To Enhance Ortho-K
To Enhance Ortho-K
Philip F. Kearney, Jr., O.D., C.Ht.
Reducing anxiety or physical distress contributes to the success of one doctor's
Skilled clinical practitioners are accustomed to the more common psychological variables that influence patients during testing and treatment. Some patients manifest fears about going blind from glaucoma, needing cataract surgery or just wearing bifocals for the first time. Some individuals are petrified at the thought of wearing contact lenses, undergoing tonometry or having a corneal foreign body removed. Our job often involves both discussing and allaying those widespread fears. Estimates show about two-thirds of all ocular symptoms and complaints have psychological components. Optometrists learn over time to recognize and deal with them in the most capable manner.
Psychology and Ortho-K
I've noticed that more obscure psychological variables can also have a significant effect on the successful outcome of an ortho-k or myopia containment case. While these variables may be covert or subconscious, we need to uncover and control them in order to achieve the best clinical results.
This first came to my attention a few years ago when an ortho-k patient's vision stopped improving as she suffered a series of personal tragedies. Her OU Rx of -5.50-2.25
x 180 had improved to -1.00 -1.00
x 180. While she was still in active treatment, her husband became ill and died. She then lost her job after a back injury, and suffered through prolonged rehabilitation and depression. Her vision regressed to about -2.50
-1.25 x 180. The patient's son invited her to visit with him in Hawaii for a few months. Upon her return, she was in a better emotional state and had improved physically. At her first checkup, her vision in the same lenses was +0.25 -0.50 x 180 OU, and her refractive error has remained the same for the last few years.
Apprehension or anxiety as well as physical or emotional distress appears to contribute negatively to the success of ortho-k. Elimination or reduction of those factors may allow vision improvement to continue successfully. I decided that I had to learn how to restore any troubled or distressed patients to a state of improved emotional "wellness" to ensure the success of our treatments. (Our ortho-k fee does not include two weeks in Hawaii.) So I immediately began to study alternative health modalities, such as deep medical relaxation, biofeedback and meditation, which have physical and emotional relaxation techniques at their core. After due study, I devised a relaxation procedure which initially included techniques similar to those of the aforementioned disciplines. This procedure was designed to alleviate any unfavorable emotional factors that might adversely affect our ortho-k or myopia containment treatments.
Within a short time, another ortho-k patient's long-improved vision suddenly became unstable. She had worn lenses for a few years, and her Rx had reduced to plano OU from -6.00D OU over a nine-month period. She maintained this functional emmetropia with just night wear. Her present complaint was that her vision was erratic lately, and no longer remained clear for the entire day. The exam revealed that her lenses were still an excellent fit, but her eyes had regressed to -1.50D OU. The patient informed me she had new stress in her life both at home and at work. After a recent promotion at her full-time job, she now worked longer hours and cared for her young son during the evening. Her life was now filled with continual stress.
I suggested we try my relaxation procedure to help her eyes and her overall psychological balance. She agreed, and we tried two relaxation sessions over as many weeks. Her vision immediately improved as she learned to relax, and her functional emmetropia was completely restored. At her final checkup, she reported a wonderful side effect of her relaxation treatments: her borderline hypertension which her family physician was monitoring had dropped 20mm over the last month.
Relaxation for Specific Needs
Occasionally patients will ask us to tailor our relaxation procedure to their own particular needs. Patient, L.N., age 35, presented for ortho-k six months after her son had successfully undergone ortho-k. She had a refractive error of -3.75-0.50 x 180 OU. The first pair of lenses were designed to reduce the refractive error in full. We mentioned that we would be doing our usual contact lens relaxation procedure prior to her instruction session. The patient asked if we might also give her relaxation suggestions to help at her job as an elementary school teacher. Knowing this at the outset, our goal was to deal with this psychological factor right at the beginning of her ortho-k treatment. We then administered an extended deep relaxation session which included our usual suggestions for general relaxation and rapid refractive error improvement, plus additional suggestions for stress reduction in the classroom.
At the patient's one week follow-up, her refractive error had improved to +0.50 -0.50 x 180 OU. She reported her stress levels and attitude at work had improved significantly. She was very pleased at the rapid improvement in her vision and in the overall effectiveness of the relaxation procedure. She has since further improved and maintains her functional emmetropia with just night wear of her lenses.
Stress is not the only variable that influences the ortho-k outcome. We have observed that any number of negative emotions or psychological states such as fear, grief, depression, self-doubt and poor self-esteem can all affect ortho-k success. This is true for children as well as adults. Deep relaxation techniques have permitted our orthokeratology and many other treatments to proceed uneventfully even with the more challenging patients.
