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.

 

 

 

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

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.

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.