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Allan Panzer said:
If either of my kids were myopic, I would put them in Ortho K. Fortunately for them, both are emmetropes..

Mom is an emmetrope. Dad is a high myope...so you can easily see it has nothing to do with IQ since my myopia obviously did not go along with my IQ..glad the rest of you got brains to go with your myopia..
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Did it ever cross your mind to try a behavioral approach on your myopic patients?

Call me crazy (WHO SAID THAT!?!) or a broken record, but has anybody besides me gotten hung up on what you all are talking about that are all just management techniques? They're not helping the myopia -- which is anatomical and genetic and mental -- to reduce, arrest, or reverse without heroic interventions.

Here's an impartial review and synopsis by a non-optometric PhD of ALL the myopic literature (>1300 references): www.myopia-manual.de. Free. It's a .pdf -- or a newer text can be bought, if you don't want to eat up 300+ pages of paper and ink.
 
Michael Molamphy said:
Once again , proof of the genetic basis of myopia. Same with my dad, me and my son.
Click to expand...

My n=1...

I topped out at -4.00, about the same as my mother, at about the same age. Her father was also myopic before lens exchange, and I presume about the same magnitude.

The punchline is that grandad has had bilateral RDs in the past few years... :-(
 
Allan Panzer said:
I treated a LASIK surgeon's children for the past 7 years. The son was 13 and already a -9.00-3.00 She had atropined them, made them play outside, restricted all electronics, reduced their contacts to -7.00 without cyl and still...

So, she wanted Ortho K.

I got the son to pl-3.00 but as usual, it wasn't good enough. Even though she said..just get him to a -5.00...
The daughter on the other hand at 9 was a -3.00 or so..she is now 16 and mom of course measures axial length regularly...can you even imagine.

She called me and said..well, it increased .2mm..sure enough I had to increase the power in the ortho k lens.

Nothing works 100%. But my experience is that Ortho K works the best of all so far.

If either of my kids were myopic, I would put them in Ortho K. Fortunately for them, both are emmetropes..

Mom is an emmetrope. Dad is a high myope...so you can easily see it has nothing to do with IQ since my myopia obviously did not go along with my IQ..glad the rest of you got brains to go with your myopia..
Click to expand...
What level of myopia do you consider a problem worth start treating? 1.oo, 2.00, 3.00 or ?.
 
Adam Lusk said:
My n=1...

I topped out at -4.00, about the same as my mother, at about the same age. Her father was also myopic before lens exchange, and I presume about the same magnitude.

The punchline is that grandad has had bilateral RDs in the past few years... :-(
Click to expand...
I thought the risk of RD was for the high myopes not -4. I am historically -6, and no RD or tears by age 71. Was he a boxer?
 
Michael Molamphy said:
What level of myopia do you consider a problem worth start treating? 1.oo, 2.00, 3.00 or ?.
Click to expand...
So, that is an interesting question.

I attend as many lectures as possible on the subject. From what I have learned, if you treat under about 1D there is not sufficient peripheral defocus to halt the progression.
That's why what I do is to see a kid who is perhaps -1.00 and then have them return in six months.

Usually I will see progression..as most of you would if you had them return in six months rather than one year.

So, say they move to -1.50...usually they started there and now they are maybe -2.00..I tell the parent the following.

I cannot promise you I can halt the progression. What I can promise is that if you do nothing, it will progress.

Progression in six months begets more progression.

If stable in six months, and it seldom is, we can certainly wait.

So, that's my approach. Just like glaucoma. Change over time means we should consider something.

I really haven't tried poisoning my kids with atropine nightly. It just doesn't seem like my favorite idea.

I realize Dr. Cooper et al say its safe, but with the internet, that parent will surely look up atropine and say..hey what exactly are you doing.

I would like to try the center distance soft lens idea, but without experience seeing it work I am a bit skeptical.


Not the biggest problem in the world, but I like to under promise and over deliver. Not sure that works with soft lenses.
 
h.c. jang said:
Nope. Risk goes up with level of myopia. -3.00 higher risk than Plano but lower than -6.00. Remember though, it's risk, not certainty.
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What's the risk with overnight Ortho K? From what I know it is at least the same risk as sleeping in other contact lenses. The literature on this is very scant. So this needs to be weighed against the "poisonous" atropine and other treatments. Nothing is risk-free.
 