I have continued to investigate and develop a variety of relaxation procedures. At the present time I am using a mutifaceted procedure that I call Deep Relaxation Suggestion Therapy (DRST). I can vary this procedure according to the age or the clinical goals of the patient. The success of any ophthalmic treatment can be strongly influenced by the initial experiences of the patient. This is especially true for young myopia containment patients.
On a subsequent checkup visit, all ortho-k and myopia containment patients now undergo a second relaxation session that encourages stress reduction, the elimination of negativity, improved self-esteem and overall treatment success. This is a purposeful attempt to positively manipulate psychological variables to enhance our treatment. The procedure has been successful far beyond my greatest expectations.
The Physiological Cornea
Stress causes a whole series of changes in our normal physiology. Intense or continual stress modulates the limbic-hypothalmic system, which in turn alters the biochemistry of the autonomic, endocrine, immune and neuropeptide systems. I believe one consequence of such physiologic change is a variation in corneal rigidity under varying stress or emotional states. The psychologically-stressed patient has more of an "unyielding" cornea; the relaxed patient has a more "pliable" cornea. Stress unquestionably halts or reverses corneal flattening in some patients; alleviating the tension restores the ability to recontour the cornea. Presently we can only speculate how the cornea varies at the biochemical level under stress. The enzymes that control the rigidity of stromal structure might vary, or there may be an alteration in the water content of the cornea. Using DRST, I have been able to enhance orthokeratology by reducing a patient's psychological stress, and I believe, alter corneal rigidity in the process.
Having the ability to apparently alter corneal rigidity with relaxation procedures is not a surprising result. Many other practitioners use alternative health modalities to achieve uncommon but desired therapeutic outcomes. Oncologists have normalized patients' immune systems with creative visualization, mental imagery, self-hypnosis and meditation. Obstetricians have cured a variety of difficult gynecological problems using ideomotor trance techniques and suggestion therapy. Dentists are able to eliminate anxiety and pain using traditional hypnosis or self-hypnosis. Physicians and researchers have improved heart rate, blood pressure, blood clotting, glucose levels and post-surgical healing using biofeedback, deep medical relaxation and meditation. Considering all that, it is certainly within our scope of practice to improve therapeutic contact lens treatments with a simple deep relaxation procedure. Indeed, the continued success with DRST has led to our using this procedure to facilitate vision training.
Most doctors understand that therapeutic health treatments of all types are influenced by stress, tension and other emotional states. Orthokeratolgy and myopia containment are no exception. With some clinical ingenuity, and new techniques like Deep Relaxation Suggestion Therapy, it is possible to alleviate the effects of adverse psychological states. Going further, it is also possible and highly beneficial to actively instill, at the beginning of treatment, new positive feelings and optimistic emotional states in place of undesired negative emotions. Manipulating psychological variables in this manner appears to vary corneal physiology so that the orthokeratologist can more readily contour the central and mid-peripheral cornea. This clearly demonstrates that contact lens practitioners can and should develop a wide range of alternative treatment modalities to effectuate our clinical goals.
How Relaxation Works with Ortho-K
Deep Relaxation Suggestion Therapy is an induced state of deep physical relaxation with heightened mental alertness and suggestibility. In this state, individuals accept and act upon positive suggestions. Our patients are given contact lens instructions as well as a wide range of helpful suggestions. This approach consistently produces the following results:
- Patients are taught to deeply relax the eyelids to ensure a normal blink rate without excessive lacrimation within a half-hour of lens insertion.
- Rigid contact lens insertion and removal practice is successfully accomplished without fear or hesitancy, and takes only 10 to 20 minutes, even with young children.
- New RGP wearers adapt to their lenses in one to two days, meaning that they experience no excessive or unpleasant awareness of lens sensation after that time.
- Night lens wear is accepted without hesitancy or experiencing discomfort.
- Patient attitude is psychologically enhanced during relaxation with a patter of direct suggestions for proper motivation, expectancy of success, removal of fears and doubts, continued lens comfort, rapid corneal improvement and enthusiasm for the entire treatment process. These suggestions eliminate negativity and instill a positive outlook.
- The recontouring of the corneal curvature proceeds quickly without vision fluctuation or intermittent regression of the refractive error. This now allows us to routinely restore functional emmetropia to patients with six diopters of myopia within three months or less.
To receive references via fax, call (800) 239-4684 and request document #61. (Have a fax number ready.)
Dr. Kearney is an Orthokeratologist whose interests are the prevention, control and elimination of myopia. He has recently been certified as a clinical hypnotherapist.
Visit Dr. Kearney's website at www.westol.com/pfkod/
Contact Lens Spectrum, Issue: June 2000