Better Vision Without Surgery

Like many people, Jeffrey Mata dedicates a couple of minutes of his morning routine to handling contact lenses that help him see better. But whereas most people are putting lenses on each morning, he’s taking them off.That’s because Jeffrey’s lenses aren’t lenses at all – at least not in the conventional sense. Though they look like traditional contact lenses, they’re eye shapers that re-contour the shape of his cornea as he sleeps, allowing him to see clearly during the day without the aid of eyeglasses and lenses. “I really like them,” says Jeffrey, operations coordinator at Envision Optique in Miami, Fla. “I see fine all day without having to worry about glasses or contacts.”Jeffrey is benefiting from orthokeratology or ortho-k, a process that – like vision correction surgery – reshapes the cornea in order to improve near-sightedness. Except no surgery is involved.  But, unlike surgery, the change isn’t permanent, a fact that repels those wanting a permanet fix but appeals to those who worry about the perpetual effects of common surgical procedures for vision correction. At the same time, ortho-k may be an option for people who are not candidates for vision-correction surgery, such as those who suffer from dry eye or whose cornea is too thin.“Lasik reduces corneal tissue, but the shapers don’t reduce tissue” explains Dr. Michael R. Obregon, who a couple of years ago became among the first doctors in the nation to undergo training on the application of Paragon CRT, one of the first ortho-k brands cleared by the FDA for use during sleep.The concept isn’t exactly new. It’s believed that in ancient times the Chinese used sandbags to flatten their eyes while they were sleeping. Even then they knew the role the shape of the eye plays in vision clarity. In cases of myopia, or nearsightedness, the wrong curvature causes light entering the eye to focus in front of – instead of on – the retina, causing distant objects to appear blurry. Eyeglasses and contacts work by redirecting the light rays. Lasik and ortho-k take the strategy a step further by re-shaping the cornea so that the rays focus on the retina.More sophisticated than sandbags, thankfully, the lenses are designed in a reverse geometry. Usually, lenses are designed to match the curvature of the eye exactly. Here it’s the reverse: the lenses are steeper at the edges, causing a pressure gradient, which stimulates cells to migrate. As the cells shift, the cornea is reshaped.Contact lens corneal reshaping has been around more than 30 years but until recently had lukewarm appeal, in part because of limited technology. But new manufacturing methods and lens designs – such as more comfortable and oxygen-enriching materials – have made the lenses more appealing. In addition, until recently, the lenses were not approved for overnight wear, rendering them impractical since they typically must be worn at least six hours a day in order to take effect.Comfort also was an issue in the lenses’ daytime use. While much improved over the years, they are the more rigid oxygen-permeable lenses, which sometimes can be felt as the eyelid interacts with the lens during blinking – something that doesn’t happen with soft lenses because they typically remain tucked under the eyelids. That problem, however, disappeared once they could be worn during sleep – when we don’t blink.  Among the first to receive FDA approval for overnight wear was Paragon Vision Sciences’ CRT or corneal refractive therapy, followed by Bausch & Lomb’s VST or vision shaping treatment. Both products are available only from eye-care professionals who have undergone training by each company. At Envision Optique, Dr. Obregon says he carefully studied the various brands and chose Paragon CRT in part because of the large amount of information the company makes available to the public. In addition, he says, he was impressed with the quality of the product. In the clinical studies for FDA approval of CRT, 93 percent of patients achieved 20/32 vision or better, and 67 percent achieved 20/20 or better. Bausch & Lomb’s VST studies also showed a high rate of efficacy: About 95 percent achieved 20/40 or better, and 73 percent achieved 20/20 or better. Both studies followed patients for at least nine months.So why hasn’t ortho-k experienced wider popularity? For one thing, not everyone is a candidate. The FDA has approved CRT for people with up to six diopters of myopia (that’s -6.00 on your prescription); the VST approval is for up to five diopters. (Astigmatism isn’t a problem as long as it’s less than -1.75 with CRT and -1.50 with VST). The best candidates generally are people with myopia of four diopters or less.Then there’s the fact that, unlike surgery, ortho-k still requires you to deal with lenses on a daily basis. Therefore, someone who wants to completely do away with the inconvenience of glasses and lenses is likely better off undergoing surgery.Another major impediment: Cost. Although it is less expensive than surgery – about $1,500 for the initial lenses and fitting versus $2,000 to $4,000 for surgery – the cost is ongoing. Annual cost for replacement lenses and follow-up exams can run upwards of $500. After a few years, the cost of ortho-k can surpass the one-time cost (usually) of surgery.Still, it’s a good option for those who can’t do or don’t want surgery but do want to do away with the daytime inconveniences of glasses and lenses, says Dr. Obregon, who notes the concept has proven popular with children, since candidates for Lasik must be at least 18 years old. And because the lenses are put on before going to sleep, when adults are around to supervise, parents have some control over the hygiene concerns that often exist when children are using traditional contact lenses. The process of getting ortho-k lenses is much like the process of getting traditional lenses. An eye doctor measures the curvature of your corneas, creating a map of the surface of your eye. Lenses are ordered and several follow-up visits are scheduled.The lenses don’t re-shape the cornea instantly. Typically they must be worn several days, possibly as many as 14 days, for the initial reshaping to take place. After that, most people need to wear them each night to sustain the cornea’s new shape during the day, although some people have reported the effect can last two to three days. If the user stops wearing the lenses, the cornea slowly regresses to its original shape. (The greater the prescription, the greater the change in shape, therefore, the longer it takes the cornea to get back to its original shape.) So while ortho-k likely won’t replace Lasik any time soon, it is slowly winning followers. “I considered Lasik [surgery] but my vision was not so bad that I always needed to wear glasses,” says Jeffrey Mata, who has been using the shapers for almost two years now. “As long as I can continue with this, I will not have surgery.”