The Nearsighted Epidemic

This is the start of my blog. Hopefully I will be able to open your eyes to a completely different way of correcting your vision. My goal is to educate as many people as I possibly can about the risks of nearsighted (Myopic) eyes and a ways to manage it. Many people only know about glasses, contact lenses or laser eye surgery (LASIK). There is, however another treatment; One that according to recent studies, may slowdown the progression of nearsighted eyes, while allowing you to be free of glasses and day time contacts. There is NO laser or surgery involved. Introducing, Advanced Orthokeratology (AOK). Other methods to manage the progression of nearsighted eyes include specialized myopia control contact lenses and medications such as Atropine.

One Question I hear is “Is it safe?”

Yes! Like with contact lenses, it's always important to keep AOK molds clean and to wash your hands. On June 13, 2002, the FDA approved the marketing of Paragon CRT lenses, one form of AOK for nearsighted kids. The FDA also approved for marketing these overnight retainers for any age. The safety is well proven, with over 40 years of corneal molding history combined with today's super high oxygen permeable materials. Another reason the safety is so high is that AOK is also reversible. Since it is non-invasive (not surgical) there is no permanent change to the cornea.

With LASIK or other laser eye surgeries if there happens to be a poor visual outcome, it usually requires more surgery and/or specialty contact lenses. Sometime even those solutions do not provide normal vision. Keep in mind this is rare but does happen with surgery. Unlike surgery, AOK is reversible and will allow a patient to return to an untreated condition over a one to two week period of discontinuing treatment. The risks of AOK are similar to contact lenses. Those who use tap water to take care of their lenses and do not disinfect them prior to insertion may develop eye infections. Some eye surgeons have used negative reports from other countries and used these uncontrolled reports in their studies. In the past, AOK patients in other countries were not necessarily examined by  trained doctors certified in corneal molding. In addition, the few eye infections reported in foreign countries were a result of poor hygiene and unsanitary conditions not the molding procedure. AOK is a very gentle procedure that leaves your eyes feeling comfortable and clear.

This sounds perfect!

Nothing is perfect. AOK works well when fit properly by an experienced Optometrist. However there are times it just doesn't work well enough. The good news is, those times are very rare and the solution is simple, just stop using the retainers. AOK is amazing I must say. The happiest patients I have are the ones that have found this incredible way of seeing. Seeing the awe on their face when they read the eye chart for the first time with out glasses or contacts, is my favorite part.

LASIK for Kids?

Not exactly... Nearsighted children are not allowed to have refractive surgery. However, AOK is safe and effective for kids of all ages. The benefits of AOK are similar to LASIK, in that the patient is free of glasses and contact lenses. If you have been reading my blog this is not new information. You also now know that AOK helps slow the progression of nearsightedness. The question is, is there anything that can be done to prevent nearsightedness before it starts? We do know that Myopia has been increasing in the USA at an alarming rate. One hundred years ago 5% of us were nearsighted; today it’s over 30%. This is a progressive disease affecting 1.6 billion children and adults worldwide. We expect myopia will increase to 2.5 billion by 2020. Educating parents and children about vision is the first step to controlling this epidemic. I am willing to speak to groups of parents, teachers, children and businesses to bring awareness to this growing problem. If there are any schools, PTA’s or other organizations interested in scheduling a lecture please contact me.

Nearsighted

Cutting Edge Eye Care without the cutting!

April 28-May 1, 2011: Orlando, Fl. Abraham Zlatin, O.D. attended the Orthokeratology Academy of America educational conference. The OAA is an international organization of orthokeratologists who provide a nonsurgical alternative to refractive surgery for nearsighted eyes, astigmatism and hyperopia. Current research also shows that Ortho-K can slow myopic progression in children.
The keynote address was given by Melbourne Hovell, Ph.D., M.P.H.-Graduate School of Public Health in San Diego-Myopia as a Public Health Concern. The international faculty of presenters covered topics including myopia control (including soft lens technology), corneal reshaping research, safety of corneal reshaping, progressive/hyperopic Ortho-K lens designs, new corneal reshaping technologies, post Lasik/ Keratoconus Ortho-K designs, lens designs for corneal rehabilitation, corneal cross-linking and Ortho-K in China.

President Dr. Cary Herzberg had the pleasure of announcing the inception of the new International Academy of Orthokeratology(IAO). The IAO brings together ortho-K organizations from the America (OAA) as well and Europe and Asia. This international organization will support, promote and advance corneal reshaping worldwide thru quality education and research presentations at meetings held around the world. The first meetings are planned for Europe (Fall 2011), China (March 2012) and Phoenix(April 2012). For more information about Ortho-K go to www.Eyeqdr.com

The number one reason most people do not know about AOK is…

The number one reason most people do not know about AOK is...

