Orthokeratology contact lens use (Video)
length: 2:23 minutes
This video shows the use of night-time hard contact lenses to change the prescription of the eye. This is orthokeratology, and can be used to temporarily mold the cornea into a steeper shape and overcome small amounts of astigmatism and near-sightedness. This method isn’t used often by ophthalmologists in the US, but could be considered a possible vision correction therapy in the appropriate patient. Complications for night-time contact lens use must be considered however: contact lens use at night can be irritating and puts you at a much higher risk for corneal infection.
I wanted to clarify a few errors in this video.
I have been doing a new and very distinctly different type of Ortho-K for 10 years and have beening teaching other doctors my “Wavefront Corneal Molding” method for almost 4 years.
There are about 350 doctors in the whole world that have the technology that allows them to design and fit Wave lenses. See: http://www.wavecontactlenses.com
WE do not use off the shelf stock Ortho-K lenses as most doctors do. That is why we do not have comfort problems. We charge almost the same fees to be competitive, but we custom design all our corneal molds as well as all of out RGP’s, Multifocals, and toric gas perm lenses, so they will be an almost exact match to the patient’s corneas.
Wave is the ultimate in custom design because we can now control every single parameter of both the front and back surface of the lens down to a 0.1 micron increment all the way out to the very periphery of the cornea and in all the radials of the cornea 360 and as such we can make the back side of the lens almost an exact match to the topography/shapes/curvatures of the front of each of the corneas.
This allows us to do some very amazing things and achieve some very awesome results.
So, comfort problems disappeared a long time ago in our ISAOK offices.
1) The Wave Ortho-K lenses that I custom design and fit are not at all uncomfortable. I never hear that complaint and I have fit so many people over the years that I have lost count.
2) There is much less risk in wearing these Ortho-K lenses than wearing any other type of extended wear lens and compared to Lasik, this is light years less risky.
In all my 10 years of doing this and the 4 years I have been teaching this to over 120 other doctors, I have yet to have nor have I heard of any infections or corneal damage in our International Society of Advanced Orthokeratology (ISAOK)membership.
There is no way the Lasik folks could even begin to say that.
3) I rarely need more than one pair of molds to achieve almost overnight success and a very happy patient in almost every case I do. Every now and then, it will take 1 or 2 more nights of wear to achieve the end point we are looking for, but that too is becoming few and far between.
Most of the ISAOK members would probably say the same, because I have yet to hear any one of my students relate any such problems to me and they all know to do so immediately should such a problem occur so I can help them solve the problem.
4) Ortho-K is ideal for policemen, firemen, tax cab drivers, pilots, athletes…..any people who need clear vision the very next day to do their jobs and to be safer while doing their jobs as well as participate in sports especially where water, wind, smoke or dust is invloved.
5) This is also being shown to slow or stop progressive myopia especially when used in conjunction with near point stress relieving lenses. I rarely see any of my patients become more nearsighted after I do my job for them.
Most research studies say that this or that will not stop progressive myopia. Most studies show that progressive myopia is caused by more than one thing and each of these things that causes myopia has its own individual solution and yet, you cannot be sure which one or more of the several things is the culprit, so they set out to test just one of those things by itself and when they find that correcting that one thing alone had little to no effect, they publish that result making it look as if it is a waste of time do do such, but I have yet to see a study that addressed correcting more than just one or two of the causes at the same time.
When I deal with a progressive myopia case, I target and try to correct all of the culprits in each patient.
I begin with Ortho-K (If they are a candidate for it) or an RGP followed by a pair of near point glasses over their contact lenses for all up close work and especially for computer work. (It takes only one hour on a computer to generate the same amount of stress in the eye as would be measured in reading a book for 4 hours) Then, I explain sustained near point stress and what effect it has on the eye and how to prevent it and I give them rules to follow.
Now I am addressing all the causes of progressive myopia and eliminating them as much as possible from the eye’s work load / overload. Now, I rarely see progression.
Ortho-K plays a big part in this equation.
6) Wave Ortho-K lenses are a bit more expensive than typical contact lenses but when compared to the cost of wearing soft contact lenses over a period of 4 years, they can actually be cheaper and then there is the added benefit of having your clear vision restored the whole time too with no haze or dry eyes and much less risk.
7) This is non-surgical, does not cause any damage nor irreversible corneal changes, is quick (overnight in most cases)and painless (Unlike Lasik).
8)This is reversable, which is a huge advantage over Lasik, because the eye never stops changing. As you age, the eye, like the rest of the body, dehydrates.
With dehydration, the eyeball becomes smaller and therefore less nearsighted.
