Discontinuation of long term orthokeratology lens wear and subsequent refractive surgery outcome

Systematic Review of Myopia Progression after Cessation of Optical Interventions for Myopia Control

Despite high discontinuation rates for myopia optical interventions, limited attention has been given to the potential rebound effects post-discontinuation. This systematic review aims to assess the extent of the rebound effects following the cessation of common clinical optical myopia-control interventions in children. A comprehensive search of PubMed, Embase, Cochrane CENTRAL, and ClinicalTrials.gov was conducted from inception to October 2023. The rebound effects, defined as changes in the axial length or spherical equivalent during and after treatment cessation, were categorized into four levels. These studies encompassed 703 participants and spanned from 2019 to 2023, with durations of treatment and cessation ranging from 6 months to 3.5 years and from 2 weeks to 5 years, respectively. This review, encompassing 14 studies, revealed a predominant strong rebound effect in orthokeratology (8 studies), a weak rebound effect in multifocal soft contact lenses (4 studies), and a variable rebound effect in peripheral-plus spectacle lenses (2 studies). Notably, with the increasing cessation duration, the rebound effects diminished, potentially linked to the reversal of choroidal thickening and the disappearance of peripheral myopic defocus. In conclusion, a temporal trend of rebound effects exists in all three myopia optical interventions, possibly contributing to their myopia control mechanisms.

The alterations in ocular biometric parameters following short-term discontinuation of long-term orthokeratology and prior to subsequent lens fitting: a preliminary study

PURPOSE

To investigate the alterations in biometric parameters among Chinese adolescents over an extended period of wearing orthokeratology lenses, as well as the subsequent changes after a one-month cessation of lens usage prior to the secondary lens fitting.

METHODS

Twenty-four myopic patients aged 7-14 were enrolled in this 37-month prospective observational study. Ocular biometric parameters were measured in the study. Ocular biometric parameters were assessed, and the utilization of Generalized Estimating Equations (GEE) was employed in the analysis to address the correlation between the two eyes of each participant.

RESULTS

The axial length (AL) increased by 0.55 mm after 36 months of lens wearing and further increased to 0.62 mm at the 37-month follow-up compared to the initial measurement. The differences in AL elongation per month between the 37-month time point and the 12-, 24-, and 36-month marks of lens wearing were found to be statistically significant (p12-month = 0.001; p24-month = 0.003; p36-month = 0.001). Following the cessation of lens wear for 1 month, there was no significant complete recovery observed in the flat and steep keratometry values. However, the intraocular pressure and anterior chamber depth returned to their baseline levels.

CONCLUSIONS

The AL elongation undergoes alterations during temporary discontinuation of lenses, with the flat and steep keratometry measurements remaining significantly flatter compared to the baseline. However, the intraocular pressure and anterior chamber depth return to their initial levels after one month of lens cessation.

Vecto-keratometry: determination of anterior corneal astigmatism in manual keratometers using power vectors

BACKGROUND

A new keratometric routine that employs power vector management for manual keratometers is described. This study evaluates the agreement of the new proposed keratometric technique with the classical one.

RESEARCH DESIGN AND METHODS

The applicability of a new keratometric routine was verified using Helmholtz's and Javal's keratometers. Results were obtained by two different and well-trained examiners over two different samples, one including 65 and the other 74 eyes, respectively. Both conventional keratometry and the newly proposed routine (named vecto-keratometry) were used in each eye to obtain the results. The clinical agreement between the methods was evaluated using Bland-Altman and Passing-Bablok analysis.

RESULTS

For Helmholtz's keratometer, Bland-Altman plots showed good agreement between methods for both astigmatic components being J₀ = 0.04 ± 0.20 D and J₄₅ = -0.07 ± 0.17 D. For Javal's keratometer, Passing-Bablok regression test determined regression line for J₀ difference as y₀ = 1.03, confidence interval: [0.98, 1.10] and regression line for J₄₅ difference as y₄₅ = 0.97, confidence interval: [0.83, 1.12].

