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Orthokeratology
(BRACE Refractive Therapy)
Orthokeratology, referred
to as BRACE Refractive Therapy in our
practice, utilizes unique designed contact lens “vision
retainers” to gently mold the cornea to a new desired shape usually in a
matter of hours, days, weeks, or in some cases months. This
procedure might be compared to the way an orthodontist uses braces to
align teeth. Small precise changes in corneal curvature dramatically
improve vision. There’s no pain and most importantly, no worry
about possible complications from surgery. Results are stabilized by
wearing retainer lenses, part time, during the day or at night. Many
enjoy functional unaided vision all day and often longer. If
retainer wear is discontinued, vision gradually returns to the original
starting point. So, unlike surgery, this procedure is totally
reversible.
It is estimated that
roughly 30% of the U.S. population suffers from nearsightedness (myopia),
the inability to see clearly at distance. Orthokeratology has been
successfully freeing people from their constant dependence on eyeglasses
or contact lenses for over 40 years. The origin of this procedure (also
referred to as Ortho-K, OK, CRT or BRACE Refractive Therapy) goes back to
around 1958 when a few pioneer practitioners in California found that some
myopic patient’s prescriptions would improve after wearing hard contact
lenses. Over the years, Ortho-K has evolved to a highly
sophisticated science. Information derived from computerized corneal
mapping can now be used with software programs to design unique “reverse
geometry” vision retainers that can rapidly and safely reduce moderate
degrees of myopia and astigmatism. These modern designs are often
worn for only 8 hours during sleep and removed in the morning, yielding
clear unaided vision during all waking hours.
Nightwear Is Not
Extended Wear
Because nightwear therapy
is normally the method of choice today, any objection a patient may have
to adaptation is virtually eliminated. An important point to
understand is that nightwear should not be confused with extended wear.
Nightwear “vision retainers” are only worn for an average of 8 hours
and removed in the AM, compared to extended wear disposable soft lenses
which are approved for up to 7 days of continuous wear. Also,
nightwear Ortho-K “vision retainers” allow up to 600% more oxygen to
reach the cornea as compared to extended wear disposable soft lenses.
And, actually these high oxygen permeable retainers are on the eye for
considerably less time than even the average 12-14 hour schedule of a
daily wear contact lens patient. Properly designed BRACE
nightwear retainers normally center and perform extremely well. In
some cases, they can reduce up to several diopters of myopia overnight.
Recent scientific evidence seems to indicate that most of the refractive
change is induced by a simple, harmless, redistribution of tissue from a
50 micron average layer of corneal epithelium. This tissue redistribution
effectively flattens the central cornea, with a corresponding degree of
steepening in the mid-periphery.
Since the cornea represents the greatest refractive component of the eye,
only a small change in curvature is normally required to create the
desired visual improvement. An analogy I use to demonstrate tissue
redistribution would be the lines and dimples created when removing tight
shoes and patterned socks. These temporary patterns disappear over
time as displaced epithelium gradually fills back in. However, since
BRACE refractive therapy involves
ongoing reinforcement, the results are gradually sustained for longer
periods of time. After a brief period of stabilization, most
individuals experience clear, functional, unaided natural vision all
waking hours (or even longer).
Children
and BRACE Refractive Therapy
 Recent myopia studies
have revealed what most eye care professionals have suspected all
along….. Rigid gas permeable (RGP) lenses offer a beneficial influence
in helping retard axial elongation (growth) of the eye during the growth
years. Thus, children who wear RGP lenses do not seem to progress
the way children who wear eyeglasses or soft lenses do.
In the past, I’ve often
been torn between what type of lens to provide for emerging myopic
(nearsighted) children. An RGP would certainly be beneficial for
myopia control, but a child’s active lifestyle would often conflict with
the benefits provided by this type of lens. I have found the ideal
solution to be BRACE refractive
therapy. These kids can now function all day long with clear,
natural, unaided vision. They don’t have to worry about rigid
lenses popping out, or debris getting trapped under their lens during
athletic activities. Long term, I am literally changing a child’s
destiny by not having him follow in his parent’s footsteps.
Typically, we see progressive myopic children eventually reach or exceed
their parent’s degree of prescription, but this outcome can now be
changed with BRACE Refractive Therapy.
Not only will this procedure allow natural unaided vision throughout the
day, but it also helps retard axial elongation of the eye. Certainly,
continuing to conform to traditional standards by allowing children to
just wear eyeglasses or soft contact lenses will do absolutely nothing to
retard myopic progression.
Civil
Service Applicants
Individuals with poor
vision desiring a career in law enforcement, fire fighting, aviation,
etc., can now meet vision requirements without surgery. Dr. Feldman
has helped hundreds of candidates over the years secure new careers by
improving their unaided vision.
Is Everyone an
Ortho-K Candidate?
 No! While Ortho-K
can help most individuals, including those with moderately high myopia,
and mild to moderate astigmatism, the procedure is often most effective
for those prescriptions falling within a specific range. Additional
factors include individual corneal shape factors and rigidity, as well as
the ability to wear contact lenses. A thorough consultation and
examination at The Contact Lens Center of Lynbrook using advanced
computerized diagnostic instrumentation can readily determine if Ortho-K
is right for you.
Safety
To date, four university
level Orthokeratology studies have been completed. There are
currently several other studies on nightwear Ortho-K being conducted.
The completed studies include: The Pacific University School of Optometry
(5 years), University of California at San Diego Medical School (7 years),
The University of Houston
College of Optometry (5 years), and the University of California at
Berkeley School of Optometry (3 years). All completed studies found
the procedure to be safe, without harmful side effects, and effective.
These studies stressed that proper care and continued monitoring of
patients under treatment is required. Only highly experienced
practitioners in the field of Ortho-K therapy should utilize the
procedure. Dr. Feldman is currently one of about 50 peer reviewed
Fellows of the International Orthokeratology Section (F.I.O.S.) in the
world.
You
Now Have A Choice
Ortho-K is a
non-surgical, totally reversible procedure normally costing less than
LASIK. LASIK is a non-reversible surgical procedure (good or bad).
Eyes undergo normal physiological prescription changes throughout one’s
lifetime, even after surgery…So, refractive surgery is not a “quick
fix” for the rest of your life. With Ortho-K, any normal
physiological prescription changes that occur over the years can be easily
compensated with new retainers. Ortho-K is totally reversible if
you’re not happy with the results, but there are always inherent risks
with surgery. The choice is yours.
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