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• W2051219708 abstract "In the last few years, there has been a trend towards case reports that present a negative and unjustified account of orthokeratology. Young et al's1Young A.L. Leung A.T. Cheng L.L. et al.Orthokeratology lens-related corneal ulcers in children A case series.Ophthalmology. 2004; 111: 590-595Abstract Full Text Full Text PDF PubMed Scopus (71) Google Scholar is one such case report, describing a one-sided, out of date, and sometimes irrelevant account of orthokeratology. Some views presented by Young et al—for example, “the refractive outcomes were unpredictable and inconsistent” and “conflicting reports regarding the safety and efficacy of these lenses”—have been supported by evidence from the 1980s and 1990s. The current body of knowledge has since moved on.2Tahhan N. Du Toit R. Papas E. et al.Comparison of reverse-geometry lens designs for overnight orthokeratology.Optom Vis Sci. 2003; 80: 796-804Crossref PubMed Scopus (83) Google Scholar There have been dramatic changes in the literature in the last few years, and orthokeratology outcomes are now much more predictable and effective due to the introduction of improved lens designs and materials and more sophisticated instrumentation for monitoring corneal changes.2Tahhan N. Du Toit R. Papas E. et al.Comparison of reverse-geometry lens designs for overnight orthokeratology.Optom Vis Sci. 2003; 80: 796-804Crossref PubMed Scopus (83) Google Scholar Young et al state that “serious infections may occur even with just overnight wear, as opposed to either extended wear (24 hours a day) or extensive daily use of contact lenses,” citing Schein and Poggio.3Schein O.D. Poggio E.C. Ulcerative keratitis in contact lens wearers: incidence and risk factors.Cornea. 1990; 9: S55-8PubMed Google Scholar Schein and Poggio's article reported occasional overnight wear by noncompliant patients whose lenses were prescribed for daily wear. Such statements are therefore unjustified and misleading. Although limitations in practice should be highlighted in patients' best interests, unwarranted insinuations about orthokeratology are needlessly provocative and counterproductive. Young et al also claimed that, “however, these reports described small, uncontrolled, nonrandomized, noncomparative case series with small sample sizes.” What treatments, particularly invasive ones (e.g., LASIK4Ojeimi G. Waked N. Laser in situ keratomileusis for hyperopia.J Refract Surg. 1997; 13: S432-3PubMed Google Scholar), do not start off with such reports? Without such studies, the body of knowledge will not move forward. Like LASIK, overnight orthokeratology wear has potential inherent risks, but it is not unethical to continue with such treatments if the benefits outweigh the risks. Through good practice, based on current knowledge and up to date practice, adverse outcomes can be minimized. Young et al's article highlighted the need for strict attention to ethical and professional attitudes of practitioners, but to minimize adverse complications, proper usage and management by both practitioners and patients are essential. The importance of good communication between patients and practitioners cannot be overemphasized. However, these factors were not addressed in the article; in fact, the authors actually stated that they had limited information about lens parameters, design, material, and lens-fitting characteristics or corneal changes due to lens wear, indicating a distinct lack of communication between the ophthalmologists and the optometrists, hindering a better understanding of these adverse outcomes. The omissions obviously failed to enlighten the readers. The authors concluded that patients considering orthokeratology must be informed and warned of the potential of permanent loss of vision—this is indeed essential, and has already been addressed in recent literature.5White P. Cho P. Legal issues in contact lens practice with special reference to the practice of orthokeratology.Ophthalmic Physiol Opt. 2003; 23: 151-161Crossref PubMed Scopus (6) Google Scholar Orthokeratology, like LASIK and any other treatments, has its pros and cons. All invasive techniques for myopia correction carry certain risks that increase if patients or practitioners do not adhere strictly to proper usage and care. Instead of counterproductively misrepresenting any of these treatments, surely practitioners should work harmoniously for the greater good of myopic patients who need, or wish to try, any of these options. After all, it is naïve and ill informed to expect a perfect option that is suitable for everybody. Orthokeratology Lens–Related corneal ulcers in children: A case seriesOphthalmologyVol. 111Issue 3PreviewOrthokeratology is a process by which the corneal curvature is flattened by sequentially fitting rigid gas permeable contact lenses of decreasing central curvature. There has been a resurgence of interest with the recent introduction of reverse geometry lenses. Although promising results have been described in reducing the myopic refractive error, the use of these lenses can be associated with corneal problems, as reported in this case series. Full-Text PDF Author replyOphthalmologyVol. 112Issue 1PreviewWe appreciate Cho et al's interest in our article. We agree, and as discussed in our article, orthokeratology had indeed moved on with the newer generation of contact lenses and, hence, the resurgence of its interest.1 As a matter of fact, the series of cases in our article appeared shortly after a major promotion campaign of the “new” orthokeratology lenses in Hong Kong. Full-Text PDF" @default.
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• W2051219708 title "Orthokeratology lens?related ulcers in children: Author reply" @default.
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