42 yo current CRT wearer for 10+ years

We inherited a new patient who has been wearing Paragon CRT for more than a decade.  The lenses are quite old, but they still work really well. This pleasant patient is extremely knowledgeable about her corneal reshaping therapy.  She knows that some days will give her great vision and other days when she does not sleep well, the vision is slightly off.  She knows when she sleeps on one side or the other based on her results the next day. Inspection of the lenses revealed some scratches but there were not obvious debris upon microscopic examination of the lenses. The corneal topography matches up with the photograph below.  The lens rides temporally in the picture of the right eye.  I will post the topography picture in another post.  This is a picture of her right eye.  The left side is near her ear and the right side of the picture is near her nose.  There is a small air bubble in the upper left of the photo only due to upright insertion. We replaced her lenses with the same parameters as the old, but we understand that there might be warpage of the lenses due to its age through wear and tear causing it to ride temporally.  We both agree that there might be some changes to the lens design to make it fit better once she wears the new lenses for a few weeks.

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Parental involvement is the key to success!

Some parents are apprehensive about their child being able to participate in this program.  They often feel that their child is not mature enough to take care of their lenses, thus they feel they want to wait a little longer.  Other parents will participate in their child’s care so that they can understand the process and help their child achieve optimal vision as soon as possible.

Our youngest patient started our orthokeratology program a week after she turned 7.

Her father was very committed in this program for both of his children.  He expressed his concern that he didn’t want his children to increase their myopia.  We had just finished getting optimal vision for her older 9 y.o. brother who is a -5.00.

One of the few things we found out about DM is that she tosses and turns at night.  Because of this, we found out that some mornings her vision is better than others.  She doesn’t really complain about her vision too much, but it can be as poor as 20/30.  When she is sleeping on one side, sometimes there could be extra pressure caused by the pillow to shift the lens out of position just slightly.

Her father was very hands on at the beginning helping to insert the lenses and remove them in the morning for her.  After 3 months, we found the best recipe was for her to insert and remove them herself.  We know that her vision in the morning is sometimes inconsistent, but her father and I are both happy that we are able to get her vision well enough that she does not have trouble seeing the board.