orthokeratology
today
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.
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Figure
1. Topography maps taken at a seven-year difference in time. Note the consistency
of the plots.
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Successful Start
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.
Contact Lens Spectrum, Issue: May 2006