Overnight Corneal Reshaping (Orthokeratology) in Adolescents S. Lance Forstot, MD, FACS The author has no financial interest in the subject matter of this poster

Introduction Orthokeratology (OK) which was born in the 1960’s, died by the mid-1980’s from the fact that fitting rigid contact lenses to reduce uncorrected visual acuity was basically unsuccessful. With the advent of corneal topographic analysis, high Dk gas permeable lenses, and reverse geometric lens designs Overnight Corneal Reshaping (OCR) was revived in the 1990’s.

Introduction The first rigid gas permeable lens approved by the FDA for overnight orthokeratology was in (Paragon CRT – Corneal Refractive Therapy) (Paragon Vision Sciences) The lens was approved for patients with myopia limit -6.00D sphere and -1.75D astigmatism We began fitting patients with this lens that year.

Introduction Our Initial Results 29 patients (56 eyes) successful fit continued in lenses UCVA –20/157 (12.5%) –20/2044 (91%) –20/254 (98%) –20/30* 1 (100%) (monovision J2) 7 patients (14 eyes) successful fit discontinued lens wear UCVA –20/150 –20/2010 (71%) –20/252 (86%) –20/302 (100%) OCR is an effective way to improve UCVA

Method We prospectively studied all patients fit with OCR lenses. For this poster we retrospectively reviewed all charts on adolescent patients ( < 16 years of age) fit with OCR lenses to evaluate the safety

Results 12 adolescent patients were fit with OCR lenses Age range: 6-15 years (median 13) Follow-up: years

Results 8 patients continue in OCR lenses 1 patient was discontinued during the fitting period for a keratitis 1 patient d/c 1.5 years 1 patient d/c 5 years 1 patient lost to 6 years

Results 11 patients had a total of 59 years follow-up 22 eyes with 118 years follow-up No patient had any complication with OCR lens wear (No abrasions, ulcers, infections)

Addendum OCR in 2 other Ophthalmology Centers Koffler Vision Group 16 patients fit with OCR 4 dropouts 12 wearing OCR lenses –Age: – (1-3 years of wear) 27.5 years of wear No complications Wohl Eye Center 40 patients fit with OCR 11 dropout or lost to f/u 3 with 3 months or less of f/u 26 wearing OCR lenses –Age: 9-16 –(10mos.- 6yrs. 11 mos.) years of wear No complications

3 Ophthalmology Centers Fitting OCR lenses 49 Adolescent Patients ( ) years of uncomplicated wear 98 Eyes years of uncomplicated wear

Conclusions OCR is an effective means of myopia correction in adolescents Literature indicates all types of contact lens wear has the potential for corneal infection including OCR, however OCR appears to be safe in adolescents with proper patient selection and with proper patient and family instruction on lens care and warning signs of problems

Study Limitations Relatively small sample size Bias of patient sample Patients lost to follow-up