Let’s say you were a -4.00 diopter nearsighted person which would give you at best a blurry 20/400 at distance without your glasses on:
With Lasik, which usually tries to set you at “Plano” or “(0) power needed at distance to achieve 20/20, over 4 to 8 years, this dehydration causes you to become from +50D to +1.50D farsighted and once again, you will have to wear glasses to correct the farsightedness or you will have symptoms of headache or eyestrain or eye fatigue.
With Ortho-k, we also shoot for the “Plano” at distance and as you age and dehydrate, your original amount of nearsightedness usually decreases (Becomes about 1.00D less), so at that point, we no longer need to mold out 4.00 diopters of myopia, but rather 3.00 diopters of myopia.
With Corneal Molding (Ortho-K, all we need to do then, is adjust your molds to only mold out the
-3.00 diopters of myopia, so there will be no need to wear glasses.
When presbyopia (After age 40 vision) sets in, all we usually have to do then is adjust your non-dominant eye’s mold such that it molds just the right amount to where we now give you back your near vision in that non-dominant eye. Therefore, you will usually not need to wear bifocal glasses.
9) Corneal Molding / Ortho-K is without a doubt, the best bang for the buck out there and it is light years ahead of Lasik as far as risk to your eye.
10) With Lasik, you usually have a time with glare and flare from car lights etc at night and then there is also the loss of contrast sensitivity which makes night vision a real problem in many of the cases and then there are the problems of very dry eyes as well as flap associated post op problems such as flap dislocation, ingrowth of epithelial cells under that flap as well as infection, scarring and damage to the stromal cells of the cornea, etc.
I have seen some real nightmares with Lasik, but in all fairness, I have seen some very happy Lasik patients too, but having been in practice for the last 30 years, I have seen patients post op 4 to 8 years and so many tell me they wish they had never done it.
On most of the basket cases, whose vision is just nowhere near acceptable, we actually use the same type of reverse geometry design as we do on Ortho-K patients, but they have to wear these lenses full time to be able to see clearly and eliminate the distortions.
With Ortho-K, I rarely ever hear any complaints of glare and flare at night, have never seen a cornea damaged, almost always achieve the clear vision that the patient’s expect and deserve and to keep their vision stable and clear throughout life, all they have to do is wear their lenses from every night to every 3rd night.
Notice that I do not claim to achieve the clear vision that patients expect in every single case.
Yes, there are some that throw me a curve or some whose lids interfere with the centration of the lens on the eye and those are sometimes just not going to work no matter how hard I try, but they are few and far between now because after years of experience and thousands of designs, I know a lot more about the things to look for up front that might make the case unsuccessful and I do not take those cases on now that I know better.
I hope this clears up some of the errors in the video and gives everyone a better understanding of how Ortho-K differs from and is more practical and safer than Lasik.
Sincerely
Dr. Grady M. Clark, Jr.
Chief Instructor
ISAOK
Thank you for your comments Dr. Clark … an interesting perspective, and it’s always good to hear the opinions of someone who actually practices this therapy.
Could you please recommend a docto with this experience in the Decatur Georgia area.-30030.My daughter is moderately myopic.
Great post Dr. Clark. I use ortho-k molds and have been for the last 4-5 years. Dr. Clark actually fitted me with the lens and I love them. I have always been leery of Lasik because I have had friends with horror stories, plus, my vision was not bad enough to merit Lasik.
Could you please recommendl a doctor with this experience in the New Orleans
area.
Thanks a lot for the information… i heard about this infection but was never sure… but i think now am sure that if we wear contact lenses at night time then we are at a high risk. Thank for sharing the information.
Please let me know the name of a doctor or doctors in the Houston area and northern suburbs of Houston that are trained in your method.
Thank you.
Dr Clark
Can you please let me know your email address. I want consultation related to progressive myopia in my eyes.
Regards
Shahab
shahab@vibrants.biz
Dr. Clark,
Would it work for my daughter a -9.00 diopter nearsighted? Could you please recommend a doctor with this experience in the Chester, New Jersey area (zip code 07930).
Thank You
I am very thankful to you for providing this demonstrative post. Apart from that, you depicted my clarification exactly through the above video.
Hi Doctor Clark,
My daughter is barely 7 yrs old and we found out today her eyesight worsened from -4 in March 2012 to -5.75 in September. She was around -3 in September 2011. As you can imagine I am very concerned. She is so young.
Is Ortho-K right for her given she is so close to -6D?
Is there any recommended doctors you cansuggest we consult in Lod Angeles? Please advice!
Regards,
Anjali
Dr. Clark,
Can you recommend the best doctor/doctors in the area of bucks county, pennsylvaina?
Thanks in advance!