Let's start at the beginning. The first doctor to examine us is our pediatrician. During our early years we go for Well Visits and some Sick Visits. The pediatrician helps us by checking our health and treating most problems as they come up. For the most part, pediatricians do a good job at taking care of us when we are little. However, since they are the gate keepers of our well being, they are responsible for referring us to other doctors for conditions beyond their scope of practice. This is the point I believe all children should be referred to an orthokeratologist.

All children should be first examined by an optometrist who specializes in orthokeratology. The reason is that optometrists are the best trained eye doctors for visual disorders and treat most eye diseases. Those optometrist that specialize in orthokeratology have advanced training in Myopia Control. Myopia (Nearsightedness) has become worse over the span of only one generation.
Let's back track a bit. The pediatrician should be concerned about the problems associated with High Myopia (Nearsightedness) because it's prevention and control is best treated at a young age. Even though the problems of Glaucoma, Macular Degeneration, and a whole bunch of Retinal problems are usually seen in adults, they are more common in highly myopic individuals. Now nearsightedness can not be reversed, but recent studies show that it can be curtailed to a point that it may not progress in to a health risk.
The real issue is that currently most pediatric ophthalmologists do not support the concept of Myopia Control. They tend go out of their way to discourage parents and pediatricians from embracing it. I have seen them refer to old studies and information, and heard them scare parents out of safe and effective treatments. This trend is changing and now more ophthalmologists are embracing AOK.
The other good news is that more and more pediatricians are beginning to send their kids for orthokeratology consultations! So there you have it. My take on why most people do not know about AOK or Myopia Control.

Nearsightedness Linked to Open-Angle Glaucoma

From Reuters Health Information Nearsightedness Linked to Open-Angle Glaucoma Print This Print This Read this article on Medscape's free mobile app. Download Now By Alison McCook NEW YORK (Reuters Health) Jul 01 - Nearsighted people may have nearly twice the average risk for glaucoma, according to a new meta-analysis. The study, reported online June 20th in Ophthalmology, focused on the link between nearsightedness and open-angle glaucoma, the most common form of the disease. Dr. Nomdo Jansonius at the University Medical Center Groningen in the Netherlands and colleagues pooled data from 11 previous studies that included tens of thousands of people. They found that, overall, nearsighted people were about 90% more likely to develop open-angle glaucoma. Those with higher levels of myopia appeared to be at higher risk of glaucoma. The findings only show that nearsightedness and glaucoma often co-occur, not that one causes the other. Furthermore, the studies the authors included were heterogeneous in terms of patient ages and different diagnostic criteria. "The results are, in a sense, an average," and may not be applicable to every group of people, Dr. Barbara Klein of the University of Wisconsin-Madison, who worked on one of the studies included in the new review, told Reuters Health "A conclusion might be that persons with high myopia should have regular ophthalmic examinations," Dr. Klein said. At this point, however, the U.S. Preventive Services Task Force says there is too little evidence to recommend for or against glaucoma screening. SOURCE: http://bit.ly/mUP30n Ophthalmology 2011.

Farsighted and over 40?

It's a drag being Farsighted and over 40! Most Farsighted (hyperopic) patients see great their first 30-40 years, but then it smacks them in the face. When you are Farsighted and around 40, your eyes have to work very hard to focus. The closer you look the harder it gets. Since hyperopes are not use to wearing glasses or contacts from a young age, this is really a big change for them. The good news is that now some of our happiest patients can see great again, Far and Near after removing Multifocal AOK retainers. Once again they have regained their glasses and contact lens free vision. These retainers have been available for Nearsighted patients for a while, now our Farsighted patients can enjoy the freedom as well.

Nearsighted

Nearsighted

Now AOK is available for Far Sighted patients as well

AOK for Hyperopia is now available. I have also launched our AOK for Presbyopia. These new designs will allow many patient over 40 years of age to continue to see in the distance as well as read up close without the need for reading glasses. 

Top 5 questions about AOK you should have answered

1. Do you know that (a child’s) nearsighted progression can be controlled? Recent studies indicate it can be. If treated by an Orthokeratologist, nearsighted progression can be slowed or stopped entirely. These children are not given any drugs like atropine. They are treated with special AOK retainers (which look like small contact lenses). These lenses are used only during sleeping hours and are therefore very comfortable. I treat children of any age, myopia, however generally begins around 7 or 8 years of age. 

2. Do you know the risks of becoming a highly nearsighted individual? As myopia increase so do the risks of sight threatening eye diseases. Theses diseases include Glaucoma, Macular Degeneration, Retinal holes - tears - or detachments. Preventing disease in adulthood starts with prevention in childhood. LASIK does not reduce these risks. 

3. Do you know how to avoid wearing eyeglasses? Many children and adults are candidates for AOK. This treatment also allows patients to see clearly during the day without needing to use glasses or traditional contact lenses. When a patient wakes in the morning, their vision is clear through the retainers. However, the retainers are not left on the eyes. They are remove upon waking. The patient now has clear vision without any additional help from glasses or contacts. The vision stays clear all day long. 

