editor's perspective
Corneal Reshaping With Contact Lenses
BY JOSEPH T. BARR, OD, MS, FAAO, EDITOR

Ever since Newton Wesley pointed out spectacle blur, and practitioners learned what Jerry Legerton said, "You can't fit a contact lens without changing the shape of the cornea," a small number of people in our field have tried to control these changes to benefit the patient. Last month in Toronto, our publisher Boucher Communications Inc. (BCI) and the planning committee of Ed Bennett, Pat Caroline, Craig Norman and I successfully completed the first Global Orthokeratology Symposium. Almost 400 people from around the world (mostly North America) met to hear the latest in corneal refractive therapy, overnight orthokeratology as it is practiced outside the United States, and daily wear as well as off-label overnight ortho-k in the United States. The late Rodger Kame and his coauthor Todd Winkler estimated that over one million people have benefited from these procedures in the past. Paragon Vision Sciences, which obtained FDA approval for overnight corneal reshaping with contact lenses, or corneal refractive therapy, earlier this year, estimates that well over 10 million persons in the United States are now interested.

Many developers of these new reverse zone lenses were in Toronto. All of us who appreciate the success of modern contact lens corneal reshaping should pay tribute to their efforts to sort out the designs and problem-solving methods for this procedure over the past decade. Of special note are the efforts of Nick Stoyan and Richard Wlodyga who received the GOS Founders Award

Will this mode of correction grow beyond the cult-like limited use of the past? More and more contact lens practitioners seem to think so. Or will this dog not hunt due to cost, chair time and low success rates? Certainly more people are interested in not having refractive surgery than in having it. Many people out there have "failed" with contact lenses and just don't like wearing them during waking hours due to activities, discomfort or hassle.

The procedure does work, there are few side effects and all evidence suggests it is reversible. Most cases are simple, but others don't seem to respond well. The patient needs to wear his lenses every night or at least every other night to keep the outcome of good daily vision maximized after a few days or weeks of overnight wear. Only one pair of lenses is needed in the best cases.

My suggestion, based on seeing what happens and the spirited interest in the GOS in Toronto, is give it a try. Start with some easy low myopes who are outdoor or sports types. I think once you see how patients like the procedure, you will too, especially with the happy patients and the fees for service.