1st day of ortho-k

Discussion in 'Optometry Archives' started by crippler, Jul 10, 2003.

  1. crippler

    crippler Guest

    in my left eye I am 20/20

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

    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.
    crippler, Jul 10, 2003
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  2. crippler

    Dr. Leukoma Guest

    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?

    Dr. Leukoma, Jul 10, 2003
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  3. crippler

    Otis Brown Guest

    Dear Crippler,

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

    Some pilots have used it successfully.



    Otis Brown, Jul 10, 2003
  4. crippler

    crippler Guest

    i'll give this a couple of weeks first and see how good it gets.
    crippler, Jul 10, 2003
  5. crippler

    crippler Guest

    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
    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.
    crippler, Jul 10, 2003
  6. crippler

    leukoma Guest

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

    leukoma, Jul 10, 2003
  7. crippler

    Dr. Leukoma Guest

    (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.

    Dr. Leukoma, Jul 11, 2003
  8. crippler

    Otis Brown Guest

    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.


    Otis Brown, Jul 11, 2003
  9. crippler

    Dr Judy Guest

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

    Dr Judy
    Dr Judy, Jul 12, 2003
  10. crippler

    Dr. Leukoma Guest

    (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.

    Dr. Leukoma, Jul 12, 2003
  11. crippler

    Otis Brown Guest

    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.



    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.


    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]
    Otis Brown, Jul 12, 2003
  12. crippler

    Mike Tyner Guest

    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?


    Mike Tyner, Jul 12, 2003
  13. crippler

    Dr Judy Guest

    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

    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
    Dr Judy, Jul 14, 2003
  14. crippler

    Otis Brown Guest

    Dear Crippler,

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




    The Berkeley Orthokeratology Study


    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


    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.


    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



    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.


    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

    Otis Brown, Jul 14, 2003
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