Overnight Corneal Reshaping Orthokeratology

Just imagine, you pull back the covers in the morning, look at the clock across the room and WOW…I can see!
How great would that be?  No, it’s not a miracle. You have not been transported to the imaginary planet of U. C. Right.  You have undergone Overnight Corneal Reshaping (OCR) right here in Kansas City.

Next question: How come I have not heard of this before?  

  • Previous versions of OCR have been around since the 1960s. You may have heard of this process called by other names: Orthokeratology (OK), Corneal Refractive Therapy (CRT), Vision Shaping Treatment (VST), Gentle Molding, or other variations.

Alternative to LASIK
Reshape

  • Let’s face it, no one wants to spend $4000-$6000 on elective eye surgery
  • What we want is freedom from wearing daytime glasses or contact lenses.
  • Who wants the risk of complications of surgery like distorted vision, chronic glare, or severe dry eyes that is common with refractive surgery procedures like LASIK and PRK?  You really need to know what the possibilities are for complications.
  • Modern day wavefront-guided LASIK procedures have improved immensely, so the complications are much less than before. Just remember, there is no reversing the effects of LASIK. What you get is what you will have to live with for a lifetime. Let Brill Eye Center guide you to the appropriate LASIK center that will likely yield good results.
  • Reversible procedures like Overnight Corneal Reshaping often can give you the results you want with the minimal effort of nighttime only specialty contact lens wear.

Overnight Corneal Reshaping does what most people want—permits them to see all day long without the
assistance of glasses, contacts, or refractive surgery.  The changes made by OCR are totally reversible, so you can change your mind about the process at any time and get right back to your original visual state. Or, you still have all of your options open when new procedures are developed in the future.

Ok, here is the story of Overnight Corneal Reshaping.  The cornea is the front-most part of the eye. It is responsible for most of the change in refractive error. A small change in the shape of the eye can mean a large change in how a person sees.  That is exactly what OCR does, and that is what all of the riskier refractive surgeries also do.infographic overnight corneal reshaping