CONCLUSIONS

Vecto-keratometry provides accurate clinical results. It has been demonstrated that there are no significant differences between methods in any of the power vector astigmatic components; thus, both methods can be applied interchangeably.

Increased Corneal Toricity after Long-Term Orthokeratology Lens Wear

Purpose

To investigate the change in corneal toricity and associated refractive astigmatism after discontinuation of long-term orthokeratology (ortho-k) lens wear.

Methods

This study investigated 136 subjects aged between 6 and 14 (9.1 ± 1.5) years old at the commencement of ortho-k treatment, who had been undergoing overnight ortho-k treatment for 24 to 72 (37.4 ± 11.9) months. Corneal refractive power and manifest refraction were measured and compared before ortho-k and 1 month after discontinuation of ortho-k lens wear. Changes in corneal curvature were analyzed. Corneal curvature data from a historical longitudinal study were used as control.

Results

Compared to pre-ortho-k values, the corneal curvature became significantly flatter in the flatter meridian (-0.22 ± 0.27 D, P < 0.001) and steeper in the steeper meridian (0.06 ± 0.34 D, P=0.032) after cessation of ortho-k lens wear, resulting in a significant increase in corneal toricity (0.28 ± 0.43 D, P < 0.001), which is associated with an increase in refractive astigmatism (0.57 ± 0.57 D, r=0.465, P < 0.001). The amount of residual corneal flattening in the flatter meridian is significantly affected by the length of ortho-k treatment (t=-2.965, P=0.004) and the baseline age of subject (t=-2.841, P=0.005), but not by the baseline spherical or cylindrical refractive error (both P > 0.05). In the historical control group, there is no significant change in the corneal curvature over two years in children wearing spectacle lenses (both meridians, P > 0.05). Change of corneal toricity was more significant in the ortho-k group than in the spectacle control group (P=0.001).

Conclusions

Long-term ortho-k lens wear increases corneal toricity after discontinuation of the treatment, which is associated with an increase in refractive astigmatism. A more pronounced change in corneal toricity was found in subjects who were younger to start ortho-k and have been in a longer period of treatment. This trial is registered with http://www.chictr.org.cn (ChiCTR-TNRC-11001210).

Corneal morphology and visual outcomes in LASIK patients after orthokeratology: A pilot study

A STATEMENT OF SIGNIFICANCE

For the first time, this study shows that corneas that previous undergone orthokeratology treatment do not respond differently to LASIK compared with previous soft contact lens wear experience.

PURPOSE

To evaluate and compare the corneal morphology and visual outcomes of long-term soft and orthokeratology (OK) contact lens fitting in wearers undergoing corneal refractive surgery (LASIK) for myopia correction.

METHODS

Sixteen (16) myopic patients wearing hydrophilic soft contact lens (SCL, n = 8 subjects, control group) and OK (n = 8 subjects, OK group) lenses who undergone LASIK were retrospectively evaluated. Preoperative fitting of contact lenses and one year postoperative were studied using Pentacam (Oculus, Inc. GmbH, Wetzlar, Germany). Corneal pachymetry and volume, corneal topography, anterior and posterior surface elevation data and the anterior surface aberrometry of the cornea were recorded and used for fitting.

RESULTS

Age, refractive error and topographic parameters before LASIK did not showed statistically significant differences between the two study groups. LASIK post-treatment results showed identical changes in both control and OK groups and did not show significant differences in all the parameters evaluated. The changes on corneal parameters and HOA due to refractive surgery intervention were not different between Control and OK group (p > 0.050).

CONCLUSIONS

Corneal changes due to OK treatment are reversible after its discontinuation. The present study gives an overview of how OK does not impair future LASIK surgery for the correction of myopia and does not influence the success/results of such intervention. These findings suggest that OK CL wear does not change corneal biomechanics and does not compromise a possible LASIK refractive surgery. Although this is a pilot study and there is a need of evaluate this results/changes in future studies.