1st day of ortho-k

in my left eye I am 20/20

right eye I was overcorrected by .75 diopter will get a ne lens for that
one.

pre ortho-k had -1.75 vision

my eye doctor said i might only have to sleep in the lenses every 3rd day.
So it looks good so far.

 

Thanks for posting this. May I ask a few questions?

Had you previously worn rigid contact lenses? How would you describe the
comfort? Is your vision stable when the lenses aren't being worn? Any
problem with glare at night?

DrG

 

Dear Crippler,

You might consider the use of a plus lens to
augment the effect of Ortho-K.

Some pilots have used it successfully.

http://geocities.com/otisbrown17268

Enjoy,


Otis

 

i'll give this a couple of weeks first and see how good it gets.

 

Well this was the first day I wore ortho-k lenses
It was a trial pair so my eye doctor will get the correct
prescription/fitting next week.

These lenses are Accelerated Ortho-k and Reverse geometry
havent worn RGP before.
Confort wise I could cope with it. It felt like a tight pair of jeans and
takes a little while to get them to fit like jeans.
If I tried to move my eyes to see rather than move my head it made the lens
a little uncomfortable. But easily bearable seems u sleep on them.
My doctor said the first time is the most unfortuable but wants ur eye
changes to the shape of the lenses it should be great.
The lenses when I wore it for the 1st time I find it was good not to blink
too much as it made the contact more unconfortable.

When I woke up it is alot more confortable than a dried out soft contact
lens like Night and day.

Problem I had was a little ghosting in the good left eye that got me 20/20
vision in the moring and alot more ghosting in the right eye that was
overcorrected.
Eye doctor said ghosting will be fine wants I get the correct lenses.

Also first day I woke up with the lens and had to where them all the way in
Sydney where I live which was a bit uncfortable but when the lenses came at
I had my natural eye sight back. Was very happy.

He said on the 1st day the eye sight should go back to normal around 3:30 in
the afternoon but noticed my eyes went back to normal at 6 Pm
So that might mean after a week or 2 with these lenses my eye doctor said I
may only have to wear the lens in the eye every 3rd night.

 

Please note that Otis is not a doctor. He is an engineer.

DrG

 

(Otis Brown) wrote in

Dear Otis,

I and others have concluded that both of you are mistaken about a number of
things pertaining to human vision.

Drg

 

Dear DrG,

And you are perfectly entitled to your "majority opinion".

But times change -- and you will not.

The second opinion was expressed by Dr. T. Grosvener,
in his advocacy that a plus lens be used before
the child is ACTUALLY NEARSIGHED.

A "tough sell" indeed.

I am certain that Crippler is a mature intelligent
adult and can read the literature and make up
his own mind about these issues.

The easiest thing to do is to just not wear the
plus lens. Nothing gained -- nothing lost.

A pleasant thoughtful conversation about
a difficult subject.

Best,

Otis

 

You have "quoted" Dr Grosvenor on this many times, could you please cite the
journal article or letter when he did this?

Dr Judy

 

(Otis Brown) wrote in

Dear Otis,

Coming from you that is a strange statement. Your ideas stem from a common
stream of thought that is decades old. I don't see a movement in your
direction. It is you who has refused to make the acknowledgement. By
quoting studies of chicks and primates you are only trying to disguise
these old ideas in a set of new clothing, when the real conclusions are
something entirely different.

DrG

 

Dear Vision Research Group,

Use of the plus (at the 20/40 level) has been advocated
for the last 100 years. This advocacy has not changed.

Equally, it is very difficult for most of us to conceptualize
the necessity of using the plus at that level.

A profession does what works "immediately". That does
not make it "right" but it certainly is understandable.

Here is the article discussing the suggestion that
the plus be used for prevention.

Best,

Otis



From: "Trying to get myopia into focus"

David Holzman, INSIGHT, Feb 16, 1987

Summary: Numerous researchers are exploring the causes of myopia
in order to find ways to prevent its onset in children. At
the heart of the problem is uncertainty whether genetics or
environmental factors such as close work cause the disorder
or, as some studies have indicated, it is a combination of
both. If one geneticist is right, two-thirds of the myopia
developed by children eventually may be preventable.



THIS IS THE DIFFICULT PROBLEM AN OPTOMETRIST WILL HAVE WITH
US IF HE ATTEMPTS TO INTRODUCE PREVENTIVE METHODS WITH US -- AND
WE DO NOT UNDERSTAND THE METHOD.

Commentary by Otis Brown

Dr. Cordova, in and interview with PREVENTION magazine, said
that "the public" would never accept the use of a plus lens for
prevention. He said that the public would go from doctor to
doctor until they found one who would give them a minus lens that
sharpened distant vision instantly -- and would not tolerate a
discussion of anything else other that that.

