Young Child with Progressive Myopia. How to Manage?
Corneal reshaping (also termed “orthokeratology,” “corneal refractive therapy,” and “vision shaping treatment”) is often effective at reducing myopia in young people and allowing them to see without vision correction during the day.
A combination of the importance of self-esteem and of athletic activities for young people makes a device that needs to be worn only at night potentially life-changing.
Integrating corneal reshaping into your practice is likely much easier than perceived. The first step is to become certified with one or more designs that are currently approved by the United States Food and Drug Administration. You can simply go to either www.paragoncrt.com or www.bausch.com and perform the online certification. The lens selection, fitting, and problem-solving for any given design is straightforward and often provided in a laminated card format.
The goal in a corneal reshaping fit is to achieve good centration such that the treatment zone — often about 5-6mm — is well centered over the pupil; otherwise, the patient will likely experience glare and haloes, especially at night. A bulls-eye fluorescein pattern with apical bearing, paracentral clearance, mid-peripheral bearing, and very mild peripheral clearance is desirable.
Care should be taken here to insure that a good portion of the cornea under the reverse-curve zone is within the photopic pupil to insure peripheral myopic defocus, thought to be the deterrent to axial elongation.
Patients as young as 8 years old can be successful with corneal reshaping and can often handle the lenses from day one. But if difficulty is experienced initially, a parent can typically insert and remove the lenses until the child becomes proficient.
Typically patients become adapted to lenses within a matter of days. If initial comfort is a problem, a non-steroidal anti-inflammatory drug can be prescribed for use during the first three to five nights of lens wear.
GP Lens Institute/Orthokeratology Academy of America
- American Academy of Orthokeratology and Myopia Control
- GP Case Grand Rounds Troubleshooting Guide
- GP Lecture Series: Corneal Reshaping
- Bennett E.S., Henry V.A. Fitting Children into Contact Lenses.
- Walline J. Current and Future Developments in Myopia Control.
- Walline J., van der Worp E. Slowing Down Myopia with Contact Lenses.
- Jedlicka J. Ortho-K and Kids: Maximize the Benefits, Minimize the Risks.
- Herzberg C. An Update on Orthokeratology.
- Sindt C. Twelve Tips to Improve Your Pediatric Contact Lens Fitting.
GP Lens Institute Advisory Committee members: Bruce Anderson OD, Marlane Brown OD, Carmen Castellano OD, Walter Choate OD, S. Barry Eiden OD, John Laurent OD, PhD, Derek Louie, OD, MS, Joe Shovlin OD, Frank Weinstock MD, Bruce Williams OD.