4. Is Advanced Orthokertaology (AOK) all the same? The short answer is No. The long answer is that AOK is very orthokeratologist dependant. Since AOK has become popular in recent years, more doctors have become FDA certified to treat patients. This is a short online course a doctor must pass in order to begin fitting patients. An experienced orthokeratologist has years of training in the field of orthokeratology and see’s AOK patients on a regular basis. Fellowship trained orthokeratologist have demonstrated advanced knowledge and proficiency in the field of orthokeratology, and are acknowledged by the International Academy of Orthokeratology. The outcome of the procedure in regards to the quality of vision and the continued health of the eyes is directly related to the doctors experience and skills. 

5. Is AOK the same as CRT? Corneal Refractive Therapy (CRT) is one type of Advanced or Accelerated Orthokeratology (AOK). AOK is not only CRT, it many include may different types of retainer lenses. CRT is a specific retainer design that is available in different parameters to fit many people. It is not a custom made lens using 1000’s of data points, therefore does not work as well as a custom made lens. In my practice I have a few patients in CRT and other pre-designed lenses, however most of our patients are in custom made retainers designed by me. First, I take a special picture (topography) of the patients eye. Every patient has a unique topography, it’s like a fingerprint of the eye. I convert and transfer the picture data to a computer program that allows me to design a custom retainer for each unique corneal shape. With over 10 years of custom designing lenses for my patients I have developed a strong understanding and preference for this method. I have had great success of taking over complicated unsatisfied CRT patients and refitting them successfully with custom AOK. There are many more questions you may have regarding AOK. Reading through my blog and visiting my website may answer them. If you have additional questions, please schedule an appointment for a consultation at either of my offices. Choosing the right doctor is the most important decision you need to make.

A thank you to our Pediatricians!

Over the years I've seen many great changes in AOK. Recently I noticed what may be the most important ones, awareness and acceptance by pediatricians. As orthokeratology becomes more popular and new studies keep supporting it's safety and benefits, I see more patients asking if they are candidates. As more and more pediatricians learn about orthokeratology more of their patients are being treated. This is great news! I'm encouraged to see this new trend. I hope to soon see the same public awareness of orthokeratologist as orthodontist.

If you think smoking and high blood pressure are bad …

In today’s post you will see a controversial point which supports some of my previous posts about Nearsightedness being a risk factor for certain sight threatening eye diseases. I will be sharing a note I received from the very wise doctor Richard L. Anderson, OD, FIAO. What you will read below is a comparison of cardiovascular disease to ocular disease and you will see how the risk factor (Myopia / Nearsightedness) has a significant “Odds Ratio, OR” for contributing to eye diseases such as glaucoma, retinal detachments, and maculopathy. This is one reason, I feel treating children early and preventing or slowing down the rate of their nearsighted progression is important.

It's time to treat myopia as a disease process that is a threat to ocular health from a myriad of related disease processes. No longer can we treat myopia as an inconvenience to be compensated for with glasses or contacts. Myopia is a risk factor for other sight threatening diseases that is "far in excess of any identifiable population risk factor for cardiovascular disease." That's from a paper
D.I. Flitcroft. (2012) The complex interactions of retinal, optical and environmental factors in myopia aetiology. (ABSTRACT) Progress in Retinal and Eye Research VOL 31 (2012) 622-660 doi: 10.1016/j.preteyeres.2012.06.004

What does this mean? It means that myopia as a risk factor for vision loss is worse than any risk factor known for cardiovascular disease. That's from Flitcroft, not me.

Take a look at the tables - they even appear in the abstract in the link.
An "Odds Ratio" of 1.5 means that the second factor is 1.5X as likely to happen if the first factor is present.

There is no "safe" level of myopia. Forget about the idea of pathological myopia starting at -6.00. It's all pathological.

Myopia of -1.00 to -3.00 has an OR of 2.3 for glaucoma.
Myopia of > -3.00 has an OR of 3.3 for glaucoma.
Myopia of -.75 to -2.75 has an OR of 3.1 for retinal detachment
Myopia of -6 to -8.75 has an OR of 21.5 for retinal detachment
Myopia of -1.00 to -2.99 has an OR of 2.2 for myopic maculopathy

How does this compare to cardiovascular disease risk factors?
Systolic BP of 150-159 has an OR of 2.2 for stroke risk.
Systolic BP of >160 has an OR of 3.2 for stroke risk.
Smoking >20 cigarettes a day has an OR of 2.9 for stroke risk.
Systolic BP < 140 on Rx has an OR of 2.6 for myocardial infarction

What do I think?

Myopia is a disease.

The compensation of myopia by prescribing glasses is an outdated vision related service.

The treatment of myopia by the prescription of specific myopia control procedures is a medical service whose benefit is the reduction of sight threatening disease processes.

Any attempt to place myopia treatment in the realm of vision services makes no more sense than considering glaucoma treatment a standard vision exam.