Corneal Reshaping FAQ

  • Only certain eye doctors are qualified to do OCR.
  • Those doctors listed are members or Fellows in the American Academy of Orthokeratology and Myopia Control. The Fellows have achieved a higher level of experience in providing the reshaping process and have passed rigorous standards and an intensive examination.  
  • They are then able to display the F.O.A.A. distinction after their name, in addition to the Doctor of Optometry, O.D. degree.
  • Specially designed oxygen permeable lenses are worn overnight to temporarily correct myopia and astigmatism by gently reshaping the cornea while you sleep.  Newer designs can be made for hyperopia and presbyopia, too.
  • Have your eyes checked by a doctor who specializes in OCR. Ask the doctor if you will be a good candidate for the OCR procedure.
  • Make sure that they have the Fellow of the Orthokeratology Academy of America (FOAA)  distinction from the American Academy of Orthokeratology and Myopia Control.
  • The doctor will make detailed observations of the front part of your eye with an instrument called a slit lamp biomicroscope that permits a detailed view of the structures involved in the process: eyelids, tear film, and cornea.
  • Your refractive error will be carefully measured to see that you are in the range that is approved by the FDA for this procedure.
  • Your eye has to be free of eye diseases to give you the best chance of success.
  • Corneal topography measurements will be made to see what the shape of the eye is in terms of the curvature and eccentricity (rate of flattening) of the eye. Note that there are different types of topography instruments that doctors use for this process.  The topography measurement is critical to the process of OCR. Do not get fit with OCR lenses by someone without a topographer.  The topography test will give a graphical plot of the curvature of the eye in micron level accuracy (a thousandth of a millimeter or a millionth of a meter).
  • You should have confidence in the abilities of your doctor to perform this procedure and have a sense that your doctor will have a good working relationship with you.  
  • Your doctor, the measurements, your motivation level, your level of patience, your ability to have reasonable expectations, your corneal topography, the actual design and actual high tech material of the lenses, the care that you give the lenses, your solution use, and your compliance with the follow-up process are all key to your success.
  • If everything points to you being a good candidate, then the doctor will be able to design a lens system that works for you.  Sometimes doctors will just make the lenses empirically from all of the examination findings. If that is the case, then the first pair of lenses made for you should be pretty close to what you need and will be used as a diagnostic pair.  Other times, doctors that do more of this process may have pre-made inventories of the lenses to try on your eyes diagnostically in the office to see how they fit, what type of vision they have with them, and how they are tolerated.
  • The doctor will be looking at the relationship of the lens to your eye.  This is checked by direct observation through the biomicroscope and may involve the use of an orange dye called fluorescein that fluoresces in response to blue light of a certain wavelength.  The doctor will have you blink several times and see how the tears are pumped under the lens and cleared from under the lens.  
  • Your vision with the lenses on will be assessed to see if the potential correcting ability of the lenses is likely to be accurate.  The vision will often be better with a minor amount of lens power above and beyond the power in the lenses. This is normal and expected. Plus, your tearing from having a foreign body on your eyes may cause some excess but temporary tearing and may blur on the projected eye chart.  Ideally, you will have had the lenses on diagnostically 20-30 minutes and may even be asked to recline flat in the doctor’s examination chair to simulate sleeping.
  • Expect a normal of amount of lens awareness to slight discomfort with lenses on for the first time.  Your eyes are trained to reject foreign objects when first applied.  This measure of initial discomfort does improve the longer you wear the lenses.
  • If the biocompatibility of the fitting of the lenses to your eyes looks acceptable for wear overnight, you are ready to learn how to apply and remove the lenses.
  • It is very important that your doctor show you at least one way to apply the lenses and two or three ways to remove the lenses. You may be given a kit with solutions and a very small suction cup device to remove lenses with if it is difficult to remove them by the “blink method” or the “two-finger method.” You should also be shown how to re-center the lenses if you at first get them on the sclera (white part of the eye) instead of on the cornea (the part that covers the colored part of the eye).
  • Solutions can vary by the doctor’s preference for the patient.  Make sure you understand which solutions you need to use for application, removal, and lubrication.  It is advisable to use the lubrication drops prior to application to make sure that any debris in the eye will be washed away and not get trapped under the lenses. You should also apply the lens lubrication drops to the eyes prior to lens removal to allow easier removal.
  • The solution preferences depend on what the doctor feels are best for your clinical situation. The processes that need to get accomplished are cleaning, wetting, soaking, conditioning, lubrication, and deposit removal.  In general, a multipurpose single solution system will not be effective for all of these functions.  Beware of cleaning solutions that are abrasive because they will be too rough on the lens and cause the curves of the lens to warp.  A system that many doctors use goes under the name Menicare.  The CDS solution is for cleaning, disinfection, and soaking. This is the solution that is used in the morning after the lenses are removed.  The WRW solution is for conditioning the lens surfaces, wetting the lenses, and lens rewetting and ocular lubrication. This is the drop that is used at night to apply the lenses.  Hands should be thoroughly washed with a non-oily soap before handling for application or removal. You must rinse the soaking solution off before applying the wetting solution.  Sterile saline is best for rinsing the lenses to avoid contamination of the lenses with microbes that exist in tap water.  Be sure to fill the concave bowl of the lens with wetting solution prior to application of the lenses. The lenses should be applied with your face parallel to a flat surface with a mirror flat on the surface. This will allow for the lenses to retain the wetting fluid and allow for easier attraction to the eye via capillary attraction.  You should receive thorough unrushed video and personal instruction until you feel comfortable with the application and removal process.
