CASE STUDY I - Dr. Rah

A 12-year-old Asian male patient, BL, presented to the New England Eye Institute interested in overnight contact lens corneal reshaping. A pre-treatment manifest refraction of -4.25 sphere in the right eye and -4.25 -0.50 x 150 in the left eye was obtained. Corrected Snellen visual acuity was 20/20 in each eye. Baseline keratometry readings were 44.00/44.75 @ 090 with clear and regular mires in the right eye and 43.50/44.75 @ 090 with clear and regular mires in the left eye. Baseline topography is seen in the top two maps of the figure below. The patient was fitted with DreimLens design lenses.

At the one-week follow-up appointment, the refraction was +0.25 sphere in the right eye and -0.25 sphere in the left eye, both corrected to 20/20. Unaided visual acuities were 20/20 in each eye. At the two-week follow-up appointment, the refraction was plano in the right eye and +0.50 sphere in the left eye, both corrected to 20/20. Unaided acuities in each eye were 20/20. The patient reported good acuity all waking hours with treatment. The patient was instructed to continue lens wear every night and to report any problems. The final topography maps are provided in the bottom two maps of the figure above.

Children can be excellent candidates for contact lens corneal reshaping. Many children are active in sports or other activities in which wearing glasses or contact lenses can be bothersome. Overnight contact lens corneal reshaping may be a good alternative for this population. Care should be taken to instruct the child and parents concerning proper handling and care of the treatment lenses.
  

CASE STUDY II - Dr. Rah

An 11-year-old male patient, JA, presented to the New England Eye Institute interested in the Children's Overnight Orthokeratology Investigation (COOKI). At the baseline visit, his manifest refraction was -2.25 sphere in the right eye and -2.00 -0.25 x 180 in the left eye. Corrected Snellen visual acuity was 20/20 in each eye. Baseline keratometry readings obtained from the Humphrey Atlas corneal topographer were 42.87/43.12 @ 090 in the right eye and 42.37/43.37 @ 090 in the left eye. The patient was fitted with Paragon CRT design lenses with the following parameters:

At the one-week follow-up appointment, the refraction was +0.25 -0.50 x 090 in the right eye and +0.25 sphere in the left eye, both corrected to 20/20. Unaided visual acuities were 20/25 in the right eye and 20/20 in the left eye. At the one-month follow-up appointment, the refraction was +0.50 -0.50 x 095 in the right eye and +0.50 -0.25 x 030 in the left eye, both corrected to 20/20. Unaided acuities in each eye were 20/20. The patient reported good acuity all waking hours with treatment. The patient was instructed to continue lens wear every night and to report any problems. The baseline and one-week topography maps are provided in the figure below.