Dr. Cordova is right. No optometrist can hope to change
this situation (i.e., institute prevention with a plus lens) until
the public is intellectually prepared to change their mind about
the use of a minus lens in the manner described by Dr. Cordova.
His issue needs to be discussed and must be evaluated before any
preventive effort initiated. It is a very important issue for
both the optometrist and the public at this point to be
understood BEFORE that first minus lens is applied.


SUMMARY: This issue speaks to the fact that the person
must be higly motivated at the 20/40 level -- when
most people are lacking in that motivation.



Re: "The ultimate study would be to put reading glasses on
first-graders before anyone has developed myopia," he says.
Dr. Theodore Grosvenor


Despite the fact that results of studies of children who have
been given bifocals are highly equivocal, Theodore Grosvenor of
the University of Houston College of Optometry -- a proponent of
the role of bifocals in the prevention of myopia -- insists that
persistent close work causes myopia. (In what researchers
generally consider to be the most carefully performed study to
date, the two scientists ** disagree on the results.) Some of the
studies have not borne out his hypothesis, he says, because they
were conducted too late. "Once the eye has started to stretch, it
may be too late to keep it from stretching," he says, explaining
that most of the children in the study had already become myopic.
"The ultimate study would be to put reading glasses on
first-graders before anyone has developed myopia," he says.



** [One of the scientists was Dr. Francis Young. His bifocal
study showed that a combination of under-correction and a
strong plus stopped the eye's movement into myopia, i.e.,,
would help the natural eye maintain clear distant vision if
used when the eye was at the 20/40 to 20/50 level. OSB]

 

You still avoid references to objective human studies. You will not convince
anybody by parroting opinions that are contradicted by objective human studies
comparing treated and untreated groups.

Your knowledge of history sucks too. The advocacy HAS changed. Eye doctors used
to recommend plus. Now they don't. Why would that happen?

-MT

 

Dr G did do well controled bifocal studies in the late '80s, early '90s and
found little to no effect.

So where is this quote from, and what year? I see that Dr G says "it may
be too late", this is speculation on his part and far from suggesting that
he advocates using plus before myopia develops, as you say he does. I also
notice that he says that using plus before myopia develops needs to be
studied; since he wants the studies done first, I doubt he would advocate
for use of plus on non myopic six year olds without clinical trial evidence
that it works. These studies have not been done and the evidence does not
exist.

When you quote Dr G as an advocate for your position about the value of
plus, I think you are seriously misusing his name.

Dr Judy

 

Dear Crippler,

Here is some background information on Ortho-K, FYI.

Best,

Otis


*********


The Berkeley Orthokeratology Study

Purpose

To evaluate the relative efficacy of orthokeratology, primarily by
assessment of changes in central corneal thickness, astigmatism,
visual acuity, endothelial cell density, and corneal curvature.

To evaluate the relative safety of orthokeratology, primarily by
assessment of changes in central corneal thickness, astigmatism,
visual acuity, endothelial cell density, induced corneal edema, and
epithelial staining.

To assess the duration of any orthokeratology treatment effect.

To study the mechanisms by which refractive error and visual acuity
changes occur, in particular the contribution that comes from changes
in corneal curvature and shape.

To determine whether there were any predisposing ocular factors that
could be used to predict which subjects will experience changes or
complications.

Background

In the early 1960s, a group of clinicians asserted that myopia could
be reduced and possibly corrected by fitting specially designed
contact lenses to induce corneal flattening and thereby reduce the
refractive power of the eye. This technique, known as orthokeratology,
required that the lenses be fitted and then changed progressively
until vision becomes normal or nearly normal. Advocates of
orthokeratology claimed that corneal changes could be induced in a
predictable fashion, were often permanent, and occurred without
causing any adverse effects to the cornea. Data on orthokeratology
were generally limited, poorly documented, and did not address the
issues of control or failure.

Description

The Berkeley Orthokeratology Study was a single center randomized,
concurrently controlled, masked clinical trial. Corneal and visual
changes in an orthokeratology treatment group were monitored and
compared with those observed in a control group whose members wore
contact lenses fitted in a standard clinical manner. Visual and ocular
characteristics were monitored for 1.5 years.

Eighty subjects were studied-40 in an orthokeratology group and 40 in
a control group fitted with conventional hard contact lenses. The hard
lenses chosen for this study were made of either polymethyl
methacrylate (PMMA) or a PMMA-silicone combination (Polycon). All
subjects were initially fitted with PMMA lenses.

