Orthokeratology (OK) is the reduction, modification or elimination of myopia through application of contact lenses. With the development of high Dk/t lens materials, overnight therapy has become the modality of choice for OK. Overnight OK lens wear has been previously investigated in terms of its efficacy to reduce myopia. However, the underlying effects of overnight OK lens wear on the human cornea have received less attention. As well as the clinical efficacy of overnight OK, this study investigated the effects of overnight OK on topographical corneal thickness and the overnight corneal edema response, and corneal tissue changes with overnight OK. Eighteen subjects participated as the OK lens-wearing group, wearing BE lenses (UltraVision, Brisbane, Queensland) in both eyes. A further ten subjects participated as control subjects, wearing conventional rigid lenses (J-Contour, UltraVision) in the right eye (RE) only. The left eye (LE) acted as a non-lens-wearing control. Both groups wore lenses overnight only, with no lens wear during the day. Measurements were conducted at baseline then on day 1, 4, 10, 30, 60, and 90 for the OK lens-wearing eyes; and up to day 30 for the control group, in the morning (after overnight lens wear) and in the evening (after 8-10 hours of lens removal). Variables measured included best vision sphere (BVS), unaided logMAR visual acuity (VA), refractive astigmatism, apical corneal power (ACP), simulated K readings (Medmont E300 corneal topographer), topographical corneal thickness (Holden-Payor optical pachometer), and keratocyte and endothelial cell densities (ConfoScan2 confocal microscope). Approximately 75% of myopia was corrected after the first night of OK lens wear and the changes in refractive error stabilised by day 10. By day 90, myopia reduction averaged 2.54 ?? 0.63 D. This was associated with significant improvement in unaided VA of about 82% after the first night of lens wear. There was no change in refractive astigmatism over the 3-month period. There was significant reduction in ACP in the OK lens-wearing eyes after the first night of lens wear, which accounted for more than 70% of the total ACP change over the 3-month period (RE: -2.16 ?? 0.53 D; LE: -2.11 ?? 0.86 D). There was significant central epithelial thinning (about 30%) and significant thickening (about 3%) in the mid-peripheral stroma in the OK lens-wearing eyes. Significant central epithelial thinning was found after the first night of lens wear while thickening in the mid-peripheral stroma reached statistical significance by day 4. Further analysis suggests that topographical corneal thickness changes account for the refractive error changes with overnight OK lens wear, rather than corneal bending. The central overnight stromal edema response was significantly reduced in the OK lens-wearing eyes (1.2 ?? 0.5%) to a level lower than in the conventional RGP (6.2 ?? 1.2%) and non-lens-wearing eyes (2.5 ?? 0.9%) in the control group. Mid-peripheral and peripheral stromal edema responses showed similar levels to those predicted based on lens Dk/t. A single overnight wear of BE and Paragon Corneal Refractive Therapy (CRT) lenses showed that the edema response to BE lens wear is significantly less than in the CRT lens-wearing eyes (BE: 2.5 ?? 0.7%; CRT 3.5 ?? 1.3%) immediately on eye opening. No significant changes were found in either central stromal keratocyte or endothelial cell densities in either OK or control groups over the study period. In conclusion, overnight OK lens wear induces significant reductions in myopia after the first night of lens wear associated with improvement in unaided VA. Overnight OK lens wear causes significant thinning in the central epithelium and significant mid-peripheral stromal thickening which results in flattening of the central cornea and steepening in the mid-periphery. Although there were no significant changes in central stromal keratocyte and endothelial cell densities, thinning of the central epithelial layer raises concerns regarding the safety of the procedure, especially with the alarming number of corneal infections reported recently in the literature.
| Identifer | oai:union.ndltd.org:ADTP/282116 |
| Date | January 2005 |
| Creators | Alharbi, Ahmed A, Optometry & Vision Science, Faculty of Science, UNSW |
| Publisher | Awarded by:University of New South Wales. School of Optometry and Vision Science |
| Source Sets | Australiasian Digital Theses Program |
| Language | English |
| Detected Language | English |
| Rights | Copyright Ahmed A Alharbi, http://unsworks.unsw.edu.au/copyright |
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