editor's perspective
Has Corneal Reshaping Reached Its Pinnacle?

With the American Society of Corneal and Refractive Technologies meeting last month in Scottsdale and the Global Orthokeratology Symposium meeting staged for July 22 to 25 in Toronto (see www.clspectrum.com for more information), hundreds of North American and many international eyecare practitioners are becoming up-to-date with the latest information on how to use contact lenses to perform corneal reshaping overnight and on the latest research in this exciting area. Although this procedure is more mainstream than it was years ago, growth remains slow. I believe that in spite of its generally predictable and safe results, which have received much publicity, most practitioners are reluctant to present corneal reshaping's relatively high fees (unlike their LASIK practitioner counterparts) and that they find the chair time associated with the treatment inhibiting.

Walline, Rah and other researchers have shown that we can use corneal reshaping and overnight orthokeratology to successfully treat myopic children, resulting in adequate device-free vision all day. As more laboratories obtain FDA approval for overnight corneal reshaping using high-Dk GP lenses and as Paragon continues to refine its marketing strategy for its CRT device, usage will eventually grow. Predicting exactly how many patients have and will receive these procedures is difficult. Certainly, we don't expect the number to reach 100,000 in the near future.

While clinicians to date have reported only a few cases of corneal ulcers associated with overnight corneal reshaping in North America, Lam et al (2003) reported six cases of children in Hong Kong who developed ulcers, resulting in some cases of corneal scarring and vision loss. Critics of this report, including yours truly, pointed out that the article didn't discuss the lens design or material, lens care, hygiene and the expertise of the practitioner who fit the lenses. Defenders indicated that the level of corneal reshaping practice in Hong Kong is high.

Researchers will monitor the adverse effects associated with this treatment. Until then, we should provide many more patients with its benefits of good vision -- all day -- and the freedom to do what activities and sports they want to do without the need for contact lenses or spectacles as long as they use their devices overnight.

Should more practitioners become certified to provide overnight corneal reshaping based on the evidence of its safety and effectiveness at this point? Probably. More patients would then benefit from it. What can we do to make it as safe as possible? Use the lenses that have undergone testing. Use the highest Dk/t materials and designs. Make sure you monitor the patients. Educate, monitor and re-educate patients on proper hygiene, hand and case washing and proper lens cleaning and disinfection so that when they apply the lenses at night, they've minimized their risk of overnight complications.