The initial treatment and control lenses were selected according to
protocol guidelines and then adjusted to achieve an "optimal fit"
based on lens position, movement, and alignment as assessed by
fluorescein study. At the outset, the treatment and control lenses
differed in that the treatment lenses were on the average thicker and
flatter and had a larger diameter.

Following the dispensing visit, subjects progressed through three
study phases. In the adaption phase (Phase A), subjects were examined
weekly until they were adapted to 12 to 14 hours of daily contact lens
wear. The postadaptive phase (Phase B) consisted of monthly followup
examinations for 1 year. The final phase (Phase C) consisted of a lens
withdrawal segment and a postwearing segment.

Patient Eligibility


Myopic volunteers, ages 20 to 35, who had not worn contact lenses were
eligible to participate in the study if they were free of ocular
disease, were in good physical health, and were not taking systemic
medications that could have ocular side effects. In addition,
eligibility was limited to persons with corneal curvature between
40.50 and 47.00 D (flatter keratometry reading), corrected visual
acuity of 6/6 (20/20) or better in each eye, astigmatism less than
0.75 D, anisometropia less than 1 D, and myopia between 1 and 4 D.

Patient Recruitment Status

Completed. Patient recruitment began in January 1978 and ended in
February 1979.

Current Status of Study

Completed.

Results


Data were available for 31 treated and 28 randomized control subjects
who wore conventional rigid contact lenses. After an average of 444
days of contact lens wear, the treatment group showed an overall mean
reduction in spherical equivalent refractive error of 1.01 D compared
with 0.54 D in the control group (p = 0.02). Both groups had
considerable variation in refractive error change. Corresponding mean
improvements in unaided visual acuity were -0.27 and -0.20 log of the
minimum angle of resolution. Corneal curvature decreased in both
comparison groups, but the actual diopter value was about one-half
that of the refractive change. The changes in these characteristics
tended to occur during the first 132 days of wear, and additional
aggressive lens therapy during the remaining 241 days of treatment
produced little additional change. The refractive error fluctuated
considerably during the periods of followup, and these fluctuations
tended to be larger in those subjects who had shown greater changes in
refractive error.

When the lenses were removed, ocular characteristics returned steadily
toward baseline levels. Ninety-five days after discontinuing lens
wear, the refractive error had returned to 75 and 69 percent of the
way to baseline levels for the treatment and control groups,
respectively. Visual acuity and corneal curvature showed similar
rebound after 95 days.

With orthokeratology, it is possible to reduce myopia about 1 D;
however, the change is not permanent. Results indicate that the level
of vision during periods of non-lens wear would be unstable, making it
difficult to predict what the quality of vision would be under a
retainer lens wear program.

It appears that orthokeratology is safe for the types of patients who
participated in this study, but it may require more patient monitoring
than would be needed to achieve and maintain a physiologically
acceptable fit with conventional hard contact lens prescriptions.

Orthokeratology produces modest reductions in myopia; however, the
effect will not persist without continued lens wear and therefore is
of limited clinical value in permanently reducing myopia.


Publications

Brand RJ, Polse KA, Schwalbe JS: The Berkeley Orthokeratology Study
part 1: General conduct of the study. Am J Optometry and Physiological
Optics 60: 175-186, 1983.

Polse KA, Brand RJ, Keener RJ, Schwalbe JS, Vastine DW: The Berkeley
Orthokeratology Study, part III Safety. Am J Optometry and
Physiological Optics 60: 321-328, 1983.

Polse KA, Brand RJ, Schwalbe JS, Vastine DW, Keener RJ: The Berkeley
Orthokeratology Study, part II: Efficacy and duration. Am J Optometry
and Physiological Optics 60: 187-198, 1983.

Polse KA, Brand RJ, Schwalbe JS, Vastine DW: Corneal Change
Accompanying Orthokeratology: Plastic or elastic? Results of a
randomized controlled clinical trial. Arch Ophthalmology 101:
1873-1878, 1983.

Polse KA, Brand RJ: Contact lens effects on ametropia: A current
example of the clinical trial. Am J Optometry and Physiological Optics
58: 281-288, 1981.

Resource Centers

Chairman's Office
Kenneth A. Polse, O.D.
School of Optometry
University of California, Berkeley
525 Minor Hall Annex
Berkeley, CA 94720
Telephone: (510) 642-7745


NEI Representative

Donald F. Everett, M.A.
National Eye Institute
National Institutes of Health
Executive Plaza South, Suite 350
6120 Executive Boulevard MSC 7164
Bethesda, MD 20892-7164
Telephone: (301) 496-5983
Fax: (301) 402-0528

*********