10 yo AS 9 month f/u (pre-treatment Rx -3.00 and -2.25 -0.50 x 175)

AS came back for her 9 mo progress evaluation.  Right eye was seeing 20/20 and her left eye was seeing 20/20–.

No complaints of glare/ haloes, dryness or blur.  The visit was done at 4PM, so there may be some fade of the treatment from the morning.  I inquired on how she takes out the lenses and found out that she does not insert any eye drops prior to removal.  I explained and showed her that the keratitis that I see may be related to her lack of attention to putting in drops to lubricate the eyes before removal.

Her parents tell me that she is independent and can insert and remove the lenses by herself.  I found out that maybe one day per week, usually on Friday night, she might fall asleep in the car while traveling and may take a day off from wearing them.

Our plan is to ask her father to bring the lenses back in the morning on Tuesday so that the staff can deep clean the lenses to recondition them back to close to new again.  Protein can build up over time to cause the lenses to not perform as well.

AS is in good shape with her treatment and we will see her in 3 months for her annual visit.

8 yo DT -5.00 and -4.75

DT came to see us after seeing his new Rx change from -3.75 and -3.25 to -5.00 and -4.75 in one year.  His older glasses was -1.50 for both eyes.  They live 35 miles away from the office, so I knew that getting here was no easy drive.

6/25/15 Paragon Continue reading

14 yo JN –6.00 (right eye) and -6.25 (left eye)

JN was seen by me last fall for a wellness eye exam.  Her vision got worse and a new prescription was written.  I mentioned to JN and her mom about our myopia control program and perhaps a good time to start would be summer.  JN was motivated and convinced her parents to let her start the program in preparation of starting high school.

June 30  CRT screening:  Due to her high Rx, we designed the iSEE lens and scheduled for training on 7/10 and her 2 day f/u on 7/12.

July 10  Initial day of training and dispense.  JN did well learning how to insert and remove the lenses and we were confident that she would have very little trouble with the program.  We dispensed the lenses and will see her back in 2 days for a follow up.

July 12  2 day follow up:

JN came in seeing 20/70 and 20/40.  She came in concerned that school was going to start in 2 weeks and was hoping that she’d see clear enough to see the board.  I reassured JN that this was only 2 days and it takes about 2 to 4 weeks for her eyes to mold considering she started at -6.00.  I took note that these lenses are rather large and consulted with the lab on adjusting the diameter of the lens.

We scheduled JN to come back in a week for a follow up for the first pair.

July 19  Nine day follow up:  Her uncorrected vision had improved to 20/50 in each eye and JN felt more confident in the program.  I had ordered a new pair based on the results from July 12 and today I dispensed the new pair to JN that was smaller in size.  A 2 week progress visit was scheduled on 8/6.

August 6  Two week f/u of 2nd pair:  JN came in seeing 20/30 and 20/20.  JN had already started school and felt that she didn’t have any trouble seeing the board in school.  She reported that it took one or two tries to insert the lenses.  Same for taking them out.  There was some mild keratitis and the lenses looked a little tight in the periphery.

I consulted with the lab and a new pair was designed based on the pictures, videos, refraction over the lenses and the corneal topography data.

As of this summary, JN has not picked up her new lenses.  A follow up will be scheduled for 2-4 weeks after she wears this new lens.  I predict a small fine tuning that might require one or two more lenses and then she would be on a 3 month maintenance program.

10 yo AR -3.50 and -2.50

Another summary of a case we started in May 2015.

5/19/15 CRT screening:  AR’s parents were concerned that her vision was getting worse and was referred to our clinic through a current patient’s referral.  It was determined that she would be a candidate even though there was almost 2 Diopters of corneal astigmatism.  I explained to her parents that she might need a dual axis lens.

5/26/15  CRT Consultation:  AR has long beautiful lashes that sometimes get in the way of us taking topographies.  Also, because she’s never worn contact lenses before, I knew that it would take time for us to get comfortable with her insertion/removal process.  Her mom volunteered to help her get started by doing all of this.

We trialed diagnostic lenses on her eyes to demonstrate to AR and her parents how the lenses look/feel/handle.  AR and her parents are committed to try to stop her myopia and signed up for our program.

6/2/15  Day of training and dispense:  We started with training AR’s mom to insert and remove the lenses so that we can get up to speed faster with the actual molding of AR’s eyes.  We knew that air bubbles upon insertion or occasional lens manipulation after they are inserted can cause variations to the results the next day.  AR’s mom was up the the task and we confidently dispensed the lenses and scheduled a follow up the next day.

6/3/15  Day after dispense:  AR’s vision was 20/60 and 20/50 the next day.   AR came in wearing an older pair of glasses.  Mom said it took about 30 minutes to insert the night before.  There was some expected keratitis on both eyes.  There was some irritation inferior from the lens removal process in the morning in the left eye.

I reassured the parents that the results are typical and to continue with the program.  Patient will get more comfortable with the insertion/removal process and the insertion time will reduce and vision will improve.  A 1 week follow up was scheduled.

