial length (no change).

Josh Lotoczky, Bruce Morgan.(2009) Myopia Control With the Euclid Emerald Contact Lens and Overnight Orthokeratology. (ABSTRACT) Optometry Volume 80, Issue 6, Pages 291-292 (June 2009) Poster 12 MyopiaPrevention.org comment: A case study report. Nine children aged 10-16 at the time of the start of the study had ortho-k lenses for 4 years at which time there was a three week wash-out period of no wear. The total progression averaged a .05 Diopter increase in myopia, essentially no change.

Walline JJ, Jones LA, Sinnott LT. (2009) Corneal reshaping and myopia progression. (ABSTRACT) Br J Ophthalmol. 93(9): 1181-5 MyopiaPrevention.org comment: This is the report of the CRAYON study (Corneal Reshaping And Yearly Observation of Nearsightedness). Ortho-K lenses slowed axial length and vitreous chamber depth (both indicators of slowing of myopia progression) compared to soft contact lens wear for 28 subjects over 2 years. Eye growth was slowed by a reported 55%, the vitreous chamber depth somewhat less percentage-wise.

Bob Kronemyer. (2007) Research encouraging for controlling myopia by reshaping the eye’s front surface. (FULL TEXT) Primary Care Optometry News 7/1/2007 MyopiaPrevention.org comment: This is an online news article from 2007 that is hesitant to claim myopia control by ortho-k until further studies are completed.

Watt KG, Swarbrick HA.(2007) Trends in microbial keratitis associated with orthokeratology. (ABSTRACT) Eye Contact Lens.2007 Nov;33(6 Pt 2):373-7; discussion 382. MyopiaPrevention.org comment: Over half of the reported cases in the literature of infections related to orthokeratology occurred in the year 2001 and that year all cases were from East Asia during a time when the practice was generally unregulated. The higher incidence of microbes found in tap water confirm the need for proper instruction in lens care and handling.

Peripheral Refraction in Orthokeratology Patients. (FULL TEXT) Optometry and Vision Science September 2006 - Volume 83 - Issue 9 - pp 641-648 MyopiaPrevention.org comment: Orthokeratology corrects the central 20 degrees of vision but very little beyond 60 degrees (30 degrees either side). The article concludes that if relative peripheral myopia limits myopic progression, then orthokeratology is an excellent option.

Swarbrick HA.(2006) Orthokeratology review and update. (FULL TEXT) Clin Exp Optom2006 May;89(3):124-43. MyopiaPrevention.org comment: A review as of 2006 of the efficacy of ortho-k, mechanisms and safety. While studies have indicated benefits in slowing myopic progression, the author would "argue strongly for a more rigorously controlled, prospective, randomized and masked clinical study to confirm these promising findings."

Cho P, Cheung SW, Edwards M. (2005) The longitudinal orthokeratology research in children (LORIC) in Hong Kong: a pilot study on refractive changes and myopic control. (ABSTRACT) Curr Eye Res. 30(1): 71-80 MyopiaPrevention.org comment: Thirty five students fitted with ortho-k lenses for two years showed that axial length (a measure of myopic progression) was reduced by half in the ortho-k group as compared to the control group although the variations were very high. The control group was actually from a different study matched for age, gender and baseline refraction, not the best study design.

Walline JJ, Holden BA, Bullimore MA, Rah MJ, Asbell PA, Barr JT, Caroline PJ, Cavanagh HD, Despotidis N, Desmond F, Koffler BH, Reeder K, Swarbrick HA, Wohl LG. (2005) The current state of corneal reshaping. (ABSTRACT) Eye Contact Lens. 2005 Sep;31(5):209-14. MyopiaPrevention.org comment: Among other comments, they state that "claims about the progress of myopia being controlled with corneal reshaping contact lenses should not be made until further studies are published in peer-reviewed literature."

Jeffrey J. Walline, Marjorie J. Rah, Lisa A. Jones. (2004) The Children's Overnight Orthokeratology Investigation (COOKI) Pilot Study (FULL TEXT) Optom Vis Sci. 2004 Jun;81(6):407-13 MyopiaPrevention.org comment: Twenty nine 8-11 year old children were enrolled in the study to wear over-night orthokeratology lenses. Twenty four completed the study over 6 months with good vision and no serious problems. Of the 5 that did not complete the study, only one dropped due to dissatisfaction with the process.

Reim TR, Lund M, Wu R (2003) Orthokeratology and adolescent myopia control. (ABSTRACT) ) Contact Lens Spectrum 2003; 18(3) MyopiaPrevention.org comment: One of the first attempts to begin studying the relationship of ortho-k to myopia control. Although the effect was detectable, it was not considered proof enough to claim a reduction in rate of progression.