10 Year Old with High Myopia

My daughter is 10 years and her vision is -5.5 and less than 4 months ago her vision was -4.75. Her vision is almost doubling within a year. Her Optometrist is pushing the Paragon CRT (Corneal Refractive Therapy) which cost $2,200. My daughter's myopia is genetic and I am skeptic about implementing this program. My daughter visit an Opthamologist once a year and she has ruled AGAINST the CRT procedure. I am a single mother and $2,200 is very expensive for a temporary fix. The Optometrist stated that if my daughter were to wear the specialized lenses for a year her vision may improve by .25 but if we discontinue use, then her vision will return to where it began. What do you recommend I do in my case? Her father's vision is -10 and he wears contacts and suggested we lean in that direction as it relates to contacts maybe multifocal. My heart breaks each time we visit the Optometrist.

My daughter have to go to the front of her class just to see the board. I request that my daughter sit in the first row despite having glasses. Please help!!!

[John C Hagan III, MD, FACS, FAAO]

I agree that CRT is a waste of time and money and does not permanently alter the progression of myopia. It is a good profit center for optometrists. It's like wearing a girdle and thinking it will stop weight gain if you overeat.

Recommend you consider:

1. Switch care to an ophthalmologist Eye MD. Find one near you at www.aao.org or go back to the one you saw in the future.
2. In the future consider contacts and later still lasik/refractive surgery.

JCH MD

[DrJJ]

Orthokeratology is reversible. LASIK is not. And orthokeratology works well for children who might have problems with glasses or daytime contact lenses.

[User1234567]

CRT is not a waste of time or money.  What is the cost of constantly changing glasses?  What is the cost of a myope who gets to -10.00 vs. -5.50?  What about the increased retinal traction leading to retinal detachment and the higher prevalence of glaucoma in higher myopia?  Recent research is showing slowed progression of myopia with CRT, excellent safety, and the cost is only an initial burden and not recurring.  

[Eyehoo]

It's always hardGood for parents when their kids are in need of help.  Orthokeratology may be your best option though.  My advice is that you speak to a fellowship trained orthokeratologist and learn how this may stop or slow down your childs myopia.  Your ophthalmologist is not trained in this and is giving you poor advice.  There are several new studies that support orthokeratology, its safety and ability to help.  

[Eyehoo]

It's always hard for parents when their kids are in need of help.  Orthokeratology may be your best option though.  My advice is that you speak to a fellowship trained orthokeratologist and learn how this may stop or slow down your childs myopia.  Your ophthalmologist is not trained in this and is giving you poor advice.  There are several new studies that support orthokeratology, its safety and ability to help.  

[myopiawarrior]

It is possible to offer some answers to this question without disparaging the motives of either optometrists doing too much CRT or ophthalmologists doing too much refractive surgery.

The classic view of myopia is that it is purely genetic, but the pendulum has swung quite a bit over the last ten years. It is well established based on numerous animal studies by optometrists, ophthalmologists and vision scientists that every animal that has ever been studied will modify its eye growth based on the type of visual input that it receives early in life. Animal studies don't necessarily apply to humans, but these findings have led to massive research efforts into rational, effective and scientifically based methods of slowing nearsightedness progression.

To boil it down to the bare minimum, there are three optical strategies that have shown promise. Bifocal or progressive multifocal eyeglasses have been shown to be largely ineffective for most myopes, however very well controlled studies consistently show anywhere from 20 to 40% slowing of myopia progression when used with children with either esophoria at near and/or various forms of focusing dysfunction.

Bifocal soft contact lenses have been shown to slow myopia progression in children and adolescents with esophoria by 90% in a randomized double masked, controlled clinical trial (only the abstract was published). Also there was an identical twin paper that showed remarkable effectiveness with this approach, published a few years ago.

Several small studies from all around the world are showing about 50% slowing of myopia progression in children that have undergone orthokeratology as compared to control groups. The prevailing theory is that by altering the shape of the front of the eye, there is a reduction in the blur in the periphery of the retina, as compared to what happens with standard contact lenses or eyeglasses. Interestingly, an eye reshaped with orthokeratology looks very similar to the optical profile of an eye wearing a typical bifocal soft contact lens, so they may share a mechanism for myopia control.

Every contact lens company and several spectacle companies are researching and developing lenses intended to slow the progression of myopia. They all generally attempt to alter the focus on the back of the eye to lessen something known as hyperopic defocus. This will lead to a true revolution in the treatment of myopia over the next several years and such lenses are already on the market in Asia.

I'm not aware of any studies that suggest that refractive surgeries slow the progression of myopia and very few surgeons would be comfortable performing laser surgery on minors.

By the way, the highest research award in Optometry was awarded yesterday to the primary researcher responsible for proving that hyperopic defocus in the periphery of the retina can cause myopia progression and that reducing the defocus can slow myopia progression, so there is a tremendous amount of science behind some of the clinical suggestions in this long post.

[JoeCRT]

Dr. Hagan is clearly out-of-touch with today's science and medicine regarding contact lens corneal reshaping (CRT).  His affiliation with LASIK may also be clouding his own vision.  CRT is a great option for many children and adults.  It has been FDA approved since June 2002 and the incidence of adverse events has been extremely low.  A recent post-market surveillance study completed at the request of the FDA confirmed that contact lens corneal reshaping is equally safe for children and adults.  These scientific results will be published in early 2011.  Commenting on any technology without the latest scientific results is unprofessional.  Commenting on any patient with certainty, without a visit, is irresponsible.  Commeting on any product, without the facts, is arrogant.  

[eyeshaper]

Dr. Earl Smith's groundbreaking work at the University of Houston College of Optometry has shown conclusively how and why Orthokeratology works. Dr. Mark Bullimore's research at Ohio State University College of Optometry revealed that Ortho-K lens wear is no more risky than any other contact lens modality. And, after three years the most comprehensive Ortho-K study to date has demonstrated just how safe and effective this treatment is for kids at 10 clinical sites around the country. If that is not enough, I personally have been successfully wearing Ortho-K lenses for over 10 years and you can believe I would not want to risk my own eyes or your child's. As for the expert you've gone to for advice on this site, please take note of the fact that he and other doctors in their LASIK specialty practice still choose to wear glasses--but I'm sure they would gladly do LASIK on others.

[AntonReiser]

Please read what the AAO says:
Safety of Overnight Orthokeratology for Myopia: A Report by the American Academy of Ophthalmology
http://www.ophsource.org/periodicals/ophtha/article/piis0161642008006477/abstract

Mesopic Contrast Sensitivity and Ocular Higher-Order Aberrations after Overnight Orthokeratology
http://www.ajo.com/article/s0002-9394%2807%2901005-7/abstract

Orthokeratology lens-related corneal ulcers in children: a case series.
http://www.ncbi.nlm.nih.gov/pubmed/15019341

But also:
http://journals.lww.com/optvissci/Abstract/2010/12000/Discontinuation_of_Orthokeratology_and_Myopic.18.aspx

[DrJJ]

If this is all about pulling out articles that make things sound bad...why not pull out some articles about contact lens wearers in general and all the problems people have. Let's get some journal articles about LASIK disasters.

If you want to discuss the Chinese system and their health care since you brought up that article, let's talk also talk about all the things that are different in China. Let's talk about the 13 story building that fell over. Let's talk about how they treat people. We could start a new thread about that.

If it's about protecting kids, then let's just prohibit them from being in a car.....you're grasping at straws.

Level with us. You don't care for OD's do you? You should disclose your bias.