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.

 

 

 

9 yo DT -5.00 and -4.75 (annual visit)

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.

11 yo TN -5.25 & -3.00

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.

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.

 

11 yo NI annual progress report (-1.75)

NI came back in December for an annual progress examination.  She was seeing 20/20 in each eye at the appointment time in the afternoon  without correction.  She started the program Dec 2014.

Her vision did not change and we did not change the lenses.  We deep cleaned the lenses and advised her that she can wear the same pair for another year.

8 YO DT -5.00 AND -4.75

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.

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.