I can’t believe that time flies and it has been 4 years since he started wearing the iSEE advanced orthokeratology lenses. He came into the office for a quick vision check 1week ago and sure enough he was seeing 20/20 in each eye and 20/15 combined.
He’s been on cruise control since the beginning, so truthfully, I’ve sometimes forgotten to check in on him.
He’s using Clear Care (daily), saline rinse, Ortho K Thin drops (nightly) and Progent (monthly).
Throughout this journey, AP has heard from me discussing cases with Dr. Clarizio at the dinner table that so and so did this. I want to relay this to the reader (especially, the prospective parent of a new patient) that if it’s possible, AP has done it. Luckily he has not broken a lens yet, but he probably will.
He’s worn 2 lenses in one eye! He’s switched left and right lenses by accident. (They are mildly tinted blue for left and right for green and the best way to discern their color is to place them on a white Kleenex) Of course, he’s dropped them. Sometimes he goes to Grandma’s house for the weekend and forgets to bring them. He’s travelled out of state and forgotten to bring a DMV plunger to remove them.
This is to illustrate to the reader that things happen and luckily all balance is restored once he gets back to his daily routine.
I’ll keep this short and summarize other cases in the next few posts.
AP first started the program February 27, 2017. He’s been in the program for almost 4 months. He is enjoying all the benefits of seeing clearly like other kids wearing soft contact lenses or glasses, but with the added protection of trying to stop or slow down his myopia.
AP is still seeing 20/20 with the original custom iSEE lenses that I designed for him. He inserts and removes the lenses by himself without any supervision.
The only comment I have is that there may be some initial discomfort upon the first insertion. There are times where I would ask him to lay down so that I can add a drop of unique pH in the nasal corner of his eye while he is laying down so that he can flush out any irritant out the temporal corner of his eye. Sometimes he does push hard into the eye with the lens upon insertion and by having an extra drop of liquid will allow the lens to loosen the suction to give better comfort.
One thing to note is that our lenses have a slight tint to them to help color code for right and left. Green is for right eye and blue is for left eye. (Green has the letter ‘R’ in it and blue has the letter ‘L’ in it.) This can be easily noticed when the lenses are placed onto a white paper towel or facial tissue.
We noticed that the peroxide containers may also have a different color scheme and may confuse patients. So when in doubt if you think you may have mixed them up, place the lenses on a white background to double check.
And finally we also use Progent to deep clean the lenses and keep them as clean as possible periodically.
We will give you updates on AP from time to time, but I expect this case to mimic others before him.
AP has been through our myopia control program for over 1 month. His vision is excellent at 20/20 in each eye. There is no eye irritation and he’s enjoying clear and crisp vision all day long.
After 2 weeks of me inserting the iSEE lenses, AP decided to be brave and try to insert the lenses himself. I am very relieved to be hands off, but there are some cautions for parents out there who are not watching their kids.
I’ve noticed that AP does not clean the DMV plunger as well as I’d like. We wash with hot water and rinse off at the end with a multipurpose disinfectant.
I’ve also noticed that he touches the lens on the inside on multiple occasions and this may lead to discomfort and multiple insertions. I’ve given him tips to pick up a dropped lens with a plunger and to handle the lenses on the edges only.
We are currently using peroxide to disinfect, unique pH as the cushioning drop upon insertion, and just a multipurpose solution for the rinse.
And finally, after he leaves for school, I look in his room and find open bottles of solutions without a cap.
Careful attention to detail can help ensure better performance and reducing chances of bad luck.
My very own son , AP was detected to be nearsighted this year when he went to the pediatrician in January and didn’t see the 20/20 line. I had just screened his vision before school started (August), so this came on very fast and as a surprise to both of us. For us parents, this meant put the brakes on the myopia ASAP. AP went straight into the myopia control program, skipping glasses.
I ordered a pair of iSEE Advanced Orthokeratology lenses for AP right after I did the refraction and took topographical maps of his eyes. Due to the unique shape of his eyes, he was not a candidate for the simpler Paragon CRT lenses, even though his Rx was so small. We did a software analysis using the collected data points to come to this conclusion.
AP started our myopia control program early March. At the beginning, I am still inserting and removing the lenses from his eyes. Our goal is summer for him to do it himself.
The first few days have been challenging only because he was very vocal about discomfort every little thing that bothered him. It was not easy with insertion/removal because his lids were tight and his eyes were small. I would have to remove and reinsert at least once for the first few weeks.
