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high myopia

Orthokeratology Patient

We’ve had the privilege of managing this amazing 6 year old, fit into Orthokeratology lenses for a few weeks now. She was referred to us for Myopia Control due to her Rx: -8.75-2.50×009 (20/25) in the right eye and -5.75-2.25×170 (20/20) in the left eye. Her baseline axial length is 25.01mm OD and 24.10mm OS.

Although her prescription is higher than the expected “ideal” Orthokeratology (orthok) candidates, these lenses allow her parents more control in handling the lenses due to its nightly regime.

Her lenses were designed with the Eyespace software. The lenses at the initial dispense showed a noticeable amount of bubbles in the mid-periphery but were reassessed 1 week later with significant improvement due to the flattening of the cornea. In these cases, we recommended filling the lenses with artificial tears and inserting the lenses face down as we would a scleral lens.

At the one week mark, she was able to see 20/25- OU without any corrective lenses during the day. She was 20/60 OD and 20/30+ OS but has been so excited with the results so far. Due to her high starting point, we expect it to take a few more weeks for her vision to improve but we are so excited to see how she continues to do.

Thank you so much Dr. Bradley Waite for this kind referral.

Thank you Dr. Michael Lipson for your help on this complicated case.

High myopia patient fit into scleral contact lens

Thank you Dr. Isozaki for sending us this fun case!

34 year old Asian male was seen at UCLA by my good friend and classmate, Dr. Veronica Isozaki. He has a long history of corneal gas permeable lens wear, since he was about 10 years old.

After a very thorough case history, and after examining his current lenses, he mentioned that his last eye doctor in New York was attempting “orthokeratology daytime lenses.” I didn’t know what he meant until I saw the lens fit on his eye and the topographies.

The lenses both showed central bearing with midperipheral pooling (not a classic orthokeratology pattern, but I can see what he meant by ‘daytime orthokeratology lenses.” The left eye also shifts during blink which causes a chance in his vision.

We reviewed a variety of lens options extensively, and we decided to attempt an oblate scleral lens for now. I could attempt to redesign lenses based on his current topography, but the artificial shape might cause me to chase the lens fit over and over again. I recommended starting fresh with a scleral lens and we can monitor his corneal “unmolding” and if he truly wants to go back to the corneal gas permeable lenses, we will have a much better baseline.

The over-refraction was not attempted due to the autorefract data being -22.25 in the right eye and -22.75 in the left eye.

With an oblate design and also adjusting the base curve, we were able to decrease the power to about -16.00.

The first lens will be sort of a custom diagnostic lens. He knows that the shape of his eye and potentially the power will need to be adjusted as things progress. Will keep you posted on his results!