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.

 

 

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 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.

 

9 Y.O. MM -5.00 D Myope 20/20 in each eye at 6PM

MM came in for his follow up on Tuesday night at 6PM and was seeing 20/20 in each eye.  He reports no troubles with the lenses, no dryness, no glare.

MM did try the Paragon CRT orthokeratology lens initially, but we found that they didn’t fit his eyes as well.  mm.09.06.2014

Because of the iSEE’s 5 curve design, it can treat prescriptions up to -10.00 diopters of myopia and up to -4.00 diopters of astigmatism.

The iSEE Advanced Custom Ortho-k.  After some revisions, this fits nicely on MM’s eyes and now he is on a maintenance schedule.

mm.10.23.2014

7 y.o. DM -1.25 D Myope 2 day follow up

DM came back in for a 2 day post treatment and see’s 20/20 at 10AM in the right eye and 20/40 in the left eye.  Our goal is myopia control and to give young children the freedom of not having to wear glasses during the day to engage in athletics.

DM was very excited to see so well because it means enhanced vision when doing gymnastics

I reassured DM’s parents that there are many reasons for the left eye to only respond half way.  DM’s father helps with insertion/removal.  He stated that it was difficult with this because DM is still nervous and squirmish.  DM moves and bobs her head and closes her eyes.  Instead of being just under a minute withe one try per eye, it took a total of 15 minutes this first few days each time.

When there are many attempts at insertion at night, there are more chances to mildly scratch the cornea.  There are more opportunities for the lens not to be inserted centrally.  If there is not enough liquid in the bowl of the lens, there may be chances of air bubbles to create a less than ideal seal when sleeping.  All of this can result in less than ideal vision the next day.

The family is planning a big trip to visit relatives for the holidays next month and I think we are right on target to wrap up the cases just in time.

9 Y.O. MM -5.00 Myope

After a many weeks of fine tuning the parameters of the lens design, MM was finally getting close to the target.

MM’s dad was very instrumental to helping us get good results by being hands on and engaged in the application process at night.  This helps to reduce chances for variability and allowing the troubleshooting skills to focus on how the lens behaves vs poor insertion practices.

Students are always advised to fill up the bowl with solution to the brim, keep their face down and try to make a good effort of not spilling or letting the lens fall off the fingers.  This ensures that there is a good seal of the lens.  We also encourage patients to go to sleep right away vs stay up and text or read.  The lens is designed for a closed eye state in order to get good results.

After a week of wear with the latest design, MM was seeing 20/40 and 20/25.  He does not to wear any glasses during the day and can engage in gymnastics w/o any vision issues.

This process took longer than average, but we knew it was not an easy case to begin with more variables to adjust.

We plan to see MM in a week to fine tune the vision so that both eyes are optimal in vision.

9 y.o. MM -5.00 Myope

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.

Stay tuned…