  • The next step is to wear the lenses overnight.  When you put the lenses on, be sure to go right to bed so that they stay centered on the eyes. Try not to read or do other activities even though you will see very well out of the lenses. If you read before you go to bed, the lenses may be decentered downward because we tend to not blink as much while reading in bed.  The best results with the lenses occur when the lenses stay on center.  
  • You should plan to sleep eight hours for best results.  In the morning, instill the rewetting lubricating drops before removal.  It is normal to want to remove the lenses right when you get up even though you will be able to see out of them just fine. You will feel the lenses a little more and they may be foggy or dry.  Wash and dry your hands before removal.  Make sure your work area is clean and uncluttered. It is nice to have a clean and dry washcloth on the surface of your work area and make sure all drains in the area are closed and covered with a towel to keep the lens out of the drain.  
  • After each lens is removed, clean and disinfect the lens and store them for disinfection. You are now ready for the next day.
Early in the day, you should be able to see very well. You are now not looking through a spectacle lens or a contact lens so more light can get into your eyes.  You will need good quality sunglasses when outside during sunlit and bright but cloudy days.  Polarized lenses will help with the glare aspect, so ask your doctor for the “better” sunglasses. Avoid getting sunglasses from discount stores, drugstores, service stations and the like. Even if you like the style, the key factor to look for in sunglasses is the proper ultraviolet light protection and good optics. Most of the cheap sunglasses are just junk.
Your doctor should tell you if you are a good candidate. The Food and Drug Administration has approved the current technologies under two main patents: The Corneal Refractive Therapy (CRT) patent granted to manufacturer Paragon Vision Sciences and the Vision Shaping Treatment (VST) granted to Bausch and Lomb have similar indications.  Approval is for up to -6.00 diopters of myopia and up to -1.75 diopters of astigmatism. Other refractive errors can be accommodated under the “off label” provisions that doctors can determine individually.  In general, the lower amounts of correction needed, the easier the process will be to accomplish.  
  • Patients who lead active lifestyles will do very well with OCR.
  • Face it, glasses and contacts are not indicated for participation in water sport activities like swimming and polo, or just horsing around in the neighborhood pool.
  • Patients who are bothered by wearing glasses and the distortions that glasses can cause.
  • Patients with concerns about dry eyes
  • Patients with who tend to get debris in their eyes.
  • Patients who need to wear safety glasses during the day and cannot wear contacts
  • Patients who want the freedom from surgery, daytime contacts, and glasses.
  • Patients who want to retard the progression of myopia, especially in children who genetically are predisposed to increasing amounts of myopia.
Costs will vary by the experience of the practitioner and the difficulty of the patient’s case.  Expect to pay about half of what LASIK averages in your area, or between $1600 and $3500.
The lenses on average will last a year before replacement, longer if they are taken care of well.  Be sure to have your doctor analyze the lenses at least every six months.
The good vision should last all day, perhaps with some fading of the treatment by the end of the day. Some people can actually go two days without wearing the lenses if the corrections are mild.
  • People who have unreasonable expectations
  • People with eyelid and corneal diseases that are not treated
  • People with keratoconus, conically shaped eyes
  • People with severely dry eye, but this can be work well for mild dry eye
  • People who cannot comply with instructions and follow-up care visits
  • People who cannot make the ongoing investment of time or money to continue with the process if they need new lenses.
Generally not. The lenses need consistency of wear to remain effective.
You will have to obtain a replacement or have a spare pair on hand.
Generally 5 to 14 days. It can take several weeks and several lens exchanges for stronger powers or very flat or steep corneas.
The doctor will either have an inventory of lenses or have them manufactured custom for you by the labs certified to do so. There are less than a dozen such labs in the U.S.
No. This is important. The lenses can only be sold to doctors that are certified to prescribe each approved product. They cannot be diverted from a manufacturer directly to the patient.
It is made of a high tech, extremely oxygen permeable plastic material that can be worn on the cornea overnight and still meet the demands of the cornea for oxygen and nutrition.
No. The FDA has not restricted OCR by the age of a patient.
  • Lenses now can be designed with computer-aided design (CAD) and manufactured robotically using computer numeric controlled (CNC) lathes to extreme sub-micron level accuracy.  
  • Also, the plastics used are very oxygen permeable
  • Advances in corneal topography mapping to high levels of accuracy
  • A greater comprehension of how to combine the above technology and information about how the cornea works.
It’s a great alternative to daytime contacts, glasses, and surgery that is reversible and affordable. It also helps prevent your eyes from getting worse.  Everyone should consider it as a viable modern option for refractive error correction!