So, the reason I do not consider overnight wear of Ortho K the same is that they are removed during the day. Everyday.
Some can even be worn every other day. Several of my patients have quit using them after many years when they told me they had to wear them "every" night. Perish the thought.

With typical EW lenses, they are left in for extended periods of time.

Usually soft lenses that become petri dishes for bacteria. Often left on for months.

Although I am sure that atropine in small doses is considered safe, I am not sure the parent would consider it so when they review the information on the substance.

Mine are a more educated group and they tend to look up everything.
 
Allan Panzer said:
So, the reason I do not consider overnight wear of Ortho K the same is that they are removed during the day. Everyday.
Some can even be worn every other day. Several of my patients have quit using them after many years when they told me they had to wear them "every" night. Perish the thought.

With typical EW lenses, they are left in for extended periods of time.

Usually soft lenses that become petri dishes for bacteria. Often left on for months.

Although I am sure that atropine in small doses is considered safe, I am not sure the parent would consider it so when they review the information on the substance.

Mine are a more educated group and they tend to look up everything.
Click to expand...

Yes, but what are the statistics on microbial keratitis, regardless if the lenses are removed or not, the incidence is not zero. From what I understand, it is about the same as other overnight modalities. I wouldn't say it unless I haven't read it from the horses mouth. Until I see studies that contradict that, this is what I have to believe.
 
Allan Panzer said:
So, the reason I do not consider overnight wear of Ortho K the same is that they are removed during the day. Everyday.
Some can even be worn every other day. Several of my patients have quit using them after many years when they told me they had to wear them "every" night. Perish the thought.

With typical EW lenses, they are left in for extended periods of time.

Usually soft lenses that become petri dishes for bacteria. Often left on for months.

Although I am sure that atropine in small doses is considered safe, I am not sure the parent would consider it so when they review the information on the substance.

Mine are a more educated group and they tend to look up everything.
Click to expand...

Regarding Google, have you ever Googled "safety of Ortho K"? I think there is some scary information out there.
 
Greg Gemoules said:
what are the statistics on microbial keratitis, regardless if the lenses are removed or not, the incidence is not zero[?]
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Optom Vis Sci. 2015 Jun;92(6):659-64. doi: 10.1097/OPX.0000000000000597.
Pseudomonas aeruginosa Survival at Posterior Contact Lens Surfaces after Daily Wear.
Wu YT1, Zhu LS, Tam KP, Evans DJ, Fleiszig SM.
Author information
1
*BOptom, PhD, FAAO †BA ‡PhD §OD, PhD, FAAO School of Optometry, University of California, Berkeley, Berkeley, California (all authors); College of Pharmacy, Touro University California, Vallejo, California (DJE); and Graduate Groups in Vision Science, Microbiology, and Infectious Diseases and Immunity, University of California, Berkeley, Berkeley, California (SMJF).
Abstract
PURPOSE:
Pseudomonas aeruginosa keratitis is a sight-threatening complication of contact lens wear, yet mechanisms by which lenses predispose to infection remain unclear. Here, we tested the hypothesis that tear fluid at the posterior contact lens surface can lose antimicrobial activity over time during lens wear.

METHODS:
Daily disposable lenses were worn for 1, 2, 4, 6, or 8 hours immediately after removal from their packaging or after presoaking in sterile saline for 2 days to remove packaging solution. Unworn lenses were also tested, some coated in tears "aged" in vitro for 1 or 8 hours. Lenses were placed anterior surface down into tryptic soy agar cradles containing gentamicin (100 μg/mL) to kill bacteria already on the lens and posterior surfaces inoculated with gentamicin-resistant P. aeruginosa for 3 hours. Surviving bacteria were enumerated by viable counts of lens homogenates.

RESULTS:
Posterior surfaces of lenses worn by patients for 8 hours supported more P. aeruginosa growth than lenses worn for only 1 hour, if lenses were presoaked before wear (∼ 2.4-fold, p = 0.01). This increase was offset if lenses were not presoaked to remove packaging solution (p = 0.04 at 2 and 4 hours). Irrespective of presoaking, lenses worn for 8 hours showed more growth on their posterior surface than unworn lenses coated with tear fluid that was aged for 8 hours in vitro (∼ 8.6-fold, presoaked, p = 0.003; ∼ 5.4-fold from packaging solution, p = 0.004). Indeed, in vitro incubation did not impact tear antimicrobial activity.

