Sometimes, Ortho-k Works Too Well Part 2
BY JOHN MOUNTFORD, DIP. APP. SC, FAAO, FCLSA
In my January column "Sometimes, Ortho-k Works Too Well," I told the tale of a missing orthokeratology patient who returned after a five-year absence with central corneal haze that resolved after one month of no lens wear.
Following is a case of another patient who returned after a seven-year absence with a totally different outcome.
Figure 1. Topography maps taken at a seven-year difference in time. Note the consistency of the plots.
Patient JJ was originally fit with ortho-k lenses in 1996 when his refraction was OD –2.75 –0.50 x180 (20/15) and OS –2.75 –0.50 x170 (20/15). He was 15 years old at the time and an unsuccessful soft lens wearer because of low-grade allergies and constant symptoms of ocular dryness. His entire family were patients of the practice. He very successfully adapted to overnight ortho-k with excellent results, achieving +0.50D sphere OD and OS and unaided VA of 20/15.
He regularly attended his follow-up visits, which were always uneventful and always demonstrated pristine corneas and perfectly maintained lenses.
His last visit was early 1999, when he reported having lost both lenses accidentally by washing them down the sink. We ordered and dispensed new lenses, but he did not return for follow up until mid-February this year.
We had sent JJ reminders and always quizzed his parents on his failure to return for aftercare. JJ's parents usually promised to tell him to make an appointment, but he never showed.
The Prodigal Son Returns
When JJ finally returned, we spent the first 10 minutes in a mild harangue about his failure to appear over the last seven years and the possible dangers he may have faced as a result. JJ received these words with a small smile. He then reported wearing the lenses every second night, with perfect vision and no problems.
My examination showed: UVA 20/15 OU, refraction (lenses removed four hours prior) +0.25D OU. The slit lamp exam was perfectly normal, with crystal clear corneas and normal healthy lids.
What's more, both lenses looked brand new. They had no deposits, and the BOZR readings were spot-on. The lens case was spotless both outside and in.
Figure 1 shows topography maps taken at his last visit in 1999 and at the latest one. Both are perfect bull's-eye plots, and the K readings are virtually identical.
Keep Sending Those Reminders
As I said in the previous article, sometimes ortho-k can be too successful and patients may not return often enough for follow up. The case I discussed in January showed what can happen when lenses are not well maintained, whereas this case shows that with proper attention to care and cleanliness, ortho-k patients can remain stable and healthy for almost 10 years.
But I still read the riot act about the need for at least annual follow up.
Dr. Mountford is an optometrist in private practice specializing in advanced contact lenses for keratoconus, post refractive surgery and pediatric aphakia. He is a visiting contact lens lecturer to QUT and UNSW, Australia.