10 yo AP (my son) 1 month report

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.

 

 

10 yo AP (my son) -0.75-0.50 x 180

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.

 

 

 

10 yo AI (2 year progress report)

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.ai.differential

10 yo AR -3.50 and -2.50

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

Paragon CRT Dual Axis

12 yo MW -3.25 & -2.50 5 mo progress

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.

 

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.

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.

CANDY is good for your child’s vision. Ask us why!

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).