CONCLUSIONS:
This study shows that postlens tear fluid can lose antimicrobial activity over time during contact lens wear, supporting the idea that efficient tear exchange under a lens is critical for homeostasis. Additional studies are needed to determine applicability to other lens types, wearing modalities, and relevance to contact lens-related infections.

PMID:
25955639
PMCID:
PMC4575223
DOI:
10.1097/OPX.0000000000000597
[Indexed for MEDLINE]
Free PMC Article
 
Well I will have to answer my own question. As expected, Google provided the answer. This looks to be the most recent review: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4697954/

Eye Contact Lens. 2016 Jan; 42(1): 35–42.
Published online 2015 Dec 28. doi: 10.1097/ICL.0000000000000219
PMCID: PMC4697954
The Safety of Orthokeratology—A Systematic Review
Yue M. Liu, O.D., Ph.D., M.P.H.
corrauth.gif
and Peiying Xie, M.D., Ph.D.

Microbial Keratitis
Microbial keratitis (MK) remains as the most serious and sight-threatening complication of OrthoK. Van Meter et al.66 provided a comprehensive review of the MK cases published in English since 1998, with most cases reported in Taiwan, Hong Kong, and Mainland China and presented as sporadic pattern without significant association with the baseline level of myopia, gender, or the specific brand of the OrthoK lenses. The sporadic pattern of MK was similarly reported in earlier Chinese publications and the attributable factors of the cases included lack of training of practitioners and wearers, improper fitting procedures, poor compliance to lens care regimens, and lost to routine follow-ups.38,41,49,58,189 A more recent large-scale multicentered retrospective study reported the estimated incidence rate of MK as 7.7 cases per 10,000 patient years (95% CI, 0.9∼27.8), and risk of MK with overnight OrthoK was similar to other overnight modalities.74 Since the publication of the aforementioned two major reviews, there had been few sporadic cases of MK reported, mostly in a tertiary eye care hospital in Hong Kong.76
 
Greg Gemoules said:
Well I will have to answer my own question. As expected, Google provided the answer. This looks to be the most recent review: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4697954/

Eye Contact Lens. 2016 Jan; 42(1): 35–42.
Published online 2015 Dec 28. doi: 10.1097/ICL.0000000000000219
PMCID: PMC4697954
The Safety of Orthokeratology—A Systematic Review
Yue M. Liu, O.D., Ph.D., M.P.H.
corrauth.gif
and Peiying Xie, M.D., Ph.D.

Microbial Keratitis
Microbial keratitis (MK) remains as the most serious and sight-threatening complication of OrthoK. Van Meter et al.66 provided a comprehensive review of the MK cases published in English since 1998, with most cases reported in Taiwan, Hong Kong, and Mainland China and presented as sporadic pattern without significant association with the baseline level of myopia, gender, or the specific brand of the OrthoK lenses. The sporadic pattern of MK was similarly reported in earlier Chinese publications and the attributable factors of the cases included lack of training of practitioners and wearers, improper fitting procedures, poor compliance to lens care regimens, and lost to routine follow-ups.38,41,49,58,189 A more recent large-scale multicentered retrospective study reported the estimated incidence rate of MK as 7.7 cases per 10,000 patient years (95% CI, 0.9∼27.8), and risk of MK with overnight OrthoK was similar to other overnight modalities.74 Since the publication of the aforementioned two major reviews, there had been few sporadic cases of MK reported, mostly in a tertiary eye care hospital in Hong Kong.76
Click to expand...

Here's s the source of that statement:

http://journals.lww.com/optvissci/F..._of_Microbial_Keratitis_With_Overnight.6.aspx

The only large-scale study on the topic. I wish the lead author was more respected ;-)

Microbial Keratitis.jpg
 
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Michael Molamphy said:
I thought the risk of RD was for the high myopes not -4. I am historically -6, and no RD or tears by age 71. Was he a boxer?
Click to expand...

Others have addressed the "sliding scale risk", but as I say, and this is my main point: n=1. When discussing with parents of patients, I will quote the data referenced above, rather than my personal anecdote.

Grandad was not a pugilist, not did he play rugby. He was a war veteran though, like your good self.
 
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