6/9/15  1 Week follow up:  Mom said that it was still time consuming with insertion/removal.  There was not a consistent pattern that she could pinpoint if it was one eye that took longer than the other.  AR was seeing 20/40 and 20/25.  She came in without wearing any glasses.  AR’s mom said that she had a new sense of confidence where she could see things in the distance in the car and point them out to her parents.  AR had no complaints about her vision, except the occasional glare but we knew were on the right direction with this program.  AR was dispensed a bottle of Ortho-K Thin.  I told AR’s parents that I will consult with the lab to design a new pair.

6/14/14  Broken lens:  AR’s father contacted me in the morning to tell me that the right lens dropped on the floor and it was accidentally stepped on amidst the anxiety.  We ordered a new one on Monday morning and provided a spare from a prior lens design so that she wouldn’t miss a beat.  A replacement lens was picked up on 6/16 in the PM and we were back on track.

6/30/15  2 week Post Dual Axis OD and 1 Month post CRT:  We ordered a dual axis lens for her right eye and this is a 2 week progress report.  Based on the maps from the last visit, the right eye needed more fine tuning and it was not centered correctly so we had to go with a dual axis lens.  The left eye was doing great, so we didn’t have to make any big changes.  AR’s vision was 20/30– and 20/20.  We reviewed insertion/removal with mom and AR.  We were getting good results, but wanted to slowly integrate AR into doing this herself.  I consulted with the lab and a new pair was also ordered.

7/28/15  2 week f/u for the new OD and 2 month f/u for the OS:  AR was seeing 20/30 for the right eye and 20/20 for the left.  We did some training for AR today with insertion/removal.  The topography maps looked fantastic.  Mom reported that it was becoming routine and there was less anxiety with the insertion/removal program.  She reported occasional dryness a few days out of the week where artificial tears or Ortho-K Thin was used.  I consulted with the lab and they asked for another data point to make sure there wasn’t any variation of the results caused by insertion techniques.

8/13/15  1 Month f/u on dual axis OD and 2+ month f/u for CRT OS:  AR was seeing 20/20 on each eye on this visit.  There was no corneal keratitis and the topography maps still look well centered.

We are pretty close to going on the extended 3 month progress evaluations for AR.  We plan to get another data point in 2 weeks to see if there is any variation to the fit and vision of the lenses.  We also just plan to bring AR back to try to assist her with insertion/removal so that she can be independent by Fall Break.

14 yo NS -6.25 and -6.00

This is a summary for you to see a timeline of a case that is going very well, but with the realities of how many visits are required.  For cases that the patients are young and not great at insertion/removal, we might get inconsistent data to drag out this timeline out even longer.

5/15/15: orthokeratology screening:  NS and mom came in to see if he would qualify for the program.  NS and his siblings have been patients of mine for several years elsewhere in Tempe and I continually see his vision getting worse every year.  I advised mom to give it some thought about our myopia control program at Sun Valley Eye Care and to start in the summer if and when he feels that he is ready.

5/28/15: orthokeratology consultation:  I consulted with NS’s mom to explain that the 5 curve iSee is the lens that would be needed because he is outside the range for Paragon CRT.

We did a demo of the Paragon CRT lens in office just to allow NS to be able to feel and get a visual experience with something on his eyes before we actually started the custom ordering process during his initial consultation.

NS was motivated and we proceeded to order him the custom retainers and get the program started.

6/9/15 First day:  Training and dispense.  Patient did very well and we proceeded to give instructions to wear the lenses and come back in 2 days.

6/11/15  2 day follow up:  NS was seeing 20/60 and 20/40.  Insertion and removal took a few minutes/tries.  He didn’t have too much trouble seeing things and even went to the movies with his friends the one day after he wore the lenses.  He didn’t have to wear any glasses to make up the difference.  NS was instructed to come back in 2 weeks to allow more time for the lenses to mold to see what our next step will be.

6/23/15  2 week progress evaluation:  NS was seeing 20/30 and 20/25–.  NS was very happy with the results so far and I reviewed caution and expectations.  Because NS had such a high Rx, we still wanted to wait a little bit longer for the lenses to mold and get another data point in before we made any changes.  I gave NS a bottle of Ortho-K Thin to use upon insertion at night to help the eyes reduce irritation.

7/10/15  1 Month progress evaluation:  NS’s vision slipped slightly to 20/40– and 20/25.  He has become proficient at insertion/removal, so we know that technique is not causing any false data to be collected.  NS was calm and still for us to take topography maps and slit lamp photos.  There was some mild keratitis and the lenses looked tight causing binding.  I trusted the results that we collected and consulted with the lab and a new pair was ordered.

8/6/15:  NS picked up his 2nd pair July 17 and this is a 3 week post new pair progress evaluation.  NS was seeing 20/20– and 20/20 — without any complaints of symptoms.  He has been using Clear Care for disinfection, Unisol Saline to rinse and no need for any artificial tears during the day at all.  No complaints of glare/haloes.  He lost his frame temple tan line and looks like a new man.  More confident and mature.  I explained that the topography maps and the lens behavior warrant a new pair, his 3rd before we discharge him to the regular 3 month intervals of progress evaluations.  It was just a little minor tweak to the lens design to ensure long term corneal health.

A new pair is on the way and I will probably not update this case unless there is something special to write about it.