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.
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
MW came in for a 4 mo progress visit. Her vision is still 20/20 in each eye. No complaints or issues with dry eyes, glare, blurry vision or discomfort.
MW has done a remarkable job with being independent and consistent with insertion/removal and cleaning.
At the visit in January, I saw some keratitis in one eye and requested that she come back in 1 month so I can investigate if it is recurrent.
MW came in today, Feb 28, reporting that she did not wear her lenses last night. Her visit was at noon and each eye was seeing 20/30 and combined 20/25. She came home late last night and forgot to insert the lenses.
The keratitis has resolved and MW speculated that it was caused by an eyelash in her eye the night before.
MW is doing well and I plan to see her 3 months.
9/13/2015: I saw DT 3 weeks after he got his new iSEE lenses.
His mom is still helping with insertion/removal, but he’s done very well to let her do it without too much trouble. Insertion and removal time is minimal. We hope to practice with him to do it on his own once we get his vision fine tuned and the lenses to fit well.
He came in seeing 20/25 with both eyes and 20/30 in each eye. There were no corneal issues and the lenses seem to center very well according to the topography maps. Because his Rx was high to start, we wanted to make sure we gave it enough time to mold, so I requested DT to come back in 2 weeks to verify if there will be any more changes. If we need to make a slight adjustment, then we can do it then.
Mom was advised to use peroxide to disinfect, saline to rinse, and unique pH for insertion. The only step that could use adjustment was mom also used peroxide to rub to clean prior to insertion. This step was not recommended and I redirected her steps to minimize sources of error that could cause us to get less than ideal results.
This is an example of a higher Rx in a young child that is doing really well.
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.
Controlling Astigmatism and Myopia in Developing Youth. (CANDY, 2008 by Bartels and Wilcox)
The CANDY Study (Controlling Astigmatism and Nearsightedness in Developing Youth) is a interoffice study performed by Dr. Wilcox and Dr. David Bartels (from New York) which showed that kids who participated in CM had a near total cessation in the progression of the nearsightedness which they were experiencing before CM. The graph below shows how the kids were getting worse before CM by an average of 0.50 diopters per year (blue line) and then only progressed at a near-zero rate of 0.05 diopters per year after starting CM (orange line). You can read the whole study here (CANDY Study, 2008).
MM came into our clinic late August for a consultation. MM was actually seen 2 weeks prior somewhere else for a general examination, but his father mentioned that no myopia control treatment options were offered.
MM’s parents were excited to offer his son a chance at stopping his Rx from getting worse and options of being able to engage in sports without the need for glasses during the day. MM is the older brother and has the highest Rx in the family so far. His mother does not have any correction. Younger sister is 7 yo with a -1.00 D Rx. Father has a -4.00 D Rx.
Initially we tried the Paragon CRT extended range orthokeratology lenses, but they did not fit well, and his response to the treatment the next day was minimal.
MM’s father was very motivated to continue the journey to finding a lens that will give MM a better chance a success. I outlined to his father that I was confident that we could find another manufacturer that would help his son.
We ordered the iSEE lens from GP Specialists. The iSEE lens is a 5 curve design vs the 3 curve design. which means that this case is more complex with so many variables to adjust.