I now can empathize with parents who go through this process for their younger children. I hope that I can offer real practice advice to parents now that I am living the process, not just teaching it.
Both patients came back in for their annual wellness examinations. MM and DM started our myopia control program in the Fall of 2014.
Their father was happy to see that they are stable with their vision and there have not been any changes that is concerning or unexpected with their treatment program. MM was still seeing the same as he has always been, 20/20 in each eye. DM was also on target at 20/20- and 20/25.
The topographical maps taken with our Medmont E300 corneal topographer were examined to reveal how the lenses behaved in a closed eye environment. A comparison was done from 3 months ago to present to see if there are any changes to the lenses caused by warpage, scratches, debris/deposits, etc.
The eyes were examined with a slit lamp microscope and photos and videos were taken to document abnormalities for patient/parent education.
A refraction was done for data analysis.
Questions were asked to see how they inserted and removed the lenses, products and techniques used and sleeping patterns. As always, we always take the time to fine tune and re-direct their focus as to why they are in the program and what they might be doing wrong that can pose risk to their treatment program.
No changes were needed and I will plan to see them back in 3 months for a regularly scheduled visit as part of our maintenance program.
DT started with us last summer when he was 8 years old with the hopes of stopping his myopia progression. He came in last week for his annual visit and has not had any changes to his vision at all.
He is seeing 20/20 in each eye. He is not reporting any issues with his system. We deep cleaned the lenses a week prior to his visit to ensure that we got good reliable results.
Because of this success, I encouraged his mom that we can continue without any changes to the program. DT is wearing the iSEE Advanced Orthokeratology lenses.
DT is scheduled to return to see us in 3 months.
TN started our myopia control program on 5/26/16. We have seen him for for 3 exams prior and every year, his vision keeps getting worse. His mom decided that she wanted to do something to try and stop his eyes from getting worse. We decided that the iSEE lens was best for him.
The one day post iSEE vision was 20/80 and 20/200.
4 days later, he was seeing 20/40 in each eye.
11 days later he is seeing 20/20– and 20/30++.
At this time, I consulted with the lab and ordered a new pair of lenses. The topographies looked great and there was no keratitis. He was inserting and removing the lenses with great care all by himself.
TN is on a summer vacation this week enjoying great vision so far. When he returns, he will pick up the new set of lenses and we hope that his vision will be fine tuned to 20/20 in each eye.
KN started our myopia control program 2/27/16. It was not easy for KN to start, but he’s making progress every time we see him. KN was slightly anxious, which made taking pictures and maps challenging.
At the beginning, his father helped to insert and remove the lenses for him to fast track his progress. This sometimes is important so that we can get good measurable results so that we don’t get misleading maps or outcomes.
Because of his astigmatism, we decided to start with the iSEE Advanced Ortho-K lenses.
We reached 20/25– and 20/50– upon one week of wearing the lenses.
After 3 weeks, we got 20/20 and 20/25++. There was just a centration issue with the left eye that we had to fine tune, but no other issues with the system.
Our plan was to teach him to be self sufficient by the end of summer so that he does not have to rely on his father for help.
Today, June 28, 2016, KN is seeing 20/20 in each eye. We reviewed insertion and removal techniques for KN and felt comfortable in seeing him in the fall.
KN is now on a 3 month follow up schedule.
AI started our program in June 2014. Today, she came in for her 2 year annual progress report.
Her uncorrected vision right eye is 20/20 and 20/25 left eye.
She has no complaints about her program and is very consistent with the recommended guidelines. She is wearing Paragon CRT.
The lenses were deep cleaned and inspected yesterday before the annual visit.
There were no issues on her corneas and the topographies looked great.
I gave her parents the go ahead to continue with the program without any changes and I will follow up in 3 months.
Below is a sample of her topography 3 months ago and today. The difference may be due to the deep cleaning that was done yesterday. There was one line of improvement in today’s outcome vs April 2016 for the right eye.
AR came back for her annual examination and she was still seeing 20/20 in each eye. We deep cleaned the lenses with Menicon’s Progent enzymatic cleaner last week to ensure that we got optimal topographies.
We are please with the outcome so far and there was no plan to make any changes to AR’s lenses at this time. Mom wanted to order a new pair and keep the old one as a back up.
The maps look very consistent from Nov 2015 to May 2016. AR is wearing a Paragon Dual Axis CRT in the right eye and a Paragon CRT lens in the left eye.
There were some questions about insertion/removal techniques and we plan to address them next week.
Paragon CRT Dual Axis